Insulin resistance has been a central topic in medical research for almost a whole century. Below, you will learn what insulin resistance is, what it does to our body, and how you can stop and perhaps even reverse this disease-promoting process.
Disclaimer: If you already have a diagnosed diabetes and are undergoing medication therapy, please discuss all further steps in advance with your doctor!
Insulin resistance – the basis for a 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 take up more glucose and fatty acids. Without insulin, the glucose circulating in the blood could not enter the cells.Additionally, it has a strong anabolic (building) 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 levels in the blood rise (hyperinsulinemia). Initially, this does not manifest in blood sugar levels. This only happens when the system quietly and slowly decompensates. But how can this occur?
The exact background is not yet fully researched. Genetic factors, lifestyle, and stress levels all seem to have an impact on the development of insulin resistance. Our nutrition also plays an important role. Many quickly absorbable carbohydrates lead to a rapid increase in our blood sugar levels.The pancreas responds to this sudden increase 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 white flour. If we snack occasionally or eat unhealthily from time to time, the body can compensate well. However, if we provoke these strong blood sugar spikes daily and for years/decades, the cells eventually 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.
Sugar comes in many different forms. Basically, all of them promote insulin resistance to a similar extent.
Why is maintained 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 for other diseases. The dangerous thing is that insulin resistance often does not produce any symptoms by itself.
The good news is that early-stage insulin resistance is reversible. Therefore, it is very worthwhile to take preventive action here. One of the strongest advocates for prevention is the American doctor Dr. Peter Attia.
Did you know? Insulin resistance is the main cause of Polycystic Ovary Syndrome (PCOS). PCOS is the most common hormonal disorder among women of childbearing age, affecting 8-13%. This condition often goes undiagnosed because the symptoms, such as a changed voice, infertility, acne, or obesity, do not suggest a disorder in glucose metabolism. PCOS is treated with Metformin, a prescription medication for type 2 diabetics.
How do I detect insulin resistance?
To have a better understanding of the glucose metabolism in our body, we first need to understand how and what we can measure. The simplest method is to measure your blood sugar using a test strip from the pharmacy.However, this only gives us a very specific insight that is hardly meaningful from a medical perspective. But why do we measure blood sugar at all and not directly insulin?
Insulin has only a very short half-life in the bloodstream. After a few minutes, it has already broken down, making accurate measurement difficult. There are two ways to measure insulin directly or indirectly. The first is the morning measurement of the "fasting insulin level". If these values are elevated, it indicates insulin resistance. Perhaps you have also heard of the HOMA index ? Here, insulin is compared to blood sugar. High values (greater than 2.5) indicate insulin resistance.
The second option is the measurement of C-peptide. This is produced in the pancreas along 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 insulin deficiency).
The most modern method is the option of a continuous glucose measurement using CGM.
CGM sensors are usually very small and self-adhesive on the skin using an adhesive film. A change must occur approximately every two weeks.
CGM Measurement – highly individual and the future
How many carbohydrates are too many? This question cannot be answered universally, as each person metabolizes carbohydrates differently. A Tour de France rider can utilize 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, according to a study particularly common among endurance athletes.
How can you determine where your ideal carbohydrate amount lies? We recommend that anyone interested wear a Continuous Glucose Monitor (CGM) for 2-4 weeks. This is sometimes also possible through the family doctor.
A CGM is a small sensor chip that is usually inserted into the upper arm with a short needle. Don't worry! It only gives a very brief prick, if at all, and the needle does not stay in. By leaving the thin measuring thread in the subcutaneous fat tissue, the sensor can measure our blood sugar 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: Ideally, blood sugar should not rise more than 30 points per meal. Then you are on the best path to reducing your insulin levels in the long term.
With the help of a CGM device, one can detect insulin resistance even before elevated blood sugar levels occur. Currently, these devices are mainly intended for diabetics, but in the future, they could be used as a screening tool for all people. Although the interpretation of the data is somewhat more complicated than with traditional lab tests, this could allow us to detect insulin resistance years in advance and take appropriate preventive action.
If you want to know more about the various ways to measure blood sugar, feel free to check out our magazine article on the topic of blood sugar levels . Here we explain in more detail what measurement methods are available.
Did you know? If sugar or carbohydrates are the problem, then it should help to replace soft drinks with their sugar-free alternatives, right? This question has been investigated by the scientists of this study . The result even surprised the researchers themselves: Sugar-free soft drinks increased the risk of diabetes and insulin resistance the most, followed by fruit juices and sugary soft drinks! A possible explanation lies in the alteration of the microbiome by the sweeteners.
