By Dr. Shawna Darou, ND
Testing for blood sugar imbalance and specifically insulin resistance is a very frequent test I request. The reason is that we are experiencing a growing number of cases of blood sugar imbalance, and diabetes at much younger ages. It is extremely important to detect insulin resistance early, because this is the phase of blood sugar imbalance that is reversible. There are several signs of insulin resistance that you may not be aware of – I’ll explain each of them below, and also how it all works.
What is insulin resistance?
Insulin is the hormone that is released from the pancreas in response to glucose (sugar) in the blood. Insulin levels spike after eating a meal. When insulin is released in a non-insulin resistant (healthy) person, it triggers the body’s cells to utilize glucose and fats from the bloodstream.
Insulin resistance occurs, when cells do not respond or respond weakly to the insulin signal. This results in the body secreting even more insulin and eventually creating toxic levels of glucose in the blood, known as high blood sugar.
6 Signs That Point To Insulin Resistance
1. Difficulty sleeping, specifically waking up in the night
Trouble with sustained sleep is a classic sign of insulin resistance. When you have over-eaten carbohydrates in the evening especially, and then insulin rises it can cause a drop in blood sugar in the night which will wake you up, and often with anxiety. This may be the cause of 2-4am wake-ups, and can be resolved by optimizing blood sugar balance through the day.
2. Feeling sleepy 1-2 hours after eating
If your energy dips dramatically 1-2 hours after eating, this is also a sign that your blood sugar an insulin is out of balance, and likely you ate too many carbohydrates at that meal. This is again a sign of the blood sugar levels falling after a rapid insulin release in response to your meal.
3. Resistant weight loss
Probably the most classic sign of insulin resistance is ‘resistant weight loss’, meaning your body is not responding at all to changes in diet, exercise or even calorie restriction. It’s important to remember that once insulin resistance is turned on, your body is in a state of storage and it can take a while to reverse this. Steady and consistent changes are necessary to turn it around, and begin to lose weight again.
4. Increased anxiety
Those drops in blood sugar following a rise in insulin can be a trigger for anxiety and even panic attacks. Your mood often follows your blood sugar, and some people are more prone to feelings of anxiety in response to these swings.
5. Bloating after meals
Another sign of high insulin levels is feeling really bloated after you eat. This comes with the tiredness, and can make you overall feel quite sluggish and foggy.
6. Hair thinning
This is one of the most often missed cause of female hair thinning, especially on the crown of the head. The mechanism is a little complicated, but what happens is that with high insulin levels, there is a drop in a binding protein called ‘sex hormone binding globulin’ (SHBG), which the results in more free-hormone expression, especially androgens which are testosterone-like hormones. This creates hair thinning, along with a possible increase in acne and also unwanted facial hair growth.
Why is it important to recognize insulin resistance?
It’s important to recognize and diagnose insulin resistance, because it is a clear marker of a diabetic tendency, and is usually evident 10 to 15 years before true diabetes is diagnosed.
What this means is that, if testing for insulin resistance began as part of a standard physical examination, we could catch people who are at high risk of developing diabetes at a stage where it is reversible. This is truly proactive and preventative medicine.
Who may be affected by insulin resistance:
Really, anyone can be affected if they overdo their simple carbohydrate and sugar intake for too long. Additional risk factors include:
- having PCOS is most often associated with insulin resistance
- family history of diabetes (type 2)
- being overweight as a child
- carrying weight around your central abdomen
- susceptibility for insulin resistance increases around perimenopause (new weight gain in the central abdomen)
- certain medications (corticosteroids, beta-blockers, thiazide diuretics, antipsychotics, and statins speficially)
How to accurately test for insulin resistance:
There are several ways to test for insulin resistance, and I’ll list them in order from the simplest to the most in-depth:
- Fasting insulin level: this is the simplest and cheapest test, and will show cases of moderate or severe insulin resistance. Optimal levels for fasting insulin are < 50 pmol/L. This simple test may however miss milder cases.
- HOMA-IR: this is a mathematical calculation using blood levels of fasting insulin and fasting glucose. Once your numbers are put into the calculator, it is very easy to interpret: Optimal HOMA-IR is 1.5 or less; early insulin resistance HOMA-IR > 2; significant insulin resistance HOMA-IR > 3. It is still very inexpensive, but requires an extra step with an online calculator. Here is one version: http://www.thebloodcode.com/homa-ir-calculator/.
- Insulin glucose challenge: The gold standard is a four-hour test called the insulin glucose challenge, and it involves visiting a standard blood lab first thing in the morning after 12 hours of fasting. A baseline fasting blood sugar and insulin level is measured first. Then, you are given a drink containing 75 grams of sugar, and blood is taken after one hour, two hours, and four hours to see how your blood sugar and insulin levels respond. Results from this test show: 1) high insulin response one or two hours after sugar ingestion if you have insulin resistance. 2) high glucose response one or two hours after sugar ingestion, if you have impaired glucose tolerance.
Take charge! Insulin resistance is reversible.
Early detection of insulin resistance is important, so it does not progress to diabetes. Insulin resistance and non-insulin dependent (Type 2) diabetes are preventable and reversible with a commitment to nutrition, exercise, and stress management. You can learn more in these articles I wrote about insulin resistance previously: https://drshawnadarou.com/2017/06/05/testing-insulin-resistance-part-every-physical-exam and https://drshawnadarou.com/2022/05/31/top-causes-of-insulin-resistance/
If you think you may have insulin resistance, would like to get tested, or are ready to work on optimizing your blood sugar balance, I’m happy to help!
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