Insulin resistance and pre-diabetes

National Diabetes Information Clearinghouse

Insulin resistance is a silent condition that increases the chances of developing diabetes and heart disease. Learning more or less insulin resistance is the first step you can take toward making lifestyle change that will help you prevent diabetes and other form problems.

What does insulin do?

After you eat, the food is broken down into glucose, the simple sugar explicitly the main source of vitality for the body's cells. But your cell cannot use glucose without insulin, a hormone produced by the pancreas. Insulin help the cells lug in glucose and convert it to perkiness. When the pancreas does not make satisfactory insulin or the body is unable to use the insulin i.e. present, the cells cannot use glucose. Excess glucose builds up surrounded by the bloodstream, setting the stage for diabetes.

Being obese or overweight affects the way insulin works in your body. Extra grease tissue can make your body resistant to the achievement of insulin, but exercise helps insulin work in good health.

How are insulin resistance, pre-diabetes, and type 2 diabetes linked?

If you enjoy insulin resistance, your muscle, fat, and liver cell do not use insulin properly. The pancreas tries to keep up near the demand for insulin by producing more. Eventually, the pancreas cannot save up with the body's want for insulin, and excess glucose builds up in the bloodstream. Many people beside insulin resistance have glorious levels of blood glucose and elevated levels of insulin circulating in their blood at alike time.

People with blood glucose level that are higher than run of the mill but not yet contained by the diabetic range hold "pre-diabetes." Doctors sometimes call this condition impair fasting glucose or impair glucose tolerance, depending on the test used to diagnose it. About 16 million ancestors in the United States own pre-diabetes and most don't know it.

If you have pre-diabetes, you own a higher risk of developing type 2 diabetes, formerly call adult-onset diabetes or noninsulin-dependent diabetes. Studies have shown that most society with pre-diabetes step on to develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight--which is just about 10 to 15 pounds for someone who weighs 200 pounds--by making modest change in their diet and height of physical activity. People near pre-diabetes also have a superior risk of heart disease.

Type 2 diabetes is sometimes defined as the form of diabetes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, contained by which the pancreas makes no insulin at adjectives. At first, the pancreas keeps up beside the added demand by producing more insulin. In time, however, it loses the means to secrete satisfactory insulin in response to meals.

Insulin resistance can also materialize in ethnic group who have type 1 diabetes, especially if they are overweight.

What cause insulin resistance?

Because insulin resistance tends to run within families, we know that genes are to some extent responsible. Excess weight also contributes to insulin resistance because too much flabby interferes with muscles' expertise to use insulin. Lack of exercise further reduces muscles' dexterity to use insulin.

Many people next to insulin resistance and high blood glucose hold excess weight around the waist, giant LDL (bad) blood cholesterol levels, low HDL (good) cholesterol level, high level of triglycerides (another fat within the blood), and high blood pressure, adjectives conditions that also put the heart at risk. This combination of problems is referred to as the metabolic syndrome, or the insulin resistance syndrome (formerly called Syndrome X).

What are the symptoms of insulin resistance and pre-diabetes?

Insulin resistance and pre-diabetes usually own no symptoms. You may have one or both conditions for several years in need noticing anything. If you own a severe form of insulin resistance, you may get gloom patches of skin, usually on the stern of your neck. Sometimes individuals get a poorly lit ring around their neck. Other possible sites for these gloomy patches include elbows, knees, knuckles, and armpits. This condition is call acanthosis nigricans.

If you have a mild or moderate form of insulin resistance, blood test may show normal or elevated blood glucose and high level of insulin at the same time.

Do you own insulin resistance or pre-diabetes?

If you are overweight and age 45 or older, you should ask your doctor in the region of having one of the standard blood glucose test that detect pre-diabetes and type 2 diabetes. If you are younger than 45 and overweight, your doctor may want to test your blood glucose, especially if you hold one or more of the following risk factors:

* household history of diabetes

* low HDL cholesterol and high triglycerides

* giant blood pressure

* history of gestational diabetes (diabetes during pregnancy) or gave birth to a babe-in-arms weighing more than 9 pounds

* minority group perspective (African American, American Indian, Hispanic American/Latino, or Asian American/ Pacific Islander)

Diabetes and pre-diabetes can be detected with one of the following test:

A fasting glucose assessment measures your blood glucose after you have gone overnight lacking eating. This assessment is most reliable when done in the morning. Fasting glucose level of 110 to 125 mg/dL are above normal but not illustrious enough to be call diabetes. This condition is called pre-diabetes or impair fasting glucose (IFG), and it suggests that you hold probably had insulin resistance for some time. IFG is considered a pre-diabetic state, intent that you are more likely to develop diabetes but do not own it yet.

