What insulin resistance actually is
Insulin is a hormone out of your pancreas and its job is parking. Sugar cannot sit in your bloodstream, so insulin moves it into your liver and your muscles.
Eat that way often enough and the cells stop answering the door.
Dr. Martin, The Doctor Is In, Episode 822So the more carbs you eat, crappy carbs, the more insulin you need.
His name for it says more than the textbook one does. Not high blood sugar. High circulating insulin, with your cells resisting a hormone that refuses to quit.
Dr. Martin, The Doctor Is In, Episode 822So when you look at people, including children, 90% have insulin resistance.
Why it gets missed for years
This is the part that frustrates him, and it explains why a woman over 60 can feel off and be told everything is fine.
Dr. Martin, The Doctor Is In, Episode 822Medical doctors, dieticians, they don't even think about insulin.
His reading of the training is simple. You are not a diabetic until your blood sugar passes a mark, so until it passes that mark nobody is looking. Insulin itself is never on the requisition.
Dr. Martin, The Doctor Is In, Episode 822What happens before you're officially or someone is officially diagnosed with diabetes is they develop insulin resistance.
Which turns the usual order upside down.
Dr. Martin, The Doctor Is In, Episode 822Diabetes, like official I'm a diabetic, diabetes is the last thing that happens. Not the first thing that happens, it's the last thing that happens.
"So don't wait till you're a diabetic."
Dr. Martin, The Doctor Is In, Episode 822Thin women get it too
If you have stayed slim your whole life, this is the line to read twice.
Dr. Martin, The Doctor Is In, Episode 822You can be skinny by the way too and have insulin resistance.
He is not saying weight tells you nothing. He tells people to go to the mall and use their eyes, and he says what he sees now is nothing like the 1970s. He is saying the opposite of the test most women apply to themselves. A dress size is not a clearance.
What you can actually feel
Here is where he is more honest than most articles on this subject. The early stage does not announce itself.
Inside every cell is a mitochondria, the battery pack that turns food into energy. When insulin resistance sets in, he says, the mitochondria releases something oxidative that signals insulin to get lost, and makes the resistance worse from the inside.
Dr. Martin, The Doctor Is In, Episode 822Now you don't feel that, maybe a little bit of lack of energy, but you're not getting a lot of symptoms about what's happening.
So the thing to take from this section is not a checklist. It is that a tired, flat feeling after meals can be the loudest thing a process this big ever says to you, and that waiting for a louder sign is waiting for the diagnosis.
What it does to blood vessels
The study he brought to this episode is about the next domino, and it is the one he gets animated about.
Dr. Martin, The Doctor Is In, Episode 822Insulin resistance starts a process within your blood vessels to make them sticky.
Sticky is his word for the start of atherosclerosis. Think of the vessels running to your brain and to your heart, he says, and the picture explains itself. What he wants instead is slippery, which is his argument for eating enough real fat and omega-3.
It is also why he thinks cholesterol takes the blame unfairly. Cholesterol in a blood vessel is the delivery truck, and blaming it for a heart attack is like blaming the police for being at the crime scene. His longer version of that is the cholesterol hoax.
Nothing here is a reason to start or stop anything a doctor has prescribed. Talk to your doctor first.
What to ask for at your next test
He does not hand out a lab panel on this episode, so here is what he does say, kept to that.
- A1C and fasting glucose are the two thresholds medicine watches, and both can read fine while insulin is high.
- Insulin is the measurement nobody orders, and it is the one he cares about.
- He treats the food on your plate as the thing that moves it, and says fixing it is a 30 day job.
On what to eat, his position on red meat and diabetes is worth reading next: does eating red meat give you diabetes.
Common questions
What are the signs of insulin resistance in women over 60?
Dr. Martin's answer is uncomfortable: mostly there are none early on. He describes a bit of low energy and not much else, while the damage starts in the cell and then in the blood vessel. That is why he says do not wait for a diagnosis.
Can you have insulin resistance and a normal blood sugar?
Yes, and he says that is the usual case. Medicine watches A1C and fasting glucose thresholds, and neither one measures insulin, so high circulating insulin can run for years while the tests look fine.
Can a thin woman have insulin resistance?
He says you can be skinny and have it. He puts 90 per cent of the population in some form of it, which is why he treats body size as a poor screening test.
How does insulin resistance affect the heart?
The study he cites has it making blood vessels sticky, which he calls the start of atherosclerosis. His counter is food that keeps vessels slippery rather than a drug aimed at cholesterol.
Read next: What Should Your A1C Be After 60? and What Is A Normal Blood Sugar For A Woman Over 60?.
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