Am I insulin resistant?

Ketone metre

Who cares?

You’d care because being insulin resistance combined with a moderate to high carbohydrate diet makes you “hyperinsulinemic” – you have high insulin all the time. This means you are now metabolically dysregulated meaning your body:

  • turns fat burning off
  • promotes fat storage
  • dials down your physical activity (feel lethargic and lazy)
  • disrupts the hunger control mechanisms in the brain
  • has all the physiological factors in play (reactive oxygen species, inflammation, IGF-1 etc) which eventually result in the range of metabolic diseases which will kill most of us with a reduced quality of life for a decade before we die – diabetes, cancer, heart disease and dementia.

Understanding how your own body reacts to different types of food, stress, and other environmental factors is absolutely key to long term health, especially weight control.

That’s why we care about insulin resistance and maybe you should too…..read on

 What is insulin?

Insulin is a protein produced by the pancreas.  It helps in the regulation of nutrients and energy around the body.  It is best known for helping move glucose (carbs) into cells so it can be used for energy.  That’s a pretty crucial function; without insulin you will die. Type 1 diabetes is a failure of the pancreas to produce insulin, so Type 1 diabetics can inject synthetic insulin.

But insulin is way more interesting than just that.  It is part of a complex hormonal and neural system that affects all parts of our body. That system controls energy storage and energy use.  That system controls:

  • Fat burning – elevated insulin turns off fat burning
  • Fat storage – elevated insulin promotes nutrients (both carbs and fat) to be stored away in fat cells
  • Physical activity – elevated insulin dials down (your brain suppresses your body) energy output
  • Hunger – a more complex interaction with insulin, leptin and ghrelin (other hunger hormones), the hypothalamus (hunger centre in the brain), inflammation and other anabolic (growth) promoting agents switch hunger off and on.  We are still learning exactly how this might work, but insulin in short spikes might switch off hunger, but when chronically high (longer term) keeps the “I’m still hungry” switch on.

What is insulin resistance?

People are said to be insulin resistant when they have trouble getting glucose into their cells.  One way to think about it is that the cells become “resistant” to insulin trying to open them up and get glucose in.  This can be temporary – for example when we starve ourselves our body wants to divert any glucose away from most cells in the body and have it used by some cells which require more glucose (eg, brain cells, red blood cells). In the meantime the rest of the body runs off fat. The same is true when we eat excessive amounts of carbohydrates. We can become temporarily insulin resistant, helping us pack away that extra energy into fat for a famine in the future.

When the body is properly regulated, the whole metabolic machine works perfectly. We produce insulin when we need to, become insulin resistant to help us when we are starving, and store extra energy when we are in times of plenty. In an evolutionary sense, this is a system designed to work across feast and famine.

Unfortunately the whole system can become “uncoupled” by modern life. Stress, lack of famine and constant feast, too little exercise, poor quality foods and much more all make you insulin resistant. Modern human life promotes insulin resistance. In fact, my colleagues at Otago University have shown that in older New Zealanders, pre-diabetes may affect as much as 50% of the populaiton.

I’d say that this condition called “pre-diabetes” really indicates the start of “end stage” failure of the body. This is because pre-diabetes is the point where people start to be unable to get glucose into their cells, regardless of how much insulin they produce OR their pancreas has started to fail because of having to produce so much insulin for so long (it’s burnt out), then we can be almost certain that the majority of the older and other higher risk groups (Maori and Pacific people in New Zealand) are insulin resistant.

We need to identify insulin resistance way before you start to fail the tests your doctor currently uses.  We’ll look at that now.

How can you tell if you are insulin resistant?

The main reason I wrote this post was because I am often asked how you tell if you are insulin resistant.  That’s a great question and hard to answer, but very very important to your health. Read on.

The health system has some serious diagnostics which will show you if you are insulin resistant. I’ve listed everything below.  You’ll know some of these already .

Diagnostics

  • High fasting blood sugar
    • 110 to 125 mg/dL (6.1 mM to 6.9 mM) – WHO criteria
    • 100 to 125 mg/dL (5.6 mM to 6.9 mM) – ADA criteria
  • High HbA1C (glycated Haemoglobin) between 5.7 and 6.4 percent.
  • Oral glucose tolerance testing: High and prolonged levels of glucose to carbohydrates ingested (usually administered as 75g of pure glucose drink). Diagnosed with a blood sugar level of 140 to 199 mg/dL (7.8 to 11.0 mM) after two hours.

