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Diabetes
From Insulin Resistance to Diabetes
November celebrates American Diabetes Month. Perhaps the best way to honor this month is to
educate you about this disease and what you can do to prevent the development of this disease so
you can celebrate being “diabetes-free.”
Insulin’s Function
Insulin is a hormone produced by the pancreas. It is released into the blood stream after food is eaten
or when stored glucose in the liver enters circulation. Although carbohydrate triggers the largest
insulin release, both protein and fat also cause a rise in insulin levels. Insulin helps muscle, fat and
liver cells absorb glucose which can then be used for immediate energy or stored for future use.
When glucose enters the cells, the level of glucose in the blood is lowered.
Insulin Resistance
Insulin resistance, also known as impaired glucose tolerance, is a condition in which the body
produces insulin but muscle, fat and liver cells do not effectively absorb glucose. In turn, this causes
the pancreas to produce even larger amounts of insulin to help glucose enter the cells. The pancreas
tries to keep up with this increased demand for insulin but when the pancreas can no longer keep up
with the body’s increased need for insulin, excess glucose builds up in the bloodstream, leading to
prediabetes, diabetes and other serious health disorders.
Causes of Insulin Resistance
Although the exact causes of insulin resistance are not completely understood, scientists think the
major contributors to insulin resistance are excess weight and physical inactivity. Some experts
believe obesity, especially excess fat around the waist, is a primary cause of insulin resistance.
Studies have shown that belly fat produces hormones and other pro-inflammatory substances that
can aggravate health problems such as insulin resistance, high blood pressure and cardiovascular
disease. Losing weight can reduce insulin resistance and prevent or delay type 2 diabetes.
Many studies have shown that physical inactivity is associated with insulin resistance, often leading to
type 2 diabetes. In the body, more glucose is used by muscle than other tissues. Normally, active
muscles burn their stored glucose for energy and refill their reserves with glucose taken from the
bloodstream, keeping blood glucose levels in balance. Muscles become more sensitive to insulin
after exercising, helping to reverse insulin resistance and lower blood glucose levels. Exercise also
helps muscles absorb more glucose without the need for insulin. The more muscle a body has, the
more glucose it can burn to control blood glucose levels.
Other causes of insulin resistance may include ethnicity, certain diseases, hormones, steroid use,
some medications, older age, sleep problems (especially sleep apnea) and cigarette smoking.
Prediabetes
Prediabetes is a condition in which blood glucose or hemoglobin A1C levels—which reflect average
blood glucose levels—are higher than normal but not high enough for a diagnosis of diabetes. Insulin
resistance increases the risk of developing prediabetes. Prediabetes usually occurs in people who
already have insulin resistance. Although insulin resistance alone does not cause type 2 diabetes, it
often sets the stage for the disease by placing a high demand on the insulin-producing beta cells in
the pancreas. In prediabetes, the beta cells can no longer produce enough insulin to overcome insulin
resistance, causing blood glucose levels to rise above the normal range.
Once a person has prediabetes, continued loss of beta cell function usually leads to type 2 diabetes.
People with type 2 diabetes have high blood glucose. Over time, high blood glucose damages nerves
and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney failure,
and lower-limb amputations. Studies have shown that most people with prediabetes develop type 2
diabetes within 10 years, unless they change their lifestyle.
Shifting Your Lifestyle in Reverse
By losing weight and being more physically active, people can reverse insulin resistance and
prediabetes, thus preventing or delaying type 2 diabetes. To decrease your risk:
1. Eat a healthy diet to reach and maintain a healthy body weight
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Small, frequent meals- A pattern of eating every three to four hours helps keep blood glucose
and insulin levels low and stable.
Eat balanced meals and snacks- Include a moderate portion of a protein-rich food and a
moderate amount of healthy fat in every meal and snack to help slow the absorption of
carbohydrate and provide a sense of fullness.
Limit refined white flour-based foods and sugar- Refined or processed grains and sugar
rapidly raise blood glucose and insulin levels and are easy to eat in excess.
Focus on fiber-rich foods- Consuming adequate fiber is essential for improving glycemic
control. Fiber, especially the soluble type found in beans, oats, vegetables and fruits, slows
digestion and absorption and improves satiety. Aim for the suggested fiber intake as
recommended by the Institute of Medicine:
o For men: under 50 years old – 38 grams per day; over 50 years old – 30 grams per day
o For women: under 50 years old – 25 grams per day; over 50 years old – 21 grams per
day
Focus on lower glycemic index and glycemic load choices. Lower glycemic index foods
are digested and absorbed more slowly than higher ones. Glycemic load takes into account
both the glycemic index and the total amount of carbohydrate eaten.
o Beans, sweet potatoes, barley, most vegetables, yogurt, nuts and many fruits have a
low glycemic index.
o Limit fruit juice, dried fruit or tropical fruits (banana, pineapple, mango and papaya).
o Choose sprouted grain or very dense whole grain breads.
Incorporate healthy fats throughout the day. Include monounsaturated fats found in extra
virgin olive oil, avocado, black olives, peanuts, almonds, natural nut butters, and cold-pressed,
preferably organic, canola oil and the omega-3 fats found in cold-water fish (salmon, arctic
char, sardines), omega-3 enriched eggs, flaxseeds, and walnuts.
Minimize unhealthy fats. Limit saturated fats from higher fat animal meats and full fat dairy
products. Avoid all foods with hydrogenated and partially hydrogenated oils (also known as
trans fats). Read labels carefully as hydrogenated fats and oil adversely affect metabolic
functioning and increase inflammation.
2. Increase regular physical activity
Regular physical activity tackles several risk factors in addition to helping the body use insulin
properly. Regular physical activity can help a person lose or control their weight, control blood
glucose levels, control blood pressure and control cholesterol levels. While recommendations
vary, studies show that people who were physically active for 30 minutes a day, 5 days a week,
reduced their risk of type 2 diabetes. Most people should aim for at least 30 minutes of exercise
most days of the week. For best results, people should do both aerobic activities, which use large
muscle groups and make the heart beat faster, and muscle strengthening activities.
3.
Stop smoking if you smoke
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