Each patient who walks through the doors of our clinic is unique, but many of them have similar experiences with weight gain and the frustration of getting the weight off. A lot of these experiences, symptoms and frustrations are due to a syndrome of symptoms called “insulin resistance.” We will try to explain the mystery of insulin resistance and how it relates to your weight loss journey.
“What are the symptoms of insulin resistance?”
Please meet my fictional patient Iris, who is typical of the experiences of many of our patients. Iris is Caucasian, 39 years old, divorced, and shares custody of twin 13-year-old boys who are very involved with multiple sports activities. When her marriage ended, Iris committed herself to regaining control of her health and reducing her weight. Her 50-pound weight gain occurred over about 3 years due to what Iris describes as “stress eating.” She struggled to find time for self-care, so she rarely went to get her hair or nails done. With no time to socialize, she didn’t get to see her friends often, and she didn’t really want to because she was embarrassed about her weight. What little free time she had Iris spent volunteering as a soccer team parent. Her job had also become very demanding, her kids got very busy and over-scheduled, her sleep became increasingly less, and Iris felt increasingly worse.
She tried to lose weight by reducing her food intake. Since she was always rushed to get out the door in the morning, she started skipping breakfast and would drink a coffee while she dropped her twins off at school. At work, sometimes she wouldn’t get to eat anything at all until 2 or 3 pm, and by that time she was tired, mentally foggy, and had a headache. She would scarf down a high-carb, high-fat sub sandwich from the café at work, but by the time she got home to cook dinner, she was starving again. She soothed her cranky mood with a couple of glasses of wine while she made dinner for herself and her kids. Her twins’ favorite is noodles, so she makes a pasta dinner at least twice per week.
Iris has lost all self-confidence because of her weight gain and how it makes her look. She is too exhausted in the evenings to get any exercise, and on the weekends, she’s too busy with kids’ sports activities, chores, and errands to allow for any time at all for herself. Even when her ex-husband had visitations, Iris would still spend these weekends traveling to see her kids’ sporting events. She had allowed her own needs to fall to the bottom of her priorities. Every week, she would try to shop for healthy groceries, research healthier recipes and look for time to take a walk outside. But each week, she remained trapped in a cycle of fatigue and frustration over the increasing fat around her middle. It seemed that no matter how hard she tried, she was met with barriers to healthy lifestyle modifications, her weight kept going up, and her energy kept going down.
This cycle may sound familiar to you, and it should, because insulin resistance is overwhelmingly common among people living with obesity. The typical traits include a family history of diabetes, difficulty losing weight on their own, extra weight around the belly, thinner limbs, and preference for carbs and sweets. And just like Iris, they likely have symptoms of unstable blood glucose levels like fatigue, cravings, and interrupted sleep patterns. Labs for a patient with insulin resistance may result elevated fasting glucose, insulin and/or cortisol levels, triglycerides above 150, and low HDL (“good” cholesterol). More specifically, the ratio of triglycerides to HDL of greater than 3:1 is consistent with insulin resistance. Also, waist measurements of 40 inches or above for men and 35 inches or above for women also indicates a level of insulin resistance independent of lab values. Other physical symptoms may include elevated blood pressure, and skin changes like skin tags or acanthosis.
“What exactly happens with insulin resistance?”
In recent years with new obesity research and treatments coming into existence, the term insulin resistance has become a popular marketing term for multiple weight-loss programs and treatments. Insulin resistance is actually a medical term describing a complicated metabolic dysfunction that’s related to multiple chronic diseases, with obesity being one of them.
Insulin resistance is a broad term to describe altered glucose metabolism in the body that usually occurs because of weight gain. The syndrome is perpetuated by chronic environmental factors such as dietary habits, stress, and lack of sleep. Insulin resistance may also have some genetic and biological factors individual to each person. Other medical terms for insulin resistance include metabolic syndrome, cardiometabolic syndrome, pre-diabetes, hyperinsulinemia, and elevated fasting glucose. If insulin resistance is not corrected, the primary outcome is the development of type 2 diabetes and associated diseases like heart disease, kidney disease, liver disease and varying severity of obesity.
Insulin is a hormone made by the pancreas, a small, leaf-shaped organ that sits in the upper abdomen behind your stomach. When you eat, food is broken down into very small sugar (glucose) particles by your digestive tract, and those particles are absorbed in the bloodstream. Those glucose molecules need to get into the cells all over your body with the help of insulin, which acts like a “key” to “unlock” the insulin receptors. In insulin resistance, the pancreas is still making insulin (sometimes quite a lot of it!), but the insulin isn’t doing its job properly, so the glucose does not get into the target cells. The high levels of glucose circulating in the bloodstream for years or even decades can do a lot of damage to the body.
Insulin resistant cells are primarily located in muscles, the liver, and in adipose tissue (fat). To understand insulin resistance a little better, think about the process of your food like a journey with the end destination being that glucose gets to the cells that need it for energy production. About 70% of glucose uptake should be in muscle tissues. However, when there’s insulin resistance in those muscle tissues and the cells don’t get the energy they need, the result will beloss of muscle. This is why sometimes patients with insulin resistance have thinner extremities. Additionally, the muscle wasting causes profound fatigue, as in the case of our patient Iris.
