Insulin resistance - therapy and management

Insulin resistance has been a central topic of medical research for almost a century now. Below you'll learn what insulin resistance is, what it does to our bodies, and how you can stop and maybe even reverse this disease-promoting process.

Disclaimer: If you already have a diagnosed diabetes and are already on medication, discuss all further steps in advance with your doctor!

Insulin resistance - the basis for disturbed sugar metabolism

As a reminder, insulin is a hormone produced in the pancreas and plays a central role in carbohydrate and fat metabolism. It ensures that our cells primarily absorb more glucose and fatty acids. Without insulin, the glucose circulating in the blood could not reach the cells. It also has a strong anabolic (anabolic) effect.

What is insulin resistance?

When cells or organs become more insulin-resistant, the pancreas has to produce more and more insulin to keep our sugar metabolism in balance - our insulin level in the blood rises (hyperinsulinemia). At first, this is not noticeable in the blood sugar. It only happens when the system quietly decompensates. But how can this happen?

The exact background is not yet fully understood. Genetic factors, lifestyle and stress levels all seem to have an effect on the development of insulin resistance. Our diet also plays an important role. Lots of rapidly absorbable carbohydrates cause our blood glucose levels to rise rapidly. The pancreas responds to this sudden rise with a large amount of insulin so that the excess sugar can be absorbed from the bloodstream into our cells.

This happens, for example, when we consume foods with a high glycemic index, such as rice, sugar or light flour. If we snack from time to time or eat unhealthier on a case-by-case basis, the body can compensate for this well. However, if we provoke these sharp blood sugar rises every day for years/decades, then at some point the cells no longer respond as sensitively to insulin. The pancreas has to produce even more insulin and a self-reinforcing cycle begins. This is the beginning of insulin resistance.

Why is maintaining insulin sensitivity important for your health?

Insulin resistance plays a central role in the development of type II diabetes mellitus, non-alcoholic fatty liver disease (NAFLD), atherosclerosis and Alzheimer's disease - to name a few examples. You see, often insulin resistance is the breeding ground on which other diseases thrive. The dangerous thing is that insulin resistance per se often does not cause any symptoms.

The good news is that insulin resistance is reversible in its early stages. Accordingly, it is very worthwhile to take preventive action here. One of the strongest advocates for prevention is the American physician Dr. Peter Attia.

Did you know? Insulin resistance is the main cause of polycystic ovary syndrome (PCO). PCO syndrome is the most common hormonal disorder in women of childbearing age, affecting 8-13% of women. Often this disorder goes undiagnosed because the symptoms, such as an altered voice, infertility, acne, or obesity, do not suggest a disorder in sugar metabolism. PCO syndrome is treated with metformin, a prescription medication for type 2 diabetics.

How do I detect insulin resistance?

To have a better sense of sugar metabolism in our body, we first need to understand how and what we can measure. The simplest method is to measure one's blood glucose using a test strip from the pharmacy. However, this only gives us a very selective insight that is hardly meaningful from a medical point of view. But why do we measure blood glucose at all and not insulin directly?

Insulin has a very short half-life in the bloodstream. After a few minutes, it has already decayed, which makes accurate measurement difficult. There are two ways in which insulin can still be measured directly or indirectly. The first is to measure the "fasting insulin level" in the morning. If these levels are elevated, it indicates insulin resistance. Perhaps you have also heard of the HOMA index? Here, insulin is put in relation to blood glucose. High values (greater than 2.5) indicate insulin resistance.

The second option is to measure the C-peptide. This is formed in the pancreas together with insulin and has a longer half-life. Endocrinologists use this value, among other things, to distinguish between type 2 diabetes mellitus (caused by insulin resistance) and type 1 diabetes mellitus (triggered by an insulin deficiency).

Probably the most modern method is the possibility of continuous glucose measurement by CGM.

CGM measurement - highly individual and the future

How many carbohydrates are too many? This question cannot be answered in a generalized way, because every person metabolizes carbohydrates differently. A Tour-de-France rider can metabolize an enormous amount of carbohydrates. The requirement is over 1000 grams - per day! However, the cells of a professional cyclist also react very sensitively to insulin, which is why a carbohydrate-rich diet is particularly common among endurance athletes, according to one study.

So how can you determine where your ideal carbohydrate level is? We recommend everyone who is interested to wear a Continuous Glucose Monitor (CGM) for 2-4 weeks. This is also possible through your family doctor.

A CGM is a small sensor chip that you normally insert into your upper arm using a short needle. Don't be afraid! This gives, if at all, a very short prick and the needle does not stay inside. By keeping the thin measuring thread in the subcutaneous fatty tissue, the sensor can measure our blood glucose in real time. You can then track this via an app on your own smartphone. To determine how many carbohydrates are too many and which carbohydrates to avoid, a quick glance at the smartphone is enough.

Tip: In the best case, blood sugar should not rise more than 30 points per meal. Then you are on the best way to reduce your own insulin levels in the long term.

