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Metabolic Disorders Insulin Resistance Syndrome (IRS) Article by Lahle Wolfe, 03/25/2006. For reprint information email Editor@isletsofhope.com What is insulin resistance? The term insulin resistance is used when a person makes insulin but resists the effects of the insulin. That is, the normal action of insulin (carbohydrate metabolism) in the body is compromised. When a person is insulin resistant, their cells do not respond to a normal secretion of insulin, and requires a higher level (more) insulin to move blood glucose (sugar) out of the blood stream and into cells. A person that is insulin resistance can still have normal fasting blood glucose (blood sugar) levels and after meals, as well as "pass" an oral glucose tolerance test (OGTT). In order to maintain these normal glucose levels, a person will overproduce insulin. Elevated insulin level are is called "hyperinsulinemia." Symptoms of Overproducing Insulin To be diagnosed as insulin resistant, your doctor will need to run certain lab tests. However, a patient often has signs and symptoms that occur before a diagnosis is made. These include:
Remember, insulin resistance is a metabolic disorder that increases the chances of developing type 2 diabetes and heart disease. It may exist without other problems, especially when caught early. But left untreated, insulin resistance typically gets worse and other symptoms begin to appear. When a combination of certain factors exist a person may be diagnosed with Insulin Resistance Syndrome. Side Effects of Overproducing Insulin Over production of insulin can aggravate or trigger other problems including infertility, weight gain, bloating, poor lipid profiles, hormonal imbalances, cosmetic problems (hair loss, hirsutism, skin tags, acanthosis nigricans), and contribute to more serious health risks like high blood pressure, heart problems, and an increased risk of developing diabetes, and gestational diabetes during pregnancy. A pancreas that continually over produces insulin may also, over time, wear out, in which case a patient usually will need to take insulin. Causes of Insulin Resistance Many things can contribute to insulin resistance including obesity, an inactive lifestyle, high levels of caffeine, certain medications, and underlying medical problems. Other things that can contribute to insulin resistance include pregnancy and hormonal imbalances (i.e. Hashimoto's thyroiditis or other hypothyroid problems, and polycystic ovarian syndrome (PCOS)). Since insulin resistance, and many of the disorders associated with this condition tend to run in families, genes also play a role in the development of insulin resistance. But it is important to note that studies show simply having the genetic predisposition for insulin resistance or type 2 diabetes is not enough to cause onset. Many people carry the risk genes for either type 2 or type 1 diabetes and still do not end up becoming diabetic. Some sort of environmental trigger usually contributes to the onset of diabetes. In the case of type 2 diabetes the environmental trigger is an unhealthy lifestyle including poor eating habits, too little activity, obesity, and smoking. So remember that, even if you have family members that are insulin resistant, obese, or have diabetes, it should be considered a warning sign of potential risk for you, but following a healthy lifestyle will go a long way towards reducing the risk that you too, will develop metabolic disorders. Insulin Resistance in Diabetes Types 1 and 2 For persons with diabetes, insulin resistance is more commonly seen in type 2 patients, but sometimes those that are type 1 can also have, or develop, a true resistance to insulin. For those that take insulin injections, repeatedly using the same injection site can cause damage to surrounding tissues that makes the area less sensitive to insulin. Rotating injection and canula sites is important to help prevent this localized insulin resistance. What is Insulin Resistance Syndrome (IRS)? IRS is sometimes referred to as Metabolic Syndrome, or Metabolic Syndrome X and was previously called Syndrome X. To understand IRS, it is important to understand what a syndrome is. A syndrome is different from a disease. To be diagnosed with a disease a person must meet a specific list of symptom or medical criteria. To be classified as having a syndrome, a person may have only some of the characteristics associated with that particular syndrome. Insulin Resistance Syndrome is a combination of problems. It is diagnosed when a patient has at least three factors identified as part of IRS. (See "Diagnosing Insulin Resistance Syndrome," below). Diagnosing Insulin Resistance & Insulin Resistance Syndrome (IRS) To be certain whether or not a person is insulin resistant, a normal glucose tolerance test, or morning fasting blood glucose test is helpful and should be done, however is not sufficient to diagnosed or rule out insulin resistance. Along with blood glucose, fasting insulin levels should also be checked. Persons that are insulin resistance may have normal,or elevated blood glucose levels (or sometimes may be hypoglycemic, having low blood glucose levels). But all persons with insulin resistance will have higher than normal levels of insulin regardless of blood glucose levels. Several measures of insulin can be used to determine insulin resistance, although, one is not practical for most people:
Insulin Resistance Index Values
IRI Chart Information Source Cognoscenti Health Labs Women with PCOS (who are often insulin resistant) typically have normal blood glucose levels throughout the day and even on glucose tolerance tests. However, when insulin levels are checked, they are likely to be found hyperinsulinemic (have elevated levels of insulin); an indication that they are insulin resistant. As the problems with this disorder progress, women with PCOS usually develop hyperglycemia (high blood glucose), and are at significant risk compared to the general population for developing type 2 diabetes. A diagnosis of Insulin Resistance Syndrome (IRS) may be made when any three of the following criteria are met: Prediabetes Polycystic Ovarian Syndrome (PCOS) Fasting Glucose of > 112 mg/dL, or current use of diabetic medication Abdominal obesity (especially apple shaped body) with a waist circumference: High Blood Pressure hypotension): Low HDL Cholesterol ("good" cholesterol) Elevated Triglycerides Note: the symbol < means less than and the symbol > means greater than, when underline it means "or equal to.") Treatment for Insulin Resistance and Insulin Resistance Syndrome Insulin Resistance (IR) - IR