What it Means to be Insulin Resistant

By: Dr. Catherine Moring, PhD, RDN, LD, BC-ADM, CDE, MCHES

When you hear the word insulin, what comes to mind? Have you ever thought much about the role of insulin in your body? Turns out, high insulin levels is one of the driving factors in why we gain weight, get heart disease (high cholesterol, blood pressure and triglycerides), metabolic syndrome, type 2 diabetes, PCOS, thyroid dysfunction, cancer, and obesity, to name a few. Let me explain.

Insulin is an anabolic, building storing hormone known as the “master” hormone. Hormones are basically messengers in the body that tell things what to do and where to go in order for our body to stay in balance and function well. In the case of insulin, it is made in the pancreas and is released in response to rising levels of blood sugar.

So, how does blood sugar rise? When we eat carbohydrates, especially refined, processed ones like bread, cereal, chips, crackers, rice, pasta, candy, soda and other sugar-sweetened beverages, corn and sugar, blood sugar levels rise tremendously. Insulin is then released from the pancreas in response to rising blood sugar levels and comes and takes the sugar from the blood to our body cells to store for use for energy later. The more carbohydrates, and the more often we eat, the more insulin is released. When we eat eggs, avocado, nuts, meats, and other low-or-no-carbohydrate foods hardly any insulin is released because there are few carbohydrates in those foods. Whereas, when we eat the aforementioned high carb foods, a lot of insulin is released because those foods are much higher in carbohydrates.

The process works fine until our cells become too full of sugar. Because of our tendency to overconsume, especially refined carbohydrates, our cells eventually become too full of sugar. We develop an energy storage problem. To protect themselves from damage due to toxic levels of sugar, they start ignoring insulin’s message to store sugar, becoming insulin resistant. The pancreas senses this and produces more insulin to keep blood sugar levels down. In someone who is insulin resistant, the pancreas releases 3-5 times more insulin to bring blood sugar to normal levels than someone who is insulin sensitive. When the storage problem arises and insulin has trouble moving the sugar from the blood stream into the cells, high blood sugar develops often eventually leading to type 2 diabetes.

I like to give this analogy to explain what happens in the body at the cellular level as we develop insulin resistance. This is a very simplified explanation, but it gives you a visual. Imagine you are in a hotel, and you go to get on the elevator. There is a bellman there and his job is to get people on the elevator, just as insulin’s job is to get sugar into the cells. The elevator door opens and it so full of people not even a baby could fit but the bellman is telling you and your friends to come get on. The elevator knows if it lets any more people on, it will break so it shuts its door and does not allow the bellman to open it to let any more people in. The cells are similar, they detect their storage capacity for sugar is maxed out and if anymore comes in, they will become damaged, so they resist insulin’s message to store sugar and become insulin resistant. Going back to the elevator example, the bellman then goes and gets his friends to help pry open the elevator door to get more people in. In a similar manner, the pancreas begins to produce more and more insulin to overcome the insulin resistance and pack more sugar into the cells. This is also how the blood levels of insulin become elevated which is associated with a myriad of chronic diseases, mentioned at the beginning of this article. Once someone develops insulin resistance, it takes 3-5 times more insulin to move the same amount of sugar into the cells as someone who is insulin sensitive, thus frequently elevated blood levels of insulin develop.

Just as high blood sugar levels are dangerous, long-term high blood levels of insulin are also dangerous. Unfortunately, many doctors don’t measure or talk about this as much. If we can address insulin resistance when it first develops, it is much easier to reverse so that a person can once again be insulin sensitive.  High insulin levels cause damage to the heart and the cardiovascular system and promote weight gain. The more insulin floating around in the blood stream, the more fat we store which leads to weight gain. Insulin stimulates the uptake of fatty acids by fat cells, which convert these molecules into triglycerides — the primary storage form of fat in your body. Thus, insulin promotes lipogenesis, the creation of new fat. Said another way, when our body has too much sugar that needs to be stored because we overconsume carbohydrates and are not very active, insulin changes sugar into triglycerides through a process called lipogenesis and stores it in our fat cells causing weight gain, leading to a whole host of other problems including metabolic syndrome and often eventually leading to type 2 diabetes. Another reason elevated insulin levels are problematic is that high levels of insulin block nutrient absorption thus causing nutrient deficiencies. It is common to see things like low potassium and low Vitamin D in people who have insulin resistance.

 When our cells start ignoring insulin’s message to store sugar, the pancreas produces more insulin to compensate for that to keep blood sugar levels down. Therefore, more insulin is present in the blood stream, leading to excess storage, weight gain, and host of other complications. Further, elevated insulin levels contribute to hardening of the arteries and constricts blood vessels causing high blood pressure. In fact, a very early warning sign of insulin resistance and the development of type 2 diabetes in some people is high blood pressure.

This whole process starts when we overCARBsume certain foods. Once we are insulin resistant, inflammation and other problems arise, including weight gain, metabolic syndrome and type 2 diabetes. Lowering our insulin levels is the real key to weight loss, weight management, sustained weight loss, reversing certain chronic health conditions and the damage done to our bodies. In order to lower insulin levels and improve your body’s sensitivity to insulin, you need to consume less carbohydrates and try to limit things like grains, bread, cereal, pasta, sugar sweetened beverages and other refined and processed carbohydrates. Fasting is also a great tool to lower insulin levels and promote insulin sensitivity.

