I am fond of saying that prediabetes is not pre-problem. Rather it is the problem and proof that insulin resistance has been going on for some time. It’s a hint that a diagnosis of type 2 diabetes might be just around the corner.
To understand insulin resistance, you must first know the roles of insulin. This hormone regulates glucose in the blood. After your food is digested and glucose enters the bloodstream, the pancreas sends out insulin to help usher excess glucose out of the blood and into the muscle and fat cells, where glucose is used for energy or stored for later use. When fat and muscle cells first become resistant to insulin’s action, the pancreas sends out more and more insulin to do the job. Blood glucose levels normalize without any sign that something is awry. These higher-than-normal insulin levels may occur for years before a diagnosis of type 2 diabetes or prediabetes. All the while, many things may be off course. In addition to working to control blood glucose, insulin affects tissues throughout the body. It may be the high levels of insulin that affect medical problems such as high blood pressure, elevated triglycerides, dementia, liver disease and increased cancer risk.
Insulin resistance is the underlying cause of prediabetes and type 2 diabetes. There are no simple medical tests to diagnose insulin resistance in the presence of normal blood glucose levels. However, elevated triglycerides, high blood pressure and low HDL-cholesterol are clues, though these conditions may have evolved for other reasons.
If you have insulin resistance, prediabetes or a strong family history of type 2 diabetes, you are not doomed. There are plenty of things you can do to tame insulin resistance. Perhaps the most important thing is to lose a few pounds if you are overweight. Losing just 10 or 20 pounds can have profound benefits. In the Diabetes Prevention Program (DPP) — a study of more than 3,000 people at high risk for developing type 2 diabetes — researchers learned that weight loss and increased physical activity prevented or delayed the onset of the disease. The goals for DPP participants were to lose 7 percent of their body weight (14 pounds for someone starting at 200 pounds) and to exercise at a moderate intensity for 150 minutes per week. In this three-year study, participants lowered their risk of developing type 2 diabetes by 58 percent. Even 10 years after the study began, the lifestyle interventions reduced the risk by 34 percent. This is proof that small changes add up to give big results.
What more can you do?
- Exercise at least every third day. In general, all types of exercise —even without weight loss — improve insulin resistance for two to 72 hours.
- Pump iron. Resistance training such as lifting weights or using elastic bands at least twice weekly also improves insulin resistance.
- Don't skip the first meal of the day. In a small study of women, eating breakfast improved insulin resistance.
- Enjoy oats and barley. Beta-glucan, a fiber in these two whole grains, lowers both glucose and insulin levels.
- Replace saturated and trans fats with healthier vegetable fats. Skip the fatty meats, full-fat dairy and packaged foods with partially hydrogenated oils. Instead enjoy seeds, nuts, avocado, olives and vegetable oils.
- Hit the hay. Researchers in the Netherlands found that even one night of inadequate sleep impairs insulin sensitivity by as much as 25 percent.
Take action before prediabetes becomes diabetes.