Insulin resistance

Preventing type 2 diabetes and metabolic syndrome

by Marcelle Pick, OB/GYN NP

It’s sad to me that most of the women we see at our clinic either aren’t concerned about type 2 diabetes — or they already have it. I so wish that all women in the first group would learn from the women in the second. The key lesson is that your risk of developing type 2 diabetes is greater than you probably realize. The good news is you can prevent it, and the path to prevention will awaken you in so many ways.

I see patients who are not overweight and who think they’re leading fairly healthy lives end up with high blood sugar. In fact, some people who have prediabetes or metabolic syndrome are not obese, and may even be considered “thin.” Yet these women can go on to develop type 2 diabetes.

How does that happen? And how do you make sure it doesn’t happen to you? In my view, there are several factors behind the diabetes epidemic. Women don’t realize how much sugar — in all its forms — they are feeding their bodies. Of course, obesity and lack of exercise are enormous issues as well. But few people — and not many doctors — realize that diabetes is a metabolic disorder that has multiple causes.

Twenty years ago very few practitioners were aware of metabolic syndrome. In fact, it was a controversial idea. Today it’s a diagnosis that’s broadly accepted in conventional medicine. The new idea today is that there are many metabolic syndromes — a family of related disorders which lead to diabetes as well as to other chronic and degenerative diseases. That may sound scary, but it’s actually good news. It means that medicine is getting insight into how the body works, how to see problems much earlier, and how to prevent disease.

So let’s look into what you can learn now about your risks of developing type 2 diabetes — and how to make sure it doesn’t happen to you.

What is diabetes?

If I told you that people with untreated diabetes were literally starving, would you believe me? It may sound extreme, but it’s true. The term diabetes mellitus is actually derived from the Greek words meaning “to run through.” And this is exactly what’s happening. In diabetes, the nourishment we take in cannot get into our cells, and literally runs through the body instead of feeding it.

Think of feeding your hanging plants with too much nutrient-rich water. Instead of the roots drinking in the nutrients and water, the nourishment runs straight through the soil and trickles out onto the floor. No matter how much you feed the plant, the water runs through it. Eventually its leaves start to yellow, shrivel, or drop. Like your plant, the cells of a diabetic patient can’t absorb the nourishment they need.

Under normal circumstances, our bodies break down food we eat into potential energy. That energy enters the blood stream mostly in the form of glucose. Glucose is then escorted into our cells with the help of the hormone insulin, where it becomes the fundamental fuel for all cell activity. In diabetes, our cells can’t access glucose because insulin is either absent or unable to open the cell door to let it in.

The result is excess glucose or “sugar” floating around in the blood with no place to go. In a desperate effort to restore blood sugar levels to normal, our bodies end up eliminating the unused glucose, allowing it to “run through” our bodies, depriving us of the energy and nourishment we need.

Just as the leaves shriveling on your houseplant signal trouble, your body will try to alert you when it isn’t getting enough fuel. The following are warning signals that your body may already have type 2 diabetes:

• Increased hunger (especially in the form of carbohydrate cravings)
• Increased thirst
• Exhaustion
• Frequent urination
• Weight loss or gain
• Blurry vision
• Cuts or sores that won’t heal

Because your cells aren’t being fed, your brain sends out the message that you’re hungry, tired and thirsty. And though you may be eating and drinking more, your cells are literally starving. This faulty insulin signaling is the thread common to all forms of diabetes.

There are three main types of diabetes: type 1, type 2 and gestational diabetes. Type 1 is characterized by a defect in the islet cells of the pancreas that makes them unable to produce any insulin at all. Previously referred to as juvenile diabetes, type 1 is thought to be autoimmune in nature and is generally diagnosed in early childhood. Type 2, also commonly referred to as adult onset diabetes mellitus or noninsulin-dependent diabetes, develops when cells become resistant to insulin. And gestational diabetes occurs late in pregnancy when a mother’s hormones interfere with her ability to utilize insulin. All forms of diabetes, if left untreated, can lead to serious complications — including eye problems, compromised circulation, kidney damage, and nerve damage.

