Is insulin resistance diabetes?

Contents

Is Diabetes Different From Insulin Resistance?

Q1. My blood sugar remains high (135 or higher) for 12 to 15 hours after I eat. My general practitioner says I have diabetes, but my ob-gyn has diagnosed me with insulin resistance. What is the difference and should these conditions be treated differently? How is it possible that two doctors think I have two different conditions?

— Patricia, Florida

Insulin resistance is usually found in people who are overweight. The metabolic changes that are brought on by excess weight prevent cells in the liver and muscles from utilizing glucose, despite normal insulin levels in the body. Insulin is the hormone that helps our body metabolize, or burn, glucose. The body in effect becomes “resistant” to insulin. The body’s response to this is to produce more insulin. Unlike some diabetics, whose bodies produce insufficient amount of insulin, individuals who have insulin resistance have high levels of insulin early on in the disease. This process is rather complex and genetic susceptibility to diabetes plays a big role, but suffice it to say that long-term insulin resistance eventually leads to diabetes.

The goal of treatment is to normalize day-to-day sugar levels. If you are carrying excess weight and your pancreas still produces an adequate amount of insulin, most likely you have some degree of insulin resistance. You will benefit, therefore, from medicines that are considered insulin “sensitizers.” These include medications that fall under the classes of drugs known as metformin (Glucophage) and thiazolinediones (two drugs in this class are pioglitazone — Actos — and rosiglitazone — Avandia). They help your liver and muscle cells better utilize glucose. It is possible, however, that additional medicines will be required to manage your diabetes. In this case, medicines that increase insulin production from the pancreas will be considered. These are called insulin secretagogues and include glyburide, glipizide, and glimepiride. If your pancreas is not producing insulin at all, then injecting insulin becomes absolutely necessary.

Q2. My husband was diagnosed as “prediabetic” following a heart attack two months ago. I did some research into that term and learned about “insulin resistance.” The symptoms listed for both diseases led me to believe my husband was not prediabetic but rather fell into the category of insulin resistant. Can you tell me more about it, and how to treat each of these conditions?

– Patti

Prediabetes is the condition of having abnormal levels of glucose, or sugar molecules, in the blood; insulin resistance refers to the mechanism by which one develops that condition. They’re not two different conditions; they’re cause and effect — insulin resistance is a prediabetes state.

The human body uses sugar as a fuel (energy) to live, function, and produce. To this end, sugar has to be transported from the bloodstream across cell walls into the cells, where the sugar is actually burned and turned into energy. Insulin is a key hormone produced by the pancreas, primarily as a response to the sugar absorbed into the bloodstream after you eat a meal. Insulin acts on cell walls in such a way that the cells can take up and metabolize sugar. If the cell walls don’t allow insulin to do its job, a person is said to have insulin resistance.

Most adults who develop prediabetes have insulin resistance. (A smaller proportion of individuals who have prediabetes have insulin deficiency.) If cells such as those of the liver and muscles are resistant to insulin, then sugar cannot enter cells easily and remains in the bloodstream at levels exceeding normal values — that’s prediabetes (or diabetes). Prediabetes is diagnosed when the level of glucose is abnormal but below diabetic values: fasting values of 100 to 125 milligrams per deciliter, and 140 to 199 mg/dl two hours after a glucose load. For diabetes, the cutoff values are 126 mg/dl (fasting) and 200 mg/dl (two hours after a glucose load).

To make things worse, lipid (cholesterol) metabolism is also affected by insulin resistance. To overcome resistance, the pancreas produces more and more insulin — and unfortunately, increased levels of insulin are detrimental to our arteries and are associated with high blood pressure.

The goal of treatment for prediabetes is to prevent or mitigate both the onset of diabetes and the cardiovascular (heart and blood vessel) complications that come with it. A research study showed that individuals with prediabetes who engaged in physical activity, consumed a healthy diet, and lost at least 7 percent of their body weight reduced their risk of developing diabetes by 58 percent. The same study showed that taking a diabetes medicine (metformin) reduced the risk by 31 percent.

Ask your husband’s doctor for a more tailored approach for your husband — and stay tuned.

Q3. I take Glucophage for diabetes. Is there a “magic number” at which I am likely to have to start taking insulin instead?

— Anna, Florida

You’re right in thinking that at some point in the future, Glucophage alone might not be sufficient to treat your diabetes. For most adults who have diabetes, adding a second oral medicine works to provide good glucose control. The point at which you might require insulin would be when those oral medicines no longer lower glucose levels to acceptable levels. This is the stage when the pancreas loses the capacity to produce an adequate amount of insulin. At this stage, oral medicines are no longer effective at normalizing your glucose levels.

