Insulin Resistance Causes, Treatment and the Best Measurement Tools and Calculations

By Tucson Functional Medicine on July 15, 2024 • 0 Comments

What Is Insulin Resistance?

Insulin resistance, also known as impaired insulin sensitivity, happens when cells in your muscles, fat, and liver don’t respond as they should to insulin, a hormone your pancreas makes that’s essential for life and regulates blood glucose (sugar) levels.

The following is a good understanding of the mechanism occurring in a person with insulin resistance and a patient with Insulin sensitivity:

Let’s say we feed a healthy person a high-glycemic carbohydrate-containing meal. The pancreas plays a crucial role in a healthy person with optimal insulin sensitivity. It adequately releases insulin in response to the rise in blood glucose. Insulin, in turn, causes most of that glucose (about 80-90%) to be absorbed by the liver and muscle and converted into glycogen.

However, in the resistant person, insulin fails to induce the same level of glucose uptake by the muscle and liver even though their pancreas is releasing more insulin in an attempt to overcome their resistance. Insulin fails to block glucose production, leading to higher blood sugar compared to a healthy person.

Insulin Resistance Symptoms

What Causes Insulin Resistance?

Insulin resistance can be genetic. However, there are also acquired causes of insulin resistance. Let’s learn more about them:

1: Excess body fat

Studies have shown that obesity, particularly the accumulation of excess fat around your waist and organs, known as visceral fat, plays a significant role in causing insulin resistance.

Visceral fat increases inflammation, which can contribute to insulin resistance.

2: Physical inactivity

Physical activity increases insulin sensitivity and helps build lean muscle mass, which helps absorb glucose from the blood and keep blood sugar levels in check.

Conversely, a lack of physical activity can have detrimental effects. Leading a sedentary lifestyle with little to no physical activity can lead to obesity, which in turn can increase insulin resistance.

3: Diet

Highly processed diets that contain a high amount of simple, high-glycemic carbohydrates and saturated fats get digested very quickly by your body and spike your blood sugar levels. If this eating pattern continues for an extended period of time, the increased blood sugar levels have the potential to increase insulin resistance.

The glycemic index (GI) is a standardized scale that ranks foods from 0 to 100 based on how quickly they are digested and absorbed by the body and how they impact blood sugar levels. Foods with a high GI (70 or more) are digested and absorbed quickly, causing blood sugar to spike. Foods with a low GI (55 or less) are digested more slowly, causing a more gradual rise in blood sugar

4: Poor Gut Health- Increased Intestinal Permeability (aka: Leaky Gut)-It is postulated that endotoxin-induced inflammation, which results from gut permeability also contributes to the development of insulin resistance

5: Genetics- Many single nucleotide polymorphisms (SNPs) have been associated with insulin resistance in the general population, including:

I recommend the following genetic lab:

DNA Type 2 Diabetes Risk Test by Genex Diagnostics

https://www.genexdiagnostics.com/dna-type-2-diabetes-test/

6: Medicines

Certain medications, such as steroids and specific hypertension and psychiatric disorders, can lead to insulin resistance.

7: Medical conditions

Certain medical conditions – hormonal and genetic can increase insulin resistance.

Insulin Resistance: The Damage It Causes

Insulin Resistance: A Trigger for Harmful Substances Insulin resistance sets off a series of reactions in your fat cells and liver, leading to the release of elevated levels of fatty acids and cholesterol into your bloodstream.

If insulin resistance is not managed on time, it can lead to severe complications such as high cholesterol, hypertension, vascular complications, and hardened arteries. It can also lead to an increased risk of stroke, cardiovascular disease, and type 2 diabetes.

