Targetting Insulin Resistance vs Glucose Intolerance

I've seen a few discussions regarding Insulin Resistance, and some criticisms of approaches (whether at home, in the medical profession or in research studies) to diabetes management which focus too heavily on Blood Glucose.

If I understand things properly, the idea is that Insulin Resistance is thought to be a precursor to Glucose Intolerance. So somebody can have worsening Insulin Resistance for years, before it finally leads to a noticeable problem with Glocuse Intolerance (and probably therefore a diagnosis of Type 2).

Furthermore, the Insulin Resistance, even before it leads to a noticeable blood glucose problem, is considered dangerous in itself, as it leads to higher amounds of insulin in the body and this is thought to be as dangerous as high amounts of glucose.

So the criticisms of things like HbA1Cs, home testing and glucose tolerance tests, is that, while you may be able to detect improving glucose control, it doesn't say much about your insulin resistance.

For example, one should not presume that if someone with Type 2 manages to take radical action and do wonders for their glucose tolerance, and even get a great result in a glucose tolerance test, that the problem with IR is solved. It's possibly still there, knocking at the door and ready to tip you back into glucose intolerance at any moment, and even if it doesn't, it's harmful in and of itself.

The problem is made worse because we can't easily / affordably monitor our insulin levels the way we can with blood glucose. Even in a medical setting, getting any real insight into our insulin levels, especially in response to eating food, is rather rare (and again, expensive).

So I looked around for suggestions on improving IR, and pretty much all of them were exactly the same advice as we get for improving glucose tolerance.

This page gives a reasonable summary of many of the bits of advice I found:

https://www.healthline.com/nutrition/improve-insulin-sensitivity#modal-close

There's even perhaps a surprising one in there: restricting calories, regardless of carb levels, seems to have a very significant effect on IR. That's been very much my personal finding at the moment in terms of *glucose tolerance* - losing weight seems to be a more important factor than reducing carbs, though obviously I can't lose weight forever.

And it leads me to wonder, given we can't easily measure insulin levels, and the advice for improving IR is so hugely similar to that for improving something we *can* measure, is it worth, on a practical level, even making a distinction?

If so, what do people do to target IR specifically?

bulkbiker said:

Doesn't say that anywhere on the page you linked to though does it?
I would however advise some intermittent fasting by which means (not eating) you are limiting the number of times per day you trigger an insulin response which your list is missing. Also not so sure about the inclusion of colourful fruit..
Insulin tests are available although not cheap I will admit. I've had 2 so far and will try to have more done whenever I get an HbA1c or a blood draw for cholesterol.

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Haha! Well spotted. I seem to have got the pages confused. I'd been reading a very similar page on the same website. This is the one I thought I'd linked to. There's a section called 'Watch Portion Sizes' which refers to calorie restriction. There's also a section about intermittent fasting. It all sounded very familiar to me, even though I'd never been looking for advice on improving IR before.

https://www.healthline.com/nutrition/14-ways-to-lower-insulin#section3

Would you say that, as a general rule, if you do something that has a measurable improvement in your glucose levels, then it's probably having a beneficial effect on your insulin resistance?

Or to look at it another way, if I tried intermittent fasting, is it safe to assume that I'll be improving my IR even if it has no noticeable effect on my blood glucose?

bulkbiker said:

As a general rule I would say yes. I credit the intermittent fasting equally with the Keto way of eating for my reduction in HbA1c and weight loss. And to be completely honest for the most part it was effortless once I had overcome my carb addictions. I do however find that extended fasting has the greatest impact on my blood sugars. I get the lowest numbers (high 3's) on the third day of a liquid only fast (that's tea with lactofree milk, coffee with cream and water only) After the third day the seem to level out in the low to mid 4's. My fasting insulin levels are verging on normal so I'm hoping that with the other measures I have got this under control.

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Very impressive bg numbers, congratulations! Given what you also know your fasting insulin levels and your ability to "pass" an OGTT, this is a great endorsement for your approach. Re fasting, I like the idea of 'autophagy' as well, though I can't find much info on whether the type of cell damage it helps repair is the same kind of damage that high bg & insulin levels are thought to cause. It can't be a bad thing, either way. Apparently you get the most benefit at 18 hours onwards, so even one meal a day might be enough of a fasting regime to reap good rewards.

How did you organise the insulin blood test? Was it just one draw of blood in a fasting state? I'm tempted to get one done myself. Do you think it would be possible to have a fasting one, plus an after-eating one, arranged, and would that be of additional value?

