What Is Insulin Resistance
Insulin resistance is a disease in which the tissue's ability to respond to insulin is hampered. Insulin is a hormone that affects cells in a variety of ways. Probably the best known of these is that insulin increases the entry of glucose into cells and lowers blood glucose or sugar levels.
Impaired glucose tolerance is a condition in which blood sugar levels are normal while fasting but rise over normal after sugar is consumed. Impaired glucose tolerance is considered a precursor to diabetes.
Diabetes is defined as a person's blood sugar level is permanently higher than normal.
Type 1 and 2 diabetics differ significantly in their origin. Central to the onset of the disease in type 1 diabetes is that the insulin-producing islet cells in the pancreas are damaged and this leads to the onset of diabetes. Islet cells are destroyed when their body's defense system mistakenly attacks them.
In adult-onset type 2 diabetes, on the other hand, the mechanism is different and multi-stage. However, as a result of these events, the end result is that blood sugar levels remain permanently elevated.
Insulin is bad
There is a wealth of false beliefs about insulin resistance and insulin. Typically, insulin has been made a big villain of events.
One belief has to do with the fact that obesity is precisely caused by elevated blood insulin levels. According to this belief, for example, a diet that does not raise insulin should automatically lose weight regardless of the amount of energy in the diet.
One of the theses of a low-carbohydrate diet has been that it is dietary carbohydrates that lead to obesity as blood insulin levels rise. Similarly, it has been argued that a fatty diet will not fatten in the same way if insulin levels do not rise.
Insulin as a villain in type 2 diabetes
Similarly, the development of type 2 diabetes is associated with various claims about the role of diet, insulin resistance, and insulin. High blood insulin levels have also been made a major scapegoat in the development of type 2 diabetes. Thus, diabetes has also been added to the previously described belief in the central role of insulin in obesity.
Type 2 diabetes is linked to a variety of conditions, including a sedentary lifestyle, a lack of exercise, and being overweight.
Lifestyle changes are also the primary means of preventing and treating type 2 diabetes.
If a patient has developed type 2 diabetes and lifestyle changes are no longer able to correct the situation, medication must be started.
Drugs affect either insulin sensitivity, insulin production, glucose absorption, or excretion. In the context of this blog, we will not elaborate on these groups of drugs.
The aim of this paper is to present as clearly and concisely as possible what the researched data says about insulin resistance, insulin, and type 2 diabetes. This article does not go into the diet of diabetes in more detail but becomes a separate article on that topic.
To improve readability, the script is formulated in a question-and-answer structure. Professor Markku Laakso, one of the world's most respected researchers in diabetes and genetics, has also acted as an expert in compiling the answers.
What does insulin resistance mean?
Insulin resistance describes a phenomenon in which the effects of insulin on tissue are less attenuated than normal.
What is the role of tissue insulin resistance?
Tissue insulin resistance is important in both metabolic diseases and cardiovascular diseases. Being overweight is associated with insulin resistance and being the main risk factor for type 2 diabetes. In cardiovascular disease, too, insulin resistance increases the risk of coronary heart disease. This was demonstrated by Professor Esko Nikkilä more than three decades ago.
Does insulin resistance have different meanings in different tissues?
The mechanisms of insulin resistance are different in different tissues. For example, in muscle tissue, insulin resistance means that the muscle tissue is unable to take up enough glucose from the bloodstream.
In the liver, insulin resistance, on the other hand, means that insulin is unable to inhibit gluconeogenesis, the new form of sugar. Normally, insulin is able to control this, but when the liver is insulin resistant, the liver begins to produce too much glucose both during fasting and after a meal.
In adipose tissue, insulin resistance means that insulin does not normally inhibit lipolysis, i.e. the breakdown of adipose tissue storage fat. This releases too much free fatty acid into the bloodstream as needed, which prevents the oxidation of glucose, stimulates the formation of triglycerides and accelerates the inflammatory state of the body.
Hypertension is also linked to insulin resistance, increases the activity of the sympathetic nervous system, and narrows blood vessels.
How can insulin sensitivity be most effectively improved?
Insulin sensitivity can be most effectively improved by weight loss and exercise.
Exercise is always beneficial for an insulin-resistant person. Exercise has an independent effect on the increase of insulin sensitivity, and the weight loss associated with a lot of exercises also corrects insulin sensitivity.
Loss of excess weight and exercise are usually able to normalize all of the above abnormalities in insulin action.
How do different diets affect insulin and insulin resistance?
Diabetes prevention studies show that insulin resistance is reduced by high fiber intake and avoidance of saturated fats. A similar diet is also helpful when type 2 diabetes has already erupted.
(A separate article will be published later on diet issues related to insulin and insulin resistance, and this topic will not be discussed in more detail in this paper.)
What is the significance of high insulin levels in the blood?
Elevated insulin levels are a sign of insulin resistance, although they are not an accurate measure of insulin resistance, as insulin levels are also affected by insulin secretion and hepatic insulin clearance. Insulin measurements are not performed in inpatient care.
An insulin-resistant person is identified by being overweight, overweight, concentrated in the middle body, often has a family history of type 2 diabetes, high triglyceride levels, and low HDL cholesterol levels, and has high blood pressure more often than usual.
Is insulin resistance always required for diabetes to develop?
The majority of people who develop type 2 diabetes are insulin resistant. However, insulin resistance alone does not cause type 2 diabetes. Insulin secretion is always required for the onset of type 2 diabetes.
Genetic studies unequivocally show that the majority of type 2 risk genes regulate insulin secretion.
What happens when an insulin-resistant person develops type 2 diabetes?
Many studies show that insulin resistance no longer increases when type 2 diabetes breaks out. Insulin resistance is quite often already increased in individuals with slightly elevated plasma glucose levels (either fasting glucose or a 2-hour value under glucose exertion).
This stage of prediabetes may last for several years before the development of diabetes.
Pancreatic insulin secretion decreases even before the development of diabetes. It is estimated that approximately 50% of insulin secretion capacity is lost at the time of diagnosis of type 2 diabetes. As elevated blood sugar levels develop, insulin secretion continues to decline.
Decreasing insulin secretion over time is the biggest challenge in the treatment of type 2 diabetes. When the diabetes balance is poor, ie the blood glucose level is clearly elevated, this also contributes to the deterioration of insulin secretion.
The reasons for the deterioration in insulin secretion are manifold in type 2 diabetes. Unlike in type 1 diabetes, pancreatic islet cells are not destroyed. After a long period (10-15 years) of type 2 diabetes, insulin secretion may be reduced to such an extent that insulin treatment is required due to low insulin secretion.
What are the key factors in the increase in type 2 diabetes?
By far the most important risk factor for type 2 diabetes is being overweight. Other risk factors include a family history of diabetes, gestational diabetes, a high-fat, low-fiber diet, smoking, and hypertension.
However, type 2 diabetes does not develop if insulin secretion remains normal. In other words, not all overweight people develop diabetes.
What are the key factors in preventing this development?
A key factor in maintaining a normal weight, exercising, and a healthy diet that avoids saturated fats, which are high in fiber, especially those derived from vegetables and whole grains.
Finally
As shown above, type 2 diabetes is a highly multifactorial disease that is affected by both lifestyle and hereditary factors. However, insulin resistance alone does not cause type 2 diabetes. Insulin secretion is always required for the onset of type 2 diabetes.
So it is not worth relying on those who offer only one explanation or simple solutions to it. What is comforting, however, is that influencing lifestyle can significantly reduce the risk of developing type 2 diabetes. The same means also enhance other treatments for type 2 diabetes, although in many situations they alone are no longer enough.
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