Insulin Resistance

Insulin resistance is a condition in which the body produces insulin, but does not use it properly. Insulin is a hormone made by the pancreas that helps the body use glucose for energy. When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin, and as a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more; however, it eventually fails to keep up with the body's demanding need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood simultaneously. Insulin resistance increases the chance of developing type 2 diabetes as well as heart disease.

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance. Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood.

Risk factors for diabetes, in addition to being overweight, obese or over the age of 45, include the following:

• Being physically inactive

• Having a parent or sibling with diabetes

• Having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander

• Giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes-diabetes first found during pregnancy

• Having high blood pressure-140/90 or above-or being treated for high blood pressure

• Having an HDL, or "good," cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL

• Having polycystic ovary syndrome, also called PCOS

• Having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing

• Having other conditions associated with insulin resistance, such as severe obesity or acanthuses Nigerians

• Having a history of cardiovascular disease

The primary treatment for insulin resistance is exercise and weight loss. Low-glycemic index or low-carbohydrate diets have also been shown to help. Both Metformin and the thiazolidinediones mitigate insulin resistance, but are only approved therapies for type 2 diabetes, not insulin resistance. In contrast, growth hormone replacement therapy may be associated with increased insulin resistance. Metformin has become one of the more commonly prescribed medications for insulin resistance, and currently a newer drug, exenatide (marketed as Byetta), is being used. Exenatide has not been approved, except for use in diabetics, but often improves insulin resistance by the same mechanism as it does diabetes. It also has been used to aid in weight loss for diabetics and those with insulin resistance, and is being studied for this use as well as for weight loss in people who have gained weight while on antidepressants.

• The Diabetes Prevention Program (DPP) showed that exercise and diet were nearly twice as effective as Metformin at reducing the risk of progressing to type 2 diabetes.

• Many people with insulin resistance currently follow the lead of some diabetics, and add cinnamon in therapeutic doses to their diet to help regulate blood sugar. This has the danger of increasing the risk of bleeding, since most commercial cinnamon preparations are actually from Cassia, which also contains anticoagulants; whereas "true cinnamon" does not.

• Some types of Monounsaturated fatty acids and saturated fats appear to promote insulin resistance, whereas some types of polyunsaturated fatty acids (omega-3) can increase insulin sensitivity.

• There are scientific studies showing that vanadium and chromium in reasonable doses have reportedly also shown some efficacy in improving IR sensitivity.

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