While soft drinks are already a true nightmare for our blood sugar levels, researchers have found that various sugar-free alternatives significantly increase the risk of insulin resistance.
How can I reverse insulin resistance?
Let's assume you recognized your insulin resistance early. Perhaps you noticed an elevated fasting blood sugar level, or you used a CGM device and saw that it takes a very long time for your blood sugar to normalize after a carbohydrate-rich meal. Now the question arises, what to do? Fortunately, we now have quite a few options in our repertoire for this purpose.The following tools are available to us in the fight against insulin resistance:
- Medications
- Stress/Cortisol Management
- Good Sleep
- Exercise/Movement
- Nutrition
1. Medications
When an elevated fasting blood sugar is detected during a routine examination by the family doctor, the “HbA1c” – the so-called long-term sugar 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 carbohydrate metabolism over the last 3 months.The normal values for HbA1c vary by gender, which is why the following notes should be understood as guidelines. Starting from values of about 5.5% and higher, one is in a prediabetic metabolic state – not quite diabetes yet, but very close. Up to 6.5%, medication is usually not initiated, as only at this value do we speak of manifest diabetes.
As first-line therapy, lifestyle modification is recommended – yes, you read that right – before any medications are used, patients should first improve their lifestyle. Less alcohol, less sugar, and more exercise. If that does not work, treatment begins with Metformin (increases insulin sensitivity). If insufficient success is achieved under this therapy, SGLT2 inhibitors (increase glucose excretion) are then introduced, and in cases of overweight, possibly still add GLP-1 receptor agonists (which promote satiety and enhance insulin production).
Subsequently, therapy with insulin, the strongest antidiabetic, is initiated. The severely advanced insulin resistance is broken through with an even higher dose of insulin.
Did you know? Rarely has a medication generated as much hype online as the GLP receptor agonists. Under the brand name Ozempic or Wegovy , the active ingredient semaglutide is currently being sold. Many non-diabetics are taking the medication due to significant weight loss. At times, there were supply shortages due to a massive rush for the expensive medications. This was fueled, among other things, by social media.
Despite adjusted medication, the pancreas of many type 2 diabetics can eventually become exhausted due to the prolonged strain of insulin production. Initially, there was too much insulin in the blood, but now the opposite is true. At this stage, only insulin therapy helps. This is the only case where a lifestyle change or therapy with insulin sensitizers (like Metformin) alone no longer provides significant benefits.
Important note: In type 1 diabetics, insulin has been absent from the very beginning. The reason for this is autoimmune processes that destroy the insulin-producing cells of the pancreas over the years. Accordingly, insulin must be replaced from the very beginning .Oral antidiabetics are completely ineffective.
Medicine provides a whole arsenal of different medications in the fight against diabetes. However, we don't have to let it get that far!
2. Stress/Cortisol Management
Who is stressed today? Most people would raise their hands in agreement to this question. We live in a world full of stimuli, which is reflected in our cortisol levels. When cortisol is released, blood sugar levels also increase as a result – the body assumes that we need more right now.
Cortisol is also a hormone produced by the body, which is also known as the stress hormone.Basically, that's true, but it’s not possible to completely avoid cortisol and stress even in peace . It wakes us up in the morning and ensures that our heart keeps beating. In various situations, it also gives us the necessary extra kick of energy.
So, controlling cortisol levels does not mean completely shutting it down, but rather maintaining 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 a maximum of 60 minutes, 3-5 times a week)
- Breathing exercises (Slowly inhale through the nose and exhale through the mouth for 2 minutes)
- In the morning, the first glance should not be at the smartphone; better to wait at least 1 hour
- Coffee (increases cortisol levels) no later than 3 PM
- Eat the last meal at least 2 hours before going to sleep
- Put away the smartphone at least one hour before going to sleep
- Pay attention to a balanced diet with adequate intake of Omega-3 fatty acids and magnesium .Good sufficient sleep
Who would have thought that lack of sleep not only makes us tired but also drastically increases the risk of metabolic diseases? Studies have shown that reducing sleep to 4 hours per night for 2 weeks negatively affects our insulin levels and glucose utilization. Accordingly, glucose tolerance was significantly reduced and cortisol levels were significantly increased. If such a short time has such drastic consequences, what does chronic sleep deprivation bring?
Magnesium is excreted in large amounts under sleep deprivation. Supplementation could at least mitigate the negative effects a bit. At the same time magnesium also significantly reduces stress and consequently our cortisol levels.