Diseases Associated with Insulin Resistance

Blood Work for Diagnosis of Insulin Resistance

Bloodwork can be a useful tool in assessing and diagnosing insulin resistance. Some blood work markers that are associated with insulin resistance include:

Fasting Glucose
Fasting Triglycerides
Fasting Insulin
Triglyceride/HDL ratio
Hemoglobin A1C (HbA1c)
LP-IR Score ( See Grid Above)
C-Peptide
Oral Glucose Tolerance Test (OGTT)
High LDL Cholesterol

How to Measure and Calculation for Insulin Resistance

You show no insulin resistance if you meet the following metrics:

Fasting glucose is 75–95 mg/dL (4.2–5.3 mmol/L).

TG: HDL ratio is near 1.0, +/- 0.5.

Fasting insulin is 3–8 uIU/mL (18–48 pmol/L).

HgbA1C level is less than 5.6% (<37 mmol/mol).

Glucose/insulin as HOMA-IR is near 1 (.5–1.5).

Your body fat is <28% for men and <32% for women.

You show slight insulin resistance if you have two or more of the following metrics:

Fasting glucose is greater than 95 mg/dL (5.3 mmol/L).

TG: HDL ratio is greater than 2.

Fasting insulin exceeds eight uIU/mL (>48 pmol/L).

HgbA1C level is greater than 5.5% (>36 mmol/mol).

HOMA-IR is greater than 1.5.

The skin fold at your hip is greater than that at your triceps (by at least 5 mm).

You show moderate insulin resistance if you have three or more of the following metrics:

Fasting glucose exceeds 100 mg/dL (>5.6 mmol/L).

TG: HDL ratio is three or greater.

Fasting insulin exceeds ten uIU/mL (>60 pmol/L).

HgbA1C level is greater than 5.7% (>39 mmol/mol).

HOMA-IR is greater than 2.5.

The skin folds at your hip measures nearly twice that at your triceps.

You show severe insulin resistance if you have three or more of the following:

When fasting glucose exceeds 110 mg/dL (>6.1 mmol/L), it is diabetes. Anything greater than 125 mg/dL (>7.0 mmol/L) is diabetes.

TG: HDL ratio is greater than 4.

Fasting insulin exceeds 12 uIU/mL (>72 pmol/L).

HgbA1C level is greater than 6.0% (>42 mmol/mol). Greater than 6.4% (>46 mmol/mol) is diagnostic of diabetes.*

HOMA-IR is greater than 3.

The skin folds at your hip measures over twice that at your triceps.

The following are two clinically established tools to determine if you have Insulin Resistance

HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance

HOMA-IR Calculator — Insulin Resistance

https://www.mdcalc.com/calc/3120/homa-ir-homeostatic-model-assessment-insulin-resistance

Healthy Range: 1.0 (0.5–1.4)

Less than 1.0 means you are insulin-sensitive, which is optimal.
Above 1.9 indicates early insulin resistance.
Above 2.9 indicates significant insulin resistance.

The triglyceride-glucose (TyG) index

https://www.mdapp.co/tyg-index-calculator-359/

<4.49 indicates being insulin sensitive

>4.49 indicates insulin resistance

Effective Treatment to Reverse Insulin Resistance

1: Get Adequate and High-Quality Sleep

Getting adequate, high-quality sleep is essential for several functions in the body, but recent research has shown it is necessary for healthy metabolic function. Aiming for 7-9 hours of high-quality sleep is recommended, and getting less than 5 hours of sleep per night has been shown to decrease insulin sensitivity, increase sugar cravings, and is considered a risk factor for developing insulin resistance. Research suggests that getting enough quality sleep can help reverse insulin resistance. A 2022 review in Cureus found that poor-quality sleep can disrupt hormone balance and increase the risk of insulin resistance. In one study, volunteers who restricted their sleep for four nights saw their insulin sensitivity drop by 23%, but two nights of extra sleep helped restore normal levels.

2: Engage in a Regular Exercise Routine

Exercise is one of the best ways to improve your insulin sensitivity. It helps move sugar into the muscles for storage, with benefits lasting 2-48 hours after exercise. Both cardiovascular and resistance training have been found to be beneficial, so the best kind of exercise is the type that you enjoy and will participate in on a regular basis.

