Insulin is a hormone that carries glucose (sugar) from your blood into your cells so that it can be burned for energy. Insulin is produced by the pancreas.
Insulin resistance is a state in which your cells are not responding to insulin appropriately, so the sugar in your blood cannot get into your cells. To compensate, your pancreas pumps out more insulin to try to get the sugar out of your blood and into your cells. The hyperinsulinimia (high blood insulin) that results is able to maintain normal blood sugar levels and delay the onset of diabetes.
Diabetes is diagnosed when your fasting blood sugar level is >/= 126 mg/dL. Type 1 diabetes is usually diagnosed in childhood and occurs when the pancreas stops producing insulin. Insulin injections are required for life. Type 2 diabetes is usually diagnosed in adulthood. It occurs when the cells stop responding to insulin (often due to insulin resistance), and the pancreas is unable to keep compensating by producing more and more insulin to maintain normal blood sugar levels.
Is it bad to have high blood insulin levels?
Yes! High insulin levels are not a good thing to have. For one, hyperinsulinimia is an independent risk factor for heart disease. Second, your pancreas eventually wears out and can’t continue to produce excess insulin to maintain normal blood sugar levels. When this happens, blood sugar rises and diabetes develops. Third, insulin can contribute to increased appetite (especially for carbohydrates and sugary foods), which can lead to increased calorie intake and weight gain. Insulin also makes it easier for you to store (vs. burn) body fat, thus worsening the weight gain problem and making weight loss more difficult.
What causes insulin resistance?
It is estimated that 1 in 4 people (without diabetes) has a genetic predisposition for insulin resistance. Whether or not the insulin resistance develops depends (in large part) on your eating and exercise habits. Not being physically active is a huge reason why insulin resistance develops. In addition, gaining weight/body fat (especially around the middle) is a common trigger. And once you have insulin resistance, it’s more difficult to lose weight. So, obesity and insulin resistance is really a viscous cycle--obesity contributes to insulin resistance, and insulin resistance contributes to weight gain! People who maintain a healthy weight and enjoy regular physical activity rarely develop insulin resistance, even if they have an underlying genetic predisposition.
NOTE: Some medications (like Depakote, an anti-seizure medication) and some disease states (like PolyCystic Ovarian Syndrome, or PCOS) have also been associated with insulin resistance and weight gain. It’s always important to rule-out these non-diet/non-exercise related problems with your clinician.
What can I do to improve my insulin sensitivity?
There are many healthy lifestyle choices that you can make to improve your insulin sensitivity. These healthy choices are important whether or not you have diabetes and whether or not you are also taking medication for your condition. See the back of this page for six healthy choices you can make for improved insulin sensitivity.
1) Enjoy exercise! -- Regular physical activity (both aerobics and strength training) increase your cells' sensitivity to insulin. Aim for 20-60 minutes of aerobic activity (e.g. brisk walking, jogging, swimming, or cycling) 3-5 days per week. In addition, aim for 30 minutes of strength training (with free weights, machines, resistance bands, or your own body’s resistance) 2-3 times per week. Gradually work up to these exercise goals, and discover a variety of different activities that you enjoy and can fit into your busy life.
2) Lose weight, if necessary! -- Even as little as a 10% reduction in weight can help improve your cells' insulin sensitivity. To lose weight safely and effectively, reduce your total calorie intake by about 500 calories each day (that’s equal to about one candy bar and one 16 oz. glass of juice or soda). Aim for a 1-2 pound weight loss per week.
NOTE: Restrictive dieting (< 1200-1500 calories per day) and rapid weight loss (> 2 pounds per week) are NOT recommended. Both can contribute to nutrient deficiencies, excessive loss of lean body mass vs. fat, reduced metabolic rate, food preoccupation, depression, fatigue, irritability, binge eating, and rapid weight re-gain.