Since various factors influence the production of insulin in the pancreas, it’s not easy to determine when this will occur. For instance, having diabetes for a long period of time and having persistently high levels of glucose lead to a decline in insulin production. Obesity, lifestyle factors, and other diseases also accelerate the rate of progression to the stage at which insulin might be required.

The most convenient and reliable method to determine glucose control is to measure the hemoglobin A1c percent in the laboratory. Excess glucose attaches itself to proteins in our bloodstream, and hemoglobin is one such protein. The higher the percent of hemoglobin A1c, the poorer the glucose control. The goal is to get this number close to 6 percent. If your number is consistently much higher than 6 percent, it is time to increase the dosage of the medicine you are currently taking or add a new medicine. A hemoglobin A1c level above 7 percent means that your average fasting blood glucose level is at least 150 mg/dl.

Having said this, insulin might be the best treatment for many individuals who are on more than two medicines for diabetes control. Insulin is highly effective and has fewer side effects than many oral medicines.

Q4. I take oral medications to control type 2 diabetes. When I eat sweets that elevate my sugar level, however, I occasionally take a dose of my sister’s insulin to lower it. I only do this once in a while. Is it dangerous?

— Elizabeth, Texas

Taking insulin to compensate for the occasional dietary intake of sweets is not harmful in itself. If, however, you’re injecting insulin without counting your carbohydrates or considering proper injection techniques or the overall severity of your disease, it is dangerous. Too much insulin can lead to severe hypoglycemia. Additionally — and in general — taking medicines prescribed for others is not recommended.

While sweets are not inherently bad, they count in your overall carbohydrate intake, and you should substitute them gram for gram for other carbohydrates that you eat on a particular day. It’s also important to consider the cholesterol and other fats contained in most sweets. As you know, cholesterol-rich and high-fat foods, including cakes, cookies, and ice cream, contribute to elevated cholesterol and triglyceride levels in your blood, which are detrimental to your cardiovascular health.

I suggest that you monitor your sugar levels, document the pattern of your intake of sweets (that is, the quantity and type of sweets you eat, and how often you eat them), and consult your doctor about the best way to manage any potential rise of glucose. If you’re not currently on insulin, you might be able to take short-acting oral medicines prior to a meal. This might be sufficient to compensate for the potential rise in sugar after you eat sweets. If your hemoglobin A1C is not at the desired level, your doctor may consider prescribing regular doses of premeal hypoglycemic medicines, or one of a new class of medications called incretin mimetics, which work by stimulating the pancreas to secrete insulin when blood sugar levels are high. Medications in this class include exenatide (Byetta) and sitagliptin (Januvia).

Learn more in the Everyday Health Type 2 Diabetes Center.

Insulin Resistance Causes and Symptoms

One in three Americans—including half of those age 60 and older1— have a silent blood sugar problem known as insulin resistance. Insulin resistance increases the risk for prediabetes, type 2 diabetes and a host of other serious health problems, including heart attacks, strokes2 and cancer.3

What is Insulin Resistance?

Insulin resistance is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates.

How Insulin Resistance Develops

While genetics, aging and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even skimping on sleep.4

As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease. 5

Signs and Symptoms of Insulin Resistance

Insulin resistance is usually triggered by a combination of factors linked to weight, age, genetics, being sedentary and smoking.

– A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent)6 increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.

– You have additional signs of metabolic syndrome. According to the National Institutes of Health,7 in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.

  • High triglycerides. Levels of 150 or higher, or taking medication to treat high levels of these blood fats.
  • Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
  • High blood pressure. Readings of 130/85 mmHg or higher, or taking medication to control high blood pressure
  • High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
  • High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

– You develop dark skin patches. If insulin resistance is severe, you may have visible skin changes. These include patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.8

Health Conditions Related to Insulin Resistance

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes. In addition, up to 80% of people with type 2 diabetes have NAFLD.9 But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.10
Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus.11, 12 The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells. 13

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease.

