Why do you need to know about insulin resistance?
Many people with the condition are unaware that they have it.
On the basis of NHANES 2011-2016 data, the prevalence of the insulin resistance syndrome (AKA metabolic syndrome) in the United States is 35%. Insulin resistance syndrome involves insulin resistance along with other medical problems. However, the prevalence of insulin resistance is not actually known because there is lack of testing for it. I will go into that further at the end of the blog.
There have been many, many studies to look at people with obesity, and the high rates of insulin resistance is well established. Insulin resistance can found in up to 70% of obese women. Among adults with type 2 diabetes, the prevalence of insulin resistance rises to over 85%.
What is the concern?
If you are a patient of mine, then we are talking about insulin resistance due to the inability to lose weight and / or difficulty in lowering hemoglobin AIC without a bunch of medications. Insulin resistance is a very common condition that often accompanies obesity or a diagnosis of pre-diabetes, type 2 diabetes.
Insulin is a key hormone involved in fat storage and weight gain; when insulin levels are elevated, it impairs the body’s ability to burn fat for energy.
Insulin resistance also is a very common condition that is found with polycystic ovary syndrome (PCOS), cardiovascular disease, and other metabolic conditions such as hypertension and non-alcoholic fatty liver disease.
In the research literature, insulin resistance is most being linked to an increased risk of some common cancers, Alzheimer’s disease (aka insulin resistance of the brain), mental health disorders. There are other chronic conditions linked as well, like migraines, but there is not as much data on those... yet.
Why don’t we know which people who are overweight have insulin resistance?
Perhaps the better question is ... What is the most important test that your doctor is not ordering? Now I am going to explain the answer.
A fasting insulin test is the most important test your doctor probably has not ordered.
The reason it’s so important to track insulin is that in many cases, the labs that are used to diagnose diabetes (fasting glucose and AIC) are going to remain normal for an average of 15 years even when you have a metabolic disruption going on, such as insulin resistance.
Your fasting glucose and A1c remain normal due to chronically elevated insulin—that is, sky-high insulin is keeping the glucose “in check.”
Time refers to “over a life span.” The insulin begins to decrease and the glucose increases when the pancreas is burning out… read more below.
Fasting glucose and HbA1c are often the last things to rise, and they become elevated only after one of two things has happened:
The pancreas can no longer pump out the inordinate amounts of insulin required to keep blood glucose within a safe range (sometimes called “beta-cell burnout”). This is relatively rare, except in type-1 diabetes, which is an autoimmune condition and not driven by a poor diet.
The pancreas still secretes large amounts of insulin but some of the body’s cells no longer respond to it properly, resulting in high blood glucose. (These cells become resistant to the presence of insulin.) This is far more common.
This explains why many people are surprised by a diagnosis of type 2 diabetes or pre-diabetes. They—and their doctors—had been lulled into a false sense of security by glucose measurements that fell within normal ranges for years, because no one was measuring insulin…but the “formal” diabetes diagnosis was really just a matter of time .
What is even worse?
The saddest part to me us that insulin resistance and high insulin levels can be found in up to 44% of obese adolescents. This explains why there is an increasing trend of pre-diabetes found in young adults that is alarming. This is also correlated with an increased trend of heart disease found in younger populations than ever before.
Medical professionals who are aware of the wide-ranging effects of chronically elevated insulin would agree that a fasting insulin test should be included as a standard part of routine bloodwork. If the medical professionals are not willing to do that, then maybe they could empathize with the future health of our children and get the testing for obese children. But until that happens, if you’re concerned with getting and remaining metabolically healthy, you will need to make an appointment with Kristin Loyd.
