Insulin Resistance

Insulin resistance is when your body does not respond properly to insulin, the hormone that moves sugar from your blood into your cells. Lab Tests Online UK explains that the pancreas makes more insulin to compensate, so blood sugar can stay normal for a while. HEART UK describes what can come next: over time the strain on the pancreas can become too much, blood sugar rises and stays high, and that is type 2 diabetes. The stage before it, when blood sugar is raised but below the diabetes range, is prediabetes.

The NHS links insulin resistance to metabolic syndrome, the group of health problems that includes a large waist, raised blood pressure and unhealthy blood fats. Because insulin resistance works in the background, guidelines assess it through several measurements read together, which the sections below explain.

Insulin resistance often has no symptoms in its early stages, according to Lab Tests Online UK. What it produces are signs a clinician can measure or see:

• a waist that is more than half your height
• raised blood pressure
• an HbA1c in the prediabetes range
• high triglycerides or low HDL cholesterol on a lipid profile
• dark, velvety patches of skin in the armpits, neck or groin

Those skin patches are called acanthosis nigricans. The NHS says obesity is their most common cause, lists type 2 diabetes among the others, and advises seeing a GP about any new dark patches. Tiredness and sugar cravings are often listed online as signs, but many things cause them, so on their own they cannot show insulin resistance. The measurements above can.

The signs of insulin resistance are the same in women as in men: usually no symptoms, with changes that show up in waist, blood sugar and blood fats. Three things can make it easier to miss or confuse:

• perimenopause, because Diabetes UK points out that tiredness and vaginal itching can be symptoms of both perimenopause and type 2 diabetes
• the menopause, because the NHS notes that weight gain at this stage often settles around the stomach and upper body, the pattern linked to insulin resistance
• pregnancy, because the NHS says women who have had gestational diabetes are more likely to develop type 2 diabetes later

If you have had gestational diabetes, the NHS advises a blood test for diabetes every year once your postnatal result is normal.

Insulin resistance has several causes that add together, and fat stored in and around the organs is a central one. Diabetes UK explains that fat stored around the liver and pancreas can cause insulin resistance, and that some people carry this fat at a healthy weight. The risk factors described by Diabetes UK and Lab Tests Online UK include:

• carrying extra weight, especially around the waist
• a family history of type 2 diabetes
• a Black African, African Caribbean or South Asian background
• getting older
• too little physical activity and long periods of sitting
• poor quality or disturbed sleep
• smoking
• having had gestational diabetes

Some of these you cannot change, such as age and family history. The others are where a plan starts, and a waist that is more than half your height is the everyday sign of the fat that matters here.

There is no single routine test for insulin resistance in the UK: a clinician judges it from your waist, blood pressure, HbA1c or fasting glucose, and a lipid profile. Lab Tests Online UK says most guidelines recommend those measures and do not recommend measuring insulin routinely, because the problems insulin resistance causes are easier to measure directly.

Some private labs offer a fasting insulin test. Lab Tests Online UK calls the use of insulin measurement for this purpose controversial, and notes that insulin results differ between laboratories, so a result is only useful when a clinician reads it alongside everything else. It also says insulin cannot be measured at home: a finger-prick kit measures glucose, which is a different thing. Single blood tests at London clinics and labs cost about £43 to £99 each, so it is worth knowing what a result will change before paying for it.

The clearest link runs from weight gain to insulin resistance: fat stored around the liver and pancreas makes the body respond less well to insulin. Diabetes UK adds that adults tend to gain weight with each decade, and that weight gained with age can raise the risk even while you are still in the healthy weight range.

Losing weight helps insulin work better. Diabetes UK says weight loss is likely to have the biggest impact if you are living with overweight or obesity, and that losing even a small amount of weight can help lower average blood sugar.

If you have tried and the weight will not move, a clinical assessment can look for other reasons, such as an underactive thyroid, which the NHS lists as a cause of weight gain.

The eating pattern that helps insulin resistance is the one Diabetes UK recommends for lowering blood sugar and type 2 diabetes risk, and it needs no special products. Its advice is to eat:

• more vegetables, fruit, wholegrains and foods close to their natural state
• fewer sugary drinks
• fewer refined carbohydrates, such as white bread, white rice and sugary breakfast cereals
• less red and processed meat, such as bacon, ham and sausages
• fewer processed foods overall

The NHS advice for metabolic syndrome adds eating less saturated fat. Portions count as well, because losing weight is one of the main ways to improve insulin resistance if you are overweight. Diabetes UK asks you to speak to your GP first if you are planning big changes to your diet or activity.

Insulin resistance improves with changes to weight, activity, sleep and smoking, which Diabetes UK says help insulin work better in your body. Lab Tests Online UK describes treatment the same way, as changes in diet and lifestyle. In practice that means:

• losing weight if you are overweight, which Diabetes UK says is likely to have the biggest effect
• moving more, and breaking up long periods of sitting
• sleeping well, since Diabetes UK lists poor or disturbed sleep as a risk factor for high blood sugar
• stopping smoking

There is no quick fix, and Diabetes UK advises small goals you can keep for the long term. The change shows on a repeat HbA1c, a lipid profile and your waist measurement, and a medical weight loss programme sets those as the numbers to review.

See your GP before starting any programme if you have symptoms that can mean type 2 diabetes. The NHS lists:

• feeling very tired
• peeing more than usual
• feeling thirsty all the time
• losing weight without trying to
• blurred vision, cuts that are slow to heal, or itching around the penis or vagina and repeated thrush

The NHS adds that not everyone with type 2 diabetes has symptoms, so it is important to get checked. See a GP about any new dark patches of skin too. If eating or your weight is causing you distress, speak to your GP or contact Beat.

A first assessment arranged by Medical Weight Loss London at UNTIL Soho looks for insulin resistance the way guidelines do. It measures your waist, weight and blood pressure, and arranges HbA1c, a lipid profile and liver function tests, with thyroid function and a full blood count to check for other causes of weight gain. First assessments at London clinics cost about £150 to £310, with tests on top (what a programme costs).

The terms are explained in the weight management glossary. Ask what to get checked and UNTIL Health Concierge arranges the appointment with a registered clinician.