How You Can Prevent or Reverse Insulin Resistance

Losing weight, getting regular exercise and not skimping on sleep can all help improve your insulin sensitivity. Don’t rely on dieting or exercise alone: in one fascinating University of New Mexico School of Medicine study, published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. And those who simply got more exercise, but didn’t lose much weight, saw almost no shift in their level of insulin resistance.14

Turn in on time, too. In a study presented at the 2015 meeting of the Obesity Society, researchers found that just one night of sleep deprivation boosted insulin resistance as much as eating high-fat foods for six months.15

Updated on: 03/29/19 Continue Reading Type 2 Diabetes Complications View Sources

The Insulin Resistance–Diabetes Connection

Insulin acts like a key to let blood sugar into cells for use as energy.

Invisible changes in the body begin long before a person is diagnosed with type 2 diabetes. That’s both bad news (no symptoms mean you won’t know you have it) and good news (you can prevent or delay it if you’re at risk). One of the most important unseen changes? Insulin resistance.

Insulin, Blood Sugar, and Type 2 Diabetes

Insulin is a key player in developing type 2 diabetes. This vital hormone—you can’t survive without it—regulates blood sugar (glucose) in the body, a very complicated process. Here are the high points:

  • The food you eat is broken down into blood sugar.
  • Blood sugar enters your bloodstream, which signals the pancreas to release insulin.
  • Insulin helps blood sugar enter the body’s cells so it can be used for energy.
  • Insulin also signals the liver to store blood sugar for later use.
  • Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
  • Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you haven’t eaten for a while.

That’s when everything works smoothly. But this finely tuned system can quickly get out of whack, as follows:

  • A lot of blood sugar enters the bloodstream.
  • The pancreas pumps out more insulin to get blood sugar into cells.
  • Over time, cells stop responding to all that insulin—they’ve become insulin resistant.
  • The pancreas keeps making more insulin to try to make cells respond.
  • Eventually, the pancreas can’t keep up, and blood sugar keeps rising.

Lots of blood sugar in the bloodstream is very damaging to the body and needs to be moved into cells as soon as possible. There’s lots of insulin, too, telling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat. Yep, weight gain. And what’s more serious, the stage is set for prediabetes and type 2 diabetes.

Do You Have Insulin Resistance?

How do you find out if you’re insulin resistant? No one test will tell you, but if you have high blood sugar levels, high triglycerides (a kind of blood fat), high LDL (“bad”) cholesterol, and low HDL (“good”) cholesterol, your health care provider may determine you have insulin resistance.

Important note: Type 1 diabetes is different; it’s thought to be caused by an autoimmune reaction (the body attacks itself by mistake). People with type 1 diabetes don’t make enough insulin and need to take it to survive.

Causes of Insulin Resistance

It isn’t clear exactly what causes insulin resistance, but a family history of type 2 diabetes, being overweight (especially around the waist), and being inactive all can raise the risk.

You do not have to be overweight to have insulin resistance. You can’t tell if someone has insulin resistance by looking at them.

How to Reverse Insulin Resistance

If you have insulin resistance, you want to become the opposite—more insulin sensitive (cells are more effective at absorbing blood sugar so less insulin is needed).

Physical activity makes you more sensitive to insulin, one reason why it’s a cornerstone of diabetes management (and good health in general!). Don’t wait until you’re diagnosed with diabetes to start moving more. The earlier you take action (literally), the better off you’ll be.

Weight loss is important too, as is avoiding high blood sugar, reducing stress, and getting enough sleep (physical activity can help you get more zzz’s too).

These lifestyle changes really work. Talk with your health care provider about how to get started.

Find Out More

CDC’s Division of Diabetes Translation
Prediabetes and Insulin Resistanceexternal icon
Prevent Type 2 Diabetes
Diabetes Features & Spotlights
CDC Diabetes on Facebook
@CDCDiabetes on Twitter

5 Healthy Steps to Reverse Type 2 Diabetes and Insulin Resistance

Breaking news! Some newly discovered compounds have just been found to turn off all of the genes that cause diabetes. Are these compounds found in a pill bottle? No!

Diabetes and insulin resistance are completely preventable and often reversible through aggressive lifestyle changes, including diet, supplements, exercise and stress management.

In my last blog, I explained how to find out if you are pre-diabetic or diabetic. Half of the 24 million people with diabetes don’t know they have it, and nearly all the 60 million people with pre-diabetes don’t know they have it.

Today, I want to share with you more information about what you can do NOW to prevent and reverse diabetes and pre-diabetes.

1. Change your diet

Eating in a way that balances your blood sugar, reduces inflammation andoxidative stress, and improves your liver detoxification is the key to preventing and reversing insulin resistance and diabetes.

This is a way of eating that’s based on a whole foods diet that’s high in fiber, rich in colorful fruits and vegetables, and low in sugars and flours, with a low glycemic load.

