By Christine Lehmann, M.A., N.T.P. and Reverse Diabetes Coach
f you have prediabetes or Type 2 diabetes, metabolic syndrome or polycystic ovarian syndrome, you may already have insulin resistance. This condition shows up earlier than prediabetes because the hormone insulin plays such an important role in controlling your blood sugar. After you eat a meal with starchy carbohydrates such as white bread, most cereals or white rice or consume a drink with sugar in it, your blood sugar rises within 15 minutes. Your pancreas secretes insulin to lower your blood sugar and maintain a normal level. Insulin does this by driving glucose from your blood stream into your muscle, fat and liver cells. Your liver and muscle tissue also store excess glucose (glycogen) and your liver produces less glucose in response to insulin.
When your blood sugar starts to dip between meals, your pancreas secretes the hormone glucagon to prompt the cells and the liver to release the excess glucose into your blood stream. Glucose is a very important source of energy for the body, including your brain, so you don’t want your blood sugar to drop too low (hypoglycemia). In the early stage of insulin resistance, the fat, liver and muscle cells, which normally accept and store glucose start to resist the action of insulin due to a signaling problem. As a result, glucose remains in the blood stream and starts to rise. The beta-cells in your pancreas respond by secreting more insulin to compensate for the insulin resistance. This increase in insulin can keep your blood sugar levels normal for several years. However, eventually, this hyperinsulinemic state damages your pancreatic beta cells, which impairs their ability to continue producing adequate levels of insulin. Then, your blood sugar levels rise above normal and you have prediabetes or Type 2 diabetes. Risk Factors for Insulin Resistance
Insulin resistance is a combination of genetic and acquired factors, which are impacted by lifestyle. These factors increase your risk of having insulin resistance.
• Signs of metabolic syndrome including abdominal fat, obesity, high blood pressure, high
cholesterol especially high triglycerides and high blood sugar.
• A sedentary lifestyle (lack of exercise) and/or a high-carb, high-sugar diet.
• A family history of Type 2 diabetes.
• A history of gestational diabetes.
• A diagnosis of Cushing’s Disease. (your adrenal glands produce too much cortisol)
• Chronic stress due to trauma, surgery, diabetes ketoacidosis, severe infection, uremia and liver cirrhosis.
• A diagnosis of polycystic ovarian syndrome. Get Tested
Unfortunately, most physicians only test for elevated blood sugar levels. By the time you have prediabetes, insulin resistance is already established. “In short, we have very well-established methods for assessing glucose regulation, allowing us to easily diagnose patients as non-diabetic, pre-diabetic or diabetic. What has been missing is a reliable way to detect insulin resistance in those years when insulin levels are rising but still keeping blood sugar levels down. This need is answered by the Glucose Tolerance/Insulin Response (GTIR) test, which offers a way to improve our ability to intervene earlier,” says naturopathic doctor Pushpa Larsen ND in the online article “Early Detection of Insulin Resistance for Improved Patient Outcomes.” The GTIR test requires fasting 8 to 12 hours beforehand and an appointment time of 2 to 4 hours to measure your fasting blood sugar and insulin levels before and after consuming a sugary drink. The results will indicate whether your glucose and insulin levels are normal or not and if abnormal, the relevant stage of diabetes and insulin resistance. “For an individual with a healthy life-style and no other risk factors, a baseline GTIR at 45 years of age would be prudent, with follow-up testing every three to five years if no signs of insulin resistance become apparent,” advises Larsen. Case Study
To illustrate how the GTIR can help with early detection and treatment of insulin resistance, Larsen shared a case example: GJ is a 38-year-old woman whose chief complaint was easy weight gain and fatigue. She is 5’4” tall and weighed 174 pounds at the initial visit. Her body mass index (BMI) was 29.9. Her pulse, respiration and blood pressure were normal. She had a history of gestational diabetes and a family history of Type 2 diabetes. Fasting blood sugar was elevated at 111, but HgbA1c was normal at 5.3. Because of her family and personal history, Larsen ran a 4-hour Glucose Tolerance/Insulin Resistance test. GJ’s fasting and 2 hour glucose levels were normal based on American Diabetes Association criteria. “However, her fasting insulin was above 10 (11.80) and peaked in the 2nd hour at 93.20. This pattern shows that extremely high insulin levels functioned to keep all blood glucose levels within normal levels,” says Larsen. GJ was put on Berberine, a Chinese herbal supplement, which several published studies have shown is just as effective as Metformin in lowering blood sugar and improving insulin sensitivity without some of the gastrointestinal side effects. She was also counseled about diet and exercise. Larsen reported that “At her six month follow-up visit she had lost 9 pounds and her BMI had decreased to 28.3. Her GTIR test demonstrated a dramatic reversal from the original Pattern IV result to a completely normal Pattern I result.” Diet
A low glycemic whole-foods diet can go a long way towards keeping blood sugar and insulin levels in the normal range. The glycemic index only applies to carbohydrates that were tested in 50 gram amounts for their glucose response in comparison to a slice of white bread, which has the highest glycemic score of 100. Then, the carbs were classified as high, medium or low. However, many people prefer using the glycemic load (GL) to the glycemic index because it is based on an average serving size rather than 50 grams of a particular food that can be several servings.
The best carbohydrates with a low GL are non-starchy vegetables including leafy greens, brussel sprouts, artichokes, and cauliflower. Some of the best fruits include all types of berries (except cherries), grapefruit, peaches, plums, pears and green apples. Although fruit contains the sugar fructose, which can spike your insulin, that is off-set by the antioxidant vitamins A and C and fiber in fruit. You want to avoid refined carbs such as white bread, white rice and complex starchy carbs with a high GL such as white potatoes and tapioca. These foods produce rapid increases in blood sugar and trigger a high insulin response that can lead to a sharp decrease in blood sugar (hypoglycemia). I also recommend adding a little healthy fat such as virgin coconut oil or grass-fed butter to medium-glycemic carbs such as sweet potatoes, which slows the release of glucose into your bloodstream.
Another index called the insulin, not only measures the insulin response to carbs but also fats and proteins. While the insulin index generally mirrors the glycemic index/load, there are a few exceptions. For example, milk and fermented yoghurt and kefir are low-glycemic foods but they contain whey protein which is rapidly digested and absorbed to release amino acids into the circulation. Studies have shown that the most insulinemic amino acids are the branched-chain ones (leucine, isoleucine and valine) found in both regular milk (skim and whole-fat) and fermented milk products. Unfortunately, a cup of yoghurt produces the same high insulin response as a slice of white bread. Beans are a good source of protein and produce a high insulin response. Exercise
The research shows that being inactive and overweight or obese contribute to chronic inflammation and the manifestation of insulin resistance. Physical activity, on the other hand, increases insulin sensitivity. The research shows when aerobic exercise was added to medication and diet, this combination was superior to medication and diet alone in reducing blood glucose and insulin scores. In a large study, insulin sensitivity was approximately 80% higher for those who participated in vigorous activity five times per week or more, compared with those who rarely or never participated. However, another study showed that exercise at moderate intensity such as 30 minutes of cycling can be as effective as high-intensity exercise in reducing insulin resistance in women. Resistance training with increasing intensity at least twice a week over a period of 16 weeks also increased insulin sensitivity by as much as 45 percent. The research shows that to sustain the increased insulin sensitivity, you need to continue to engage in the activity regularly. Otherwise, it can take only one week for the improvement to disappear. FRA