Voice of the Diabetic

Voice of the Diabetic

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INSULIN RESISTANCE EXPLORED

by Peter J. Nebergall, Ph.D.

Photo: portrait. Caption: Peter J. Nebergall, Ph.D.

Diabetes Mellitus is not one, but two different conditions,

that share the symptom of elevated blood sugars. Type 1 diabetes arises from

insulin deficiency, from the absence of the hormone, and thus type 1 diabetics

need to inject insulin, to preserve life. Type 2 diabetes arises from a body's

inability to correctly and completely use the insulin it is producing, and we

call that initial condition insulin resistance.

What is "insulin resistance?" What do we know about it? How can we

change it? Insulin resistance is a serious condition, closely correlating with

obesity, heart disease, and high blood pressure. We do not know the exact mechanism

of insulin resistance, only that it is a measurable lessening in the body's

ability to metabolize glucose, even though an otherwise adequate supply of insulin

may be present. We don't know what the root cause is, but we suspect it is genetic

(which would explain why type 2 diabetes so much seems to run in families).

Although there is close correlation between obesity and insulin resistance,

it is not simple "cause and effect." Being overweight does not cause

insulin resistance -- even though losing weight does indeed reduce insulin resistance.

There are many overweight people who are not insulin-resistant, and these folks

may never develop type 2 diabetes.

It appears that if a person carries the genetic trait for insulin resistance,

but follows a healthy lifestyle (good diet, not too much of it, plenty of regular

exercise), they may show little or no overt insulin resistance. If that same

person slips into overeating and under-moving, one may expect the insulin resistance

to become overt (obvious and apparent), and perhaps type 2 diabetes to appear.

Taking it further, if such a person, overweight, under-active, takes control

of their lifestyle, loses the weight, and commences a regular exercise program,

the insulin resistance should drop, perhaps even into insignificance. This "diet

and exercise" approach is the core of all good blood glucose self-management

programs. There is no better argument for living a healthy lifestyle.

Insulin resistance as a syndrome cross-correlates with a number of potentially

damaging conditions, most cardiovascular in nature. Although we cannot say which

conditions cause insulin resistance, which are caused by it, and which are merely

covalent, we know that aggressively reducing it, by lifestyle change and/or

by medication, can both improve general health and lessen the severity and likelihood

of diabetes complications.

Talk to your doctor. If you have it, your health care team can help you keep

it under control. If you have progressed to full blown type 2 diabetes, your

doctor can help you treat it, both with lifestyle change and medications, like

Metformin, Actos, and Avandia, that reduce insulin resistance. There is much

that can be done.

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