Adults generally should engage in 150-300 minutes of low-intensity or 75-150 minutes of vigorous exercise per week.

Aerobic (cardio) and resistance training (strength) are equally important. Some studies suggest that combined exercise provides greater benefits than either alone.

When you are physically active, your muscles are more responsive to insulin, resulting in improved glucose uptake by your muscles, promoting healthier blood sugar levels.

Muscle is the fountain of youth and one of the essential keys to reversing insulin resistance.

Strength training should be the cornerstone of your exercise program.

3: Reduce Your Stress Levels

Research has demonstrated a link between chronic stress, insulin resistance, and metabolic dysfunction. Reducing stress can help reverse insulin resistance. Stress can be a risk factor for insulin resistance because stress hormones like cortisol and adrenaline can make it harder for insulin to work properly. This can lead to increased blood sugar levels, also known as hyperglycemia. Stress is a risk factor for insulin resistance, as high levels of stress hormones can disrupt glucose metabolism.

4: Focus on a Healthy Diet

Nutrition is a proactive key component of maintaining a healthy weight and preventing or reversing insulin resistance. A diet based on whole foods, including fruits, vegetables, nuts, seeds, and high-quality protein, is most beneficial for blood sugar regulation.

A balanced meal contains:

Lean protein (like fish).
Healthy sources of carbs (vegetables, legumes, fruit & whole grains).
Healthy fats/oils (nuts, seeds, olives, olive oil & avocados – not trans fats or partially hydrogenated oils).

Strive to get 30-40 grams of protein per day. Although I advocate a more plant-based protein source, such as soybean products, seitan, beans, and lentils, which contain high amounts of protein, you can also find protein in nuts, whole grains like quinoa and amaranth, and hemp seeds.

Lean muscle is a powerful tool for improving insulin sensitivity. Studies have shown that people with more muscle mass and less fat have lower insulin resistance than people with less muscle mass and more fat. Additionally, strength training and other types of exercise can increase muscle mass and insulin sensitivity, motivating you to incorporate these into your routine.

Leucine plays a crucial role in building new muscle tissue. It is needed to signal the process of building new muscle.

Leucine is the most potent activator of muscle growth out of all other amino acids.

With that said, consuming a minimum of 2.5 grams per meal is recommended.

The following foods groups will supply 2.5 grams of Leucine

Leading research recommends that 2.5 grams of leucine per meal can trigger the body’s muscle-building process for five to six hours and improve insulin sensitivity.

Fruits and vegetables: The overall healthy diet that I recommend to anyone is plant-based, unprocessed foods.

Fill half your plate with vegetables daily.

Strive for a generous 6 servings daily of non-starchy vegetables. These include a wide range of options such as asparagus, leafy greens, broccoli, onions, and radishes. If you’re on blood thinners, it’s always best to consult your physician first.

You can eat an unlimited amount of Non-starchy vegetables without causing glucose/insulin spikes.

Soluble fiber: Soluble fiber is found in food such as beans, legumes, oatmeal, whole grains, sweet potatoes and Brussels sprouts

There are two types of fiber: soluble and insoluble. Soluble fiber attracts water and turns into a gel-like substance, which helps to slow digestion. Insoluble fiber (sometimes called “roughage”) adds bulk to stool and allows food to pass quickly.

By slowing digestion, soluble fiber empowers you to feel fuller for longer, preventing overeating and aiding in weight loss. It’s also a powerful tool in reducing visceral fat, a dangerous form of fat that surrounds internal organs like your liver, stomach, and intestines. This fat type raises the risk of many health conditions, including diabetes and heart disease. But with the help of soluble fiber, you can take control of your health and reduce visceral fat.

One study found that for every 10-gram increase in soluble fiber, visceral fat accumulation decreased by 3.7%.