4.Sport/Exercise
Everyone can probably guess that sports are good for our blood sugar. But why is that actually the case? Primarily, it has to do with our body's own reservoir for glucose. Yes, you guessed it – we are talking about our muscles! The larger the muscle mass, the more capacity we have to store and utilize glucose.
Strength Training
The goal is to increase muscle mass. It doesn't necessarily have to be free weights. Cable machines, resistance bands, or your own body weight are completely sufficient at the beginning. The main thing is to move your body against resistance. We recommend a frequency of 2-3 times per week.
“Zone 2” Cardio Training
What initially sounds quite vague refers to cardio training at a heart rate between 130 and 140 beats per minute. In this range, the mitochondria work with the highest efficiency for most people. This increases one of the most well-known fitness markers – VO2max. Studies have repeatedly shown that even with less than one hour per week, insulin resistance can be significantly reduced. We recommend starting with 30-45 minutes of Zone 2 cardio per week.
5. Nutrition
Insulin resistance is simply put a disorder of carbohydrate tolerance.In the presence of insulin resistance, prediabetes, and diabetes, carbohydrate intake should first be reduced. A general calorie reduction often carries the risk of losing muscle mass – muscle mass is considered the largest reservoir for glucose – so we do not want to reduce that. In some cases, the loss of muscle mass can even worsen the situation!
Although some studies show that calorie restriction leads to improved insulin resistance, there are some points to consider. The most important thing is that when reducing calories, you always pay attention to a minimum intake of 1g of protein per kilogram of body weight – that is just enough to maintain muscle.To lose weight, we recommend about 1.5-2g of protein per kilogram of body weight. In addition to improved insulin resistance, fasting can bring you further health benefits. Through various molecular mechanisms, the longevity genes are activated during fasting.
Did you know? Fasting is considered healthy and recent studies have scientifically proven this. It is often difficult to incorporate fasting into your daily routine. The feeling of hunger, social contacts, or work make extended fasting challenging. However, there is also the possibility to mimic fasting on a molecular level.
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 the autophagy, the recycling, of old cells is stimulated. Additionally, berberine helps you maintain stable blood sugar levels.
A ketogenic diet can also be very helpful in some cases, but it is significantly more complex, presents some pitfalls, and would exceed the scope of this article.
What helps besides fasting with insulin resistance?
Fasting is not suitable for everyone, but it remains a very useful tool that can reverse existing insulin resistance. In this study , the authors were able to show, for example, that multi-day fasting significantly reduces liver fat in overweight type 2 diabetics and decreases insulin resistance .
Did you know? Due to insulin resistance, we are less able to utilize carbohydrates. The mitochondria, also known as the power plants of our cells, lack glucose and fatty acids as a result. Their function is therefore impaired. Prof.Sekhar and his team were able to show in an exciting study on type 2 diabetics that regular intake of GlyNAC improved mitochondrial function and thus reduced insulin resistance.
When looking at the research on possible dietary patterns, 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 Key to Longevity
Let's take a look at what a Mediterranean diet actually consists of. In addition to proteins from legumes and fish, there is a variety of plant species 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 secondary plant compounds in our food is decreasing more and more. If you eat an apple today, you have to expect that it contains up to one third less secondary plant compounds than before. If you want to know more about secondary plant substances, then take a look at our overview on this topic.
There are also some natural molecules that have shown a positive effect on our insulin sensitivity in studies. They significantly reduce the blood sugar spike after a meal. This includes particularly Berberine and Carnosine.
The Mediterranean diet contains many healthy fats and secondary plant substances that have a very positive effect on blood sugar levels.
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 consume carbohydrates. For this, they provided type 2 diabetics with a consistently structured meal. This consisted of three parts
- Carbohydrates (ciabatta bread and orange juice)
- Protein (chicken breast, skinless)
- Vegetables (salad, tomatoes, and cucumbers)
The individual components were always served at ten-minute intervals. The quantities were always the same; only the order was changed.The astonishing result: It actually makes a striking difference when carbohydrates are consumed! When carbohydrates were consumed last, the blood sugar spike was not as steep. This allowed the scientists to show that a small change in the structuring of meals already has a measurable effect. You can also find more interesting studies on the topic in the book “The Glucose Revolution” by Jessie Inchauspé.
We hope this little insight into the world of insulin resistance and blood sugar management has pleased you. Even though insulin resistance often shows no symptoms for a long time, you now know how important the topic is for your health. With this knowledge, you now hold the reins in your hands!