With the help of a CGM device, insulin resistance can therefore be detected before elevated blood glucose levels occur. These devices are still mainly intended for diabetics, but in the future they could be used as a screening tool for everyone. Even if the interpretation of the data is somewhat more complicated than with the classic laboratory tests, this would enable us to detect insulin resistance years in advance and thus take appropriate preventive action.

If you want to know more about the different ways of measuring blood sugar, take a look at our magazine article on blood sugar levels. Here we explain in more detail which measurement methods are available.

Did you know? If sugar or carbohydrates are the problem, then replacing soft drinks with their sugar-free alternatives should help, right? This was one of the questions investigated by the scientists in this study. The result surprised even the researchers themselves: sugar-free soft drinks increased the risk of diabetes and insulin resistance the most, followed by fruit juices and sweetened soft drinks! One possible explanation is the change in the microbiome caused by the sweeteners.

How can I reverse insulin resistance?

Let's say you caught your insulin resistance early. Maybe you noticed elevated fasting blood glucose, or you used a CGM device and saw that it takes a long time for your blood glucose to return to normal after a high-carbohydrate meal. Now, of course, the question is, what to do? Fortunately, we now have a few things in our repertoire for this purpose. The following tools are at our disposal in the fight against insulin resistance:

1. Medication
2. Stress/Cortisol Management
3. Good sleep
4. Sports/Exercise
5. Nutrition

1. medicines

If elevated fasting blood glucose is detected during a routine checkup with the family doctor, "HbA1c" - the so-called long-term glucose value - is usually requested. HbA1c reflects the proportion of our 'sugared' red blood cells. Since these live for about 3 months, the doctor can use this to get an overview of the carbohydrate metabolism over the last 3 months. The standard values for HbA1c vary according to gender, so the following comments are only intended as guidelines. Values of around 5.5% and higher indicate a prediabetic metabolic state - not quite diabetes yet, but close to it. Up to 6.5%, one does not usually take medication, because this is the level at which one speaks of manifest diabetes.

The first-line therapy is lifestyle modification - yes, you read that right - before any drugs are used, patients should first improve their lifestyle. Less alcohol, less sugar and more exercise. If this does not work, metformin (increases insulin sensitivity) is started. If this therapy is not successful enough, SGLT2 inhibitors (increase glucose excretion) are added and, in case of overweight, GLP-1 receptor agonists (make you feel full and increase insulin production).

This is followed by therapy with insulin, the strongest antidiabetic drug. The highly advanced insulin resistance is broken through with an even higher dose of insulin.

Did you know? Rarely has a drug caused so much hype on the web as GLP receptor agonists. The active ingredient semaglutide is currently sold under the trade names Ozempic or Wegovy. At the same time, many non-diabetics are taking the drug because it results in significant weight loss. At times there have been supply bottlenecks, as there has been a mass rush for the expensive drugs. This was further fueled by social media, among other things.

Despite adapted medication, the pancreas of many type 2 diabetics can eventually become exhausted due to the continuous load called insulin production. If there was originally too much insulin in the blood, the opposite is now the case. At this stage, only insulin therapy will help. This is the only case in which a lifestyle change or therapy with insulin sensitizers (such as metformin) alone no longer brings any significant benefit.

Important side note: Type 1 diabetics lack insulin right from the start. This is due to autoimmune processes that destroy the insulin-producing cells of the pancreas over a period of years. Accordingly, insulin must be replaced right from the start. Oral antidiabetic drugs are completely ineffective.

2. stress/cortisol management

Who has stress today? Most people will raise their hands in agreement with this question. We live in a world flooded with stimuli, and this is reflected accordingly in our cortisol levels. If cortisol is released, the blood sugar level also increases as a result - the body assumes that we currently need more.

Cortisol is also a hormone produced naturally in the body and is also known as the stress hormone. This is basically true, but we can 't do without cortisol and stress even when we are at rest. It wakes us up in the morning and keeps our heart beating. It also gives us the extra boost of energy we need in all kinds of situations.

So controlling cortisol levels doesn't mean switching it off completely, but keeping the natural rhythm. High in the morning, low in the evening.

Tips for managing cortisol levels:

• Regular strength and endurance training several times a week (short sessions of no more than 60 minutes, 3-5 times a week).
• Breathing exercises (Inhale slowly through the nose for 2 minutes and exhale through the mouth).
• In the morning, the first glance should not fall on the smartphone, better to wait at least 1 hour
• Coffee (increases cortisol levels) not after 3 p.m.
• Eat the last meal at least 2 hours before bedtime
• Put away smartphone at least one hour before going to bed
• To a balanced diet with sufficient intake of omega-3 fatty acids and magnesium pay attention

3. good adequate sleep

Who would have thought that lack of sleep not only makes us tired, but also drastically increases the risk of metabolic diseases? In studies, sleep reduction to 4 hours per night for 2 weeks has been shown to negatively affect our insulin levels and glucose utilization. Accordingly, glucose tolerance was significantly reduced and cortisol levels were significantly elevated. If even such a short time has such drastic consequences, what is the point of chronic sleep deprivation?