It may give you some comfort to know that type 2 diabetes doesn’t just hit overnight, but develops gradually over time. And though there are several risk factors that can increase your likelihood of developing it, the progression toward type 2 diabetes begins when you become resistant to your own insulin. In functional medicine, insulin resistance is an early indication of metabolic syndrome.

The connection between metabolic syndrome and type 2 diabetes

Twenty years ago, metabolic syndrome was almost an unknown idea among conventional practitioners. Today it is recognized as the precursor to full-blown diabetes. This is gratifying because it means conventional medicine accepts the idea that diabetes develops over time — it doesn’t just appear overnight.

The diagnosis of metabolic syndrome is made when three or more of five disorders are present in the patient: high triglycerides, low HDL cholesterol, high blood sugar, high blood pressure and an above-average waistline.

In functional medicine, insulin resistance and metabolic syndrome are the same thing. We view them this way because they begin with the same faulty cell signaling that, over time, causes metabolic disorders and damage, symptoms such as those used in the conventional diagnosis of metabolic syndrome, and eventually, degenerative diseases.

New research is showing that we can use specific nutrients to sort out the mixed-up cell signaling that occurs in metabolic syndrome and reverse the problem. This is fascinating to me because it promises that we can use food and supplements to prevent or reverse insulin resistance and other metabolic disorders instead of medication with its unwanted side effects! We will be hearing more about this in the next few years, but in the meantime following a Mediterranean diet can help provide similar effects.

Interestingly, making poor food choices is one of the big culprits leading to insulin resistance in the first place.

What causes prediabetes and the diabetes progression?

Type 2 diabetes manifests itself differently in each individual. And though symptoms and severity may vary, the starting point for most women is a diet with a high glycemic load (high in refined sugars and carbohydrates), combined with inactivity and a family history of type 2 diabetes. Next, the body reacts to high blood sugar by producing more insulin. With persistently high insulin levels, cells eventually build up a resistance to it and stop opening their doors. This stage, known as insulin resistance, is when glucose begins to pass through the body without being absorbed.

Soon enough, the pancreas gets the message and decreases insulin production. As insulin levels drop and diet remains high in glucose, blood sugar continues to creep up. Ultimately, insulin levels drop and blood sugar jumps dramatically. This is the point where the official diagnosis of diabetes is typically made. Since the harmful effects of insulin resistance cut across all the body’s systems, the severity at this point varies widely from individual to individual based on the health of their other systems. While some people with diabetes continue to make small amounts of insulin and can control their blood sugar through diet, others stop producing insulin altogether and have to rely on outside sources of insulin.

The progression is shown in the following diagram.

Numbers may differ from lab to lab, but type 2 diabetes is generally diagnosed when fasting blood glucose has reached 126 mg/dL or higher (compared to a normal range blood sugar level between 70 and 99 mg/dL). At Women to Women, we feel it’s much more beneficial to watch trends in blood glucose over time than to stick with one number.

In other words, if I see a woman’s blood glucose going up a little every year — even if those levels are still well under 99 mg/dL — I begin working with her right away to make healthy changes in her life. A gradual increase in blood sugar means that her cells are already insulin resistant, though the degree depends on her unique situation. And this is our chance to intervene early!

Fortunately, there are several stops on the pathway to type 2 diabetes and, as with any good road trip, there are various routes available and opportunities to turn around. The problem is that many conventional healthcare practitioners don’t step in early enough to change a patient’s course until it becomes difficult to reverse.

Waiting for sugar

It makes sense that if one out of every three of us is walking around with prediabetes, healthcare practitioners would be prepared to implement strategies to halt its progression to type 2. But this isn’t always the case. Standard blood tests look at blood sugar, among other things, but leave out one of the first indicators of prediabetes: insulin. Remember that insulin levels are among the first markers of change on the pathway to diabetes. At first they increase as insulin resistance sets in, then they start to decrease. So understanding how your insulin is working can help you to make important changes early on.

Sadly, many conventional practitioners lack the time to look closely at a patient’s lifestyle to determine if they could benefit from an insulin test. In fact, there is no set protocol for intervention until blood sugar begins to creep up, which means the patient has passed insulin resistance already. And though you can still reverse the problem, you’re much further along by then.