It is a way of eating that includes anti-inflammatory, antioxidant and detoxifying foods. It includes plenty of omega-3 fats and olive oil, soy products, beans, nuts and seeds.

All these foods help prevent and reverse diabetes and insulin resistance. This is the way of eating that turns on all the right gene messages, promotes a healthy metabolism, and prevents aging and age-related diseases like diabetes andheart disease.

2. Exercise

Exercise is critical for the improvement of insulin sensitivity. It helps reduce central body fat, improving sugar metabolism. Regular exercise will help prevent diabetes, reduce your risk of complications, and even help reverse it.

Ideally you should do 30 minutes of walking every day. Walking after dinner is a powerful way to reduce your blood sugar.

More vigorous exercise and sustained exercise is often needed to reverse severe insulin resistance or diabetes. Doing sustained aerobic exercise for up to 60 minutes five to six times a week is often necessary to get diabetes under full control.

Interval training can be an added benefit to helping improve your metabolism and mitochondrial function. It helps to increase the efficiency calorie burning so that you burn more calories and energy during the time you are NOT exercising. This is described in detail in UltraMetabolism.

Strength training also helps maintain and build muscle, which can help also with your overall blood sugar and energy metabolism.

3. Take supplements

Nutritional supplements can be very effective for type 2 diabetes and insulin resistance. I recommend a number of different supplements, depending on the severity of the problem:

  1. A multivitamin and mineral
  2. Calcium and magnesium and vitamin D
  3. Fish oil (1,000 to 4,000 mg a day) improves insulin sensitivity, lowers cholesterol and reduces inflammation.
  4. Extra magnesium (200 to 600 mg a day) helps with glucose metabolism and is often deficient in diabetics.
  5. Chromium (500 to 1,000 mcg a day) is very important for proper sugar metabolism.
  6. Antioxidants (such as vitamins C and E) are important in helping to reduce and balance blood sugar.
  7. B-complex vitamins are important and are part of a good multivitamin. Extra vitamin B6 (50 to 150 mg a day) and B12 (1,000 to 3,000 mcg) are especially helpful in protecting against diabetic neuropathy or nerve damage.

4. Manage stress

Stress plays a dramatic role in blood sugar imbalances. It triggers insulin resistance, promotes weight gain around the middle, increases inflammation, and ultimately can cause diabetes. So it’s essential to engage in relaxation practices on a regular basis, such as yoga, breathing, progressive muscle relaxation, guided imagery, hot baths, exercise, meditation, massage, biofeedback, hypnosis or even making love. Your survival depends on it.

5. Use medications if necessary

A number of medications may be helpful for diabetes. There are several specific classes of medications, each with their own effects. Sometimes combinations are helpful.

These are the main classes:

  1. The biguanides, especially metformin (Glucophage), is one of the best medications to improve insulin sensitivity. It can help lower blood sugars by improving your cells’ response to insulin.
  2. Thiazolidinedione drugs are a new class of diabetes medication and can help improve uptake of glucose by the cells by making you more insulin-sensitive. They also reduce inflammation and help improve metabolism working on the PPAR, a special class of cell receptors that control metabolism. They can cause weight gain and liver damage. Thiazolidinediones include rosiglitazone (Avandia) and pioglitazone (Actos).
  3. Alpha-glucosidase inhibitors include acarbose and miglitol, which can help lower the absorption of sugar and carbohydrates in the intestines, reducing the absorption of sugar after meals. And there are newer medications on the market every day.

Insulin is the last resort after all other measures have failed and often leads to a slippery slope of weight gain and increased cholesterol and blood pressure. Many patients have been able to come off insulin entirely if they are treated early and aggressively through the other methods I’ve listed.

If you follow these guidelines, you will see a dramatic change very quickly in your health, your weight and your diabetes.

Just try it!

To your good health,
Mark Hyman, M.D.

Insulin Resistance And IGT

Insulin Resistance And IGT

INSULIN RESISTANCE AND IGT

Diabetes isn’t simple. Although every diabetic,

by definition, has difficulty with insulin supply and glucose metabolization, there are a

number of different ways to arrive there. You may encounter the terms insulin resistance

and impaired glucose tolerance. What are they?

Insulin resistance is the body’s inability to

correctly utilize its normal (endogenous) insulin supply, even though that insulin is

present in sufficient volume. IGT, Impaired Glucose Tolerance, once called

"borderline diabetes," or "subclinical" diabetes, means your numbers

are still short of the diabetic threshold, but exhibit abnormalities in the processing of

blood sugar.