Magnesium is excreted en masse under sleep deprivation. Supplementation could therefore curb the negative effects at least a little. At the same time, magnesium also significantly reduces stress and consequently our cortisol levels.

4. sports/movement

Everyone can probably imagine that sport is good for our blood sugar. But why is that actually the case? First and foremost, it has to do with our body's own reservoir for glucose. Yes, you guessed it right - we are talking about our muscles! The larger the muscle mass, the more capacity we have to store and utilize glucose.

Strength training

It is necessary to increase the muscle mass. For this, it does not necessarily have to be free weights. Cable pulleys, elastic bands or your own body weight are sufficient in the beginning. The main thing is to move your body against a resistance. We recommend a regularity of 2-3 times a week.

"Zone 2" Cardio Training

What sounds rather meaningless at first means cardio training at a heart rate between 130 and 140 beats per minute. This is the range in which most people's mitochondria work most efficiently. This increases one of the best-known fitness markers - VO2max. Studies have repeatedly shown that even less than one hour per week can significantly reduce insulin resistance. We recommend 30-45 minutes of Zone 2 cardio per week to start with.

5. diet

Insulin resistance is, simply put, a disorder of carbohydrate tolerance. In the presence of insulin resistance, prediabetes as well as diabetes, carbohydrate intake should first be reduced. A general reduction in calories often carries the risk of loss of muscle mass - muscle mass is also considered the largest reservoir of glucose - so we don't want to reduce that. In some circumstances, the loss of muscle mass can even make the situation worse!

Although some studies show that calorie restriction leads to improved insulin resistance, there are a few points to bear in mind. The most important thing is that you always ensure a minimum intake of 1g protein per kilogram of body weight when reducing calories - this is just enough to maintain muscle. For weight loss, we recommend around 1.5-2g of protein per kilogram of body weight. In addition to improved insulin resistance, fasting can bring you other health benefits. Various molecular mechanisms activate the longevity genes during fasting.

Did you know? Fasting is considered healthy and thanks to recent studies, this is also scientifically proven. Often it is difficult to incorporate fasting into one's daily routine. The feeling of hunger, social contacts or work make extended fasting difficult. However, there is also the possibility to imitate fasting molecularly.

With the MoleQlar Fasting Bundle you can biochemically activate the health-promoting signaling pathways. Glucosamine activates SIRT1, one of the most important longevity genes. Spermidine supports this process and ensures that autophagy, the recycling of old cells, is boosted. Additionally supports you berberine helps to keep your blood sugar levels stable.

A ketogenic diet can also be very helpful in some cases, but is significantly more complex, offers some pitfalls, and is beyond the scope of this article.

What helps with insulin resistance besides fasting?

Fasting is not suitable for all individuals, but it remains a very useful tool that can be used to reverse existing insulin resistance. In this study, for example, the authors were able to show that fasting for several days in overweight type 2 diabetics greatly reduces liver fat and decreases insulin resistance.

Did you know? Insulin resistance makes it harder for us to utilize carbohydrates. The mitochondria, also known as the power plants of our cells, lack glucose and fatty acids as a result. This restricts their function. Prof. Sekhar and his team were able to show in an exciting study on type 2 diabetics that the regular intake of GlyNAC improved mitochondrial function and thus reduced insulin resistance.

If you look at the studies on possible diets, one name keeps coming up: the Mediterranean diet. Among other things, this study showed that a Mediterranean diet can reverse insulin resistance. But what is the reason for this?

Mediterranean diet - the Adriatic longevity key

Let's take a look at what a Mediterranean diet actually consists of. In addition to proteins from legumes and fish, a number of plant species can be found on the menu. These have a high content of secondary plant compounds. These molecules have a number of positive effects on our body.

The problem is that due to industrialized agriculture, the content of phytochemicals in our food is decreasing more and more. If you eat an apple today, you can expect it to contain up to a third fewer phytochemicals. If you want to know more about phytochemicals, take a look at our overview.

There are also one or two other natural molecules that have had a positive effect on our insulin sensitivity in studies. They also significantly reduce the blood glucose spike after a meal. These include in particular Berberine and Carnosine.

Carbohydrates at the end - does it make a difference in which order we eat?

In a very interesting study, researchers investigated whether it makes a difference when we eat carbohydrates. To do this, they gave type 2 diabetics a meal that always had the same structure. This consisted of three parts

• Carbohydrates (ciabatta bread and orange juice)
• Egg white (chicken breast, without skin)
• Vegetables (lettuce, tomatoes and cucumbers)

The individual ingredients were always served at ten-minute intervals. The quantities were always the same, only the order was changed. The amazing result: It actually makes a striking difference when the carbohydrates are eaten! If the carbohydrates were consumed last, the rise in blood sugar was not as steep. Hereby the scientists could show that a small change in the structuring of the meals already has a measurable effect. You can find more interesting studies on this topic in the book "The Glucose Trick" by Jessie Inchauspé.

We hope you enjoyed this little insight into the world of insulin resistance and blood glucose management. Even if insulin resistance does not cause any symptoms for a long time, you now know how important this topic is for your health. With this knowledge, you now hold the reins in your hand!