At Women to Women, we encourage our patients to take the driver’s seat when it comes to their health. Oftentimes, this means taking an honest look at your symptoms, nutrition and exercise habits, and it could also mean deciding for yourself that you could benefit from an insulin test. There is nothing wrong with requesting an insulin test from your healthcare provider yourself.

Staying on top of insulin early can help you avoid type 2 diabetes, insulin imbalance — and the problems associated with it, including imbalance of your sex hormones.

Insulin and hormonal balance in menopause

The hormonal systems in our bodies are intricately linked by what is called the endocrine system. And contrary to what many practitioners think, when one aspect of the endocrine system is off-kilter, it can throw other parts out of balance as well. This is the case with diabetes and menopause. Insulin interacts with estrogen, testosterone, DHEA and thyroid hormones. When insulin is out of balance from a poor diet, it can interrupt the regulation of estrogen, testosterone and other hormones. This can make the already bumpy hormonal path during perimenopause even more difficult.

Over time, poor insulin control can send all the body’s systems — neuroendocrine, cardiovascular, digestive and immune — out of balance, worsening your menopausal symptoms significantly.

What many women don’t realize is how nutrition is integrally connected to the web of hormonal balance. Put simply, if you change your diet, you can change your hormones. By eating balanced meals, including complex carbohydrates and high quality protein and fats, you can regulate the insulin your body releases and keep estrogen and testosterone in balance.

Getting back on track starts with making healthier choices.

The pillars of diabetes control

How many times have you reached for a cookie or a bag of potato chips after a bad day? We’ve all been there, and I’m the first to admit that these foods feel good in the short-term. But preventing diabetes means focusing on long-term solutions — nutrition, exercise, balance!

In fact, a recent study done on over 3000 people at risk for diabetes showed that lifestyle interventions, such as weight loss and regular exercise, reduced the incidence of type 2 diabetes by 58%, whereas Metformin, a common antidiabetic drug, reduced it by only 31%. Additionally, whole foods rich in phytonutrients — such as those emphasized in the Mediterranean diet — have been shown to be favorable in lowering markers of insulin resistance. What all this research tells us is something that makes complete sense — that preventing diabetes through a holistic lifestyle approach is far easier and more effective in the long-term than any drug solution could ever be. And the first cornerstone of diabetes control is diet.

Nutrition — our food talks to our genes. If I had to pick the gold star in preventing diabetes, it would be food. What you eat can prevent and even control type 2 diabetes. At Women to Women we view food as complex information that our cells have been primed through the ages to receive. In other words, good food talks to your genes to keep things going just the way Mother Nature intended. Rising rates of type 2 diabetes should come as no surprise when you consider that the ways in which we grow and process our food have changed so drastically in just one or two generations, while our human genetic constitution hasn’t changed much in 40,000 years!

This might seem like a novel idea, but there is nothing revolutionary about the concept of balanced meals. This means that each time you sit down to eat, you should include protein, complex carbohydrates, healthy fats, and as many non-starchy fruits and vegetables as you can. This will help to keep your insulin levels in balance and make it less likely for you to store too much energy in the form of fat. And with insulin in good control, you will have better balance throughout your endocrine system, including other hormones like cortisol, estrogen and progesterone.

Insulin control is strongly affected by the glycemic index of the foods you eat. The glycemic index of a food is a measure for how quickly insulin rises in response to the amount of glucose entering your blood stream after you eat it. Foods high in protein tend to have a lower glycemic index than carbohydrates. Simple carbs, like white flour and sugar, have a higher glycemic index than complex carbs like whole grains and fresh fruits. Simple carbs can overload your insulin receptors and make insulin resistance more likely to develop. To prevent the quick sugar surge from high glycemic foods, balance each snack and meal with all four basic groups.

But it’s about more than just the ratio of protein to carbohydrate to fat in your diet. The plant kingdom has been quietly evolving alongside us humans for many years, and the micronutrients available in fresh, richly colored, organically grown fruits and vegetables are instrumental in preventing the diseases of modern life — including type 2 diabetes. So choose the best information your food dollar can buy, and remember that all four food groups play key roles in your digestion, metabolism and hormonal balance.

Exercise — move your body. Getting regular exercise is another excellent way to help prevent yourself from developing type 2 diabetes. Not only does it keep your weight down, but it lowers blood sugar, helps you utilize insulin more efficiently, keeps your cholesterol levels balanced, and improves circulation, thereby keeping your heart and blood vessels healthy and strong. Exercise also supports nervous system health and releases positive endorphins to boost your mood! The benefits are endless.