Bringing it all together, i.e. every bit of info I've read from all angles, and considering I can probably comfortably lose about 3 stone, but am reasonably fit for walking fast up and down hills, I'm thinking this sounds like a plan. At least during the weight loss phase:

* Eat once a day. ~20g carbs max. ~800 calories if not walking that day, or ~1200 calories if walking e.g. 1 hours brisk.
* If walking, do it shortly after eating.
* As far as possible, get a good night's sleep. Minimum of 8 hours.

Do you have any insight into that "plan"?

Thanks.

bulkbiker said:

I used a company called Medichecks..
The problem is getting the blood drawn. They can provide a finger prick lancet but the amount of blood needed for the test is more than I was comfortable/capable with using finger pricks. The last one I had done was timed to coincide with an HbA1c and cholesterol test so I got the phlebotomist to fill the phial from medichecks too while she was doing the others. She was fine with this and half interested in what I was having tested. To have a pre and post meal done would require 2 blood draws which unless you have a personal nurse becomes a bit difficult hence I just had my fasting insulin done. You send off the blood sample first class and get the results online usually within 48 hours.



As you know very well I'm quite against calorie restriction per se when trying to loose weight. I would follow your plan eating once or max twice per day max 20g of carbs. The walking is fine the "dieting' would in my opinion lead to metabolic slowdown which is the last thing you want when trying to shed pounds. Eat until you feel full without stuffing yourself and let your body tell you how much it needs. Those are my thoughts.

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Great, I'll see if the nurse at the GP where I get the HbA1C would be okay drawing extra blood for me! I might even see if I can persuade her to do two a couple of hours apart Thanks.

Re calorie restriction, I'd forgotten you were against that for the reasons of metabolic slowdown. I'd mis-remembered that you just thought it wasn't necessary on VLCHF, not that it was potentially problematic. Sorry. I do remember now that you mention it again!

Bluetit1802 said:

Current thinking is that insulin resistance and hyperinsulinemia occur years before T2, maybe decades. However, it isn't known which comes first - IR or hyperinsulinemia. What is known is that it is a vicious circle in that the more circulating insulin there is the worse IR will become, and the worse IR is the more circulating insulin there will be. And the longer this vicious circle goes on, the sooner T2 will rear its head. Once T2 has appeared, if nothing is done to break the vicious circle, T2 will progress.

@AdamJames

Like @bulkbiker I sent of for the test with Medichecks , and was lucky enough to get a big discount in a sale. However, the test kit is still in a cupboard because my surgery would not allow me to have the blood withdrawn (even at the same time as HbA1c) on the grounds that the nurse/phlebotomist would not be covered by insurance should anything go wrong. I found a local private GP that would do it for me (for a fee) but Christmas and whatnot got in the way, so I haven't had it done yet. Before you order a kit, it would be wise to find out where you can have the blood drawn and how much it will cost.

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Great, thanks for the tip. I'll see how adventurous the nurse at the GP surgery is, if not I'll look around. I've just done a quick Google on taking your own blood sample. Not sure I want to go there!

NicoleC1971 said:

IR as I ynderstand it is at the root of what is called Metabolic Syndrome which is easily diagnosed by htoertension, fatty liver and a widening girth. Dr Kraft was able to oredict better than current risk factors whether someone got heart disease on the basis of theie hypeinsulinaemia (IR) but that is a long duration test and because there is no pill at the end of it I guess that nobody has invested in a better method.
Anythung from fasting to the Newcastle diet or low carbing that removes fat from the liver and pancreas will improve sensitivity to insulin as will gaining more muscle. The frustrating thing is that the public think that diabetes is the start of a diagnosis and not the end stage of IR, whereas as i implied here on this thread people need ro know early on that they are developing metaboluc/IR problems and be given effective dietary options beyond Eat Less/Move More then take meds when you fail at that!

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It would certainly be nice if insulin tests were quick, easy and affordable!

Re things like widening girth, and advice to 'eat less / move more', this is where I find it hard to distinguish between the advice for T2 generally, glucose control or insulin resistance. Lose fat if you can, exercise more if you can, and eat less if you can, do all seem to be factors that can get good results for a lot of people whether from an IR or GT perspective. I'm pretty sure I'm a classic case where they all apply.

NicoleC1971 said:

Since BG is a symtom of IR anything that works fir 1 will work for the other. The issue is that we fatten then develop bg oroblems becausrme we have IR not the other way around so any lifestyle intervention should be targetted at the IR and done when the signs and symptons begin not at the point if T2 diagnosis My sin aged 12 is fat and clearly gains fat more easily than his thin siblings and has dine so since age 7. Would like to know if this is IR or gut microbiime because he is not guzzling donuts! GP is assuming puberty will sort this out but I have my diubts:::::

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If an expanding waistline is a sign of IR, then yes, I really wish I'd taken action 20 years ago! I had the warning then. I remember being bemused at the time, wondering why I had a stomach when I was far more active than most people I knew. I don't think I ever ate more sensibly than anyone I knew, just I mistook feeling fit and being active for being healthy and therefore didn't take any action to lose fat.

