After you eat, sugar circulates in the blood. This raises blood sugar levels, which triggers the pancreas to secrete insulin. Insulin acts like a key to let blood sugar enter cells, where it’s used for energy.
People with insulin resistance often don’t have any symptoms, so they may be unaware of their condition until it’s picked up during a routine health exam or blood test. But weight loss and exercise can help reverse insulin resistance and prevent prediabetes and type 2 diabetes.
Symptoms
Insulin resistance is a condition in which cells in your muscles, fat and liver don’t respond well to insulin, a hormone made by your pancreas that helps manage your blood sugar. It’s a key step on the path to prediabetes and type 2 diabetes, which can cause serious health problems including heart disease, blindness and nerve damage.
Your body gets its fuel from glucose, or sugar, which enters your bloodstream after you eat. Insulin acts like a key that lets glucose enter your body’s cells, where it is used for energy. If your body can’t use the glucose, it sends it to your liver to be stored for later use or as body fat. Over time, insulin resistance can lead to prediabetes and type 2 diabetes, or even severe complications such as cardiovascular disease and amputation.
You’re more likely to develop insulin resistance as you get older, but a number of factors can contribute to it. A diet high in sugar and refined carbohydrates raises your blood glucose levels, which can make you resistant to insulin. Excess body fat, especially around your abdomen, increases your risk of insulin resistance as well. A sedentary lifestyle and some health conditions, such as polycystic ovary syndrome or nonalcoholic fatty liver disease, also increase your risk.
People who are resistant to insulin often have borderline high blood sugar levels, which your doctor may test for using a simple fingerstick or a more sophisticated blood test known as hemoglobin glycosylated A1C. These tests measure how much blood sugar, or glucose, is in your blood over a period of two to three months.
Many people with insulin resistance have no symptoms, but if your blood sugar is high enough to be called prediabetes, you may notice darkened areas of skin in the armpits and on the back or sides of the neck (acanthosis nigricans) and small skin growths known as skin tags. In some cases, the changes caused by insulin resistance can lead to a serious eye condition called retinopathy. But the good news is that people can prevent or reverse the progression to insulin resistance and pre-diabetes with lifestyle approaches such as weight loss, exercise and a healthy diet.
Diagnosis
Insulin resistance isn’t a routinely tested condition, but doctors may look for it when they diagnose other conditions. They might order a blood test called the A1c, which shows average blood sugar levels over the past three months. They might also check your lipid panel, which measures your cholesterol and other fats in the blood.
If you have insulin resistance, the fatty tissues in your body don’t respond normally to insulin, and blood sugar levels are higher than normal. Doctors use various methods to measure insulin sensitivity, including the glucose clamp technique. In this technique, the doctors place a catheter in your body and deliver large doses of insulin and glucose at the same time to see how much glucose enters cells. The more glucose goes into the cells, the lower your blood sugar levels become.
Your doctor will take a history of your symptoms and do a physical exam. They might also order a fasting blood glucose (sugar) test, which checks your blood sugar level after you’ve not eaten for 8 hours. Or, they might order an oral glucose tolerance test, in which you drink a sweet liquid and then take a second blood test.
The underlying cause of insulin resistance isn’t well understood, but it has been linked to obesity, high blood pressure, abnormal cholesterol, and a large waist size. It also has been linked to a condition called polycystic ovary syndrome (PCOS) and a family history of diabetes.
Eventually, insulin resistance leads to prediabetes and type 2 diabetes. It isn’t clear why this happens, but researchers think excess weight and a lack of physical activity play major roles.
People with insulin resistance can prevent or delay the onset of these conditions by losing weight, getting at least 30 minutes of moderate exercise per day, and making healthy food choices. They should also avoid alcohol and tobacco. Your doctor can recommend a diet and exercise program for you, or prescribe medications such as metformin (Fortamet, Glucophage, Glumetza, Riomet). These drugs help improve your body’s sensitivity to insulin and keep blood sugar levels in the normal range.
Treatment
Insulin resistance is a condition that occurs when cells in your muscles, fat and liver don’t respond normally to insulin. Insulin is essential for regulating blood glucose levels and helps move blood sugar into cells for use as energy. When your body becomes resistant to insulin, blood sugar levels remain high and your pancreas has to produce more insulin to help lower them. This leads to prediabetes or Type 2 diabetes, if not treated.
It’s not clear exactly what causes insulin resistance, but scientists have identified several risk factors. Excess body fat, particularly around the belly (visceral fat), is a primary cause. Lack of physical activity also contributes. Certain medications can increase your risk, including steroids, some blood pressure medications and HIV drugs. Some conditions, such as Cushing’s syndrome and acromegaly, can also be associated with insulin resistance.
If you’re at risk for insulin resistance, a few simple lifestyle changes can help. Maintaining a healthy weight through diet and exercise can improve your response to insulin. Eating foods with a low glycemic index can help you find the right balance of carbohydrates to keep your blood sugar stable.
For many people, a combination of lifestyle changes and medication can reverse insulin resistance and prevent or delay the onset of pre-diabetes or Type 2 diabetes. Your doctor can recommend a weight loss plan, such as the National Diabetes Prevention Program, to help you make these changes.
Medications to treat insulin resistance may include metformin, gliptinides and SGLT2 inhibitors. Glucose-lowering medications are the most important medicines for treating insulin resistance, but they can cause other side effects, such as dehydration and genitourinary tract infections. In some cases, it’s possible to improve your response to insulin by adjusting your doses or trying new types of insulin.
Insulin resistance doesn’t usually cause symptoms, but it can lead to prediabetes or Type 2 diabetes, so it’s important to get diagnosed and treated. Our experts can help you develop a treatment plan that fits your unique needs. We can also help you find support groups and educational materials to encourage positive behavior changes.
Prevention
Insulin resistance can lead to prediabetes or type 2 diabetes, but it rarely causes symptoms and is often picked up by a doctor during a health exam or blood work. If you have insulin resistance, you can take steps to reduce your risk.
Getting plenty of sleep, staying physically active and not smoking can all help. Some diet changes also can improve your chances of avoiding insulin resistance. You should eat foods that are minimally processed, low in sugar and high in protein and fiber. Try to eat two to three meals a day and avoid snacks. It is important to talk to a dietitian before starting any new supplements or eating plans, because they can affect your blood sugar levels.
In insulin resistance, your body stores more energy in fat cells than it should, and that can make you gain weight. It can also cause other problems, including high blood pressure, high cholesterol and triglycerides and coronary artery disease, as well as gout and fatty liver.
You may be at risk of insulin resistance if you have a family history of diabetes, a large waistline or other signs of obesity, such as having a belly pouch and the patches of dark velvety skin called acanthosis nigricans. Your doctor can screen you for this condition by measuring your blood sugar, checking a fasting glucose or a hemoglobin A1c (A1C) level and looking at your blood pressure and cholesterol levels.
If you have a high risk, your doctor can give you advice on how to change your lifestyle to prevent or delay insulin resistance and other complications of diabetes. You may be able to participate in a clinical trial that can help you make the necessary lifestyle changes.
Insulin resistance can become prediabetes or diabetes, which can lead to serious and sometimes life-threatening health problems, such as cardiovascular disease, kidney damage, nerve damage and eye problems. Our experts can provide a treatment plan to help you reverse your insulin resistance and avoid the problems associated with these conditions.
