If you’ve been in my office with PCOS, acne, weight retention, a history of gestational diabetes, family history of diabetes, or high Hemoglobin A1C (HbA1C) on bloodwork- you’ve likely heard me talk about insulin resistance.
Insulin is the hormone that allows your body to take glucose (from all of the food that you eat) out of the bloodstream and put it in our cells to use or store for fuel. Insulin resistance occurs when your cells aren’t responding as effectively and efficiently to insulin. Your body tries really hard to maintain a certain level of blood glucose and not get too high (or too low). To compensate for your insulin resistance, your body will make more insulin. Rising insulin can make blood sugar regulation more difficult and increase susceptibility to metabolic syndrome, non-alcoholic fatty liver disease, and Type II diabetes. High insulin can also cause androgen levels to rise (testosterone and metabolites of testosterone) - this can be a problem for women especially; contributing by PCOS, other hormonal conditions and to acne for some.
Insulin resistance is something that we can measure on blood work! We’ll usually see insulin resistance before we see changes in fasting blood sugar and Hemoglobin A1C (a measure of average blood glucose). We calculate insulin resistance through a ratio called the HOMA-IR a measure of fasting blood glucose in relation to fasting blood insulin. This test is inexpensive, but gives so much valuable preventative information.
We’re seeing more and more information on using the HOMA-IR as a predictor of gestational diabetes, non-alcoholic fatty liver disease, pre-diabetes, metabolic syndrome, insulin resistance in PCOS, Alzheimers, and even more conditions. The range for normal depends on a patient’s age, gender and ethnicity.
Insulin resistance is treatable. We can improve insulin sensitivity by making changes around food choices (less sugar/carbohydrate in the diet means less insulin is needed), losing weight if needed, changing eating patterns in terms of time of day and volume at each meal, exercise, and supplements. The exact plan that is created depends on a person’s lifestyle, complicating factors, and end goals.
If you feel like your blood sugar and hormones are out of whack, or have a family history of diabetes this is a great test to start with to understand your risk and prevention plan!