A glucose tolerance interview measures your blood glucose after an overnight fast and 2 hours after you drink a sweet juice provided by the doctor or laboratory. If your blood glucose falls between 140 and 199 mg/dL 2 hours after drinking the liquid, your glucose tolerance is above middle-of-the-road but not high satisfactory for diabetes. This condition, also a form of pre-diabetes, is called impair glucose tolerance (IGT) and, like IFG, it points toward a history of insulin resistance and a risk for developing diabetes.

These test give one and only indirect evidence of insulin resistance. The test that most accurately measures insulin resistance is too complicated and expensive to use as a screening tool in most doctors' office. The test, call the euglycemic clamp, is a research tool that helps scientists revise more about sugar metabolism problems. Insulin resistance can also be assessed near measurement of fast insulin. If conventional tests show that you enjoy IFG or IGT, your doctor may suggest changes surrounded by diet and exercise to reduce your risk of developing diabetes.

Can you reverse insulin resistance?

Yes. Physical diversion and weight loss kind the body respond better to insulin. By losing weight and mortal more physically active, you may avoid developing type 2 diabetes. In reality, a major study have verified the benefits of healthy lifestyle change and weight loss. In 2001, the National Institutes of Health completed the Diabetes Prevention Program (DPP), a clinical trial designed to find the most successful ways of preventing type 2 diabetes in overweight people near pre-diabetes. The researchers found that lifestyle changes reduced the risk of diabetes by 58 percent. Also, various people beside pre-diabetes returned to normal blood glucose level.

The main hope in treating insulin resistance and pre-diabetes is to minister to your body relearn to use insulin normally. You can do several things to assistance reach this aim.

Be Active and Eat Well

Physical activity help your muscle cells use blood glucose because they obligation it for energy. Exercise make those cells more sensitive to insulin.

The DPP confirmed that associates who follow a low-fat, low-calorie diet and who increase activities such as walking briskly or riding a bike for 30 minutes, five times a week, hold a far smaller risk of developing diabetes than people who do not exercise regularly. The DPP also reinforced the hurry of a low-calorie, low-fat diet. Following a low-calorie, low-fat diet can provide two benefits. If you are overweight, one benefit is that limiting your calorie and fat intake can help you lose immensity. DPP participants who lost consignment were far smaller quantity likely to develop diabetes than others within the study who remained at an unhealthy cargo. Increasing your activity and following a low-calorie, low-fat diet can also develop your blood pressure and cholesterol levels and have many other condition benefits.

Scientists have established some numbers to back people set goal that will reduce their risk of developing glucose metabolism problems.

* Weight. Body mass index (BMI) is a test used to evaluate body weight relative to increase. You can use BMI to find out whether you are underweight, normal bulk, overweight, or obese. Use the table on page 5 to find your BMI.

--Find your height surrounded by the left-hand column.

--Move across in impossible to tell apart row to the number closest to your weight.

--The number at the top of that column is your BMI. Check the word above your BMI to see whether you are common weight, overweight, or obese. If you are overweight or obese, chitchat with your doctor just about ways to lose weight to dampen your risk of diabetes.

* Blood pressure. Blood pressure is expressed as two numbers that represent pressure in your blood vessel when your heart is beating (systolic pressure) and when it is resting (diastolic pressure). The numbers are usually written beside a slash--for example, 140/90, which is expressed as "140 over 90." For the general population, blood pressure below 130/85 is considered majority, although people whose blood pressure is slightly elevated and who own no additional risk factor for heart disease may be advised to bring in lifestyle changes--that is, diet and exercise--rather than take blood pressure medicine. People who have diabetes, however, should give somebody a lift whatever steps prerequisite, including lifestyle changes and prescription, to reach a blood pressure purpose of below 130/80.

* Cholesterol. Your cholesterol is usually reported with three values: low density lipoprotein (LDL) cholesterol, lofty density lipoprotein (HDL) cholesterol, and total cholesterol. LDL cholesterol is sometimes called "fruitless" cholesterol, while HDL cholesterol is called "devout" cholesterol. To lower your risk of cardiovascular problems if you have diabetes, you should try to hold your LDL cholesterol below 100 and your total cholesterol below 200.

If you have metabolic syndrome, your doctor may recommend immensity loss with diet and exercise, as in good health as medication to lower your cholesterol and blood pressure levels.

