Our body is a marvellous biological machine that performs thousands of behind-the-scenes functions to produce and maintain several different types of biological entities so we can feel, look and be at our best. One such wonder product is a hormone called insulin.
Insulin is a hormone responsible for regulating our body’s blood glucose level. There is a delicate balance between glucose and insulin to keep blood glucose levels stable. When this balance gets out of kilter, you can develop insulin resistance, increasing the risk of developing type 2 diabetes. To appreciate this better, let us first understand what insulin is and what it does.
How insulin works?
Insulin is a hormone made by the pancreas. The pancreas is a large gland that sits snugly against the liver right behind the stomach and one of its functions is to produce insulin. When we eat, the carbohydrates in your food are broken down into glucose (sugar). Our bloodstream absorbs this glucose and subsequently, our blood glucose levels rise. This increase in blood glucose levels signals our pancreas to produce and distribute insulin into the blood stream. Insulin acts a key to unlock the cells and allow glucose to leave the blood stream and enter body cells in muscles, the liver, the kidneys and other organs where it is used for energy. In cases where our bloodstream contains more glucose than our body needs, insulin will signal the body to store excess glucose as glycogen in the liver and muscles. This ensures we will have an easily accessible energy source to use when our blood glucose runs low between meals or while we sleep. This is a very intricately regulated process.
Insulin is made by very specialised cells called beta cells that reacts to the blood glucose levels in our bloodstream. When blood glucose levels increase after eating a meal insulin secretion rises accordingly to keep glucose levels stable. When blood glucose fall due to long periods of not eating or exercise, insulin level fall. In this way, Insulin helps in maintaining balanced glucose levels. It prevents our glucose levels from getting too low (hypoglycaemia) or too high (hyperglycaemia), ensuring our bodies function at their best.
This insulin – glucose balance system is extremely well organised like a healthy economy. At any given moment the perfect amount of insulin is produced to maintain blood glucose levels within the normal range – no more, no less.
What is Insulin Resistance?
Insulin resistance is when cells in your muscles, fat and liver don’t respond well to insulin and the glucose stays in the blood stream instead of moving into the muscles. To make for it, your pancreas makes and releasees more insulin in an attempt to lower blood glucose levels. Over time, your pancreas will become tired and be unable to meet the constant demand for insulin, causing a downward spiral of elevated blood glucose levels. This can have negative impacts throughout your body.
Doctablet in their YouTube video explains how economic inflation is a good analogy to understand insulin resistance. They used economy as an example to best explain insulin resistance. Imagine insulin hormone being a dollar ($). As insulin resistance develops (imagine this as economic inflation), the same amount of insulin that previously lowered blood glucose into the healthy range is no longer works adequately. In simpler terms, the pancreas used to spend 1 insulin $ to bring the blood glucose levels down. When insulin resistance develops this dollar is no longer enough. The pancreas must produce 10 insulin $ to do the same job that had before only cost $1. This is exactly like inflation and is termed as insulin resistance in this case.
Just like inflation, which is generally thought to be unhealthy for the economy, the same is true for insulin resistance in the body. Insulin resistance may not cause any noticeable symptoms, so you can have insulin resistance and not known it. Symptoms don’t usually occur until you develop prediabetes or type 2 diabetes. The pancreas is working overtime, forced to produce more and more insulin $ in an attempt to maintain glucose levels within the normal range. Gradually, pancreas reach its maximum ability to produce more money, and blood glucose levels continue to be elevated. This has adverse effects on the metabolism, inhibiting the body’s ability to break down fats. Elevated fasting blood glucose, also known as impaired fasting glucose, may be one of the first clues that body gives about having insulin resistance.
Insulin resistance syndrome includes a group of problems including obesity*, high blood pressure, high cholesterol, and type 2 diabetes this is often known as metabolic syndrome.
*It is important to appreciate that while insulin resistance usually occurs in people who are obese, it can also occur in people whose weight is in the normal range, depending on their diet, lifestyle and genetic make-up. The common denominator is that fat accumulation is concentrated around the abdomen.
A Vicious Cycle
Insulin Resistance creates a vicious cycle and if not managed correctly, can quickly lead to more serious health issues. On one side, the cells that need glucose become starved of energy and on the other side, glucose in the bloodstream stays elevated because there’s no place for it to go. Higher insulin levels signal the body to store fat, especially around the abdominal area. This fat (also called visceral fat) is especially dangerous because it induces the liver and other organs to become fatty and inflamed. While the visceral fat is thought to be a contributing factor to insulin resistance, insulin resistance also causes an increase in this belly fat, resulting in a vicious cycle.