If a person has insulin resistance, the body is

incorrectly using the hormone. Let’s track it: You’re hungry. You eat. Blood sugar levels

rise…all strictly normal. Remembering insulin is necessary for that last stage of

digestion—moving the glucose from the blood into the cells—your body puts out

insulin, to do its job.

But, for whatever reason, the body does not fully

respond to the insulin, and the sugars stay in the blood. The pancreas senses the problem,

and puts out MORE insulin, trying mightily to bring down those blood sugars. It isn’t

subtle about it, and, in the early stages, can over-produce, and down you can go into

hypoglycemia. This is IGT, Impaired Glucose Tolerance.

The overworked pancreas can, and often does,

"go on strike." Perhaps 50% of all individuals with IGT go on to full-blown

diabetes. In time, insulin output slows below insulin needs, and sugars rise into the

hyperglycemic range, where they stay, until medication (sulfonylureas, Metformin, Rezulin)

brings them back down. They have progressed to type 2 diabetes.

If you have not been diagnosed with diabetes, how

do you know if you are insulin resistant? You talk to your doctor, and you test. Your

doctor may suggest you get a blood glucose monitor, just as if you had been diagnosed

diabetic. It all comes down to the numbers.

In its early stages, IGT is hard to call. The

pancreas is in overdrive, and may even be "pulling its share," at least some of

the time. At this stage, you will be hyperinsulinemic, you have an insulin oversupply. As

glucose monitors test sugar, not insulin, we don’t have a reliable way to detect this

stage.

Do you have a history of hypoglycemia? As this

condition progresses, you can have highs and lows, of less intensity than those

experienced by a "full" diabetic, but inconvenient and unpleasant. Again, TEST!

As IGT, like type II, is often connected with "lipid abnormalities," abnormal

levels of cholesterol, with risk of high blood pressure and heart disease, can follow in

its wake. Talk to your doctor.

What to do about it? Insulin resistance is

connected with obesity. Though fat does not necessarily cause IGT, it increases its

severity, and weight loss decreases same. Exercise burns blood glucose, and a regular

fitness program is as beneficial to persons with IGT as it is to those with

"full" diabetes. So, whether you’re looking to prevent or treat IGT, diet and

exercise should be at the top of your list.

Insulin Resistance & Prediabetes

On this page:

  • What is insulin?
  • What is insulin resistance?
  • What is prediabetes?
  • How common is prediabetes?
  • Who is more likely to develop insulin resistance or prediabetes?
  • What causes insulin resistance and prediabetes?
  • What are the symptoms of insulin resistance and prediabetes?
  • How do doctors diagnose insulin resistance and prediabetes?
  • How can I prevent or reverse insulin resistance and prediabetes?
  • Clinical Trials

Insulin resistance and prediabetes occur when your body doesn’t use insulin well.

What is insulin?

Insulin is a hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat, and liver, where it’s used for energy. Glucose comes from the food you eat. The liver also makes glucose in times of need, such as when you’re fasting. When blood glucose, also called blood sugar, levels rise after you eat, your pancreas releases insulin into the blood. Insulin then lowers blood glucose to keep it in the normal range.

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells. As long as your pancreas can make enough insulin to overcome your cells’ weak response to insulin, your blood glucose levels will stay in the healthy range.

What is prediabetes?

Prediabetes means your blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Prediabetes usually occurs in people who already have some insulin resistance or whose beta cells in the pancreas aren’t making enough insulin to keep blood glucose in the normal range. Without enough insulin, extra glucose stays in your bloodstream rather than entering your cells. Over time, you could develop type 2 diabetes.

How common is prediabetes?

More than 84 million people ages 18 and older have prediabetes in the United States.1 That’s about 1 out of every 3 adults.

Who is more likely to develop insulin resistance or prediabetes?

People who have genetic or lifestyle risk factors are more likely to develop insulin resistance or prediabetes. Risk factors include

  • overweight or obesity
  • age 45 or older
  • a parent, brother, or sister with diabetes
  • African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American ethnicity
  • physical inactivity
  • health conditions such as high blood pressure and abnormal cholesterol levels
  • a history of gestational diabetes
  • a history of heart disease or stroke
  • polycystic ovary syndrome, also called PCOS

People who have metabolic syndrome—a combination of high blood pressure, abnormal cholesterol levels, and large waist size—are more likely to have prediabetes.

