Our Paleo Family

What is Insulin Resistance? Part 2 in the Series

Last week, I shared with you the unsettling news that I have been diagnosed with “almost” insulin resistance. This condition apparently came on quickly and my hope is that it will go away just as quickly.

However, the simple fact that I could get thrown onto the path to Type 2 Diabetes in just a few months is pretty disturbing. It has certainly made me rethink the splurging I tend to do over the holidays every year. And I don’t mean at the shopping mall. Every year, due to the genius of marketing, the “holidays” last longer and longer, beginning with pumpkin spice season in September and running all the way through the New Year. If you’re good at math, you realize that is about a third of the year. We can’t really be splurging a whopping one third of the time and walk away unscathed, can we?

In Part 1 of this series, I introduced you to my current situation and set up the rest of the series. If you haven’t yet, I recommend you go back and read that article first. You can find it here.

A word of warning: today’s post is going to get a little science-y on you. If you hate scientific details,  don’t worry, I promise I won’t go too deep. If you love science and always want to know more, I’ll link to a great website with tons of details. You can also visit the National Library of Medicine’s archive of published scientific research if you really want to get into the nitty gritty of insulin resistance. I did a quick search, which turned up over 100,000 articles! If you want to do more reading on the topic, I’d suggest you enter a specific search, such as insulin resistance and paleo vs. just insulin resistance alone. Unless you have time to work through 100,000 articles.

Take a deep breath and let’s get started.

What is Insulin Resistance?

Basically insulin resistance is a step on the pathway to Type 2 Diabetes. It isn’t quite there, but it isn’t totally normal either. Occasionally, you will see this term used interchangeably with Pre-Diabetes or Metabolic Syndrome, both of which are discussed below. Scientists and doctors still haven’t come up with a clear definition of insulin resistance. It’s more a collection of symptoms, traits or lifestyle factors that may make you more likely to develop Type 2 Diabetes, rather than a concrete diagnosis.

An excellent source of information on this topic is this article from the NIDDK (the National Institute of Diabetes and Digestive and Kidney Diseases), a division of the National Institutes of Health. Unless otherwise stated, where you see information in quotes below, it is taken directly from that website. The NIDDK article includes some great graphics that help make their points even more clear, so if you’re interested in this topic, I suggest you read it in its entirety.

There are a lot of terms that get thrown around in the arena of diabetes and insulin disorders and I want you to understand what they mean. In this post we’ll cover:

Insulin resistance
Metabolic Syndrome

First, it’s important to understand the role insulin plays in the body. Insulin is a hormone made in the pancreas. The pancreas contains clusters of cells called islet cells. Beta cells within the islets make insulin and release it into the blood. In Type I Diabetes, formerly known as Juvenile Diabetes, these cells no longer produce insulin due to an autoimmune response. That’s not what we’re talking about in this article.

Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates (sugars and starches found in many foods) into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy. Insulin is essentially the trigger that makes cells open up and swallow the glucose.

When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.

•Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.

•Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.

•Insulin also lowers blood glucose levels by reducing glucose production in the liver. (Yes, the liver both stores and produces glucose, depending on the needs of the body at any given time.)

In a healthy person, the body performs these functions flawlessly allowing blood glucose and insulin levels to remain in the normal range at all times.

In a body with insulin resistance, muscle, fat, and liver cells do not respond properly to insulin and therefore cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter those cells.

Think of insulin as the irritating salesperson at your door and glucose as the product they’re selling. At first, when the salesperson comes by, you open the door and buy what they’re selling, because you want it. You need it. They come the next day and you buy some more. But they keep coming. Day after day after day, pushing more and more of their product. Eventually, you don’t need anymore of their product. Your house is full. You really can’t  take anymore. But instead of giving up and going away, the sales company sends more sales people to your house to ring the doorbell even more frequently. When you don’t answer the door, they start banging on your windows too. The more people they send and the more they bang and ring your bell, the less receptive you become. Eventually you don’t even notice them anymore. You have become salesperson resistant. Then when you need more of their product, you find that they’ve given up and gone away. So all the product is left out on the lawn, just making a mess rather than being a help to you.