3) Eat a moderate carbohydrate diet (about 45% of total calories)! -- Carbohydrates (especially low fiber, refined white grains and sugary foods/beverages) stimulate the most insulin secretion after you eat them. Your insulin levels are already high, so eating a diet that further increases insulin is not desirable.
· Choose a diet rich in mostly nonstarchy vegetables (leafy greens, broccoli, cabbage, cauliflower, zucchini, etc.). Aim for about 3 cups of chopped veggies per day (6 servings per day).
· Choose a diet with whole fruits instead of juices, most of the time. Aim for about 3 small pieces of fruit per day (3 servings per day).
· Choose mostly high fiber, whole grains and legumes (brown rice, whole wheat pasta, beans, whole wheat bread, whole grain cereals), and keep portion sizes moderate. Aim for about 5-7 servings per day. One serving equals one slice of bread, one 6” tortilla, ½ cup grains, legumes, or starchy vegetables, or ½ small bagel.
· If you enjoy sweet desserts on occasion, just balance them out by eating fewer amounts of other carbohydrate-rich foods (like bread, pasta, and rice) at that meal. For example, if you choose a grilled chicken breast salad (with light oil and vinegar dressing) for dinner, it’s okay to enjoy a small slice of cake or a couple of cookies for dessert.
4) Replace excess carbs with more heart healthy monounsaturated fats! (nuts, peanut butter, olive/canola oil, avocados) These fats don't affect your insulin levels, and they are good for your heart! But, like all foods high in fat, they have a lot of calories, so be sensible about your serving sizes. For instance, enjoy 1/4 cup of nuts for a snack instead of "bready" things. Enjoy 1-2 Tbsp. oil/vinegar dressings on your salads. Add a couple slices of avocado to sandwiches/salads.
5) Consume adequate protein with meals! Protein-rich foods (like tofu, fish, chicken, lean meat, low fat cottage cheese, and eggs) will help promote satiety so you don't feel hungry all the time.
6) Manage stress, and get enough sleep! Stress and inadequate sleep increase stress hormones (like cortisol) which increase insulin levels. Again, your goal is to lessen your already high insulin levels, so be sure to practice daily relaxation exercises and get to bed at a reasonable hour.
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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A simple, inexpensive, shorthand way to diagnose insulin resistance and hyperinsulinemia is a fasting serum insulin and a c-peptide level. In the pancreas, when insulin is made, it starts out as two fragments attached to each other by a connecting peptide called c-peptide. When this molecule comes out of the pancreas, two pieces split off the c-peptide, to form regular insulin, and the insulin and c-peptide exist separately. For each molecule of insulin made, a molecule of c-peptide is made, so that high insulin secretion by the pancreas is associated with high c peptide levels. If fasting serum insulin is high (greater than 20), or if c-peptide is high (greater than 4.6), then it is very likely that insulin resistance syndrome is present. This can occur with normal blood glucose or commonly in type 2 diabetes, with high blood glucose, can lead to the insulin resistance syndrome.
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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Some of the best ideas for preventing and reversing insulin resistance come from emerging treatments for adult-onset diabetes, the condition in which insulin resistance is most severe. One approach aims at reducing glucose levels (and consequently insulin levels) and the other uses vitamins to counteract free radicals generated by glucose.
A number of micronutrients help insulin efficiently move glucose into cells for burning. If you think of your body's cells as engines, refined carbohydrates provide plenty of high-grade fuel. But you also need spark plugs to efficiently ignite the fuel. One of the most promising of these biological spark plugs is alpha-lipoic acid.
A natural cell constituent, alpha-lipoic plays a fundamental role in converting glucose to energy. Researchers have known from animal experiments that it can lower and stabilize glucose levels and, in Germany, alpha-lipoic acid is sold as a "drug" for the treatment of diabetic polyneuropathy, a type of severe nerve pain.
At the ADA meeting, Stephan Jacob, M.D., of the University of Tuebingen, Germany, described his recent study of 74 diabetic given at least 600 mg of alpha-lipoic acid supplements daily. The alpha-lipoic acid stimulated insulin activity, which safely lowered and stabilized glucose levels. It also made the patients more insulin sensitive and increased their glucose tolerance, both positive changes.