Along with these risk factors, other things that may contribute to insulin resistance include

  • certain medicines, such as glucocorticoids, some antipsychotics, and some medicines for HIV
  • hormonal disorders, such as Cushing’s syndrome and acromegaly
  • sleep problems, especially sleep apnea

Although you can’t change risk factors such as family history, age, or ethnicity, you can change lifestyle risk factors around eating, physical activity, and weight. These lifestyle changes can lower your chances of developing insulin resistance or prediabetes.

Being overweight or having obesity are risk factors for developing insulin resistance or prediabetes.

What causes insulin resistance and prediabetes?

Researchers don’t fully understand what causes insulin resistance and prediabetes, but they think excess weight and lack of physical activity are major factors.

Excess weight

Experts believe obesity, especially too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance. This is true even if your body mass index (BMI) falls within the normal range. However, research has shown that Asian Americans may have an increased risk for insulin resistance even without a high BMI.

Researchers used to think that fat tissue was only for energy storage. However, studies have shown that belly fat makes hormones and other substances that can contribute to chronic, or long-lasting, inflammation in the body. Inflammation may play a role in insulin resistance, type 2 diabetes, and cardiovascular disease.

Excess weight may lead to insulin resistance, which in turn may play a part in the development of fatty liver disease.

Physical inactivity

Not getting enough physical activity is linked to insulin resistance and prediabetes. Regular physical activity causes changes in your body that make it better able to keep your blood glucose levels in balance.

What are the symptoms of insulin resistance and prediabetes?

Insulin resistance and prediabetes usually have no symptoms. Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck, a condition called acanthosis nigricans. Many small skin growths called skin tags often appear in these same areas.

Even though blood glucose levels are not high enough to cause symptoms for most people, a few research studies have shown that some people with prediabetes may already have early changes in their eyes that can lead to retinopathy. This problem more often occurs in people with diabetes.

How do doctors diagnose insulin resistance and prediabetes?

Doctors use blood tests to find out if someone has prediabetes, but they don’t usually test for insulin resistance. The most accurate test for insulin resistance is complicated and used mostly for research.

Doctors use blood tests to find out if someone has prediabetes.

Doctors most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose prediabetes. Less often, doctors use the oral glucose tolerance test (OGTT), which is more expensive and not as easy to give.

The A1C test reflects your average blood glucose over the past 3 months. The FPG and OGTT show your blood glucose level at the time of the test. The A1C test is not as sensitive as the other tests. In some people, it may miss prediabetes that the OGTT could catch. The OGTT can identify how your body handles glucose after a meal—often before your fasting blood glucose level becomes abnormal. Often doctors use the OGTT to check for gestational diabetes, a type of diabetes that develops during pregnancy.

People with prediabetes have up to a 50 percent chance of developing diabetes over the next 5 to 10 years. You can take steps to manage your prediabetes and prevent type 2 diabetes.

The following test results show Prediabetes2

  • A1C—5.7 to 6.4 percent
  • FPG—100 to 125 mg/dL (milligrams per deciliter)
  • OGTT—140 to 199 mg/dL

You should be tested for prediabetes if you are overweight or have obesity and have one or more other risk factors for diabetes, or if your parents, siblings, or children have type 2 diabetes. Even if you don’t have risk factors, you should start getting tested once you reach age 45.

If the results are normal but you have other risk factors for diabetes, you should be retested at least every 3 years.2

How can I prevent or reverse insulin resistance and prediabetes?

Physical activity and losing weight if you need to may help your body respond better to insulin. Taking small steps, such as eating healthier foods and moving more to lose weight, can help reverse insulin resistance and prevent or delay type 2 diabetes in people with prediabetes.

Physical activity can help prevent or reverse insulin resistance and prediabetes.

The National Institutes of Health-funded research study, the Diabetes Prevention Program (DPP), showed that for people at high risk of developing diabetes, losing 5 to 7 percent of their starting weight helped reduce their chance of developing the disease.3 That’s 10 to 14 pounds for someone who weighs 200 pounds. People in the study lost weight by changing their diet and being more physically active.

The DPP also showed that taking metformin, a medicine used to treat diabetes, could delay diabetes. Metformin worked best for women with a history of gestational diabetes, younger adults, and people with obesity. Ask your doctor if metformin might be right for you.