This is what your body does in the presence of too much glucose (sugar/carbohydate). You eat carbohydrate (bread, bagel, apple), it becomes glucose circulating in your bloodstream, insulin is released, cells open up and take in the glucose to use for fuel. But if you feed your body too much too often (more than you are using), your body is constantly producing insulin, so there is a constantly high circulating level of insulin in your bloodstream and your cells are full. The cells can’t take anymore glucose and so they get less and less responsive to the insulin. This is insulin resistance. 

As I stated above, sometimes you will see insulin resistance used interchangeably with metabolic syndrome.

Metabolic syndrome as a “condition” has been around longer than insulin resistance and is a little better defined. It generally refers to a group of traits and medical conditions linked to overweight and obesity that puts people at risk for both cardiovascular disease and Type 2 Diabetes. Metabolic syndrome is defined as the presence of any three of the following:

• large waist size—waist measurement of 40 inches or more for men and 35 inches or more for women

• high triglycerides in the blood—triglyceride level of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride level

• abnormal levels of cholesterol in the blood—HDL, or good, cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL

• high blood pressure—blood pressure level of 130/85 or above, or taking medication for elevated blood pressure

• higher than normal blood glucose levels—fasting blood glucose level of 100 mg/dL or above, or taking medication for elevated blood glucose

Over time, insulin resistance can lead to pre-diabetes and Type 2 Diabetes because the beta cells (the guys that produce the insulin) fail to keep up with the body’s increased need for insulin. Without enough insulin, excess glucose builds up in the bloodstream, leading to pre-diabetes, diabetes, and other serious health disorders.

There is a step in between insulin resistance/metabolic syndrome and Type 2 Diabetes and it’s called Pre-Diabetes.

Pre-diabetes is a condition in which blood glucose or HbA1C levels—which reflect average blood glucose levels over about a three month period of time—are higher than normal but not high enough for a diagnosis of diabetes.

“Pre-diabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that at least 86 million U.S. adults ages 20 or older had pre-diabetes in 2012. People with pre-diabetes are at increased risk of developing type 2 diabetes and Cardiovascular Disease (CVD), which can lead to heart attack or stroke.”

How does insulin resistance relate to Type 2 Diabetes and pre-diabetes? From the NIDDK:

“Insulin resistance increases the risk of developing type 2 diabetes and pre-diabetes. Pre-diabetes usually occurs in people who already have insulin resistance. Although insulin resistance alone does not cause type 2 diabetes, it often sets the stage for the disease by placing a high demand on the insulin-producing beta cells. In pre-diabetes, the beta cells can no longer produce enough insulin to overcome insulin resistance, causing blood glucose levels to rise above the normal range.”

Insulin resistance —> Pre-Diabetes —> Type 2 Diabetes

“Once a person has pre-diabetes, continued loss of beta cell function usually leads to type 2 diabetes. People with Type 2 Diabetes have high blood glucose. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney failure, and lower-limb amputations (due to nerve damage and subsequent undetected infections).

Studies have shown that most people with pre-diabetes develop Type 2 Diabetes within 10 years, unless they change their lifestyle. I repeat: most people with pre-diabetes develop Type 2 Diabetes within 10 years, unless they change their lifestyle. Lifestyle changes include losing 5 to 7 percent of their body weight—that’s just 10 to 14 pounds for people who weigh 200 pounds. This can be accomplished by making changes to your diet and level of physical activity.”