Stop Smoking

In assimilation to increasing your risk of cancer and cardiovascular disease, smoking contributes to insulin resistance. Quitting smoking is not easy, but it could be the single smartest point you can do to improve your form.

Can medicines comfort?

Two classes of drugs can improve response to insulin and are used by prescription for type 2 diabetes--biguanides and thiazolidinediones. Other medicine used for diabetes act by other mechanism. Alphaglucosidase inhibitors restrict or delay the incorporation of carbohydrates after eating, resulting in a slower rise of blood glucose level. Sulfonylureas and meglitinides increase insulin production.

The DPP showed that the diabetes drug metformin, a biguanide, reduced the risk of diabetes in those with pre-diabetes but be much less successful than losing mass and increasing activity. In another study, treatment next to troglitazone, a thiazolidinedione later withdrawn from the bazaar following reports of liver toxicity, delayed or prevented type 2 diabetes in Hispanic women with a history of gestational diabetes. Acarbose, an alpha-glucosidase inhibitor, have been significant in delay development of type 2 diabetes. Additional studies using other diabetes medicine and some types of blood pressure medicines to prevent diabetes are beneath way. No drug have been approved by the Food and Drug Administration (FDA) specifically for insulin resistance or pre-diabetes.

Hope Through Research

Research sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases and other components of the Public Health Service have clearly shown that people can do seriously to prevent or delay type 2 diabetes. Volunteers contained by the DPP were recruit from groups known to be at mainly high risk for type 2 diabetes. About 45 percent of the DPP volunteers be from minority groups known to be at lofty risk for diabetes. The study was designed to assess the value of lifestyle changes (weight loss through exercise and diet) and drug psychotherapy (metformin). A control group received a placebo and information on diet and exercise. Participants assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent over 3 years. Participants treated with metformin reduced their risk by 31 percent. Metformin is not currently approved for use in preventing diabetes, but the FDA may determine whether to form diabetes prevention an added indication for this drug. In any event, the DPP demonstrated that a healthy diet and exercise are the most successful treatment for insulin resistance and pre-diabetes.

Body Mass Index Table

Normal Overweight

BMI 19 20 21 22 23 24 25 26 27

Height Body Weight
(inches) (pounds)

58 91 96 100 105 110 115 119 124 129
59 94 99 104 109 114 119 124 128 133
60 97 102 107 112 118 123 128 133 138
61 100 106 111 116 122 127 132 137 143
62 104 109 115 120 126 131 136 142 147
63 107 113 118 124 130 135 141 146 152
64 110 116 122 128 134 140 145 151 157
65 114 120 126 132 138 144 150 156 162
66 118 124 130 136 142 148 155 161 167
67 121 127 134 140 146 153 159 166 172
68 125 131 138 144 151 158 164 171 177
69 128 135 142 149 155 162 169 176 182
70 132 139 146 153 160 167 174 181 188
71 136 143 150 157 165 172 179 186 193
72 140 147 154 162 169 177 184 191 199
73 144 151 159 166 174 182 189 197 204
74 148 155 163 171 179 186 194 202 210
75 152 160 168 176 184 192 200 208 216
76 156 164 172 180 189 197 205 213 221

Overweight Obese

BMI 28 29 30 31 32 33 34 35 36

Height Body Weight
(inches) (pounds)

58 134 138 143 148 153 158 162 167 172
59 138 143 148 153 158 163 168 173 178
60 143 148 153 158 163 168 174 179 184
61 148 153 158 164 169 174 180 185 190
62 153 158 164 169 175 180 186 191 196
63 158 163 169 175 180 186 191 197 203
64 163 169 174 180 186 192 197 204 209
65 168 174 180 186 192 198 204 210 216
66 173 179 186 192 198 204 210 216 223
67 178 185 191 198 204 211 217 223 230
68 184 190 197 203 210 216 223 230 236
69 189 196 203 209 216 223 230 236 243
70 195 202 209 216 222 229 236 243 250
71 200 208 215 222 229 236 243 250 257
72 206 213 221 228 235 242 250 258 265
73 212 219 227 235 242 250 257 265 272
74 218 225 233 241 249 256 264 272 280
75 224 232 240 248 256 264 272 279 287
76 230 238 246 254 263 271 279 287 295

Obese Extreme Obesity

BMI 37 38 39 40 41 42 43 44 45

Height Body Weight
(inches) (pounds)

