How Insulin Resistance Develops

By Marcelle Pick, OB/GYN NP

Our metabolism evolved eons ago, when our diet included fewer (and more complex) carbohydrates. Today most calories in an average diet come in the form of carbohydrates, and most of those are simple carbohydrates — sugars that quickly enter the bloodstream. The body has to release high levels of insulin to keep the level of glucose in the bloodstream from spiraling out of control. But in time the cells quit responding to this signal. At this point the body is “insulin resistant.”

One immediate consequence is that the body is forced to release even more insulin. Letting blood sugar get too high is simply not acceptable. The resulting excess of insulin in the bloodstream is called hyperinsulinemia. But the body wasn’t designed for these prolonged high levels of insulin, which disrupt cellular metabolism and spread inflammation. Diabetes occurs when the body is unable to keep blood glucose under control. But as we have noted, that is only the most obvious disease caused by insulin resistance. There are many negative health effects before full-blown diabetes.

Syndrome X and menopause

Of special concern to women is how insulin resistance disrupts fat metabolism. When the cells won’t absorb the extra glucose, the liver has to convert it into fat. Fat cells are loaded with glucose receptors, so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose, so she feels exhausted and tends to eat carbohydrate-heavy foods in search of energy.

These extra fat cells are also little estrogen factories. So weight gain contributes to the estrogen dominance that causes so many symptoms during the early stages of perimenopause.

Symptoms relating to syndrome X usually predate the onset of menopause, but most women do not complain of them until then. A woman’s health can deteriorate rapidly during menopause with the decrease of estrogen levels in the body. And digestive issues that were once merely a hassle become an affliction when the body’s natural defenses against inflammation (estrogen being one) are depleted.

In addition, women approaching menopause are particularly prone to becoming insulin resistant due to metabolic changes related to fluctuations in adrenal and thyroid secretions. In fact, the decrease of certain hormones, like estradiol, may trigger a resistance to insulin in patients who never experienced it before. Certain blood pressure medications can mask symptoms without treating the problem. Frequently, women unwittingly make their symptoms worse by trying to lose weight with low-fat, high-carbohydrate diets.

How do I know if I’m insulin resistant?

The unfortunate truth is that anyone can become insulin resistant — even if she is thin because we have access to a lot of refined carbohydrates (white bread, sugar, bagels, pasta, potatoes, sodas, processed foods with added fructose, etc.)  In fact, most of us are likely to be somewhat resistant to insulin – it is just a matter of degree. The more processed and refined food that we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.

If you suffer from high cholesterol, high triglycerides, or hypertension, you should get checked for insulin resistance, regardless of your weight or age. If you have high blood pressure, it is likely that you are also suffering from insulin resistance, and high blood pressure medication will not cure insulin resistance.