Let’s start on a sombre note. Cardiovascular disease is the leading cause of death in Australia and adults with Type 2 diabetes (T2D) are two to four times more likely to develop heart disease than those without type T2D. (1, 2) Hang on, it gets better… T2D is preventable. In fact there are three key stages that the body goes through before T2D rears its ugly head. Catching it early could drastically reduce this growing epidemic.
Stage 1: Insulin Resistance
Insulin is a hormone produced in the pancreas. Think of it as a bus that collects and transports glucose from the blood into our cells. In some people, over time, the insulin bus starts running abit like our state transit system, running late, missing stops and and leaving too much glucose at the station (aka in the bloodstream). The body responds by releasing more insulin, and over time our muscles, liver and fat cells slowly become resistant to insulin. This process causes an imbalance in the relationship between glucose and insulin, but in many cases blood sugar levels still appear relatively normal, even though something pretty serious is happening. We can be insulin resistant for years and not even realise it. Cue stage 2...
Stage 2: Prediabetes
Prediabetes means that your blood glucose levels are higher than normal, but not high enough to be diagnosed with T2D. This can occur because the pancreas is not producing enough insulin but in most cases it’s as a result of years of insulin resistance. In the US, one in three people have prediabetes. (3)
Stage 3: Type 2 Diabetes
T2D occurs when the body resists the effects of insulin and cannot make enough insulin to maintain blood glucose levels within the target range. This leads to high blood glucose levels. Left unchecked, high blood glucose wrecks havoc on blood vessels with the eyes, heart, liver, kidneys and extremities (hands and feet) at risk of damage. Not to mention many other negative metabolic ripple effects. Lifestyle modifications such as exercise, low glycaemic eating and weight loss can manage this condition, many end up on injectable or oral medications, which can last the rest of their life.
Catch it early:
As they always say, prevention is better than cure (and in this case there is no official cure of T2D), so it makes sense to go back to stage one insulin resistance and catch it before it progresses.
Who is at risk of Insulin Resistance?
- If you are classified as overweight or obese (if you don’t trust BMI, have a Dexa scan)
- age 45 or older
- a parent, brother, or sister with diabetes
- Aboriginal or Torres Strait Islander
- Physical inactivity
- Health conditions such as high blood pressure and abnormal cholesterol levels
- A history of gestational diabetes
- A history of heart disease or stroke
- Polycystic ovary syndrome, also called PCOS
Signs & Symptoms
Insulin resistance has no observable symptoms, only specific blood tests can determine this. Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck, a condition called acanthosis nigricans. Many small skin growths called skin tags often appear in these same areas. However many people with prediabetes do not develop these.
The symptoms of type 2 diabetes can include:
- being thirsty and drinking more than usual
- going to the toilet (to pass urine) more often
- feeling tired and low on energy
- sores or cuts that won’t heal
- blurred vision
- itching and skin infections
- pain or tingling in the legs or feet.
How to get tested?
People at risk of Insulin resistance or prediabetes should go and see their GP. The doctor will look at the patient’s entire clinical picture and may suspect that the patient has insulin resistance if they have increased glucose levels, increased levels of triglycerides and LDL (bad) cholesterol and decreased concentrations of HDL (healthy) cholesterol.
Most common tests taken are:
- Glucose tolerance test (to see if there is an impaired response)
- Average blood glucose levels over 3 months (A1c test)
- Blood lipid profile.
- Fasting Insulin test (to see if elevated levels even when low blood glucose)
- Inflammation test (hs-CRP as inflammatory markers often higher in insulin resistance)
Treatment for Insulin Resistance:
The best treatment for insulin resistance is diet and lifestyle changes with the goal of:
- Decreasing blood pressure levels
- Increasing insulin sensitivity
- Decreasing triglyceride and LDL levels
- Raise HDL levels (with regular exercise)
A wholistic approach is needed potentially using doctors, dieticians, exercise physiologists to set up an effective program. That may sound a bit overwhelming but it’s actually very simple advice; more activity, eating healthy low GI food, smaller portions and lots of support along the way.
There are one stop shop clinics available where practitioners work as a team and are getting incredible results. Even a 5% reduction in weight has been shown to eliminate insulin resistance in some, that’s as little as 3.5kg lost in a 70kg person. The key is making sustainable changes, not short term unrealistic changes.
Amelia Phillips is a nutritionist, exercise scientist and online health coach who has helped thousands live a healthier life through optimised nutrition and targeted supplementation.