How can I tell if I’m insulin resistant?

All about insulin resistance: How can I tell if I’m insulin resistant?

Since we are focusing on ways to reduce insulin resistance this month an important question comes to mind: How can we tell if we are insulin resistant? It can be hard to combat something that we don’t know is happening. Here are some signs that can indicate that you might be either showing some level of insulin resistance or at higher risk to struggle with insulin resistance in your diabetes management.

Signs of higher levels of insulin resistance include:

• Skin changes- Severe insulin resistance can result in forming dark spots on the skin, often of the neck, elbows, knees, knuckles or under arms. This is called acanthosis nigricans and is typically seen in people experiencing severe insulin resistance or in children ahead of diabetes diagnosis.  This sign prior to diabetes diagnosis is indicative of a state of insulin resistance. Once blood sugars normalize with treatment the skin presentation goes away, but the insulin resistance may remain.
• Reproductive changes- In women a diagnosis of PCOS (poly cystic ovary syndrome) can be directly linked to insulin resistance. 70-95% of women diagnosed with PCOS who also have an above range BMI were found ot be insulin resistant, likewise, 30-75% of women diagnosed with PCOS with a BMI in range were also found to be insulin resistant.  Increased levels of insulin in the body are typically a causal factor for POCS as the insulin blocks androgen receptors causing these levels to elevate, in much the same way the blockage of insulin receptors causes insulin resistance. We see a sort of cascade effect throughout the endocrine system when one hormone is out of balance.  Weight loss and
• Higher than “normal” insulin needs – Total daily insulin use of roughly 0.6 units/kg is the “text book” amount of anticipated typical insulin use for an adult. (Don’t you love the words approximately, anticipated, and typical in one sentence? It lets us know we have entered waters that are particularly murky) Insulin use above this amount, particularly over 1 unit/kg could indicate insulin resistance.

However, we stress, we use the amount of insulin our bodies need. Reducing insulin levels to get to a certain perceived “Target” amount is going about things backwards. We need to find ways to reduce resistance and work with our bodies to get better insulin sensitivity AS WELL AS good blood sugar control and a healthy well-rounded lifestyle. There are also a host of other factors that can push blood sugar needs up including growth, pregnancy, illness or healing, elevated carb intake and a host of others. So, we should never take a single number like Total daily dose of insulin or insulin sensitivity/Correction factors as an indicator of our overall health or physiologic abnormality.

Signs of increased risk of insulin resistance:

Metabolic Syndrome People with metabolic symdrome have been shown to be at increased risk of developing or displaying insulin resistance. This is a multi-faceted issue and so the causal factors are numerous, but common themese are elevated triglyceride levels and increased amounts of abdominal visceral fat on the body. These have both been shown to exhibit insulin receptor blocking that leads to a state of insulin resistance.

Signs of metabolic syndrome include:

• High waist to hip ratio: Waist over 35 inches for women, 40” for men (31.5” for women , 35.5” for men of Asian or south east Asian decent): carrying more weight around the middle and in the upper body as opposed to in the hips and lower body increases metabolic syndrome risks.
  • High triglycerides – over 150 or on medication to reduce cholesterol levels.
  • High BP – above 130-85 or on medication for hypertension
  • Low HDL levels (below 40 for men, 50 for women

Additional aspects of one’s medical history that may increase your risk for insulin resistance include:

• History of Gestational Diabetes: The presence of elevated pregnancy-related insulin resistance prior to type 1 diagnosis increases risk of insulin resistance after type 1 diagnosis.
• High doses of steroid medications: Steroid medications cause insulin resistance, and high doses or long term use of these medications can make this temporary state permanent.
• Chronic stress: this is another case of endocrine imbalances cascading. When we are under chronic stress we release a lot of cortisol which directly causes insulin resistance. However elevated blood sugar levels then impair the body’s ability to clear cortisol effectively, making the problem worse and more prolonged. Stress also impairs sleep and increases gut and other inflammatory processes. These all increase glucose levels, and insulin resistance. Prolonged cortisol elevation also causes our body to store more abdominal fat and inhibits the burning of abdominal fat which we have already mentioned increases risks of metabolic syndrome and insulin resistance. Oh and all that cortisol, the production of it can also directly imbalance reproductive hormones (Hello PCOS again)
• Sleep disturbance (sleep apnea) – Speaking of sleep, poor sleep leads to increased levels of cortisol production (See big paragraph above) Sleep is an important restorative time for our bodies and reduced numbers of hours of sleep have been shown to result in reduced metabolic rates, increased insulin resistance and reduced glucose conversion. Sleep apnea and the hypoxic  (low oxygen) periods caused by this disorder have been shown to significantly increase insulin resistance regardless of the number of hours the individual slept and also independent of obesity or other metabolic factors. So take your sleep seriously. Snoring, waking up still tired, or waking suddenly multiple times through a night are not normal and can all be signs of a serious medical issue so follow up with your PCP and a sleep specialist for effective diagnosis and treatment.
• Severe illness: The intense levels of inflammation in the body during a time of severe illness can cause marked increases in insulin resistance and increased glucagon release resulting in liver glucose output. For someone with type 1 diabetes we see this in elevated blood sugar levels. Typically as the illness abates these effects reduce as well, however they can linger and even become permanent.
• Chronic inflammation
• Skin tags
• Ethnicity: Latino, African American, Native American, Asian American
• Cigarette smokers
• Cpeptide test ( not useful for type 1 diabetes)

However we stress, we use the amount of insulin our bodies need. Reducing insulin levels to get to a certain perceived “Target” amount is going about things backwards. We need to find ways to reduce resistance and work with our bodies to get better insulin sensitivity AS WELL AS good blood sugar control and a healthy well-rounded lifestyle.

Insulin 0.6 units/kg “text book” Insulin use over 1 unit/kg would indicate particularly high degrees of insulin resistance