So how do you know if you have high insulin levels or if you are insulin resistant? There are several ways to tell. If you have any of the following, you may have high insulin levels and/or insulin resistance: extra body weight especially around the stomach, a fasting blood sugar above 100, an A1C above 5.5, high cholesterol, high blood pressure, high triglycerides, muscle weakness, fatigue (tiredness), cognitive brain fog, loss of memory, vision problems, headaches, artery inflammation, skin tags, acne, PCOS, gout, fatty liver, obesity,  thyroid disfunction, not satisfied after eating, nutrient deficiencies, often feel hungry (cells are not well fed), and leptin resistance.

Food can be your medicine. If you suspect you have or may be developing insulin resistance, consider changing your diet to include anti-inflammatory low-carbohydrate foods such as non-starchy vegetables, eggs, meats, fish, nuts, and healthy fats. If you have questions or would like more information, please don’t hesitate to email me at cmoring@mytgh.com.

Snap Shot: What’s happening Federally and in other States regarding Diabetes Management & Pervention

Written by: Deborah Colby, MEd, RD, LD, CDE

Federal Advocacy:

  • House Diabetes Caucus Co-Chairs Diana DeGette (D-CO) and Tom Reed (R-NY) led a letter to the House Appropriations Committee requesting funding increases for diabetes prevention and research programs in NIH and the CDC for fiscal year 2022. The bipartisan letter was signed by more than 100 Members of Congress.
  • Reps. Tom Rice (R-SC), Tom Reed (R-NY), Diana DeGette (D-CO), and G.K. Butterfield (D-NC) reintroduced the  Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-Based Strategies (PREVENT) Diabetes Act. The bill would include virtual suppliers in the Medicare Diabetes Prevention Program to allow more people with diabetes to access it remotely.

State Levell:

  • Arkansas, Colorado, and North Dakota took tremendous steps toward bridging equity gaps in health care by adding coverage for continuous glucose monitors to their Medicaid programs.
  • The New York legislature passed the state budget, eliminating premiums for more than 400,000 New Yorkers enrolled in the state’s Essential Plan, which covers people who make too much to qualify for Medicaid but may be unable to afford an exchange plan.
  • West Virginia voted to retain state funding for diabetes ed/prevention. New York’s legislature rejected a proposal to cut 20% from funding for obesity and diabetes prevention efforts and Washington’s governor approved legislation increasing access to free and reduced-price school meals.
  • Alabama’s Governor and state legislature passed a bill to cap insulin co-pays for Alabamians on state-regulated health care plans.

How the New CDC COVID Guidance Impacts Diabetes Patients and Healthy Coping

Healthy coping, as a behavior, has been critical for coaching and success for people with diabetes in dealing with the ups and downs (no pun intended) of living with the diagnosis. It comes with additional stress, increased risk for depression and other mental health concerns, feeling isolated, overwhelmed when it comes to social events involving food, medications and finances related to medications and other health related costs. As if that were not enough, the global pandemic threw us all for a loop, and a lot of our usual healthy coping strategies like group fitness, social groups, gathering with friends, church or other outings became risky, especially for those with chronic conditions like diabetes and even more so for those in minority populations. While social distancing was necessary and effective for helping control the spread of the novel coronavirus while treatments and vaccines were being developed, the impact on our mental health and isolation was lonely and disorienting at best and devastating at worst. Through innovation, funding and scientific cooperation, the best and brightest minds have developed vaccines that have been distributed at record pace with public health officials leading the way. On April 27, 2021, the CDC released new recommendations for those that have been vaccinated that we can now recommend to our patients with diabetes. These include:

  • Walking, running or biking outdoors with members of your household without a mask
  • Attending small, outdoor gatherings with fully vaccinated family and friends without a mask
  • Attending a small, outdoor gathering with fully vaccinated and unvaccinated people without a mask
  • Dine at an outdoor restaurant with friends from multiple households without a mask
  • Go to outdoor concerts or sporting events with a mask (if in a crowd)
  • Go to movie theaters, malls or museums with a mask
  • Attend small gatherings with multiple households who are unvaccinated with a mask
  • Still avoid large gatherings
  • Avoid those who are exhibiting symptoms of COVID

As a reminder fully vaccinated means, 2 weeks or more after the 2nd Pfizer or Moderna vaccine or 2 weeks or more after a single Johnson and Johnson vaccine. If you need assistance finding a vaccine near you, please visit, https://vaccinefinder.org/.  All of these activities that we can now participate in, thanks to vaccines and better control of COVID, are essential options for people with diabetes to begin accessing for healthy coping as alternatives to less than healthy ones that we can all default to. It is also important to remind patients that when if an unhealthy coping strategy is chosen, like overeating, smoking, overconsumption of alcohol or any other behavior that takes a person further from their goals, it is never an all or nothing decision. Keep a list of other strategies that work for you and that you enjoy and begin to use that one as soon as you realize you need it as well as scheduling it regularly before those others creep up due to stress or other reasons.

Written By: Ashley W. Ellis, PharmD, CDECS

About the Coalition

The Diabetes Coalition of Mississippi is a group of Mississippians who care about the health of our residents and who know that diabetes is a major issue for our state. We know that there are many people working diligently to address this issue.

By sharing our experiences, both good and bad, by leveraging our collective resources, and by focusing our efforts on activities that create the most impact, member of the DCM believe that we can make a difference in the lives of people with diabetes in our state. We also believe that, together, we can change the culture and environment so that everyone becomes healthier.

We invite you to join us: attend our quarterly meetings, be active in our workstreams, and share your experiences and opportunities for improvement with our members.

Together, we can Give Diabetes the Blues in Mississippi.

Click here to register online today!