While cardiovascular exercise is specifically beneficial to your heart, toning muscle — through weight training, yoga, Pilates or swimming, for example — is also a great way to increase the activity of your insulin receptors and prevent insulin resistance. This is because of all the tissues in your body, your muscles use the most glucose, so they are most important for keeping your blood glucose levels steady. And once you learn how good it feels to move your body, you’ll be looking forward to fitting exercise into your schedule as much as possible!

Blood glucose — better regulation through diet and lifestyle. Of course blood glucose is important as well — it’s what we’ve been talking about getting into balance. For women who already have diabetes, it’s important to check blood glucose daily. But for those concerned with preventing diabetes, I recommend getting it checked a couple times a year to see if it’s trending upward.

As I mentioned above, a normal fasting blood glucose should be well under 100 mg/dL, but it is much more important to watch the trend. Once you go above 100 mg/dL, you are considered prediabetic, which usually means that your blood glucose levels are somewhere between 100 and 126 mg/dL — higher than normal, but not high enough to be considered diabetic. You are insulin resistant at this point and much more likely to develop type 2 diabetes and other factors associated with metabolic syndrome — unless you step in.

Rather than focus on the numbers, know that you have much more control over blood glucose by eating well and getting more exercise. Astoundingly, 65% of diabetes patients die from heart disease or stroke, which tells us that treatment should be about more than just glucose control. Making lifestyle changes allows you to reap huge benefits in blood sugar control right away.

Emotions — feed your soul! You can’t go wrong with good diet and plenty of exercise, but at Women to Women, we understand that there’s more to this equation than just eating right and exercising. And that’s the emotional piece. Reaching for sugar may be a sign that you’re lacking sweetness in your life. I want you to think about all the things that make you happy and consider the possibility that these things nourish you in profound ways that your food — no matter how impeccable — cannot. Whether it’s spending more time with your children, relaxing on your own, painting or digging around in the garden, giving yourself time to do the things you love will have a positive effect upon all your systems — from your heart to nerves to immunity to metabolism.

Just remember that feeling better means looking at the whole picture — your happiness, nutrition, exercise habits, hormonal balance, blood pressure, and cholesterol. But while we always encourage women to start inward on a quest for overall health and diabetes prevention, it also makes sense to look at what’s all around you.

Diabetes and our environment

From the four pillars outlined above, we can begin to see how the rising rates of diabetes may be the result of a complex interplay between our genes and environmental influences. It stands to reason, then, that scientists are starting to look more closely at how our environment affects our risk of diabetes. No one will argue with the fact that as modern technology surges on, we benefit from lots of conveniences. But along with all these conveniences we’re also taking in the heavy metals and manmade toxins that come with them. Materials used to create plastics, pesticides, household cleaners, flame retardants, rugs and furniture, computers — even white paper — all contain what are known as endocrine disruptors. And many of these foreign molecules have been shown to mimic the action of hormones in our bodies.

Since hormones turn on and off bodily functions, open cell doors, keep our moods stable, and so much more, it makes sense that endocrine disruptors could contribute to a shift in insulin production or utilization in the body. In fact, a recent study found that exposure to the specific kind of endocrine disruptors known as persistent organochloride pollutants (POP’s) may contribute to the development of type 2 diabetes.

Keep in mind, however, that endocrine disruptors are most likely not the primary cause of type 2 diabetes, though they certainly may contribute. And the good news is that there are many things you can do in your life to limit your exposure to these unwanted disrupters. Start by throwing out your plastic food containers and replacing them with glass, avoiding the use of plastic in the microwave, and giving your body a chance to recover by implementing regular detox and drinking more water.

There are lots of ways to help yourself when it comes to the prevention of type 2 diabetes. Just remember to look at the whole picture.

Preventing diabetes holistically — the Women to Women approach

At Women to Women, we believe you are the most important caretaker of your body. This leaves you with choices when it comes to what you eat, whether you exercise, and the spaces with which you surround yourself. This can be a powerful — and, for some women, overwhelming — concept.

