Why is it difficult to lose weight for some of us. We recognise that of the various factors which make losing weight difficult, one of them is well recognised as Insulin resistance. I will be focusing on weight loss in more detail separately.
When someone tells us they have ‘bad genes for heart disease or diabetes’ , I think they are referring to their body’s genetic ability to handle and metabolise energy and related oxidative stress. And if I am allowed to simplify this complex relationship, they are referring to their genetic predisposition to deal with carbohydrates and fat in a healthy manner. While some of these factors are genetic, we all can modify them and re-shape (also literally) our body’s metabolic outlook. It is here that understanding insulin resistance helps us take control of our body and health.
What does it do
Let us try to see understand more about Insulin resistance. Insulin resistance is a condition where the body does not respond properly to the hormone insulin, which is essential for regulating blood sugar levels. This can result in excess glucose circulating in the blood, which can damage the blood vessels and organs. Insulin resistance can also cause inflammation and oxidative stress, which can contribute to chronic diseases.
Insulin resistance can cause various health problems such as
· diabetes,
· cardiovascular disease,
· non-alcoholic fatty liver disease,
· metabolic syndrome,
· polycystic ovary syndrome,
· some cancers
Insulin resistance is also a marker of underlying metabolic health and may be a sign of other diseases to come. Insulin resistance is also linked with a higher risk of depression .
Insulin resistance can also affect other aspects of health such as hirsutism (excessive hair growth) and even cancer. Hirsutism is caused by high levels of androgens (male hormones) in women with insulin resistance. Androgens stimulate hair follicles and cause unwanted hair growth on the face, chest, back and abdomen.
Insulin resistance can also increase the risk of some cancers such as breast, colon and endometrial cancer. This is because insulin can promote cell growth and division and inhibit cell death. High insulin levels can also increase the levels of other hormones such as estrogen and insulin-like growth factor-1 (IGF-1), which can stimulate tumor growth.
How do I recognise it
We can recognise Insulin resistance by some visible signs such as
· darkening of armpits, neck and groin (also known as acanthosis nigricans)
· absence of menstruation,
· lethargy,
· brain fog,
· hunger,
· frequent urination,
· extreme thirst and
· abdominal obesity.
Tests to confirm the condition
However, these signs may not be present in everyone with insulin resistance. Therefore, it is important to get tested for insulin resistance if you have any risk factors such as obesity, sedentary lifestyle, high blood pressure, steroid use, family history of diabetes, pregnancy, sleep problems or infection.
Furthermore, some of these symptoms may not appear until the blood sugar levels are very high. Therefore, it is important to test for insulin resistance in the lab using tests such as fasting blood sugar, glucose tolerance test, random blood sugar and glycated hemoglobin test.
As an Endocrine specialist, if I see signs of acanthosis or hyperpigmentation I do not need any biochemical or lab tests to confirm the diagnosis. The situations where I might need to request the tests are when I do not see visible skin changes, but suspect that the presence of insulin resistance is actually resulting in the underlying problems that I come across in the people visiting me for consultation.
The tests that I would then plan are
1. fasting glucose and fasting insulin levels . I put the results in a HOMA IR calculator available online. And based on the index confirm the presence of insulin resistance.
2. Oral glucose tolerance test . This test performed in hospital based settings, may demonstrate inability to handle glucose load and result in results consistent with impaired glucose tolerance. This again would point towards underlying insulin resistance.
3. Glycated Haemoglobin or Hba1c is not my favourite for this purpose as it often tends to lag behind in terms of the disease evolution. glycated haemoglobin test measures the average blood sugar levels over two to three months . These tests can help diagnose prediabetes or diabetes associated with insulin resistance.
How can I manage insulin resistance
The good news is that insulin resistance can be treated and prevented by some lifestyle changes such as physical exercise, weight loss, eating a balanced diet and avoiding refined foods and sugars . Some medications such as pioglitazone and metformin may also help improve insulin sensitivity in some cases. In severe cases, bariatric surgery may be an option for morbidly obese patients.
To read more about specific strategies of weight loss, such as intermittent fasting or calorie restriction please click here. We will discuss more about weight management in the next blog.
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