So these are the techniques your doctor will use to screen you to understand whether you have Type 2 diabetes or pre-diabetes.  All of these by definition indicate moderate to severe insulin resistance, which has probably been persistent for decades.

But it’s not the end of the story. The problem is that you can pass any one of these tests fine but still have insulin resistance and all the problems described above.

Why?  Because current medical testing looks at our inability to get glucose into cells, rather than how much insulin we are producing. Many people can move glucose into their cells at an acceptable rate but need to do so with massive amounts of insulin.

Therein lies the biggest unnoticed problem in modern medicine. We have a large part of the population told they are metabolically healthy when they are not. We send them away, tell them all is good, and it is only when they show “end stage” symptoms that we act.

Do you see a problem?

Bottom line 1: High and prolonged levels of insulin because of carbohydrates ingested, even with normal blood glucose responses, is dangerous to your health.

There is a better way – that is measuring both insulin and glucose response in the oral glucose tolerance test. That way we can see if you have this condition called “hyperinsulinemia” even with good glucose disposal.  The trouble is that would cost you nearly $1000 in New Zealand, if you could find someone willing to do it and interpret the results. It’s costly, time consuming (a few hours in a lab) and messy and painful  (lots of blood samples).

You could measure fasting insulin – but I’m not convinced that most insulin resistant people show problems here.

But can you observe symptoms yourself without a clinical diagnosis?  I think if you have a few of the symptoms below then it is likely you have insulin resistance.

A checklist

  • I’ve had trouble controlling my weight my whole life
  • I have a high waist circumference (I’ve got a fat gut) – more than 100 cm men, 85 cm women
  • I always feel hungry
  • I feel like something sweet after dinner to stop my hunger
  • Fatigue, exhaustion, depression
  • High blood pressure
  • Frequent hypoglycemia (low blood sugars)
  • You are over 50 years old

BTW – if you have failed one of the glucose tests then don’t bother with the checklist, you are already insulin resistant.

 Bottom line 2: If you have some of these symptoms, the easy “try it yourself” work around is to severely restrict the amount of carbohydrate you eat for a couple of weeks and see how you feel. I’d say if you are insulin resistant, then the carb restriction is the method which can best help you reset your metabolism.

31 comments

  1. Also regional adiposity around the midsection – especially the front of the abdomen (as indicated by a high abdominal skinfold in calliper testing) is a reliable co-marker for IR.

    1. Good point Cliff _ i’;; add that ow

  2. Thanks for this post and all the others! I have a few questions about your last post; If you do try a carb restricted diet, and are in fact insulin resistant, are you supposed to feel better in 2/3 weeks? Would you feel really sick and run-down at first? Are we talking below 50g of carbs?

  3. Tim Bolter · · Reply

    Grant,

    In New Zealand people will now be receiving their lab reports with Hba1c reported in mmol/L not per cent.

    A non diabetic range is generally defined as /=50 on two tests or on one test with symptoms consistent with diabetes.

    Most guidelines/district health boards/labs now encourage us to use Hba1c as our primary screening and diagnostic test for diabetes
    (eg: http://www.bpac.org.nz/BPJ/2012/february/docs/bpj_42_hba1c_pages_14-19.pdf)

    Just thought this might help someone reading you blog make sense of their results.

    Tim.

    Tim.

  4. Greg Sharp · · Reply

    Great article professor. I’m an internal medicine primary care doc in the US and have been using low-carb/Paleo nutrition teaching in my patients (and myself) for the last few years with fantastic success. In my opinion, insulin resistance is the great unifying feature of the so-called diseases of western civilization.
    I would only add the following recommendation to your readers looking to screen for insulin resistance before hyperglycemia/prediabetes becomes obvious: look at the triglyceride to HDL ratio on a standard lipid panel. High triglycerides and low HDL are 2 of the main features of the “metabolic syndrome” that define advanced insulin resistance. Anytime the TG:HDL ratio is greater than 3 to 3.5, it’s exceedingly likely you are dealing with an insulin resistant patient. This often shows up years before an impaired fasting glucose level or elevated Hgb A1c. And since you can measure TGs and HDL directly on a standard lipid panel, it’s exceedingly more cost effective and time efficient compared to a glucose tolerance test as you described. Cheers and keep up the good work!

    1. Yes very very good point I should have added that so thanks! In fact will add it

      1. What would you conclude about my situation? My A1C is 5.7%, but I have high HDL and low TG (ratio of TG to HDL is under 1.) It seems like I’m in the reverse of what’s typically the case. Also, my fasting glucose is at 83.