But making better choices doesn’t have to be difficult. Start by determining where you are and what your goals are. You may want to put it all down on paper. We find that articulating and defining what we want and don’t want in life can help us more easily achieve our greatest desires.

Here are a few ideas to get you started:

• Move toward healthier meals and snacks. It may be true that fast food is less expensive and more expedient than buying fresh whole foods and cooking yourself, but keep in mind the old adage: Food is the cheapest medicine you can buy. And when you do need to eat in a hurry, even making different fast food choices can make a world of difference. Chose the grilled chicken instead of a cheeseburger next time. Or simply drink water instead of soda with your meals. Be sure to include the four food groups in all your meals, and don’t forget to check the labels for trans fats and high-fructose corn syrup. Remember that you don’t have to do everything all at once. Little by little, making better food choices will help you reverse your insulin resistance within weeks. (You may find our articles on nutrition helpful as you prepare to balance your meals.)



• Strive for regular physical activity. We don’t advise jumping right into the recommended 40 minutes a day if you haven’t exercised in a while. Just start by doing something active a few days a week. Getting into the habit of moving your body and increasing your heart rate is what counts. Be sure to talk with your healthcare practitioner about what forms of exercise are safe for you. Proceed from there to find an activity that fits your life. Nearly everyone can benefit from walking more. Before you know it, you’ll work up to a longer period of exercise and start to feel all the positive results!



• Enhance your nutrition with vitamins and minerals. Our cells are constantly using micronutrients in their everyday functions to produce energy and keep us thriving. Diabetes and prediabetes compromise the nutrients our bodies are able to take up, which can lead to nutritional deficiencies. Adding a high-grade multivitamin/mineral complex and supplemental omega–3 fatty acids will help fill in any nutritional gaps, regulate hormones such as insulin, and protect your body from the complications associated with diabetes. In fact, certain vitamins, minerals, and phytonutrients have been shown to be particularly helpful in terms of insulin resistance and diabetes.



• Detox your personal environment. Avoid unnecessary chemical exposure by using glass instead of plastic to store your food and drink. Never use plastic in the microwave, or avoid the microwave altogether. Make a point to use all-natural cleaning products and cosmetics. Drink plenty of water, and try our two-week Quick Cleanse to detox your system.

It will also help your health on all levels, including your endocrine system, to limit time you spend in stressful relationships and environments. As scientists are now discovering, stress takes a heavy toll on our bodies. Ironically, the very technology invented to save us time, such as laptops, cell phones and e-mail, may afford us less time to decompress. Make time to relax and get away from the pressures of life. Even if it’s just a one-day yoga retreat, a walk on the beach or an hour-long bubble bath, taking a holiday from stress is never a bad thing for your body.

• Consider other complementary treatments. As you may understand by now, diabetes is a complex disease. It manifests itself differently in each individual and the preventative methods that work for some may not be enough for you. Certain complementary treatments have shown positive effect in managing the risk factors leading to diabetes, and may be worth looking into. Whatever course of treatment you pursue, remember to work closely with an experienced practitioner for the best results.

Find the sweetness in your life!

Learning how to prevent type 2 diabetes changes the way we look at everything — the way we eat, travel, exercise, work, and view the world around us. And, trust me, all of this is for the better! It can certainly feel overwhelming sometimes. It helps to remember that you can’t change everything in one day — nor should you try. Revising our habits takes time and commitment.

At Women to Women we believe in balance, which is achieved through a dynamic equilibrium between forces. There are positives to every negative, and though preventing diabetes may seem daunting, what it requires is for you to pay more attention to your body and do what makes you feel good in the long run. This is never a bad thing. Embrace the chance to take better care of yourself, and before you know it life will be sweeter than you ever imagined possible!

Our Personal Program is a great place to start

The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.

• To learn more about the Program, go to How the Personal Program works.
• To select the Program that's right for your symptoms, go to Choose the plan that works for you.
• To assess your symptoms, take our on-line Hormonal Health Profile.
• If you're ready to get started, learn about our risk-free trial.

If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.

We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.

Related to this article:

References & further reading on preventing type 2 diabetes

Original Publication Date: 04/19/2007
Last Modified: 08/17/2009
Principal Author: Marcelle Pick, OB/GYN NP