What is Insulin & Why Does it Matter?
Have you been told by your doctor you have diabetes, pre-diabetes, or insulin resistance (IR). IR is particularly important for PCOS and hypothyroidism. ⠀⠀⠀⠀⠀
Let’s start with insulin…⠀⠀⠀⠀⠀⠀⠀⠀⠀
Insulin is a hormone that helps each of our cells get access to sugar or glucose. It’s released after we eat, from an organ called the pancreas. Insulin knocks on the door of each of our cells to tell them, “hey there’s extra glucose in the blood, please take some.” If everything is working as it should, the cells open their doors and take in extra glucose from the blood. Cells cannot take in glucose without insulin. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
So what’s insulin resistance? ⠀⠀⠀⠀⠀⠀⠀⠀⠀
Insulin resistance occurs when cells cannot hear insulin knocking clearly anymore. If our cells cannot hear the knock, then they cannot open the door to let glucose in. This leaves too much glucose in the blood. In response, the body produces more and more insulin to get glucose inside our cells, leading to hyperinsulinemia.
Signs of Insulin Resistance
While labs are a great objective tool to check for insulin resistance, some physical and physiological signs might show IR well before labs.⠀⠀⠀⠀⠀⠀
Insulin resistance may be an issue if you have: ⠀⠀⠀⠀⠀⠀⠀
- Skin tags (small, soft skin growth that show up on the neck, upper chest, underarms, and eyelids)⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Acanthosis Nigricans (velvety dark skin patches found in body folds/creases)⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Can’t lose weight⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Can’t maintain a weight⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Pee more frequently⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Are thirsty all the time⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Have sugar cravings that don’t go away with eating carbs⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Low blood sugar in between meals⠀⠀⠀⠀⠀⠀⠀⠀⠀
- High inflammation (body pain, chronic fatigue, insomnia, depression, mood disorders, gut issues, frequent infections, weight gain or loss, high C-Reactive Protein). ⠀⠀⠀
Blood work can be a great objective tool to assess insulin resistance. Some labs that might be used to assess insulin resistance include:
- HbgA1c measures how much glucose is attached to red blood cells. This lab reflects average blood sugar over a 2-3 month period. A normal A1c is < 5.7. An A1c between 5.7 and 6.5 is considered pre-diabetes, and greater than 6.5 is diagnosed as diabetes. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Fasting glucose checks blood glucose after no food or drinks for ≥8 hours. This test is usually done first thing in the morning, before breakfast. A normal fasting glucose is <100; pre-diabetes range is 100-125; diabetes range is 126 or higher. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
- Insulin. Each lab test will provide its own reference range for insulin. This tool is used with other labs to assess a patient’s IR. High insulin levels can indicate IR.
Schedule an appointment with your doctor if you’re concerned you might have insulin resistance.
The Link Between Insulin Resistance & PCOS
I had idiopathic hirsutism for 11 YEARS before my PCOS diagnosis. This is hirsutism in women who don’t show hormonal dysfunction in labs. I had no idea insulin resistance is independently linked to hirsutism, until I started learning about PCOS. Meaning, you don’t have to have PCOS to have hirsutism. But idiopathic hirsutism could be an early sign for increased risk for PCOS. I likely had blood sugar regulation issues since I was a teen and I just didn’t know it.
65-70% of women with PCOS struggle with insulin resistance and high insulin levels. The likelihood that they have had blood sugar regulation issues long before their diagnosis is high.
Here’s why Insulin resistance plays a BIG role in PCOS:⠀⠀⠀⠀⠀⠀⠀⠀
- Insulin resistance increases male hormone production from the ovaries. This leads to symptoms like coarse, dark facial hair and male pattern baldness. ⠀⠀⠀⠀⠀⠀⠀⠀
- Insulin resistance blocks the liver from producing sex hormone binding globulin (SHBG). SHBG is a protein found in the blood that binds testosterone and estrogen. Not having enough of this protein means there’s extra testosterone and estrogen in the body, which makes PCOS symptoms worse. ⠀⠀⠀⠀⠀⠀⠀⠀
- Insulin resistance can cause weight gain or make it harder to lose weight. This causes excess estrogen to be made in the body, because fat tissue has a specific protein that can convert testosterone to estrogen. Too much estrogen, also known as estrogen dominance, is a big cause of PCOS symptoms. It’s also a part of a vicious cycle, where estrogen can make insulin resistance worse.
- Insulin resistance can lead to irregular ovulation, which can show up as: not having a period, having very long cycles (a few periods a year), or even menstruation without ovulation (called anovulatory cycles).⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
What does Hypothyroidism Have to Do with Insulin Resistance?
While we know overt hypothyroidism is linked to insulin resistance, research is also starting to show that individuals with subclinical hypothyroidism are also at risk for insulin resistance.⠀⠀⠀⠀⠀⠀⠀⠀⠀
How can hypothyroidism lead to insulin resistance?
- Thyroid hormone is intricately involved in how the body uses carbs. When we don’t have enough thyroid hormone, we cannot convert the carbs we eat into energy.
- Thyroid hormone regulates how well our liver can make glucose and store glucose. This is absolutely crucial because our liver is responsible for balancing our blood sugar during periods when we are not eating (like between meals, while sleeping, etc.) When the liver cannot make enough glucose to regulate blood sugar properly, the body has to resort to using stress hormones. A chronic reliance on stress hormones to balance blood sugar leads to insulin resistance because the job of stress hormones is to keep blood sugar high.
- Thyroid hormone helps glucose get into cells, by turning on a transporter of glucose.
- Thyroid hormone supports proper mitochondrial function, which is the powerhouse of the cell. This is where all the magic happens! Mitochondrial 𝐝𝐲𝐬𝐟𝐮𝐧𝐜𝐭𝐢𝐨𝐧 is linked to type 2 diabetes.⠀⠀⠀⠀⠀⠀⠀⠀⠀
How Are Stress & Insulin Resistance Related?
Laura, a single mom, is working full-time and homeschooling her son. Between her demanding job and getting her son ready for school, it’s unlikely she’ll get to breakfast before noon and she’ll remember the lunch she was making by dinner time! That’s still on the stove, because her meeting went on too long. On top of all this, Laura’s struggling with hypothyroidism and she knows she has to make some changes, but it’s all too much!
Who can relate to Laura?
We often think about stress as external–like finances, family, or social life. But stress from the body’s perspective is as simple as too much demand and not enough resources.
Laura has a lot of demands, which literally translates to demand for energy. We need energy (ATP) to focus, play with our kids, and do all of the things.
The body is designed to handle short episodes of stress by using its normal stress response. Swipe to see what a normal response looks like. Essentially, a normal response shuts off after addressing the demand.
But the Modern Human’s ability to turn off the stress response is compromised. We are chronically stressed by our chaotic lives!
Chronic stress increases our risk for diabetes, heart attacks and heart disease, obesity, etc because chronic stress makes us rely on stress hormones to get through the day.
Ongoing exposure to cortisol and adrenaline can lead to insulin resistance because they:
- Cause blood sugar to be constantly high
- Block insulin production and storage of glucose. This can starve cells of nutrients and creates a vicious cycle of hunger/cravings, overeating, and weight gain.
- Cause weight gain, which is linked to insulin resistance.
Have you been told you have insulin resistance or recently diagnosed with pre-diabetes, PCOS or hypothyroidism? Let’s chat!