Insulin Resistance (IR)

Background – Insulin is a hormone produced by the pancreas that plays a central role in regulating carbohydrate and fat metabolism. In an individual of normal insulin sensitivity, the insulin produced by the pancreas works effectively to maintain a normal blood sugar level. In a person with IR, insulin effectiveness is reduced thus the pancreas is forced to secrete larger amounts of insulin in order to push glucose into the cells.
IR is associated with an increased risk for type II diabetes (DM-2), coronary artery disease, hypertension, sleep apnea, impotence, female sexual dysfunction, hypercoagulability (thrombophilia), gallstones and kidney stones. Insulin resistance can be followed by syndrome X or metabolic syndrome and finally DM-2 and all the medical consequences associated with DM-2 throughout the body.

Etiology – The origin of insulin resistance is multi-factorial, meaning that it is caused by a combination of genetic and life style factors. However, life style appears to be the major determinant of onset; standard American diet coupled with stress and lack of adequate physical activity. Additionally, obesity is a well known factor that often coexists with insulin resistance. However, causal links between obesity plus dietary factors and IR are complex and quite often controversial. For a relatively small number of cases, a number of medications such as diuretics, beta blockers and antipsychotics also present risk factors.

Diagnosis – As an initial metabolic defect, IR should be regarded as pre-diabetes. Since the 1970s, a number of medical organizations, including the World Health Organization, have recommended the use of standard Glucose Tolerance Test as a means of determining how quickly glucose is cleared from the blood to test for insulin resistance, diabetes and other disorders of carbohydrate metabolism. Though a number of variations of the test have been devised over the years, common practice is to perform an Oral Glucose Tolerance Test (OGTT),whereby a standard dose of glucose is orally ingested and subsequently blood levels are checked at intervals afterward as follows:

  1. A fasting blood glucose value is obtained to provide a baseline for comparing other glucose values
  2. The patient is asked to drink a sweet liquid containing a measured amount of glucose; typically 75-100 grams
  3. Blood samples are collected at timed intervals of 1, 2, and sometimes 3 hours after the consumption of glucose drink (samples may also be taken as early as 30 minutes to more than 3 hours afterward depending on the individual case)

Early detection offers a reasonable opportunity for intervention that would then prevent the usual transition to DM-2.

Integrative Therapy – An effective IR treatment approach must be customized based on the specific characteristics of the individual patient as there are a number of factors that have to be measured (i.e.; lab tests) and considered before moving forward. Having said that, because of the multi-factorial nature of IR involving an interaction between genetics and the environment, treatment is viewed as “management” and almost always consists of the following two facets:

  1. Lifestyle: The primary tool for managing IR is exercise and weight loss. To that end, education about exercise, weight management and overall eating habits is regarded as the foundational basis for treatment. A loss of 7% to 10% of body weight can improve IR significantly. The Diabetes Prevention Program showed that exercise and diet are nearly twice as effective as pharmaceutical drugs such as metformin at reducing the risk of progressing to DM-2. In a large number of cases stress can also be a major factor and so stress management must be emphasized as a mitigating measure.
  2. Nutrition: Food is an important aspect of human life not just from a biological stand point but also from a psychological and social/cultural stand point. Due to its complexity and breadth, food intake should be viewed as an area of management unto itself as it involves far more than simple eating habits. As a start, a low-glycemic index diet has proven to be effective in IR management. Additionally, a review of current literature recommends against certain types of foods in lieu of a diet high in protein, low in simple Carbohydrates and plentiful in healthy fats. Certain monounsaturated fatty acids, saturated, and trans fats promote insulin resistance while some types of polyunsaturated fatty acids, such as omega-3, can have a moderating influence on the progression of IR into DM-2. It is important to note however that the effects of omega-3 fatty acids in reversing insulin resistance are limited and once DM-2 has developed, they may cease to be effective altogether.

Supplements: In addition to fish oil (omega-3 fatty acids) the management of a number of other micronutrient is just as important as the foods consumed. Some of the micronutrients that play key roles in treating IR are: magnesium, chromium, vanadium, vitamin E, Vitamin C, Biotin and alpha lipoic acid. Recommended: Chromium Plus.

Botanicals: The use of botanical as a complimentary measure represents an attractive, novel, and potentially effective approach to the problem IR management. Some botanicals that have been noted for their efficacy in IR management are fenugreek, garlic and bitter melon. Recommended: Glucose Support Formula.

Pharmaceuticals: Drugs such as Metformin and the thiazolidinediones have been shown to improve insulin resistance and are commonly deployed in the treatment of IR as well as DM-2.

Note: If you are overweight, not following a healthy lifestyle/diet or have a family history of diabetes, you may be a candidate for the evaluation of IR or other metabolic syndrome.

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