I sort of do and sort of don't fit the news headline T2 stereotype. I've been hugely overweight, I think 21.5 stone at my max, but even then when I went on walks with people I'd be the fastest, and I even did a bit of climbing, where clearly weight should be a huge issue. I was never the best at pulling myself up a bit of rock, but I could do it, and so never really addressed weight early enough or seriously enough.

I also must look very deceptive. When diagnosed I was about 18.5 stone I think, and the doctor, not having weighed me, told me I don't need to lose weight. My BMI will have been about 35, well into the obese range. I had to tell her my weight in order to convince her that I was overweight. I had a similar experience in hospital when I was over 17 stone.

Anyway none of this really helps distinguish between thinking in terms of IR and GT, if anything it just confirms that the advice is always very similar. Getting fat is not a great idea. If you get fat because of IR rather than regularly forcing food into you, then it doesn't hugely change what you need to do to try to make things better.

NicoleC1971 said:

Since BG is a symtom of IR anything that works fir 1 will work for the other. The issue is that we fatten then develop bg oroblems becausrme we have IR not the other way around so any lifestyle intervention should be targetted at the IR and done when the signs and symptons begin not at the point if T2 diagnosis My sin aged 12 is fat and clearly gains fat more easily than his thin siblings and has dine so since age 7. Would like to know if this is IR or gut microbiime because he is not guzzling donuts! GP is assuming puberty will sort this out but I have my diubts:::::

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Another point about a widening girth pointing to insulin resistance and therefore being an early warning for T2:

My sister fits the stereotype of a person with T2 even better than I do. She's older than me, and in spite of being female she has reached quite a few more stone than I ever have. She still is a few stone heavier than me, but she's working on it.

The thing is, though, she isn't Type 2. Not even "pre". I've tested her, and she can process sugar more efficiently than Tate & Lyle.

That's not to say that her insulin levels aren't sky high - who knows? And I suspect that my diagnosis, and fairly dire bg problems a few months ago that prevented me being awake more than a few hours a day, has helped her resolve in losing weight. Had she not made that decision, who knows what was in store for her a few months or years down the line, and what she may have avoided?

bulkbiker said:

You may find this interesting re fasting as opposed to calorie restriction
https://www.ketogenicforums.com/t/the-difference-between-fasting-and-caloric-reduction/28036

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Yes, that's exactly the kind of thing I've been wondering when thinking about this.

On a simplistic level, fasting = calorie restriction, but with different timing. But biology is never that simple, and this could be the perfect example of favouring one approach if you want to target insulin resistance.

The extreme thought experiment in the link sort of serves to make the point but, again because biology is never that simple, I'd love to compare real-world results between two groups of people, one adopting calorie restriction and the other fasting.

I can find a couple of such studies referred to online, but as always they come under criticism, such as the actual macro nutrients used in both groups, and how different things may have been had the ratios been different.

Unsurprisingly the best page I can find online in favour of fasting was written by Jason Fung, and that refers to a couple of studies.

https://idmprogram.com/difference-calorie-restriction-fasting-fasting-27/

I like the first graph with just the red and blue lines under the section "Intermittent Fasting vs Calorie Restriction". That makes a compelling case for IF at a glance.

Then again one could look at that graph and say that, if you just want to go on a weight loss campaign for a month, either approach will have the same benefit on insulin levels. And again, detail is important. How different would the graph look if the macro nutrients used were altered. And what if the caloric amounts in each diet were different?

The second study referred to shortly after that suggests a particular advantage of IF for people with Type 2 - it seemed to show it was quite a bit better at removing *visceral* fat. I've always believed that no two diets are likely to be the same in terms of removing fat from various parts of the body, in spite of the general medical consensus.

One study suggests intermittent fasting alone isn't better than calorie restriction, but that has come under fire by people suggesting, probably quite rightly, that it would have been a hell of a lot more effective when combined with LCHF macro ratios. I'm not sure it even addressed insulin levels, to be honest it's been a bit of a blur reading around recently.

I'd love to see three experiments run which look at the 3 main diets discussed on this forum for addressing Type 2: LCHF eat what you want every day, LCHF IF at a regular pattern, and ND (many weeks calorie restriction on ~100g carbs a day followed by an attempt to keep weight off).

Then again even that would raise more questions. I'm sure people would question what the best fasting periods are for IF, and what the definition of LCHF is. One person can be having 4 to 5 times the amount of carbs as another and they both describe themselves as eating LCHF. And also whether the rapid weight loss phase of ND approach becomes a vastly better or worse thing from various perspectives depending on how long it's kept up for.