There is not an HbA1c level associated with Insulin Resistance of Metabolic Syndrome, or at least not that I was able to find. But there are reference ranges available for pre-diabetes and diabetes. Remember, HbA1c is a measure of your average blood glucose levels over about a three month period. The reference ranges are as follows:

normal healthy individuals: below 5.7
pre-diabetes: 5.7-6.4
Diabetes: anything above 6.5

What is it that you’re doing that might be causing this insulin resistance? If eating carbohydrates is what causes the body to produce insulin, then eating more and more and more carbohydrates (sugar), more than your body can use, is what causes this condition. We’re not talking about one day, or even a week long vacation event, but an extended period of over-feeding.

In my case, I had blood work done and saw my functional medicine doctor in August. My fasting glucose and insulin levels were fine. Then I had the same blood work done again at the end of December and surprise! almost insulin resistant. By almost insulin resistant, I should clarify that this means a group of blood tests are completed and their results together produce a score. My score was one point lower than the score that means a person is considered insulin resistant.

A lot of people who end up insulin resistant are clinically overweight or obese, do not exercise, do smoke and generally consume an unhealthy diet. I don’t qualify in any of those areas. I do need to lose 10-15 pounds to really be as lean as I should be, but I’m not clinically overweight (according to BMI). I actually didn’t gain any weight through the holidays and during a long vacation between Thanksgiving and Christmas. I do not smoke, never have. I don’t even drink alcohol (well, maybe once a year). I exercise 5-6 days a week, doing a healthy mix of cardio, weight training and interval training and generally have a very healthy diet. So what gives?

I’m apparently extremely carbohydrate sensitive. This is how my doctor described it so this isn’t just an excuse. While I was eating all those paleo treats over the holidays, I did think about the health impact, but I thought because these treats were made with almond flour rather than wheat flour and other non-inflammatory foods, the negative effects would be minimal. After all, almonds won’t spike your blood sugar like wheat flour will. Same goes for honey vs. white granular sugar. And maybe the effects wouldn’t be so extreme in someone who isn’t so carbohydrate sensitive. Or in someone without a genetic predisposition to this disease.

I had a conversation with someone the other about this and they were saying that they don’t eat many carbohydrates for this very reason – trying to avoid diabetes. Then they proceeded to tell me what they typically eat:

breakfast begins with a big glass of orange juice, then cereal with milk, maybe a piece of toast and occasionally an egg (don’t want too many eggs because of the fear of high cholesterol)

lunch is a turkey and cheese sandwich on whole grain bread, a big bowl of fruit and some chips, occasionally a piece of chocolate

dinner is some sort of meat and a lot of vegetables, a dinner roll most days and sometimes dessert

This person considered their only sugar consumption for the day to be the dessert they may or may not have at dinner, and that piece of chocolate at lunch. But in fact, the entire breakfast is sugar with a teeny bit of fiber thrown in with the cereal/bread. The lunch is all carbohydrate, minus the meat and cheese on their sandwich. Dinner is a better picture with meat and vegetables, but a lot of times those vegetables are peas, potatoes and/or corn, which are a legume, a starch and a grain respectively, meaning carbohydrate. All the red foods are carbohydrates. How many foods are left that are not red? Hardly any!

Do you relate at all to that food “diary?”

I think about food all the time – because of my own health concerns and because I own a food blog. I track what I eat pretty consistently so I do have a realistic picture of the amount of carbohydrate I consume. I’ve varied my carb intake over the years and never really noticed anything different other than some light-headedness if I let my carb intake get too low. I’ll get into this in more detail in Part 3 of this series where I’ll discuss my specific plan of attack, but ultra low carb is not necessarily the answer to the problem here. However, the source of the carbohydrates is important.

Everyone is different and we all have different struggles. There are people who could change their diet overnight with little heartache, but don’t you dare ask them to take a walk. Then there are others who could practically live at the gym as long as they don’t have to stop eating the oreos. Where do you fall?