The optimal goal for Fiber intake:

35 grams a day of fiber for men

25 grams a day of fiber for men

Fiber is key to promoting healthy blood sugar and preserving insulin sensitivity. Vegetables, avocados, and legumes are good sources of fiber, and whole grains are another good source.

Low-glycemic carbohydrates: It’s essential to select carbohydrates with a low glycemic load. Some smart choices include green vegetables, non-starchy vegetables, sweet potatoes, berries, and gluten-free whole grains. In addition, it’s essential to limit high-glycemic carbohydrates, including refined sugars, refined grains, processed foods, and sugary drinks.

When planning your meals, remember the importance of balance. A balanced plate, with a complex carbohydrate, a high-quality plant-based protein, a healthy fat, and a source of fiber, is a powerful tool in managing your diet. By including all these components in your meal, you can control the digestion of the meal, preventing a high blood sugar spike and maintaining your health.

Reading labels is a crucial step in making informed food choices. Keep an eye on the total added sugars, aiming for less than 24 grams for women and 36 grams for men. By being responsible and informed about your food choices, you can take control of your health and nutrition.

The following is an effective recipe for success in reversing insulin resistance.

Based on the work of Cyrus Khambatta, PhD, and Robby Barbaro, MPH, authors of the outstanding book Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes, I have witnessed LONG-TERM improvements in Diabetes and Insulin Resistance Reversal.

There are three categories:

The green light category contains the foods you can eat ad libitum (i.e., as much as you want). These are all unrefined whole foods. They are optimal for reversing insulin resistance; you do not need to limit your intake.

The yellow light category contains foods that can be included in small quantities because they are either slightly processed or have a higher fat content. They shouldn’t be daily staples but are still considered “healthy” choices.

The red light category contains the foods we recommend removing from your fridge, kitchen cabinets, and, most importantly, your plate. Evidence-based research has documented that these foods cause insulin resistance, increase blood glucose, and promote chronic diseases.

The preponderance of evidence recommends a more plant-based diet with no more than 6-10 ounces per week of antibiotic-free, organic/grass-fed meat/fish. This has proven over and over again to improve health longevity and the reversal of disease (cardiovascular, diabetes, auto-immune disease, etc.), including the topic of today’s article on insulin resistance.

I will get pushback from strong low-carb, high-protein, and high-fat diet advocates.

Although impressive SHORT-TERM health benefits are undisputable, the long-term complications are worrisome.

Please read my article titled: Low Carb/High Protein and Increased Mortality

https://www.functionalmedicineuniversity.com/public/1989.cfm

The Position on the Camp of Increased Consumption of Saturated Fats

Saturated fat can worsen insulin resistance in humans. Studies have shown that a diet high in saturated fat is associated with insulin resistance and the development of type 2 diabetes. Saturated fat can directly affect insulin resistance in skeletal muscle and the liver.

Saturated fat can increase the amount of diacylglycerol in muscles, which can strongly affect muscle insulin resistance.

Saturated fat can activate the toll-like receptor 4 (TLR-4) receptor in the liver, which can produce ceramide and inhibit insulin signaling.

Avoid or reduce artificial sweeteners such as sucralose, acesulfame potassium, aspartame, saccharin, and maltodextrin.

You can use Stevia monk fruit and allulose.

5: Maintain a Healthy, Ideal Weight and Bodyfat Level

Excessive weight, particularly in the belly area, has been associated with an increased risk of insulin resistance and increased risk of type 2 diabetes. A study by Johns Hopkins University found a 5-7% weight loss correlated with a 54% decrease in the risk of developing type 2 diabetes.

6: Stay hydrated- total water intake (≥2,657 mL or >90 ounces) was associated with lower insulin resistance.

7: Intermittent fasting—a daily 12-14-hour fast is a great habit to implement to lower insulin resistance.

8: Herbs for Insulin resistance

Several herbs have been shown to increase insulin sensitivity. Herbs that have been found to improve insulin sensitivity include:

Fenugreek seeds: These are high in fiber, helping slow digestion and controlling blood sugar spikes.

