Insulin resistance and diabetes — two interconnected yet distinct health conditions — have been the subject of intense discussion on social media.
Limited literature and awareness on insulin resistance means that there is a demand for information on the difference between the two and why it might be important to know if one is insulin resistant.
Dr Sudhir Kumar, Consultant Neurologist from Apollo Hospital in Hyderabad, says, “Diabetes and prediabetes are among the commonest risk factors of stroke and heart attack. Doctors have realised that it is better to prevent diabetes and coronary vascular disease. Treatment most often does not result in complete recovery. Therefore, interest in recognising insulin resistance (IR) has gone up in recent times.”
Difference between diabetes and insulin resistance
Endocrinologists say that diabetes and insulin resistance are related but distinct conditions that involve problems with insulin, produced by the pancreas. Insulin plays a crucial role in regulating blood sugar levels.
Dr Abhay Gundgurthi, an endocrinologist from The Sagar Centre for Diabetes in Bengaluru, to explains the difference.
“Diabetes is a chronic metabolic disorder characterised by high blood sugar levels (hyperglycemia) due to either inadequate insulin production or the body’s inability to use insulin effectively. The body’s immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. As a result, people with type 1 diabetes produce little-to-no insulin. They require insulin injections or an insulin pump to manage their blood sugar levels effectively,” Dr Gundgurthi tells South First.
“In type 2 diabetes, it is a combination of insulin resistance and reduced insulin production. Insulin resistance means the body’s cells do not respond well to insulin and, as a result, glucose uptake into cells is impaired.
“This leads to higher blood sugar levels. Initially, the pancreas compensates by producing more insulin but, over time, it may become unable to keep up with the body’s demands, leading to insufficient insulin levels,” Dr Gundgurthi explains.
He adds that insulin resistance is a key factor in the development of type 2 diabetes.
Putting it more simply, gastroenterologist Dr Rajeev Jayadevan, who recently spoke to a group of 400 youngsters aged 17-19 years on the subject, tells South First: “Glucose is fuel for our body’s cells. Insulin is required for glucose to enter the body’s cells, where it can be burned as energy. When this entry becomes difficult for various reasons, it is called insulin resistance. Consequently, the cell is unable to use the glucose that is circulating in bloodstream.”
Symptoms of insulin resistance
Sharing her struggle with insulin resistance, Jyoti Bhupati, a 43-year-old content writer from Bengaluru, says, “I was puzzled by my constant fatigue even after eating a meal. My energy levels were extremely low and I would constantly crave for sugary food. Immediately after eating those I would feel giddy, sometimes black out too. My waist size began to expand as well.”
Similarly, businessman Sanjay Shriram recalls that the darkness around his neck began to increase. Interestingly, he was very lean but eating certain foods like ice cream and wheat would cause him to sweat, feel dizzy, and there were skin tags on his face too. Sanjay also felt very sleepy in the afternoons after lunch.
That is when their doctors asked Bhupati and Shriram to get a HOMA IR blood test done and diagnosed them with insulin resistance.
“I was advised dietary changes and exercise. It was challenging, but it helped me avoid diabetes,” says Shriram.
Similarly, 50-year-old Deepak Shinde recounts his journey with diabetes, “I wish I had known about insulin resistance earlier. I neglected the signs and eventually developed type 2 diabetes. It’s been tough, but with proper medication and lifestyle adjustments, I manage it.”
Dr Mohan V, a renowned diabetologist from Dr Mohan’s Diabetes Specialty Centre, in a recent video, gives a simple tip to measure IR. He says, “Using an inch tape, one should measure the waist size. If it is above 80 cm for women and above 90 cm for male, then you probably are insulin resistant.”
Dr Gundgurthi adds that another good marker for IR is fasting lipid blood test or triglycerides ratio to HDL.
“Triglycerides to HDL ratio has to be below 2. Anything above that means the person is insulin resistance,” explains Shashi Iyengar, a metabolic health coach who works in the field of low-carb nutrition for diabetes remission.
He also warns that it is not true that only those who are obese and have increased waist size are insulin resistant. “In India, even lean people are prone to be insulin resistant,” he He tells South First.
Why does insulin resistance occur?
According to Iyengar, IR often occurs due to genetic predisposition, however, lifestyle factors such as obesity, sedentary behaviour, and an unhealthy diet can also contribute to its development.
Although insulin resistance itself is not diabetes, it is a significant precursor to type 2 diabetes, a condition in which the body can’t use insulin effectively, resulting in high blood sugar levels.
“Insulin resistance is a warning sign that the body’s glucose-regulating system is struggling. Early detection and lifestyle changes can help prevent progression to diabetes,” he says.
Dr Rajeev Jayadevan adds that advancing age, lack of exercise, abdominal obesity due to bad dietary choices, lack of sleep, familial factors, and hormonal imbalance such as polycystic ovarian syndrome could worsen insulin resistance.
“While all the factors are not preventable, health education at an early age to avoid as many factors as possible will reduce the impact of insulin resistance in future,” adds Dr Rajeev.
How to test for insulin resistance
Being overweight or obese, an impaired glucose tolerance test, HbA1c levels >5.7, and abnormal lipid profile (elevated total & LDL cholesterol, elevated triglycerides, and lower HDL cholesterol levels) are all markers of insulin resistance.
Dr Sudhir Kumar says that fasting insulin levels are also useful in some cases, as people with IR have elevated fasting insulin levels.
He explains that the cornerstone of managing IR is exercise — both aerobic exercises and strength training, along with weight control. Diets low in carbohydrate have been advocated to reduce the insulin resistance. There is no approved medicines for treating IR.
Why is insulin resistance dangerous?
Insulin resistance is the precursor for many serious diseases, most notably diabetes mellitus and cardiovascular diseases, such as heart attack and stroke, explains Dr Sudhir Kumar.
A recent school-based study from a city in eastern India showed that a higher prevalence of insulin resistance was seen in children who were overweight or obese. The study claimed that around 32.3 percent of children who were overweight or obese had a HOMA IR level of 2.5 and above. This could predict an increased future risk of adverse cardiovascular events in the studied children. The findings of this study could help in planning and implementing primary prevention programmes targeting weight management and lifestyle change in school children.
“It is not just in adults, there is an increase in children too showing insulin resistance. This is dangerous and there are several diseases that are associated with insulin resistance,” explains Shashi Iyengar.
Dr Rajeev explains that IR is the central axis of multiple disease conditions, including type 2 diabetes, and contributes to obesity and heart disease.
Studies have shown that chronic stress, ultra-processed food, sugar, lack of sleep, refined carbohydrates, sedentary lifestyle, and use of seed oils can lead to insulin resistance. This, in turn, can lead to the risk of heart disease, erectile dysfunction, stroke, high blood pressure, certain cancers, gout, type 2 diabetes, Alzheimer’s disease, obesity, inflammation, migraines, PCOS, arthritis, osteoarthritis, and dementia.
Ways to reduce insulin resistance
Dr Abhay explains that insulin resistance is possible and can be completely reversed by making lifestyle changes.
Exercising is the easiest way to improve insulin sensitivity and the effects are almost immediate. One can lose belly fat too through this. Also, reducing sugar intake, ultra-processed food, stopping seed oil consumption, following a low carbohydrate diet, and adding protein to your diet can help.
Dr Shraddhey Katiyar, a doctor known well on Twitter for his tips on managing insulin resistance, says that signs your insulin resistance is improving or your HOMA IR level is falling include:
- not feeling hungry after meals
- not having much sugar cravings
- decreasing triglycerides
- increasing HDL
- reduction in waist size
- regularisation of periods
- reduction in body and joint pain