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Symptoms of insulin resistance; What do they mean? – Metabolic Syndrome.

Symptoms of insulin resistance are mild in most of the cases. However, the body damage that is occurring underneath might not be overturned.

In this article, I am going to answer and thoroughly explain some of the most common questions regarding insulin resistance and metabolic syndrome.

And why is this so important? Right now, this disease is affecting the whole world, causing trillions in dollars of an economic burden to countries. Most of the time, people can cope or surpass their symptoms, so when the complications or severe symptoms arise, it is probably too late.

Frequently, obtaining information about this disease on the internet could be confusing or sometimes misleading. That is why I will give you the doctor’s point of view of it with the most up to date information in the field. Therefore, keep reading; you would receive key insights about metabolic syndrome directly from a doctor, free of charge.

What is metabolic syndrome?

Metabolic syndrome, or just insulin resistance, is a disease that develops from multiples factors. This disease implies an abnormal localization of the fatty tissue in the body plus its lousy function.

So, why name it metabolic syndrome when it is just an insulin resistance? That is because an isolated insulin resistance could happen, and can be managed. Metabolic syndrome was the name given to the whole miscarriage that occurs to all levels in the body because of it.

Accordingly, metabolic syndrome carries several risk factors for other diseases, such as coronary artery disease, diabetes, fatty liver, and various types of cancer, for just naming some.

Therefore, insulin resistance is the start, but metabolic syndrome is the road, and the complications of it, the end. As you will see further, a person could have insulin resistance and not having a diagnosis of metabolic syndrome. This situation exists because metabolic syndrome is a diagnosis that requires several items.

The factors that determine a person to have metabolic syndrome are waist measurement, high blood glucose, blood triglycerides, and blood pressure. On the contrary, insulin resistance determination is based solely on chemical exams that forecast a bad insulin action.

This disease sources on an unhealthy lifestyle. Mostly due to unnecessary high in calories or fatty food, plus being inactive, not exercise at all. Also, some genetic diseases can cause it, although they are not that usual.

Fast Food
Source: https://www.flickr.com/photos/foto_db/12164863054

Who is more likely to develop it?

Several studies identify the factors concerning the further development of metabolic syndrome; it includes:

  • Family history of metabolic syndrome or diabetes.
  • Smoking habit.
  • Elderly.
  • Obese people.
  • People with low socioeconomic status.
  • Women after menopause.
  • Physical inactivity.
  • Sugary drink and soft drink consumption.
  • Excessive alcohol consumption.
  • People with a standard American diet: high quantity of processed or red meat, sweets, butter, candy, fried food, refined grains, and more.
  • Low cardiorespiratory fitness.
  • Excessive television watching.
  • Utilization of medication (as antipsychotics, for example).
  • People with depression, anger, among other mental health issues.

What causes insulin resistance syndrome?

First, insulin is a hormone produced in the pancreas. For a hormone to function, it needs to get directly to a receptor. Typically, this hormone travels through the blood and reach the insulin receptors that are widespread throughout the body.

Insulin’s purpose will be to participate in glucose metabolism (blood sugar). This hormone accomplishes this task by binding to its insulin receptor. The coupling allows that tissue to fulfill many metabolic functions that, in the end, will diminish the high blood sugar and causes an overall growth.

Metabolic syndrome begins when the receptors start having insulin resistance. This term means that the pancreas would need to produce many times more insulin for what usually just one molecule could have done.

Sadly, the insulin secretion capability of the pancreas is not infinite, and it could fail. Then, the body would start having high blood sugar because there is no insulin to downplay it.

So, we now would have two problems. The unnecessary high insulin levels modify tissues and cause disease alone. Besides, when sums up impaired glucose tolerance, high glucose levels also cause disease.

It becomes a chronic state when one potentiates the other over time, modifying every tissue influenced by this hormone, which is almost all the body.

How the insulin receptor gets damaged in the first place, is not precisely known and still is a matter of debate. The main idea is that all the risk factors in the question mentioned above play its role. Nonetheless, the result of it is clear to see.

Two tissues have many insulin receptors. Hence they are keener to change due to the insulin effect, which is the muscle, and fatty tissue. They are essential in fat molecules and glucose metabolism. And as we will see, they see the worse of this disease.

Does insulin resistance always lead to diabetes mellitus?