  5. It is easier said than done. Do you have a guideline, or sample diet or recipes to use. I know all this as I am insulin resistant but just can’t seem to get anywhere with it. It would be great if you brought out a book with recipes and menu plans.

    1. Catherine Crofts · · Reply

      Lots of good recipes at http://www.lowcarbcooking.co.nz

  6. Yes, failing an OGTT test is usually telling of a dysfunctional insulin response, but not necessarily: you can also fail an OGTT test if you’ve been low-carb for a while and suddenly ask your body to deal with a large liquid glucose bolus…your body tries to be efficient by down-regulating enzymatic and metabolic responses that are no longer a daily requirement (like dealing with daily and large glucose boluses because you’re now low-carb). This is not pathological but more an adaptive response as far as I understand it. I thought it worth pointing out.

    1. Great point, LCHF will also make you insulin resistant. So if you are LCHF then the whole point becomes mot. You can refeed with varbs for a couple of days and then do the OGTT and that will be accurate. If you are LCHF then you can’t get hyperinsulinemia anyway so it moot?

  7. Very interesting Grant. My trig is .8 and my HDL is over 2. Does that mean my ratio is .4?

    1. Exactly right, but the ratio in your case is good high HDL low TG

  8. What about a C-peptide test??? Won’t that be a good indicator of insulin levels without the annoyance of a glucose tolerance test?

    As someone who follows a low carb diet, the glucose tolerance test with insulin levels may be inaccurate. And my HDL is high and triglycerides are low, as long as I follow this diet. But I have no doubt that if I ate insulogenic foods, my insulin levels would be very high because I’m severely insulin resistant with PCOS. So I find it kind of funny that I get such a low IR score on my lipid panel–I’m here to tell you the problem, while under control, has NOT gone away.

    1. Good point on C peptide – a good marker but not routinely available at least in my country

  9. […] Am I insulin resistant? […]

  10. Thanks- this is a very timely blog.

  11. Interesting new High Fat Diet study: http://www.metabolismjournal.com/article/S0026-0495(14)00017-1/abstract
    Interesting because baseline SFA was 1/3 of fat, so no attempt to follow “less than 10%” guideline, and supplementing stearate had anti-inflammatory benefit. At least, that’s what the abstract says, haven’t seen the full text yet.

  12. Simon Riley · · Reply

    At the risk of being critical ( I applaud your effort here to raise the curtain on Insulin resistance ) you have completing ignored the role of visceral fat in the equation . People need to appreciate that visceral fat is ” metabolically active ” to use the medical term – in laymans terms visceral fat is pumping toxins 24 / 7 directly into the liver and bloodstream with devastating consequences with T2D being near the top of the list .

    You also ignore the ” skinny fat ” syndrome which I suffered from when I was diagnosed with pre diabetes in spite of exceeding the ” gold standard ” re diet and exercise for the past 30 years ( I had a BMI of 25-26 when diagnosed )

    I have since reversed T2D completely – 16 kg later . My ” secret ” was simple – a calorie reduced diet – 60% RDI being the magic number.

    My message here is fat loss not weight loss ( they are not the same ) is key to reversing T2D. Get rid of all empty calories beginning with processed carbs which was one of the main reasons why I adopted adopted 80/20 Paleo diet 2 years ago . Because Paleo eliminates all grains and legumes it could be construed as ” low carb ” – but wait . In my situation daily carb intake is 40-45 % due in large part to 10+ servings of vegetables / per day.

    1. YesI agree, definitely not ignoring it. Just each blog covers a specific issue. Visceral fat also causes insulin resistance of course

  13. […] is starting to sound a lot like insulin resistance, and if you are over 40 you are very likely insulin resistant to some […]

  14. I just watched a video where Dr Mercola interviewed Dr Richard J Johnson. In his interview he said that there research showed that if you have high uric acid levels you are most likely insulin resistant.

    1. Yes uric acid and urase from sugar mostly – fructose pathway

  15. Michael · · Reply

    Hi Prof Grant,

    I’ve an avid reader of your blog which was also my introduction to LCHF. I took up cycling and LCHF about 6 months ago. Within a month I dropped 6kg and within 3 months my FTP increased from 250 to around 380W (which is approximately where it’s been since). Also after about 3 months I began to feel no need to eat on the bike. I simply don’t bonk whether the ride is 50km or 230km. I imagine I’ve become quite fat adapted.