can be treated through Lifestyle management including weight loss, and exercise. Persons who are IR usually benefit from a diet low in processed carbohydrates and fat, or low-glycemic index plans. They may gain weight even on moderate- to low-calorie diets if they are high in carbohydrates because consumption of carbohydrates (simple or complex) can trigger over production of insulin -- a fat storing hormone. Sometimes insulin sensitizing oral medications like Glucophage are also prescribed. It should be noted that weight loss and exercise have been shown to be overall more effective at stopping the progression of, and reversing insulin resistance, than medication. Insulin Resistance Syndrome - Many aspects of IRS can be treated through Lifestyle management including weight loss and exercise. Persons who are insulin resistant usually benefit from a diet low in processed carbohydrate and fat, or from following low-glycemic index plans. They may gain weight even on moderate- to low-calorie diets that are high in carbohydrates because consumption of carbohydrates (simple or complex) can trigger over production of insulin -- a fat storing hormone. Sometimes oral medications are prescribed for insulin sensitizing, or for other symptoms like high cholesterol or blood pressure. It should be noted that weight loss and exercise have been shown to be over all, more effective at stopping the progression of, and reversing insulin resistance which is at the heart of other problems associated with IRS. To see if you may need to lose weight, read about "Body Mass Index" (chart included). Other Metabolic Disorders that may be Associated with Insulin Resistance Other conditions may cause, be exacerbated, or result from insulin resistance. It is important for your doctor to take a complete medical history for you, and for family members as some disorders can be hereditary in nature. Be sure to tell your doctor if any family members have autoimmune disorders, metabolic disorders, or other serious health problems like cancer, heart disease, or high blood pressure or cholesterol. In addition to the potential for diabetes, other disorders that may also be present with either insulin resistance, or with IRS include: Prognosis for Insulin Resistance and Insulin Resistance Syndrome Since insulin resistance may be the result of poor lifestyle habits it can often be completely reversed or halted from further progression by simply adopting more healthy eating and an exercise plan. Even when there is another underlying disorder that requires additional treatment, with proper medical care and a healthy lifestyle, most disorders can be managed very effectively. Insulin resistance, just one aspect of IRS can often be completely reversed or halted from further progression with lifestyle changes, although sometimes insulin sensitizing drugs may be prescribed. But if let untreated, insulin resistance can develop into more complex medical problems including prediabetes, and even lead to the onset of type 2 diabetes. It may also be a triggering factor in other medical problems and disorders. And, both IR and IRS can also worsen the symptoms and increase the likelihood of complications from other disorders sometimes associated with IRS, including Hashimoto's Thyroiditis, Addison's Disease, and Cushing's Syndrome. Women that have PCOS typically experience worsening of their symptoms of PCOS when insulin resistance is not addressed medically and through lifestyle changes. This not only has cosmetic impact (acne, excess facial hair, scalp hair loss, etc.) but can also have a strong, negative impact on fertility and increases the risk of serious complications of PCOS including diabetes, heart disease, and cancer. A hallmark of IRS is often poor lipid profiles which can result in complications and health problems from high blood pressure, low HDL cholesterol and high LDL cholesterol and/or triglycerides. Risks include stroke and heart attack, and an increased risk of certain types of cancers. The upside is that, for the most part, unlike diabetes, insulin resistance can be reversed and controlled. See your doctor as soon as possible if you suspect you have any of the symptoms or signs of insulin resistance. Side Bar Information Did You Know? ... that a syndrome is not a disease? A syndrome is a combination of problems and not everyone with a syndrome will have the same (or all) symptoms associated with a particular syndrome. ... that Insulin Resistance Syndrome (IRS) is still sometimes referred to as Metabolic Syndrome or Syndrome X: three names, but all the same syndrome. ...That the diabetes drug metformin, a biguanide, reduces the risk of diabetes in those with prediabetes, but studies show that it is not as effective in reversing prediabetes and IRS as losing weight and increasing activity? See our Lifestyles section to learn about how you can improve your health without medication. Brief Overview of Insulin Resistance Insulin resistance (IR) is determined by several factors (below) and is more commonly seen in older persons (than younger), Mexican Americans (than other Americans), and more often in women than men. Insulin resistance may be associated with gout, polycystic ovarian syndrome (PCOS) or Hashimoto’s Thyroiditis. While there is a genetic component involved in developing IR onset appears to be triggered by lifestyle. Westernized cultures see a significantly higher incidence of IR, as well as type 2 diabetes than do other cultures. This is attributed to the high-fat, high-calorie, processed carbohydrate diet common in Western populations. IR is often marked by abdominal obesity, elevated triglycerides, low HDL cholesterol (the good kind), high blood pressure, or high blood sugars. It is important to stress, however, the IR cannot be determined by a simple oral glucose tolerance test that tests only blood sugars. This is because those with IR often still produce sufficient insulin to keep blood sugars in a normal range, but they are resistant to the effects of insulin so they over produce the hormone insulin. During a GTT therefore, it is important to not only test blood glucose levels but also to test insulin levels at the same time. It is possible that a person, especially those with PCOS, will test in a normal range for blood glucose, but show an elevated level of insulin. Source Notes: The definition of IRS comes from the World Health Organization, the Association of Clinical Endocrinologists, and the National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), National Heart, Lung, and Blood Institute, National Institutes of Health, May 2001. |
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