58 177 181 186 191 196 201 205 210 215
59 183 188 193 198 203 208 212 217 222
60 189 194 199 204 209 215 220 225 230
61 195 201 206 211 217 222 227 232 238
62 202 207 213 218 224 229 235 240 246
63 208 214 220 225 231 237 242 248 254
64 215 221 227 232 238 244 250 256 262
65 222 228 234 240 246 252 258 264 270
66 229 235 241 247 253 260 266 272 278
67 236 242 249 255 261 268 274 280 287
68 243 249 256 262 269 276 282 289 295
69 250 257 263 270 277 284 291 297 304
70 257 264 271 278 285 292 299 306 313
71 265 272 279 286 293 301 308 315 322
72 272 279 287 294 302 309 316 324 331
73 280 288 295 302 310 318 325 333 340
74 287 295 303 311 319 326 334 342 350
75 295 303 311 319 327 335 343 351 359
76 304 312 320 328 336 344 353 361 369

Extreme Obesity

BMI 46 47 48 49 50 51 52 53 54

Height Body Weight
(inches) (pounds)

58 220 224 229 234 239 244 248 253 258
59 227 232 237 242 247 252 257 262 267
60 235 240 245 250 255 261 266 271 276
61 243 248 254 259 264 269 275 280 285
62 251 256 262 267 273 278 284 289 295
63 259 265 270 278 282 287 293 299 304
64 267 273 279 285 291 296 302 308 314
65 276 282 288 294 300 306 312 318 324
66 284 291 297 303 309 315 322 328 334
67 293 299 306 312 319 325 331 338 344
68 302 308 315 322 328 335 341 348 354
69 311 318 324 331 338 345 351 358 365
70 320 327 334 341 348 355 362 369 376
71 329 338 343 351 358 365 372 379 386
72 338 346 353 361 368 375 383 390 397
73 348 355 363 371 378 386 393 401 408
74 358 365 373 381 389 396 404 412 420
75 367 375 383 391 399 407 415 423 431
76 377 385 394 402 410 418 426 435 443

Source: Adapted from Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults: The
Evidence Report.

Metabolic Syndrome

Metabolic syndrome is the term researchers tender to the presence of any three of the following conditions:

* excess weight around the waist (waist breadth of more than 40 inches for men and more than 35 inches for women)

* high level of triglycerides (150 mg/dL or higher)

* low levels of HDL, or "suitable," cholesterol (below 40 mg/dL for men and below 50 mg/dL for women)

* high blood pressure (130/85 mm Hg or higher)

* high fast blood glucose levels (110 mg/dL or higher)

Source: National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol contained by Adults (Adult Treatment Panel III), National Heart, Lung, and Blood Institute, National Institutes of Health, May 2001.

Lab Tests and What They Show

* Blood glucose. High blood glucose may be a sign that your body does not have satisfactory insulin or does not use it well. However, a fast measurement or oral glucose tolerance trial gives more precise information.

* Insulin. An insulin width helps determine whether a illustrious blood glucose reading is the result of insufficient insulin or poor use of insulin.

* Fasting glucose. Your blood glucose level should be lower after several hours lacking eating. After an overnight speedy, the normal even is below 110 mg/dL If it is in the 110 to 125 mg/dL inventory, you have impair fasting glucose or pre-diabetes. A result of 126 or superior, if confirmed on a repeat test, indicates diabetes.

* Glucose tolerance. Your blood glucose height will be higher after drinking a sugar solution, but it should still be below 140 mg/dL 2 hours after the drink. If it is complex than normal (in the 140 to 199 mg/dL range) 2 hours after drinking the solution, you enjoy IGT or pre-diabetes, which is another strong indication that your body has trouble using glucose. A plane of 200 or higher, if confirmed, vehicle diabetes is already present.

Points to Remember

* Glucose is the simple sugar that is the crucial source of energy for the body's cell.

* Insulin helps cell take surrounded by blood glucose and convert it to energy.

* If you hold insulin resistance, your body's cells do not respond economically to insulin.

* Insulin resistance is a steppingstone to type 2 diabetes.

* Lack of exercise and excess weight contribute to insulin resistance.

* Engaging in moderate physical entertainment. and maintaining proper immensity can help prevent insulin resistance.

* Insulin resistance plays a role in the nouns of cardiovascular disease, which damages the heart and blood vessels.

* Controlling blood pressure and LDL cholesterol and not smoking can also oblige prevent cardiovascular problems.

* The Diabetes Prevention Program confirmed that exercise and a low-calorie, low-fat diet are the best ways to prevent type 2 diabetes.