    The issue I now face is I believe I’m insulin resistant. My weight loss has stalled for the last 3 months despite consistent calorie deficits. I began recording my fasting blood glucose and it is all over the place. Anywhere from 6.3 right up to 8

    I’ve read other blogs which reference research showing mice fed high fat diets develop insulin resistance within 3 days. (High saturated fats, mono unsaturated didn’t have the same effect)

    I’ve seen people explain that glucose sensitive cells when fat adapted can drive up insulin production.

    I understand cortisol can increase insulin resistance as well as large calorie deficits. I cycle anywhere between 15 and 22hrs per week (polarized training structure). I’ve definitely been running a consistently large calorie deficit and putting in long hours (but at a relatively low % of V02MAX). I was wondering if you’ve seen these kind of problems in your experience with LCHF and endurance athletes?

    1. Interesting, what are you eating exactly grams of fat, CHO and protein? Any adrenal fatigue? Awesome FTP

  16. Hi Professor Grant!
    I Lost the Wheat, But Didn’t Lose the Weight.

    The thing is, this is happen to me and I don’t know what to do anymore.

    Some extra data:
    28 years old
    Height 1,65m
    Weight 59,8k

    My history:
    I used to be an overweight kid and teenager, not too much, something about 10kg more than I should. About 10, I’m mother took me to a dietician and I’d lost 10k, but when I got my teens I put in some extra weight and went to 70k.

    Anyway, time passed and keeping an eye on my diet I could keep my weight around 60k to 64k.

    The point is, all my fat is in my belly, I have a 90cm belly that I understand is not health! I’m trying to get to 85cm (or less) but this is impossible!

    It’s been about 2 months I quit wheat and sugar. And I just lost 200g of my weight and 1cm of my belly.

    I have no idea what is happening and why can’t I loose this fat.

    So, I was thinking, maybe you could help to making it clear to me, what should I do?

    Here is my week menu:
    Breakfast
    Everyday: cup of coffee + pure cream
    2x week: 2 scramble eggs (butter and pure cream) + 40g halloumi cheese, sometimes half avocado.
    5x week: 3 heaping tbsp of plain yogurt, 2 tbsp coconut cream, 1 tbsp chia seeds, 1 tbsp cinnamon, 1tsp jam 0 sugar, 30g nuts and 30g berries.

    Lunch
    Salad, with a variety of green leaves.
    Dressing made of: olive oil, pure cream, vinegar, salt and some times tahine.
    100g of meat: beef, fish, chicken or pork.

    Dinner
    Salad, veggies, meat and sometimes a tbsp of almond butter for dessert or some nuts. No dressing.

    Some days I have a cup of coffee + whole milk at work.

    This is what I’m eating. None of them are light, ou low fat, or with added sugar.

    I also walk 5x week, 40min to work and then 40min back home.

    I don’t feel starving between meals (I used too before putting fat in my diet), but I don’t understand why I can’t loose weight!

    1. First well done on the weight loss. Nice work. 20 kg is a big deal. Second walking is good. But I wonder how you’d respond to a little less aerobic work and a bit more resistance, hard interval exercise? I’m not sure why the weight didn’t come off the tummy – but it will. The diet is great. Time to crack up into some metabolically challenging exercise and bulk a little muscle?

      1. Wow! Thank you very much for answering so fast!
        Yes, I was wondering if I should try a different exercise. I’ll do that.

        Thanks, again.

  17. Larissa · · Reply

    Please add that taking certain medications can induce insulin resistance. Many “victims” are “blamed” for their insulin resistance, visceral adiposity or weight gain when they may have gotten that way following doctors orders. SSRIs, which are prescribed to millions of people, are well-known to promote insulin resistance. There was a half a billion dollar class action lawsuit against the makers of Seroquel, one of the top ten biggest selling pharmaceuticals, because it directly causes diabetes. Patients might be told that these drugs may possibly cause weight gain, but they are virtually never told these drugs can cause IR and diabetes and so cannot make informed decisions. Instead health professionals blame sedentary lifestyle and poor food choices.

    1. Oh my god, is that true?? I’ve had SO MUCH TROUBLE controlling my weight since I did a stint on SSRIs. I’m 25-30kg heavier on average than I was before I was taking them (I used to hover between a BMI of about 24-28, now I’m pushing 40!!), nothing else has changed, really! I exercise, I still eat my greens… I always thought it was the SSRIs that made me gain weight, but my doc said there was no research showing that. If there’s research, I’d love to read it!

  18. are there any otc supplements for insulin resistance or prescription meds which may help? What tests can i have done to be sure i am insulin resistant?

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