Nearly everyone has heard of diabetes. And most of you have heard of prediabetes. Some of you may even have been told by your Doctor that you are prediabetic and if you don’t take care of yourself, you might become diabetic. But what does that all mean? How do you get in control? In order to understand, we have to start with Insulin.
Insulin – What is it? What does it do?
Insulin is a substance made by the pancreas, an organ that sits behind the stomach. Insulin plays a major role in how our body uses energy. In a healthy person, insulin helps maintain blood sugar in a normal range. It helps fat, muscle, and liver cells absorb sugar, it stimulates the liver and muscle cells to store extra sugar as glycogen (an intermediate energy storage form), and it shuts off the production of sugar by the liver. At normal levels, insulin is not only necessary for life, but helps your body work efficiently.
Pre-pre-diabetes – Insulin resistance
Insulin resistance is a condition where the body produces insulin, but does not use it effectively. Most people don’t know they have insulin resistance until they develop prediabetes or type 2 diabetes. So what causes insulin resistance? Scientists think that excess weight and physical inactivity are the major causes of insulin resistance. Other causes of insulin resistance may be ethnicity, hormones, steroid use, some medications, older age, sleep problems, and cigarette smoking.
When the fat cells become plump with fat, the body starts to look for other places to store the fat. Since the muscle and liver cells are prime utilizers of energy, fat starts getting stored in the muscle and liver cells. When this happens, the muscle and liver cells start to resist the effects of insulin. Sort of a message saying, “hey, we are full up here. We don’t need any more energy.” This causes the blood sugars to go higher which stimulates the pancreas to produce more insulin in order to shove the sugar into the cells. Initially your pancreas can keep up with this demand and maintain your blood sugar within the normal range by producing more and more insulin.
High Insulin Levels – too much of a good thing
Insulin is a life saving hormone, but too much is harmful. High insulin leads to fat accumulation within the abdomen, muscles and liver. This fat accumulation directly and indirectly causes inflammation which predisposes to certain diseases (high blood pressure, heart attack, stroke and some cancers). High insulin levels indirectly induces hunger, so we eat more, we have higher sugar levels, higher insulin levels, more fat accumulation, more insulin resistance, more hunger, we eat more, have higher sugar levels, higher insulin levels, more fat accumulation, more insulin resistance, more hunger, we eat more, have higher sugar levels, higher insulin levels, more fat accumulation, more insulin… you get the picture.
Prediabetes – the first stage of pancreas failure
With the early stages of insulin resistance, our pancreas is able to keep up with the demand, but it gets to the point where it starts to falter and the blood sugars go slightly out of control. The fasting glucose may be normal, but the blood sugars after meals may be high. This is prediabetes. The pancreas is working hard at pumping out insulin and some of the insulin producing cells (the islet cells) start to get damaged.
Type 2 diabetes – the second stage of pancreas failure
If nothing is done to reverse insulin resistance, the pancreas will eventually be unable to produce enough insulin to keep the blood sugars in normal range. More and more islet cells become damaged and the sugars are continually high. People with type 2 diabetes have high blood sugars. Over time, high blood sugar levels damage nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney failure, and vascular disease.
Symptoms and risk factors of prediabetes
There are usually no symptoms of insulin resistance and prediabetes. People may have them for many years without knowing it. Even without symptoms, we can identify people at high risk for both.
Being overweight, being physically inactive, having a family history of diabetes, having a history of gestational diabetes, high blood pressure or being treated for high blood pressure, low HDL or high triglycerides, having polycystic ovarian syndrome (PCOS), increased abdominal fat (waist greater than 40 inches in men or 35 inches in women), or having cardiovascular disease. Certain ethnic groups have a higher risk of insulin resistance and prediabetes: African American, Alaska Native, American Indian, Asian American, Hipanic/Latino, or Pacific Islander American.
Can insulin resistance and prediabetes be reversed?
Yes, weight loss and physical activity help the body respond better to insulin. The medication Metformin is effective in reducing risk of diabetes in all patients at risk, but was the most effective in preventing or delaying the development of type 2 diabetes in younger, heavier people with prediabetes or history of gestational diabetes.
Your Next Steps
If you are overweight and have risk factors for prediabetes and type 2 diabetes you need to be checked for insulin resistance and prediabetes. If there is evidence of insulin resistance, you need to lose weight and be physically active to prevent diabetes and all the evils that come with the disease. A medical weight loss specialist will often be more aggressive in the identification and treatment of insulin resistance and prediabetes. At Strong Weight Loss, we have helped many people lose weight, reverse their prediabetes and control their insulin resistance.
I would like to thank Dr. Allen Rader from Idaho Weight Loss for getting me on the right track in the identification and treatment of insulin resistance.