What is Insulin Resistance? What is Prediabetes? How Can You Prevent It?

Today we have a post from our guest blogger, Brent Wilson, who is a registered and licensed dietitian and certified diabetes educator with the INTEGRIS Diabetes Education Center. He completed the Coordinated Program of Dietetics at the University of Oklahoma Health Sciences Center.

A young woman recently came to me with an interesting question. She was athletic and trim but had just been diagnosed with prediabetes. She wanted to know: How can this happen to a slim, “healthy” person like herself?

It’s a terrific question.

I'm going to answer the question first, and then I'm going to explain why. It is possible to be thin and become prediabetic. It is also possible to be obese and never get diabetes. It depends on our genes. Anyone who develops diabetes has a gene that allows insulin resistance to happen. Our genes load the gun but more importantly, our lifestyle pulls the trigger.

What is prediabetes?

Prediabetes is when your blood sugars are higher than normal but not yet high enough to be type 2 diabetes. An estimated 33.9 percent of U.S. adults ages 18 years or older (84.1 million people) have prediabetes.

Next, let’s walk through the digestion of a perfectly functioning body. When we eat, certain foods cause a rise in blood glucose levels. That’s normal. Of the three macronutrients (carbohydrates, proteins and fats) only carbohydrates make a substantial impact on blood glucose levels. Carbohydrates, or carbs, are foods like grains, breads, cereals, pasta, rice, starchy vegetables (potato, corn, peas) beans, milk, yogurt, fruit juice, and (obviously) sweets and sugary beverages.

When we eat carbs, whether it’s a bowl of whole-grain pasta or a bag of potato chips, as soon as they touch your tongue, they immediately begin to break down into glucose (aka sugar). This breakdown into glucose continues as the carbs move through the stomach and into the intestine. From there, the glucose leaves the digestive tract and enters the blood stream.

As glucose enters the blood stream, the body asks the pancreas to create insulin, a hormone that takes the glucose out of blood and feeds it to the body’s cells. Insulin is like a key. It connects to our body’s cells at a receptor site, and opens the cell to allow blood glucose into the cell, where it will either be used as fuel for energy production, or stored for later use, in the form of body fat.  

However, with prediabetes (or diabetes), it doesn’t work as well. Commonly, people assume if blood sugar levels are too high, the problem must be that the body needs more insulin. But, it’s not that there is a lack of insulin production — rather, the insulin the body is making is not working properly.

The average American consumes more than 300 grams of carbohydrates each day. Generally speaking, that is WAY too much. When we eat carbs in abundance, we raise our blood glucose levels, and that creates a rise in insulin. The insulin then does its job by pushing sugar into the cells. But if we aren’t physically active, our cells don’t need the sugar. For years our bodies will do this, but eventually our cells begin to down-regulate.

Cells become exhausted with the unneeded glucose coming in, like a suitcase being stuffed full of clothes. Eventually, cells become so full of sugar that no more can go in. Like clothes spilling out of the suitcase, the sugar spills into the bloodstream. The cells block the receptors so no more sugar can come in while sugar overflows into the bloodstream, and trouble begins.

When blood vessels are overloaded with sugar they become damaged. It starts with the tiny blood vessels, which aren’t designed to hold large amounts of sugar. This damage is first seen in the eyes, feet and kidneys. Over time, large blood vessels become damaged as well. This is why there is such a direct correlation between uncontrolled blood sugar and heart disease.

What can you do if you are prediabetic?

There is good news! If we can get patients to reduce their carbohydrate intake, and ensure the carbs they do consume are used for energy, not storage (by increasing physical activity) then insulin resistance can be reversed. This goes for not only folks with prediabetes, but diabetes as well.

The first thing to do is evaluate your carbohydrate intake. Opt for a diet based on vegetables and plant foods; grass-fed, responsibly-raised meat; pastured eggs and a lot of healthy fats! Fat is not what makes us fat. What makes us fat is too many carbs, causing too much insulin, which then causes the sugar to be stored as fat. To lose weight, you must keep insulin levels low.

Recommended carb intake

Here’s the carb chart I use with my patients:

0-50 grams per day

• Easy, effortless weight loss for any and everyone. Diabetics and the severely obese may find it useful to remain in this zone, while others might employ it now and then to jumpstart weight loss or break a plateau.

50-100 grams per day

• Steady, gradual weight loss. This is the sweet spot, in my opinion. You can still enjoy a wide variety of foods and lose weight slowly but surely.

100-150 grams per day

• If you just want to maintain, I recommend this level. Hardcore athletes may want to increase them a bit, but your average exerciser and eater will maintain supreme leanness, health and performance at 100-150 grams per day.

150-300 grams per day

• Steady, insidious weight gain. It’ll creep up on you. Just look around next time you’re at a high school reunion – people gain weight at this level without even realizing it.

300+ grams per day

• Remember, this is what most Americans average in a day. Unless you’re an extreme endurance athlete, 300+ grams of carbs per day will inevitably show on your waistline. Tragically, the average “healthy” American diet reaches this carb count consistently.

I initially place folks in to 50-100 grams daily carb range and see how they do. It will lead to weight loss and reduction in blood sugars without being so restrictive they want to quit.

Also, we evaluate what type of activity folks are doing. If someone is always doing cardio, I suggest they switch it up with resistance/strength training, weight-lifting, (which can be beneficial for men and women) and high-intensity interval training (HIIT). These exercises are shown to make our cells more receptive to insulin.

Why not evaluate your risk for diabetes so you can take steps to change some habits before it becomes prediabetes? Simply visit the INTEGRIS website to take the American Diabetes Association's Diabetes Risk Assessment test. If you are at risk, we offer an excellent prediabetes/diabetes management program, LIFESTYLE IS MEDICINE, at INTEGRIS. People can find it on our website or call me (405) 949-6000 to get started.