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More than half of the women that I see in clinic who are struggling with their weight and hormones have undiagnosed insulin resistance. Insulin resistance is an early sign of metabolic stress, and untreated can lead to prediabetes, type 2 diabetes, and heart disease. Insulin also has a cascading effect on our sex hormones, and excess levels can worsen PMS, perimenopause and menopausal symptoms. Other signs of and symptoms of insulin resistance include:

  • Increased abdominal circumference
  • Difficulty losing weight
  • PCOS
  • Fatty liver
  • Skin tags
  • Acanthosis nigricans (areas of hyperpigmented skin, especially behind the neck and under the arms)

How is insulin resistance different from diabetes?

Type 2 diabetes is a condition that takes many years to develop and is characterized by high levels of glucose (sugar) in the bloodstream. The process of developing diabetes often begins with insulin resistance, which is characterized by higher than normal levels of insulin the bloodstream. Insulin is a very important hormone we need to survive. It is released after we eat, and its main job is twofold:

  1. Direct the cells of our body to store the calories/glucose molecules from our meal so it can later be used as a source of energy
  2. Block the breakdown of fat in our body since there is an abundant supply of energy in the bloodstream after eating a meal

This process can go wrong, however, through genetic susceptibility and/or when excess insulin is present over a prolonged period of time (for example, from eating a diet high in sugar and carbohydrates). Our cells start to become “resistant” to insulin’s message, requiring greater amounts to be secreted in order to manage blood sugar levels effectively. Chronic, high levels of insulin puts our body in a fat-storage-mode (making weight loss very difficult), leaves us feeling tired, bloated, and sluggish, and has negative health impacts on our hormones and cardiovascular system.

How to identify if you have insulin resistance

There are two common ways to identify insulin resistance:

1. Measure your waist to height ratio. Measure your height and waist at its smallest circumference, and calculate your ratio here. A healthy waist to height ratio is less than 50%, while greater than 50% is a strong predictor of insulin resistance.

2. Test your fasting glucose and fasting insulin to calculate your HOMA2. Patients with insulin resistance often have normal blood glucose levels, but high or high-normal insulin. The HOMA2 is a calculation based on the ratio between fasting insulin and fasting glucose. It provides an approximation of insulin resistance as well as the function of the pancreas (which often declines as diabetes progresses or is diagnosed). You can access a HOMA2 calculator here.

Fasting insulin is generally not included as part of an annual physical check-up. It is, however, one of the most common tests that I run when I meet with a patient and suspect that insulin resistance is contributing to their health concerns. The fee is less than $50, and well worth the information it provides to direct a patient’s treatment plan. If insulin resistance is detected, treatment often includes a combination of diet and lifestyle modifications, and in some cases, supplementation. This month’s Community Sugar Challenge offers additional resources for those with insulin resistance.

References:

https://www.ncbi.nlm.nih.gov/books/NBK507839/

https://pubmed.ncbi.nlm.nih.gov/29116305/