Metabolic Dysfunction: The Path of Insulin Resistance to Type 2 Diabetes

Sugar is everywhere in our diets, from sweet desserts to everyday foods like bread and sauces. This high consumption of sugar comes at a time when more and more people are getting diagnosed with diabetes. Many of us know there's a link between sugar and diabetes, but the details can be a bit fuzzy. In this article, I want to explain some of the lingo we hear about all the time when it comes to sugar balance and the downstream effects of not being able to manage it properly.  Words like insulin, insulin resistance, metabolic syndrome, pre-diabetes and diabetes.

I want to set the stage so you understand what’s happening inside your body so you can better understand your own symptoms. Maybe you’re in the early days of insulin resistance and you don’t know it yet? Maybe there are small things you can switch up to better manage your blood sugar and avoid the spiral effect of insulin resistance, pre-diabetes and diabetes.

Before we do that, however, I want to make it clear that I’m talking about Type 2 diabetes when I say diabetes. I’m not talking about Type 1 or 1.5 or even what they are now calling Type 3 (Alzheimer’s).

Let’s start with some definitions and the general progression of disease that leads to diabetes. This is in easy-to-understand terms today…the progression varies and there are many other diseases at play other than diabetes if you have chronically mismanaged blood sugar. But the name of the game here at Nicole Schur Wellness is simplicity, so here goes!

First up is insulin.

Insulin

Insulin is a hormone produced by the pancreas that regulates the amount of glucose (sugar) in the blood. It acts like a key, allowing glucose to enter your cells and be used for energy. Insulin regulates how the body uses carbohydrates, fats, and proteins, and is a key player in metabolic processes. We need insulin. 

Insulin Resistance

Normally, insulin helps regulate blood sugar levels by facilitating the entry of glucose into cells, where it can be used for energy production or stored for later use. However, in insulin resistance, the cells become resistant to insulin's actions, resulting in elevated blood sugar levels (i.e it circulates in the bloodstream and not inside the cells where you want it). Because the blood sugar levels get so high, the pancreas starts to release extra insulin to compensate. This is where things start to slide off the rails.

When I was training in diabetes education, one of my teachers described it as a pizza delivery. Read on, I promise this makes it easier to understand…

Imagine you’re inside your house (your house represents the cells of your body) and you’re hungry (the cells need energy). You decide to call for a pizza to be delivered (so you can get some sugar in your cells). The pizza delivery guy arrives and knocks on your door. You open the door and let the pizza into your house. All is good so far. Your cells now have some energy.

But then the pizza guy comes back to the house and knocks on the door again (i.e. you eat more sugar and it’s banging at the cell well to be let in and give you more sugar energy). You’re still a little hungry, so you let the pizza inside your house again. This happens a few more times during the day (akin to eating sugar in excess throughout your day now). You’re stuffed. You ate too much pizza.

But the pizza delivery guy keeps knocking with more pizza (sugar) until finally you’ve had enough. You can’t.eat.one.more.bite. He’s driving you crazy with his knocking and he’s not listening to you when you open the door and tell him to go away.

Finally, you just stop answering the door. There’s no more room inside the house for pizza because there are uneaten boxes everywhere inside the house already. This is what your cells are going through every time you bang at the door with sugar. It needs some sugar, but eventually it closes off the cell wall and can’t take any more inside.

So now what happens? Well, the sugar has to go somewhere, so it starts circulating in your bloodstream since it can’t go into the cells anymore. When the sugar circulates in your blood, it causes you to have elevated blood sugar. Elevated blood sugar is harmful because it damages blood vessels and organs, increasing the risk of heart disease, stroke, and other health complications like diabetes.

Early Symptoms of Insulin Resistance

• feel the need to eat every few hours to avoid crashing

• shaky or light-headedness

• sweet cravings

• headaches

• irritability if meals are delayed

• mood swings

• brain fog

• fatigue or energy fluctuations 

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and diabetes. It's like a team of health problems working together against the body's well-being. These conditions include

• high blood pressure

• high blood sugar

• excess body fat around the waist

• abnormal cholesterol levels and

• insulin resistance.

The high blood pressure (AKA hypertension) puts strain on the heart and blood vessels, increasing the risk of heart disease and stroke.

High blood sugar, as we’ve been discussing, can lead to diabetes and its complications.

Excess fat around the waist (what we often call visceral fat accumulation) is quite harmful, even more harmful than “regular” body fat perhaps, because it surrounds vital organs and increases inflammation and insulin resistance.

Abnormal cholesterol levels (e.g. high triglycerides, low HDL cholesterol) contribute to plaque buildup in arteries, narrowing them and raising the risk of heart disease.

Finally, as we’ve talked about, insulin resistance occurs when cells don't respond effectively to insulin, leading to elevated blood sugar levels. This can further increase the risk of diabetes and cardiovascular disease.

Metabolic syndrome often develops due to a combination of genetic and lifestyle factors, including unhealthy diet, lack of exercise, and excess weight.

What can you do to fix it? It’s all the things you’ve heard before: eat healthy, exercise, and maintain a healthy weight. Easier said than done, I know, but those are the ways out of this predicament. I’m here to help you and there are many free resources to get you started. Reach out if you’d like more information on this topic.  

Pre-Diabetes

Prediabetes is a condition where blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. It's a warning sign that indicates increased risk of developing diabetes and other health problems I mentioned above. Lifestyle changes can prevent or delay progression to diabetes.

Diabetes

Type 2 diabetes is also called type 2 diabetes mellitus and occurs when the following

criteria have been met:

• a fasting plasma glucose of ≥7.0 mmol/L

• a 2-hour plasma glucose value in a 75 g oral glucose tolerance test of ≥11.1 mmol/L or

• a glycated hemoglobin (A1C) of ≥6.5%

Most of us are familiar with this disease and it can lead to many other serious complications including:

• kidney disease (nephropathy)

• eye damage (diabetic retinopathy)

• heart disease & stroke

• mental health issues

• high blood pressure

• nerve damage & amputation 

“Over 3 million Canadians, or 8.9% of the population, have diagnosed diabetes and, after adjusting for the aging population over time, the prevalence has been increasing at an average rate of 3.3% per year. In addition, 6.1% of Canadian adults have prediabetes, putting them at high risk of developing type 2 diabetes.”

Public Health  Agency of Canada, 2022

When insulin resistance goes on untreated, your blood sugar will continue to creep higher and higher until your doctor diagnoses you with Type 2 diabetes and puts you on medication. At this point, your risk for other associated diseases has already gone way up.

This journey doesn’t happen overnight. It takes years, sometimes even decades, to develop.

It happens when we consume too much starch like flour, bread, pasta, rice, and processed grains and sugar. (Diabetes is not just about the sugar.)

There are blood tests that you can do to find out where you stand with respect to insulin resistance. Markers like hemoglobin A1C can be beneficial to get an average of your blood sugar (glucose) over the past 3 months. Other options include wearing a continuous glucose monitor for a while to see what foods and activity spike your sugar (and then modify as required).

The good news is that insulin resistance, pre-diabetes and diabetes can all be reversed through diet and lifestyle changes such as eating more non-starchy veggies, healthy fats, clean protein, exercising regularly, getting good quality sleep, and finding ways to reduce your stress levels.