Turmeric: Turmeric contains curcumin and has been shown to aid in insulin sensitivity by reducing sugar and free fatty acids in the blood.

Cinnamon: Cinnamon has been shown to help lower blood sugar levels and improve insulin sensitivity.

Ginger: Ginger has been shown to increase insulin secretion, helping to lower blood sugar levels after a meal. It has also been shown to improve insulin sensitivity.

9: Nutraceuticals for Insulin Sensitivity

Chromium: Chromium has been shown to improve insulin sensitivity and lower blood sugar levels. Chromium works by binding to insulin receptors on the surface of cells. This enhances insulin activity, so fewer hormones are needed to move glucose out of the blood.

Magnesium: The body’s insulin receptors use magnesium, and a magnesium deficiency has been associated with insulin resistance. Taking magnesium supplements may help improve insulin sensitivity in those with low magnesium levels.

Resveratrol: Resveratrol is naturally found in the skin of grapes and berries. In its concentrated form, it has been shown to improve insulin sensitivity.

Berberine: significant berberine studies found that it had similar effects on blood sugar as the diabetes drug metformin (Glucophage)—those who took berberine experienced reductions in A1c, fasting glucose, post-meal glucose, and triglyceride levels.

Pendulum Glucose Control- I have seen fantastic improvement in glucose management and reversal in insulin resistance

https://pendulumlife.com/products/pendulum-glucose-control-2-og

Apple cider vinegar: Apple cider vinegar has become more popular over the past few years due to its ability to increase insulin sensitivity in people with insulin resistance and type 2 diabetes.

Omega 3-Omega-3 fatty acids can improve insulin resistance by improving mitochondrial function and beta-oxidation, regulating the secretion of adipocytokines, and inhibiting the remodeling of adipose tissue.

Dr. T’s Comments:

Although I agree approximately 80-85 percent with the work of Cyrus Khambatta, PhD, and Robby Barbaro, MPH, I still have seen outstanding results in reversing Type 2 Diabetes and insulin resistance with the science-based Mediterranean Diet.

https://www.functionalmedicineuniversity.com/mediterranean-diet1.pdf

I understand that some readers of this article may be confused by the two presented ways of eating.

I want to be very transparent and say that it comes to MODERATION and BLEND. Leaning more toward a Mediterranean Diet/Dominant Plant-Based Diet will consistently produce outstanding clinical outcomes.

One issue that needs to be considered is carbohydrate tolerance level.

Everyone has a different carbohydrate tolerance level, which is the amount of carbohydrates they can eat before their blood glucose levels rise. For example, some people can tolerate 25 grams of carbohydrates daily, while others can tolerate 100 grams. To calculate your carbohydrate tolerance level, you can track how many grams of carbohydrates you eat daily and measure your fasting blood glucose level in the morning. You can also consider testing your response after eating certain foods, such as brown rice, oats, quinoa, sweet potatoes, beets, corn, lentils, and bananas

Exercise is extremely beneficial to overall health and a vital part of reversing insulin resistance, but you can’t exercise your way out of a bad diet.

To reverse insulin resistance and reduce your risk of chronic disease, you need to follow a whole-food diet that provides 30-40 grams of quality protein per three meals a day, plenty of low-glycemic vegetables, legumes, and healthy fats.

Books I Recommend:

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes by Joel Fuhrman M.D.

Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes by Cyrus Khambatta PhD, Robby Barbaro MPH

Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs by Neal Barnard

Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine: Unpacking the Science Behind Food and Health by Robert H Lustig

Forever Strong: A New, Science-Based Strategy for Aging Well by Dr. Gabrielle Lyon

If you are not physically active, checking with your healthcare provider before starting an exercise regimen is best.

References:

** Always consult with a physician or healthcare practitioner with significant integrative or functional medicine training before starting any of the above recommendations.

You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com

Insulin Resistance Causes, Treatment and the Best Measurement Tools and Calculations

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