Making a plan, tracking your progress, and getting support from your health care professional, family, and friends can help you make lifestyle changes that may prevent or reverse insulin resistance and prediabetes. You may be able to take part in a lifestyle change program as part of the National Diabetes Prevention Program.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Insulin Resistance and Pre-Diabetes

  • Are you at risk?
  • What is insulin resistance?
  • What causes insulin resistance?
  • Metabolic Syndrome
  • What is pre-diabetes?
  • What are the symptoms of insulin resistance and pre-diabetes?
  • How are insulin resistance and pre-diabetes diagnosed?
  • Risk Factors for Pre-diabetes and Type 2 Diabetes
  • Can insulin resistance and pre-diabetes be reversed?
  • Body Mass Index (BMI) & BMI Table
  • Can medicines help reverse insulin resistance or pre-diabetes?
  • Points to Remember
  • Hope through Research
  • For More Information

Are you at risk?

What is insulin resistance?

Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy.

The body’s digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time.

Insulin resistance increases the chance of developing type 2 diabetes and heart disease. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.

What causes insulin resistance?

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.

Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.

Metabolic Syndrome

Metabolic syndrome is defined as the presence of any three of the following conditions:

  • waist measurement of 40 inches or more for men and 35 inches or more for women
  • triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride levels
  • HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels
  • blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels
  • fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glucose levels

Source: Grundy SM, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735-2752.

Similar definitions have been developed by the World Health Organization and the American Association of Clinical Endocrinologists.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007.

People with pre-diabetes are at increased risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes. Type 2 diabetes is sometimes defined as the form of diabetes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, in which the pancreas makes little or no insulin.

Studies have shown that most people with pre-diabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with pre-diabetes also are at increased risk of developing cardiovascular disease.

What are the symptoms of insulin resistance and pre-diabetes?

Insulin resistance and pre-diabetes usually have no symptoms. People may have one or both conditions for several years without noticing anything. People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Other possible sites for dark patches include elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.

How are insulin resistance and pre-diabetes diagnosed?

Health care providers use blood tests to determine whether a person has pre-diabetes but do not usually test for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood. However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most doctors’ offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. If tests indicate pre-diabetes or metabolic syndrome, insulin resistance most likely is present.

Diabetes and pre-diabetes can be detected with one of the following tests:

  • Fasting glucose test. This test measures blood glucose in people who have not eaten anything for at least 8 hours. This test is most reliable when done in the morning. Fasting glucose levels of 100 to 125 mg/dL are above normal but not high enough to be called diabetes. This condition is called pre-diabetes or IFG. People with IFG often have had insulin resistance for some time. They are much more likely to develop diabetes than people with normal blood glucose levels.
  • Glucose tolerance test. This test measures blood glucose after people fast for at least 8 hours and 2 hours after they drink a sweet liquid provided by a doctor or laboratory. A blood glucose level between 140 and 199 mg/dL means glucose tolerance is not normal but is not high enough for a diagnosis of diabetes. This form of pre-diabetes is called IGT and, like IFG, it points toward a history of insulin resistance and a risk for developing diabetes.

People whose test results indicate they have pre-diabetes should have their blood glucose levels checked again in 1 to 2 years.

Risk Factors for Pre-diabetes and Type 2 Diabetes

The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45.

Risk factors for pre-diabetes and diabetes—in addition to being overweight or obese or being age 45 or older—include the following:

  • being physically inactive
  • having a parent or sibling with diabetes
  • having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
  • giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes—diabetes first found during pregnancy
  • having high blood pressure—140/90 or above—or being treated for high blood pressure
  • having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL
  • having polycystic ovary syndrome, also called PCOS
  • having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing
  • having other conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans
  • having a history of cardiovascular disease

If test results are normal, testing should be repeated at least every 3 years. Health care providers may recommend more frequent testing depending on initial results and risk status.

Can insulin resistance and pre-diabetes be reversed?

Yes. Physical activity and weight loss help the body respond better to insulin. By losing weight and being more physically active, people with insulin resistance or pre-diabetes may avoid developing type 2 diabetes.

The Diabetes Prevention Program (DPP) and other large studies have shown that people with pre-diabetes can often prevent or delay diabetes if they lose a modest amount of weight by cutting fat and calorie intake and increasing physical activity—for example, walking 30 minutes a day 5 days a week. Losing just 5 to 7 percent of body weight prevents or delays diabetes by nearly 60 percent. In the DPP, people aged 60 or older who made lifestyle changes lowered their chances of developing diabetes by 70 percent. Many participants in the lifestyle intervention group returned to normal blood glucose levels and lowered their risk for developing heart disease and other problems associated with diabetes. The DPP also showed that the diabetes drug metformin reduced the risk of developing diabetes by 31 percent.