If the glucose can’t get into the muscles, it will be carried by the bloodstream to the liver for storage. The liver’s job is to create and store glucose as well as deliver it to the blood stream when necessary, like between mealtimes when your blood glucose dips. Sometimes the liver releases a lot of glucose, making blood levels TOO high (hyperglycemia) again. Over time, too much glucose in the liver can lead to a disease called “fatty liver.” So, AGAIN, circulating glucose excreted from the liver will eventually go into fat tissues for long-term storage. Any glucose that remains in the bloodstream can gradually get higher over time, eventually getting to the threshold of a type 2 diabetes diagnosis.
When the target cells don’t get the glucose they require for energy, the cells signal the brain that you are hungry or having a craving, and you will eat more food despite already having high blood glucose levels. Eating more causes the glucose to go even higher, triggers more weight gain, and worsens insulin resistance. The processes of insulin resistance make obesity worse, and obesity makes insulin resistance worse. This is why so many people who try to correct insulin resistance with lifestyle modifications and weight loss feel trapped and frustrated by this cycle. The more they reduce their food intake and increase their activity, the more profound the insulin resistance syndrome becomes, and the weight loss becomes more difficult.
The progression of insulin resistance is very slow and gradual and can last up to 20 years before finally progressing to Type 2 diabetes. When insulin resistance has progressed to this level, it means that your body’s compensation processes can no longer keep glucose levels stable. So, it’s a self-fueling fire that needs an intervention to extinguish this cycle.
“What happens if insulin resistance progresses to diabetes?”
If insulin resistance progresses to Type 2 diabetes, patients will require medication(s) to treat the disease long-term. New You’s Certified Diabetes Educator is available to provide education, answer questions, and prescribe treatments for any of our patients who are being managed by our practice.
“So, how do you break the cycle of insulin resistance?”
This can vary depending on the severity and duration of the insulin resistance syndrome. If lifestyle changes are made early in the disease process, they are way more likely to have impact on the cycle. Following are a few things that can help address the varying severity levels of insulin resistance.
Move your body – Getting moderate cardiovascular exercise like walking, particularly immediately following meals can greatly improve glucose metabolism. Getting in some physical activity can help prevent sharp spikes and drops in blood glucose after meals. Try to get into the habit of getting up and moving around for 5-10 minutes after a meal whenever possible.
Change up your nutrition – Limiting intake of refined sugars (like in sodas and sweets) and simple carbs (like white bread or snack chips) and replacing with complex carbs (high fiber) like fresh fruits, whole grains, and starchy vegetables can improve symptoms as well. Simple carbs tend to be absorbed very quickly and contribute to the instability of blood glucose. Additionally, it’s strongly recommended to eat at consistent intervals (approximately every 4 to 5 hours) to keep appetite, energy and glucose more stable. Drinking coffee on an empty stomach can increase cortisol (a stress hormone) and blood glucose, so don’t skip breakfast like our patient Iris. Having a meal within an hour of walking up can set your glucose on a more stable pattern for the day. It is strongly recommended that you talk to a Registered Dietitian about your specific nutritional needs and goals.
Natural supplements – There are a few natural supplements that are known to improve insulin sensitivity, like berberine, chromium and inositol. Even though these supplements are available over-the-counter, it’s strongly recommended that you speak with your medical provider before starting to ensure there are no interactions or contraindications for taking them, and you can get advice about dosing.
Prescription medications – there are many medications on the market that can help improve glucose metabolism. When insulin resistance becomes VERY resistant, patients may require a prescription medication to help “break the cycle.”
Metformin is a common treatment for treating insulin resistance, and it’s a well-accepted and affordable treatment. However, about 15% of patients who take metformin are unable to tolerate it at any dose due to the common complaints of GI side effects like diarrhea, bloating and nausea.
There are two anti-obesity injections on the market (Wegovy and Zepbound) currently that were originally developed as diabetes treatments, and they are very effective in treating insulin resistance. Since these medications are prescriptions, you must discuss with your medical provider if you think you might benefit from these prescriptions. Some of them are very expensive and may not be realistic for every person. Investigate your health insurance coverage for what is available to you with your plan.
“Can compounded medications help with insulin resistance?”
There is no way to know if a medication will be effective on insulin resistance unless it’s been studied in clinical trials. Compounded medications are not FDA-approved and are not recommended by the providers at New You for multiple reasons.
Firstly, since there has been no standardized testing or study of the medications, it’s difficult to know exactly what is in the medication and how much you might be getting, and you may be getting a different amount with each dose. This is not safe, because the side effects and interactions are unknown and the efficacy is inconsistent.
Secondly, because the medications can be quite expensive, the money spent on them is taking away from spending on legitimate, approved treatments. Although compounding of medications may have initially addressed supply constraints of the FDA-approved versions of the medications, the practice has become predatory for people living with obesity who are desperate for help.
“How do I know if I have insulin resistance?”
There are lab tests, clinical history and physical examinations that can determine the presence of insulin resistance. The team of medical providers at New You will be happy to discuss the common tests and treatments of insulin resistance. Some of the assessments a patient could anticipate are as follows:
Clinical assessments:
- Past medical history and family history
- Waist circumference
- Blood pressure readings
Lab tests:
- Fasting serum insulin
- Fasting morning cortisol
- Fasting glucose
- 2-hour glucose challenge
- Hemoglobin A1C
- Lipid (cholesterol) panel
If any of the symptoms or experiences sound familiar to you and you would like to be evaluated for insulin resistance, call and make an appointment today with New You’s medical team. We are here to help you break the cycle!