No, that is not true. In fact, it is pretty far from it. I will thoroughly explain why to you all. First, it is essential to remember some basic terms. Diabetes has three core divisions, type 2 diabetes, type 1 diabetes, and gestational diabetes. Here, we are going to focus on type 2 diabetes because type 1 has an entirely different cause, nothing to do with lifestyle.

This situation could be seen in a stepwise fashion. Let us start with the first one, which is insulin resistance. As I told you, it is the first one to develop mostly due to insulin receptor impairment, which halts insulin sensitivity in the muscle tissue. If the hormone insulin is not doing its job, the blood sugar will rise over time.

How could I know that I have insulin resistance? In its early phases, only by measuring the insulin levels, which should be high in the blood. Not necessarily blood sugar (glucose) needs to be high too.

Furthermore, when the glucose levels start increasing, but they are not sufficiently high to be diabetes, it is called prediabetes. Now, insulin is not doing its job, so glucose levels rise. Importantly, not all patients with insulin resistance develop prediabetes. And, even more, only a third of the patients with prediabetes will be developing diabetes.

The patients most likely to progress from prediabetes to diabetes, are the ones with more obesity. It is imperative to highlight that having prediabetes is not a sentence of having diabetes or whatsoever. A significant proportion of those people never get to type 2 diabetes.

If people are caught on time, the progression from insulin resistance to prediabetes is pretty low. Similarly, for prediabetes to progress for established diabetes with the right lifestyle changes could either not happen at all.

Can it be reduced or reversed?

Most of the time, yes. However, it will depend on your specific background. Sadly, it is not the same for everyone.

The studies support that some interventions could aid in a significant reduction of prediabetes or diabetes. The most important one is the combination of diet and exercise. After a considerable time of incorporating both of them, patients that reduce their weight, and change its usual food from fatty to high in fiber. It minimizes glucose and fatty molecules’ blood levels. Therefore, people get a significant reduction in their risk of developing diabetes compared to the ones that do nothing about their situation.

Furthermore, other studies went far beyond explaining the overall impact of lifestyle modification in these people with prediabetes. They compared the effect of lifestyle modifications, metformin (the most used drug for diabetes and prediabetes), and not doing nothing.

The group with pure exercise and diet prevented even more than the group with the medication the risk of having diabetes. Obviously, both of them were better than doing nothing also. Additionally, for every kilogram of weight loss, it cuts down the risk of having diabetes by nearly a fifth (16%). And these results were accurate even ten years after those interventions.

So, is it possible to reduce or reverse these states of high glucose? Yes, with a lot of effort. It is important to remember that these interventions require help from professionals and a lot of them. It includes your primary physician, endocrinologist, nutritionist, and more.

All the measures the doctor would recommend to you have the scope of increase the insulin sensitivity of the receptors. This change would help the pancreas in their insulin secretion and decrease blood glucose. Overall, beating the insulin resistance would guide the path for a reduction or reversion of metabolic syndrome.

When does insulin resistance become prediabetes or type 2 diabetes?

Metabolic syndrome could exist either with prediabetes or diabetes; both of them have an abnormal increase in blood glucose. However, prediabetes is the previous step for developing diabetes.

The difference between the two of them is based on two exams, fasting glucose and glucose tolerance. The doctors use another one, which is the HbA1c levels in the blood.

These three exams determine when a prediabetes diagnosis changed towards diabetes, which would complicate the scenario of a patient with metabolic syndrome. I say this because prediabetes yields complications as we will see, it is not a safe state at all. However, diabetes is severer, and the difficulties are even worse.

Fasting glucose levels in the blood is an exam that will usually require you not to ingest any food or drinks in the morning. So, you will be fasting from the previous day at least 8 hours of drinking water only. The standard value for this exam is to have blood glucose levels below 100 mg/dL. In prediabetes, these values range from 100 to 125 mg/dL. In diabetes surpass this, and is 126 mg/dL and beyond.

Then, there is the glucose tolerance test, which measures how good is insulin production and function when people consume food. For the exam, you would take a fixed amount of glucose, remember that this is a standardized exam. A routine tolerance test would give glucose blood levels values below 140 mg/dL. People with prediabetes would have values between 140 and 199 mg/dL, and the ones with diabetes more than 200 mg/dL.

From a blood sample and a simple analysis, a doctor could tell if you have prediabetes or type 2 diabetes. This examination is essential for patients with metabolic syndrome and their possible outcomes.

