Insulin Resistance: What is it, Symptoms, Diagnosis & Treatment
What is Insulin Resistance? Insulin resistance describes the inability of the biological events that this hormone should stimulate to occur despite normal or elevated insulin hormone levels. Liver, muscle tissue and fat tissue are the main organs where the insulin hormone is effective. At the same time, with the development of insulin resistance, the pancreas can produce more insulin hormone to break this resistance. This condition causes the level of the insulin hormone in the bloodstream to be detected much higher than normal, which is called hyperinsulinemia. Insulin resistance may progress over time to different clinical conditions such as metabolic syndrome or type 2 diabetes mellitus. It is estimated that approximately 9% of the world’s population is affected by type 2 diabetes, which can develop due to insulin resistance. Apart from type 2 diabetes, diseases such as obesity, cardiovascular (heart and blood vessel) diseases, fatty liver not due to alcoholism, metabolic syndrome and polycystic ovary syndrome (PCOS) are examples of other conditions associated with insulin resistance.
Causes of Insulin Resistance
Many different metabolic changes and disorders can play a role in the development of insulin resistance. The most important of these factors is the increase in the amount of fatty substances in the bloodstream. Free fatty acids are substances that can disrupt the cells’ response to the insulin hormone. Intake of high amounts of calories through nutrition and the presence of excessive amounts of fat tissue in the body cause an increase in the amount of free fatty acids in the bloodstream. Therefore, they are examples of conditions related to unbalanced and excessive nutrition, obesity and insulin resistance.
The reasons that may lead to the development of insulin resistance can be examined in two categories: acquired and hereditary (genetic). There are many different conditions that can cause the development of insulin resistance over time, which can be considered among the causes of acquired insulin resistance:
- Functioning and excessively increased fat tissue
- Lack of physical activity
- Imbalances regarding the nutrients consumed
- Use of various medications
- Increase in the amount of salt consumed in the diet
What are the symptoms of insulin resistance?
People with insulin resistance can live for years without being diagnosed with this condition. This occurs because insulin resistance continues to develop without causing any noticeable symptoms in the person. There are many symptoms associated with insulin resistance that are considered risky:
- Waist circumference over 102 centimeters in men and 88 centimeters in women
- Having blood pressure of 130/80 or higher
- Detection of fasting blood sugar level above 100 mg/dl
- Triglyceride level measured after fasting is over 150 mg/dl
The development of insulin resistance may pave the way for the development of diabetes in a person. After the development of diabetes, various symptoms are added to the table:
- Feeling of extreme hunger and thirst
- Feeling of hunger does not go away after completing the meal
- Increased frequency of urination
- Feeling more tired than usual
- Development of susceptibility to infectious diseases and frequent illnesses
Apart from these symptoms, another finding that indicates the presence of insulin resistance in the person is acanthosis nigricans. Acanthosis nigricans refers to the formation of velvety brown discolored areas that usually occur in the neck, armpit and groin areas.
How to Calculate Insulin Resistance?
Although there are many different methods for calculating insulin resistance, the calculation method called HOMA is one step ahead. In addition to insulin resistance, this test also provides information about the functions of cells capable of producing insulin from the pancreas. In the HOMA calculation method, the person’s post-fasting sugar level and insulin level are the parameters used. If these two parameters are multiplied and the result is divided by 405, the HOMA score is calculated.
People whose HOMA score is calculated to be higher than 2.5 can be said to have insulin resistance.
However, it is unnecessary to check the HOMA value in every patient. The best parameter that shows insulin resistance in clinical practice is waist circumference measurement.
How to Diagnose Insulin Resistance?
Diagnosis can be made by the patient’s complaints, physical examination findings and simple waist circumference measurement. However, in some cases, additional tests may be ordered to determine the risk of diabetes.
Fasting plasma glucose test, oral glucose tolerance test and HbA1c test, which shows the average blood sugar level over the last 2-3 months, are among the tests that may be requested.
Fasting plasma glucose test is a test that determines the sugar level in a blood sample taken after a fast of at least 8 hours. In case of high values detected as a result of this test, the test may need to be repeated a few days later for confirmation.
According to the measured test results, values below 100 milligrams per deciliter are considered normal. A sugar level detected between 100 and 125 milligrams per deciliter may indicate the presence of prediabetes (the period just before diabetes). Values of 126 and above have diagnostic value for diabetes.
Another test, the oral glucose tolerance test, is based on measuring the blood sugar level 2 hours after drinking a sugary liquid. Values of 140 and below are considered normal, values between 140 and 199 are considered prediabetes, and blood sugar levels above 200 are considered diabetes.
How is Insulin Resistance Treated?
The first and most important stage of the treatment approach for people who develop insulin resistance is a set of practices called lifestyle changes. These practices include classifying the amount of calories taken in daily nutrition and avoiding the consumption of foods with high glycemic content. By increasing the body’s energy use with physical activity, it can contribute to the muscle tissue becoming sensitive to insulin again. Regular physical activity can also reduce fat tissue in the waist area.
Tobacco use is one of the harmful habits that can cause insulin resistance. Therefore, by quitting this habit, an important step is taken to break insulin resistance.
Eating balanced and unprocessed foods is another important practice to break the body’s insulin resistance. Avoiding the consumption of foods with artificial sweeteners and limiting the amount of sugar consumed daily is important to break the insulin hormone resistance.
Apart from these practices, consuming omega-3 fatty acids, avoiding sources of stress and ensuring a quality sleep pattern are among the lifestyle changes that can contribute to the regression of insulin resistance.
Providing correct and planned lifestyle changes requires raising the patient’s awareness. Information can be obtained from professional dietitians on limiting salt, fat and total daily calories. Ensuring that a person loses approximately 7% of his or her body weight along with diet planning can reduce the risk of developing type 2 diabetes by nearly 60%.
In cases deemed necessary by the physician, or if lifestyle changes are determined to be ineffective in overcoming insulin resistance, or in cases where the risk of diabetes is high, the prescription and use of some insulin sensitizing drugs may be considered.