Other nutrients also help improve insulin sensitivity and, conversely, reduce insulin resistance. The mineral vanadium, found in vanadyl sulfate supplements, also improves insulin's ability to transport glucose into cells. With insulin working efficiently, the body needs and produces less of it. According to Barbara F. Harland, Ph.D., of Howard University, Washington, D.C., vanadium has been researched for 40 years and is close to being recognized as an essential nutrient.
Chromium, which is recognized as an essential mineral, also helps lower glucose levels. It is a component of the "glucose tolerance factor," a molecule essential for normal insulin function and glucose metabolism. Last year, Richard A. Anderson, Ph.D., a researcher at the U.S. Department of Agriculture, described a joint U.S./Chinese study in which diabetics received either daily supplements of chromium picolinate or dummy pills. He said that 200 mcg of chromium picolinate daily safely lowered and stabilized blood sugar levels in diabetics in just four months. People taking 1,000 mcg of chromium daily ended up with glucose and insulin levels comparable to those of normal people.
The omega-3 fatty acids, or fish oils, also improve insulin sensitivity and reduce insulin resistance, according to a recent animal study by Margaret T. Behme, M.D., of University Hospital, London, Ontario. The omega-3 fatty acids restore a balance disrupted by excessive consumption of omega-6 fatty acids and saturated fats.
Vitamin E Prevents Damage
Researchers at the ADA meeting came close to unanimously endorsing vitamin E to relieve some of the "oxidative stress" caused by excessive glucose and free radicals in diabetics. It's likely that non-diabetics with insulin resistance also suffer from oxidative stress, though to a lesser degree.
Why the emphasis on vitamin E? Many studies have reported that 400 IU or more daily can dramatically reduce the risk of coronary heart disease, the cause of death among 80 percent of diabetics-and the leading cause of death overall in the United States. In fact, it appears that the same process that causes coronary heart disease in most people is accelerated in diabetics.
What happens is this: free radicals generated by glucose oxidize the low-density lipoprotein (LDL) form of cholesterol in the blood. White blood cells scavenge the oxidized LDL, then infiltrate heart tissue and get stuck. This causes the cholesterol deposits characteristic of heart disease.
Vitamin E can neutralizes many of these free radicals and retards the development of coronary heart disease, according to research by Ishwarlal Jialal, M.D., of the University of Texas Southwestern Medical Center. Jialal described a 14-week study in which he gave 21 healthy patients 1,200 IU of natural vitamin E daily. The vitamin significantly reduced LDL oxidation and prevented white blood cells from sticking to the heart. Jialal has seen similar reductions in oxidized LDL among diabetics. "In my own practice, I suggest to my coronary artery disease patients that they take 400 IU of vitamin E daily," he said.
Angelo Azzi, Ph.D., a professor at the Institute of Biochemistry and Molecular Biology in Bern, Switzerland, echoed Jialal and expressed a strong preference for natural vitamin E. "Natural vitamin E is two times more effective than the synthetic compound," he said, adding that the body prefers the structure of the natural molecule. "The important thing is to take it," he said.
As antioxidants go, alpha-lipoic acid is also extremely important, according to the University of California's Packer. In 1988, researchers discovered that it was one of the most potent and versatile antioxidants. It also helps recycle vitamin E and other antioxidants, such as vitamin C and CoQ10.
In sum, you have a one-in-three statistical risk of developing insulin resistance, but your real risk increases sharply if you consume a lot of refined carbohydrates, omega-6 fatty acids (found in fried foods and vegetable oils), and saturated fats. But you're not going to wake up one morning to discover that you're suddenly insulin resistance.
Insulin resistance takes years to become severe. If you pay attention to some of the early signs higher blood pressure and elevated triglyceride and cholesterol-when you're in your 30s or 40s, you can reverse insulin resistance and stand a good chance of preventing diabetes and coronary heart disease when you're older.