From the NIDDK article linked above, this is how exercise impacts insulin sensitivity and why if you are relating to what I’m saying in this article and you do not currently exercise, that would be a good place to start (even if you don’t yet make any dietary changes):

“Many studies have shown that physical inactivity is associated with insulin resistance, often leading to type 2 diabetes. In the body, more glucose is used by muscle than other tissues. Normally, active muscles burn their stored glucose for energy and refill their reserves with glucose taken from the bloodstream, keeping blood glucose levels in balance.

Studies show that after exercising, muscles become more sensitive to insulin, reversing insulin resistance and lowering blood glucose levels. Exercise also helps muscles absorb more glucose without the need for insulin. The more muscle a body has, the more glucose it can burn to control blood glucose levels.”

This is part of the reason I was so surprised at my recent lab results. Even though I was eating all those treats through the holidays, I continued my regular workout routine. And that extended vacation was to Disney World, where I was walking 10-15 miles per day. That’s a lot of activity. Apparently, too much exercise can also be detrimental. My doctor advised me to reduce the number of intense workouts per week to 3-4 max to help reduce the inflammation in my body.

My husband has Type I Diabetes. It is a different disease in cause, but it plays out the same as Type 2 Diabetes in that you have to take insulin to keep blood glucose levels stable and you must pay attention to your food intake, especially carbohydrates. This is what he had to say about exercise and it’s effect on his blood glucose: “I do notice that the day after I workout and generally the next one as well, my BG (blood glucose) tends to be lower. Also working out regularly helps to keep it lower. I check my BG 4-5 times a day so it’s something that’s easy to track.”

So what if my blood tests don’t go back to normal after I get back to my regular, non-holiday and vacation diet? What would be next for me?

Possibly full on insulin resistance and then possibly Type 2 Diabetes. A lot of my family members do have this disease and there is a genetic component to susceptibility, so I have to take this seriously. In a small way, I am fighting an uphill battle here. I remember being with aunts and uncles when I was young and it seemed they all had “the sugar.” That’s what they called diabetes. I remember them always having candy in their pockets or purses and would “feel” like they needed a little sugar and then out came the candy. This seemed strange to me, but not a bad thing. Why wouldn’t you want a disease that means you need to randomly eat candy? Seems like a dream come true for a child.

Thankfully, we do get some warnings before the onset of Type 2 Diabetes. Unfortunately, if you don’t get some relevant blood tests, you may not know. I wouldn’t have had any idea that I was on this path had my doctor not ordered these tests.

If you suspect that you may be headed down this path, please see your doctor and request these tests: A basic lipid panel, specifically fasting triglycerides, the LipoProfile discussed in Part 1, HbA1c, fasting glucose and fasting insulin levels. These results can shed a lot of light. If your doctor looks at you and sees someone like me: looks healthy, not overweight, no obvious risk factors, and therefore says you have nothing to worry about and doesn’t want to order the tests, fight for yourself. If your diet looks like our example above that is mostly carbohydrates, if you know you eat a lot more sugar than you should, if there is diabetes in your family, push for these tests.

As you can see, these conditions are no joke. The outcomes can be quite serious. It is my opinion that these symptoms of high blood pressure, high A1C levels, abnormal lipids, etc., have become so commonplace that they aren’t treated with the urgency that they should be. It’s almost assumed that we will develop Diabetes and then we just get drugs to treat the problem. Don’t forget that you are your own health advocate. No one cares about your health as much as you do. No one has as vested an interest in your well-being as you. Take that responsibility to heart.

My diagnosis of almost insulin resistance was a great big wake up call to me. I’m not sitting around eating bags of jelly beans and potato chips. Although, somedays my kids stress me to the max and I would really enjoy some jelly beans. Or potato chips. Or potato chip encrusted jelly beans! But no, I am eating pasture raised eggs and meats, healthy fats, lots of vegetables, very little fruit and occasional paleo treats. And here I am standing on the path to diabetes.

In Part 3 of this series, I’ll explain in detail how I’m eating, how I’m exercising, supplements I’m taking and how I’m doing so far.