Causes and Risk Factors
Although exact causes if insulin resistance is unknown, certain factors (link) that can make this condition more likely include:
1. Overweight or obesity (especially weight gain around the middle – belly fat)
2. Intake of diet high in processed carbohydrates & high calories
3. Lack of physical activity
4. Chronic stress
5. Polycystic ovary syndrome (PCOS) or Cushing’s disease
Some people are also at a higher risk of developing insulin resistance (link). These can include people with :
6. A family history of type 2 diabetes
7. Personal history of gestational diabetes
8. Over the age of 45
9. With a history of high blood pressure or high triglycerides
10. With a waist circumference larger than 40 inches (man) or larger than 35 inches (women)
11. Ethnicity — it’s more likely if your ancestry is African, Latino, or Native American
Prevention and Treatment of Insulin Resistance
There’s no magic pill to treat Insulin Resistance, but the good news is that it’s completely reversible. Making lifestyle changes can help reverse insulin resistance so that your body can respond properly to insulin.
Treatment consists of a multi-faceted approach which includes:
· Lose excess weight
A study published in The Lancet Diabetes & Endocrinology (link) found that weight loss improved insulin responsiveness and normalised blood glucose levels.
· Get Active and Exercise
Do a moderate-intensity exercise. Choose activities that you find enjoyable, such as walking, biking, swimming, or playing sports. Not only will exercise and being active help you to lose excess weight, but it also causes muscles to be more insulin sensitive which decreases Insulin Resistance (link).
· Healthy Diet
- Avoid diet high in ultra-processed foods. A diet rich in sugar and ultra-processed foods is known to negatively impact insulin secretion. Focus on incorporating healthy foods you can eat long term. Include variety of whole food sources like fruits, vegetables, whole grains, nuts, beans, fish, legumes, and other lean protein.
- Choose complex carbohydrates and whole grains. Refined or “simple” carbs do not contain a lot of fibre or micronutrients and are digested very quickly. Refined carbs include simple sugars as well as grains that had the fibrous parts removed. Cereals with added sugar, highly processed fast foods, foods made with refined flour and sugar are examples of food that contain refined carbs. Regular consumption of refined carbs can lead to several health issues including high insulin levels and excessive weight gain (link, link).
- Balance meals. Including a balance of carbs, protein and fats at each meal or snack can reduce the blood glucose response and keep blood glucose levels more stable. Thinks “carbs need a buddy”. If you’re having a piece of fruit, add nuts, yoghurt or cheese to balance it. This reduces the spike in blood glucose and will also keep you satisfied for longer.
- Prebiotic fibres have been shown to help control healthy insulin levels and thus benefit blood glucose management. Microbial fermentation of prebiotic fibres in the gut produces short-chain fatty acids (SCFAs). Apart from variety of beneficial effects, SCFAs are also involved in enhancing insulin sensitivity and reduce appetite, thus promoting reduction of energy intake (link).
Its’s important however to appreciate that not all prebiotic fibres are created equal. If you want to know more about different types of prebiotic fibres, check our other blogs for more information here & here. The best prebiotic fibres are those that closely represent the complexity of plant fibres as well as the micronutrients and phytonutrients of the plant material.
For instance, Kfibre – Virgin Sugarcane Prebiotic (sucrose reduced) is a complex prebiotic with insoluble & soluble prebiotic benefits along with other phytonutrients inherently present in the sugarcane. Kfibre is a whole-plant complex prebiotic dietary fibre prepared to closely represent the plant fibres to harness the maximum benefits for your gut health and overall well-being. It is prepared from whole virgin sugarcane (sucrose removed) with minimum processing to preserve not only the fibres in their most natural forms, but to also retain the inherent micronutrients and antioxidant phytonutrients for added health benefits.
· Get plenty of sleep
According to the Sleep Foundation, not getting enough sleep may increase your risk for diabetes or make it harder to manage (link). For optimal health, adults need between seven and nine hours of sleep a night according to a recommendation by a study published in Sleep Health (link).
· Manage Stress well
When under stress, our body produces a higher amounts of stress hormone – cortisol. Elevated levels of this hormone can make your muscles and cells resistant to insulin resulting in higher blood sugar levels. Hence, chronic stress may increase your risk of prediabetes and type 2 diabetes (link). It is therefore important to adopt practices into your life that bring balance to mind and body.
No medications are specifically approved to treat insulin resistance. Diabetes medications like metformin and thiazolidinediones, or TZDs, are known to lower blood glucose, at least in part, by reducing insulin resistance.
Insulin is a hormone that is responsible for regulating our body’s blood glucose level. People with insulin resistance gradually build up a tolerance to insulin, making the hormone less effective. However, when insulin levels peak too high, you could increase your risk of insulin resistance resulting in higher blood glucose levels.
Insulin resistance is a hallmark of prediabetes and type 2 diabetes and can also affect those with type 1 diabetes. Diabetes is the epidemic of the 21st century and the biggest challenge facing Australia’s health system. According to Diabetes Australia, 280 Australians develop diabetes every day. That’s one person every five minutes.
Although fighting this invisible foe can be frustrating, there are effective ways to combat insulin resistance. Incorporating a healthy diet and lifestyle habits can help you get back to healthy blood glucose control and better health.
By Dr Tanvi Shinde (PhD) | Reviewers – Joanna Baker (APD | RN) & Kent Taylor