People with insulin resistance or pre-diabetes can help their body use insulin normally by being physically active, making wise food choices, and reaching and maintaining a healthy weight. Physical activity helps muscle cells use blood glucose for energy by making the cells more sensitive to insulin.

Body Mass Index (BMI)

BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI table below to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, follow these steps:

  • Find the person’s height in the left-hand column.
  • Move across the row to the number closest to that person’s weight.
  • Check the number at the top of that column.

The number at the top of the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes.

The BMI table has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age and sex in addition to height and weight. Information about BMI in children and teens, including a BMI calculator, is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults.

Body Mass Index Table

Printer-friendly version (pdf)

Body Mass Index Table 1 of 2

Normal

Overweight

Obese

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Height
(inches)
Body Weight (pounds)
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287

Body Mass Index Table 2 of 2

Obese

Extreme Obesity

BMI

Height
(inches)

Body Weight (pounds)

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, National Institutes of Health, 1998.

Can medicines help reverse insulin resistance or pre-diabetes?

Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes. The first therapy should always be an intensive lifestyle modification program because weight loss and physical activity are much more effective than any medication at reducing diabetes risk.

Several drugs have been shown to reduce diabetes risk to varying degrees. No drug is approved by the U.S. Food and Drug Administration to treat insulin resistance or pre-diabetes or to prevent type 2 diabetes. The American Diabetes Association recommends that metformin is the only drug that should be considered for use in diabetes prevention. Other drugs that have delayed diabetes have side effects or haven’t shown long-lasting benefit. Metformin use was recommended only for very high-risk individuals who have both forms of pre-diabetes (IGT and IFG), have a BMI of at least 35, and are younger than age 60. In the DPP, metformin was shown to be most effective in younger, heavier patients.

Points to Remember

  • Insulin resistance is a condition in which the body’s cells do not use insulin properly. Insulin helps cells use blood glucose for energy.
  • Insulin resistance increases the risk of developing pre-diabetes, type 2 diabetes, and cardiovascular disease.
  • Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.
  • Causes of insulin resistance and pre-diabetes include genetic factors, excess weight, and lack of physical activity.
  • Being physically active, making wise food choices, and reaching and maintaining a healthy weight can help prevent or reverse insulin resistance and pre-diabetes.
  • The Diabetes Prevention Program (DPP) study confirmed that people at risk for developing type 2 diabetes can prevent or delay the onset of diabetes by losing 5 to 7 percent of their body weight through regular physical activity and a diet low in fat and calories.

Hope through Research

Researchers continue to follow DPP participants to learn about the long-term effects of the study. Other research sponsored by the National Institutes of Health builds on the findings from the DPP, including research focusing on lowering diabetes risk in children. Once considered an adult disease, type 2 diabetes is becoming more common in children, and researchers are seeking ways to reverse this trend.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors the HEALTHY study, which is part of a broad research initiative called STOPP T2D (Studies to Treat or Prevent Pediatric Type 2 Diabetes). The study seeks to improve the treatment and prevention of type 2 diabetes in youth, exploring the roles of nutrition, physical activity, and behavior change in lowering risk for type 2 diabetes in children. The participating 42 middle schools are randomly assigned to a program group implementing changes or a comparison group. Students in the program group have healthier choices from the cafeteria and vending machines; longer, more intense periods of physical activity; and activities and awareness campaigns that promote long-term healthy behaviors. Results from the HEALTHY study are expected in 2009.

The NIDDK also sponsors the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study, which focuses on treatment of type 2 diabetes in children and teens at 13 sites. The TODAY study will evaluate the effects of three treatment approaches on control of blood glucose levels, insulin production, insulin resistance, and other outcomes. Each approach involves medication, but one of the three treatment groups will also receive an intensive lifestyle intervention to help the participants lose weight and increase physical fitness.

More information about the TODAY study is available at www.todaystudy.org.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

For More Information

For more information about the DPP and the risk of developing diabetes, see these publications:

  • Diabetes Prevention Program
  • Am I at Risk for Type 2 Diabetes?

These publications are available at www.diabetes.niddk.nih.gov or by calling 1-800-860-8747.

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1-800-DIABETES (342-2383)
Email: [email protected]
Internet: www.diabetes.org

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your doctor for more information.

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally reviewed by George A. Bray, M.D., Pennington Biomedical Research Center, Louisiana State University, and Richard F. Hamman, M.D., Dr.P.H., Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

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