I have IR... I am trying to get my body prepared for a baby and have begun to workout 3 times a week. I understand that this is a cycle.. but can it be broken or will i always be IR. If I succeed at losing some of this weight.. will the IR go away? I have lost 17 pounds since starting glucophage.. I have about 45 more to go.. i am at 215.. and 5'6". I was fit at one time.. I exercised several times a day.. it was an obsession.. I was never skinny 165 at my smallest.. but i had about 21% body fat or less.. I got so frustated because i could no longer lose weight... i quit the gym.. i even worked as a trainer... i had no idea that i had pcod.. the docs dismissed my symptoms and just put me on bcp.. i wish i had known.. i could have accepted the weight and continued.. now i am so far gone..
Read this and tried safflower oil capsules & also flax seed. Also tried taking HCA, which is not mentioned in articles but helped cut down my appetite.
Finally on Met and I feel better already, less tired.
I say that since I know some other cysters like me don't want to go on any Rx, we want to try only the vitamin, healthy-eating & working out approach (which I did...I gave it my college try). At first I felt like a failure for going to drugs to help me, the Californian in me hates the idea of meds, but a few days later I am singing the praises of meds since I am feeling better.
Thanks for these articles and all you do Kat. Appreciate it.
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I just wanted to say thank you it helped me to understand all this I was told I had this on monday of this week. I am very much over weight I've lost some but not alot. I have thyroid problem as well as depression so it was hard to here that I had another problem but from what I understand from a fellow sister it makes since now. thanks again
Kat, I have a simple questions. I can't find a clear answer to this problem anywhere! I was hoping that maybe you can help or give me the place to look! ( I love learning!)
I was diagnosed with Hyperinsulinism almost 3 years ago. I was told one time that it was the same thing as IR, but I can't find a clear answer! Can you please help?
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Erika Leigh - Teen Mod
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Hello. I am a newbie. I was recently diagnosed with IR/PCOS etc.
I am on Metformin now and such but was trying to find out more on this and things. Like good books to help you with what you can eat, even ideas on Good vitamins and such you can take with this. Plus want to work on getting my weight down while still can do it etc. I know it will probably be heard. I feel depressed and more at times because of the way I look and more. I wish had known that all the stuff I have had over the years were part of this problem and all. Acene, facial hair too boot as well. It was like 1994 or somewhere there when I first suspected something but my symptom that had then seemed to subside till like in the last few years. So went to OB and such and glad they did a little more testing this time and more.
I have IR... I am trying to get my body prepared for a baby and have begun to workout 3 times a week. I understand that this is a cycle.. but can it be broken or will i always be IR. If I succeed at losing some of this weight.. will the IR go away? I have lost 17 pounds since starting glucophage.. I have about 45 more to go.. i am at 215.. and 5'6". I was fit at one time.. I exercised several times a day.. it was an obsession.. I was never skinny 165 at my smallest.. but i had about 21% body fat or less.. I got so frustated because i could no longer lose weight... i quit the gym.. i even worked as a trainer... i had no idea that i had pcod.. the docs dismissed my symptoms and just put me on bcp.. i wish i had known.. i could have accepted the weight and continued.. now i am so far gone..
I wish I had known a long time ago. It would of explained a lot of things that I went through. However, I was just diagnosed and I'm glad it happened. I managed to gain 30 or so pounds, I am ready to lose them! Chin up.
Thanks so much for all of the helpful information! I was recently informed that I am IR and I had no idea! My RE said I should have known because of the dark thick skin in my inner thighs...how was I to know that was the cause! I am so happy I found this website and can talk to people who share similar problems.
LOL I have the dark skin on my inner thighs and I had no clue that was because of IR until just recently. Your RE should be explaining things to you not just assuming you know, geez
What is insulin resistance? (pcos mentioned) 
