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.