What do fat, inflammation, insulin resistance and diabetes all have in common?

Metabolic syndrome is a condition where several risk factors coexist, such as obesity, insulin resistance, hypertension, and blood lipid disorders (fatty molecules as fatty acids or cholesterol). All of them are in a close relationship, and it ends in a chronic inflammatory state that causes complications in the long run. Most of the time, due to cardiovascular disease.

Since the 20th century, renowned scientists have pointed out that insulin resistance grounds the base for metabolic syndrome to develop. And, that, when it exists, the impairment of the carbohydrate and lipid metabolism in the body causes the domino effect that ends in a significant disorder.

Furthermore, regardless of the overall obesity of a person, upper body obesity (visceral obesity) is explicitly an independent factor for developing metabolic syndrome. Besides, in the metabolic syndrome, chronic inflammation and oxidative stress have a leading role causing disease in the long term, including the swelling of their fatty tissue.

Before developing metabolic syndrome, there would be an insulin resistance mainly within the skeletal muscle. This situation causes an uprising in the insulin secretion by the pancreas. This new high insulin level will persist over time, causing a lot of changes in the body, mainly on the fatty tissue where lipid metabolism takes place.

The body will raise its bar, and now, due to the insulin action, there would be excess glucose and excess weight. Abdominal fat strictly speaking cause the liver to receive way more fatty molecules than any other part of the body. It also frees particles to the body, which causes widespread inflammation. All of this is not taking into account that a high cholesterol level causes it to deposit in tissues. Similarly, this ends in more inflammation and damage.

What are the symptoms of insulin resistance?

So, which would be the insulin resistance symptoms? Or the ones caused by long-lasting high insulin levels? Because both terms are nearly the same. Here we would see signs and symptoms of diseases that cluster in this condition, such as diabetes, hypertension, obesity, and dyslipidemia (lipid disorder).

The symptoms include:

  • Increased thirst and hunger.
  • An increased frequency in daily urination.
  • Chest pain.
  • Shortness of breath.
  • Menstrual irregularities (patients that also has polycystic ovary syndrome)

The signs include:

  • High blood pressure.
  • Weight gain (abdominal obesity).
  • Hirsutism (excessive hair growth or its increase in places where they usually would not come out)
  • It is possible to have a tingling in the distant part of the upper or lower extremities.
  • Inner eye damage (that could even lead to visual loss)

The skin symptoms of metabolic syndrome will be mainly discussed in the next section. Nevertheless, it is essential to note that people tend to cope with their symptoms and ignore them. This behavior is dangerous because, as this condition progresses, over time, it yields awful complications.

What are the dermatological symptoms of insulin resistance?

The skin symptoms of metabolic syndrome partially overlap with the ones of type 2 diabetes. Also, it is in a relationship with many skin symptoms and disorders.

The manifestation includes skin lesions that itch, change in color, and more. The list is very extensive. So I will show you some of the most common diseases and symptoms of metabolic syndrome.

Here it is how some of them look:

  • Psoriasis.
  • Acanthosis nigricans
Acanthosis Nigricans
Acanthosis nigricans
Source: Brady MF, Rawla P. Acanthosis Nigricans. [Updated 2020 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431057/
  • Acne vulgaris
  • Hidradenitis suppurativa
  • Xanthomas
  • Xanthelasma
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Xanthelasma
Source: Elghazi, T., & Hafidi, Z. (2016). Xanthelasma. Pan African Medical Journal, 25. doi:10.11604/pamj.2016.25.41.10510
  • Granuloma annulare
File:Granuloma Annulare overview.jpg
Granuloma annulare
Source: https://commons.wikimedia.org/wiki/File:Granuloma_Annulare_overview.jpg
  • Necrobiosis lipoidica
Necrobiosis lipoidica
Source: Tong, L. X, Penn, L., Meehan, S. A, & Kim, R. H. (2018). Necrobiosis lipoidica. Dermatology Online Journal, 24(12). Retrieved from https://escholarship.org/uc/item/0qg3b3zw

What are the complications of insulin resistance?

There are complications for both, insulin resistance all by itself, and for an established metabolic syndrome. Let us begin with the former.

