What Every Person With Diabetes Should Know About Insulin Resistance
I’ve been on a real insulin-resistance kick lately. It’s imperative that all people with diabetes understand the causes of insulin resistance and thus the importance of reducing it with a healthy diet and active lifestyle.
Causes of insulin resistance are multi-factorial. First: obesity, specifically abdominal obesity. This is primarily due to a high circulation of free fatty acids and unwanted fat deposits in the muscles and liver (enlarged adipose tissues at max capacity). This process causes chronic inflammation, resulting in a decrease in protective metabolic regulators and an increase in inflammatory mediators. These mediators have been directly associated with increased insulin levels (or insulin requirements). This inflammatory process can also occur high fat diets.
Lipoatrophy, the partial or complete loss of adipose tissue, and lipodystrophy, unwanted fat deposits in the muscles or liver (fatty liver), have also been associated with insulin resistance. The reason for this is unclear, but it is hypothesized that this condition results in a decrease in insulin receptor expression and insulin signaling. People with PCOS are also prone to higher levels of insulin resistance as a result of their associated generalized lipodystrophy. Acanthosis nigricans (Google it) is a common skin condition observed with lipodystrophy and is often seen in insulin resistant PWD.
Research also shows a correlation between chronic stress and insulin resistance thanks to the hormone cortisol. In acute stress, cortisol stimulates production of glucose by the liver, designed to be immediately utilized in a fight-or-flight response. Chronic stress, however, is directly correlated with increased insulin requirements (endogenous or exogenous), a disruption of insulin signaling, and impaired overall insulin-mediated glucose uptake.
Menstruation tends to have a negative effect on insulin resistance, particularly just after ovulation. There is little research, but this phenomenon is thought to be due to the progesterone spike that happens during the luteal phase. Hopefully, there will be more research on this topic in the near future (insert empowering feminist comment here).
These are a few of the many contributors to insulin resistance. I haven’t even scratched the surface so I will likely do another post shortly. I just wanted to get some food for thought out to you all. Those of you who have been following me closely know that I have been attempting to decrease my insulin resistance with a low-fat, plant-based, whole-food diet. I have been on the diet for about a week thus far and have really been enjoying it! I have seen a reduction in my prandial insulin requirements, yet I have been eating more than I was when on my previous standard diet. Also, I’ve really been enjoying fruits, something I used to stay away from!
Nalani Hunsaker is a Physician Assistant board-certified in advanced diabetes management. As a person with T1DM for >20 years, she feels especially lucky to share her passion through education and the treatment of her patients as the Associate Director of the Diabetes Program at Apex Healthcare in Southern California. She hopes to spread knowledge to people with diabetes and their caregivers through The Mighty, her personal blog, diabetespa.net, and her Instagram, @diabetes_pa. Her goal in patient care is to educate and inspire people with diabetes so that they may eventually answer their own questions and in doing such, increase their health and independence. To book an appointment in Hemet or Menifee call (951)929-1333.
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