What is Insulin?

Insulin is the hormone released by your pancreas in response to eating. The amount of insulin released largely depends on the rise in your blood sugar (glucose). Once the insulin enters the blood, it helps to drive the glucose into the tissues of your body. Muscle and fat are the major insulin responsive tissues in your body.

What happens to Insulin in Diabetes?

There are two types of diabetes.  In type I diabetes (insulin dependent), the cells of the pancreas that make insulin are destroyed. Thus, people with type I diabetes have a deficiency of insulin. Their treatment requires them to receive insulin on a daily basis. Since insulin is a large protein, it must be injected into the body to function, as it would be digested likely any other protein if it were taken orally.

In type II diabetes, the body has plenty of insulin. In fact, the levels of insulin may be quite high. This is because the tissues which repsond to insulin have become resistant to its action. Thus, the blood sugar of type II diabetics runs high due to inadequate effect of their excessive insulin. The fact that the insulin levels are more than adequate, but not effective, is referred to as Insulin Resistance.

Is Insulin Resistance Important?

All type II diabetics suffer from insulin resistance. In fact, many people with insulin resistance have yet to develop diabetes. This is because the level of resistance has not compromised their ability to clear glucose from the blood after eating. This "pre-diabetic" state will exist as long as the person can compensate by increasing their insulin levels further. When they can no longer increase their insulin release to keep their glucose "normal", they become defined as diabetics.

The important point is that insulin resistance is associated with many problems, even in the absence of an elevated blood sugar (that is, in people who have yet to meet the definition of diabetes). In fact, 50% of people with hypertension (high blood pressure) have insulin resistance. In many of them, the insulin resistance contributes to their hypertension.

Also, we have known for some time that people may develop complications of "diabetes", before they become diabetic (that is, before their blood sugars increase). This suggests, that the insulin resistance (that is, the high insulin levels) may be the culprit in causing the complications of type II diabetes. This notion is also supported by the fact that excellent blood sugar control in diabetics does not eliminate the complications (e.g. eye problems, kidney disease and nerve disorders).

How do I know if I have Insulin Resistance?

The easiest test to diagnose Insulin Resistance is a fasting insulin level. This is because insulin levels fall to their lowest point after an overnight fast (the insulin level falls at night to prevent your blood sugar from falling to low while you are sleeping). People with insulin resistance have elevated fasting insulin levels.

Since this is not a routine screening test, other potential clues which may suggest you have insulin resistance include:

• Family History of Diabetes
• A History of High Blood Sugars
• Diabetes during Pregnancy
• An elevated Triglyceride (fat) level in the blood.
• A low HDL (High Density Lipoportein, the "good" cholesterol)
• An elevated Glycohemoglobin (the glycohemoglobin, or Hemoglobin (Hb) A1c, represents the amount of glucose which has randomly stuck to your blood's Hb. Hb is the major protein used by your body to transport oxygen).

If you have any of these risk factors, it may be worthwhile to check a fasting insulin level. If you do have insulin resistance, you can take action to improve the function of your insulin, and hopefully, prevent future medical problems.

What can I do about Insulin Resistance?

Things you can do to improve the function of your body's insulin. They include:

• Aerobic Exercise
• Weight Loss if overweight
• Altering the starches in your diet

Aerobic exercise can improve the ability of your muscles to remove glucose from the blood. This premits the insulin your body releases in repsonse to eating to remove more glucose from the blood. The more exercise you do, the better your insulin will work. A good starting goal is to walk 10 miles a week. You may not be able to achieve this quickly, but it may be a good 6 month goal.

Weight loss is quite helpful in improving insulin function. The problem is that it may be hard to keep the weight off. Current research suggests that the types of starches (carbohydrates) we eat may not only influence our insulin levels, but also our appetite, and thus, consumption.

The starches which improve your insulin function are those which have a low glycemic index. The glycemic index refers to how much your blood sugar increases after eating a particular food. Foods with a high glycemic index are problematic, while those with a low glycemic index are preferred.

A no starch diet will take the greatest amount of stress off your insulin/blood sugar system. This diet is less complicated than a diet containing starches which tries to minimize the glycemic index. However, it totally eliminates foods which may be a cultural part of one's diet.