Insulin resistance, which can be slandered in prediabetes increases the chances of dying due to cardiovascular disease. What am I trying to tell you? That a patient that has not progressed to diabetes yet can still develop severe heart disease. It increases the risk of having:

  • Myocardial infarction (heart attack).
  • Stroke (A lack of blood flow that causes brain damage)
  • Kidney disease.
  • Inner eye disease.
  • Artery disease.
  • Nerves damage.

Then, there is metabolic syndrome, which would have a severe insulin resistance scenario where all the other symptoms are also damaged. The major reason why people with metabolic syndrome die is because cardiovascular disease, although many others can arise as we will see. The list includes:

  • Cardiovascular disease: coronary artery disease, atrial fibrillation, heart failure, and stroke.
  • Fatty liver disease.
  • Obstructive sleep apnea.
  • Several types of cancer.
  • Psoriasis.
  • Preeclampsia (high blood pressure while pregnant).
  • Impaired mental health.
  • Kidney disease.

Importantly, in women, they could have a disease, which is the polycystic ovary syndrome. This disease is a hormonal disorder based on genetic, metabolic, endocrine, and environmental causes. It has features that overlap with the ones of the metabolic syndrome, such as abdominal obesity. Consequently, it potentiates the cardiovascular risk of dying by either of both diseases.

How do you check for insulin resistance or metabolic syndrome?

There is a standard way to check about prediabetes and diabetes, as I told you before—the measurement of blood glucose by fasting glucose, glucose tolerance test, and HbA1c levels.

However, for diagnosing metabolic syndrome, there should be a lot more. A patient should have at least three of these five elements:

  • Fasting blood glucose levels equal to or greater than 100 mg/dL ( or a diagnosis of prediabetes or diabetes).
  • Blood pressure equal to or greater than 130 and 85 mm Hg, systolic, and diastolic pressure correspondingly. (or a diagnosis of hypertension).
  • Triglycerides are equal to or greater than 150 mg/dL (or people already receiving treatment for it).
  • Reduced HDL-C, below 40 and 50 mg/dL in women, and men, respectively.
  • Waist circumference equal to or greater than 40 and 35 inches in men, and women, correspondingly. (If Asian American this would be 35, and 32 inches, men, and women, sequentially).

Even though it looks that everything is covered. Probably you are asking yourself, so what happens with people that are at the very beginning of the insulin resistance syndrome? It has not developed either prediabetes or any of the other diseases yet.

In these patients, despite having a decreased insulin sensitivity. Their sugar level is on average because there is still enough insulin to lay it down. Yes, the key here is that “enough insulin” is because the pancreas is overworking, producing it a lot, causing it to rise on the blood.

So, right now, there is the Homeostasis Model Assessment (HOMA), which measures fasting insulin and glucose levels. Hence it determines early how is the pancreas functioning. Besides, many other hormones and molecules are measured to complement the study of these patients.

Is there a home test for insulin levels?

Right now, there is not. However, there is a way to assess the blood glucose level at home safely. The device name is a glucometer.

What is the treatment for insulin resistance or metabolic syndrome?

For insulin resistance syndrome alone, exercise, dietary modifications, and medications, solely or in combination, are great for reducing the risk of its progression. The list includes:

  • Weight loss (reduce abdominal obesity): It should be around seven to 10 percent of the total body weight—similarly, a decrease in the waist circumference measure.
  • Physical activity: The recommendation is 30 to 60 minutes daily for at least five days a week. The exercise could be as intense as brisk walking.
  • Diet composition: The fatty food should only compose 25% of the whole diet, and avoid trans fat and simple sugar food most as possible.
  • Medication: Metformin is a great resource here, whenever possible. However, there are a lot more.

Sadly, in medicine, 1+1 is not always 2. The specific requirements of every patient will come to light when a doctor assess its situation.

Furthermore, patients with diabetes may need insulin therapy to fulfill their body’s insulin requirements. Sometimes it is enough with medication that facilitates insulin production or function to downplay glucose levels. And, sometimes not, for that, there is insulin medication, which will do the job of decreasing blood glucose and possible complications.

Does walking help insulin resistance?

Yes, physical activity would always help decrease the impact of metabolic syndrome. Also, it helps to reduce the blood glucose level.

The recommendation is to walk at a brisk pace for at least 150 minutes a week or more. This time walking would ensure blood flow to the muscles.

What can you do if you are having symptoms of it?

This tool is a metabolic syndrome symptoms checker. It will help you to assess your symptoms to determine further the likelihood of having this condition. It is free, and it will only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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