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insulin resistance describes an abnormal
process in the body that goes along with
lots of medical conditions that are very
common like type 2 diabetes obesity and
atherosclerotic cardiovascular disease
insulin is a hormone produced by the
pancreas that helps your body break down
the energy we eat in nutrients into
substances it can use
like glucose which is the medical word
for sugar
and fats
in states of insulin resistance
the body is not responding normally to
levels of insulin they're being produced
and as a result we see lots of
abnormalities the most common one we see
is slightly elevated glucose glucose
won't always be elevated but if the body
isn't making enough insulin to keep up
with insulin resistance then it
certainly can be very elevated and lead
to type 2 diabetes
lots and lots of different things can
cause insulin resistance but when we
commonly talk about insulin resistance
occurring
it's usually because people are carrying
extra weight
and that extra weight ends up getting
stored in places it shouldn't be like
liver and other tissues and that extra
fat sitting in the liver then interferes
with the body's ability to respond
appropriately to insulin
so there are lots of common conditions
that go along with insulin resistance
one of the most common is fatty liver
but there are other conditions such as
polycystic ovarian syndrome type 2
diabetes fatty liver is a very common
condition that you could be diagnosed
with by a doctor and that is described
when people are really carrying extra
fat in the liver when you take a big
step back the liver is really the
factory that processes our energy and
carrying extra fat in the liver
interferes with a lot of a body's normal
ability to function the good news is
that when we overeat the fat goes
straight to the liver but also when we
diet the first place we lose weight is
from the liver a common syndrome
accompanied by insulin resistance
without high blood sugars or diabetes is
polycystic ovarian syndrome polycystic
ovarian syndrome is a syndrome
characterized by irregular menstrual
cycles people with pcos often have very
high insulin levels that said the high
insulin levels in pcos probably to some
degree drive the irregular menstrual
cycles and even to some degree drive the
excess androgen or male hormone levels
people often say insulin resistance
causes type 2 diabetes and i want to
point out that that's not true
unless the pancreas is not making enough
insulin to keep up with the body's
demand so there are many many people who
have insulin resistance who are
overweight with fatty liver
who don't have type 2 diabetes because
their pancreas just produces more and
more and more insulin and keeps up to a
large degree with the body's demand
that's not a good situation because
those high levels of insulin probably
drive other abnormal body processes so
even those people would do would benefit
from weight loss but you really need
insulin deficiency
in combination with insulin resistance
to lead to type 2 diabetes
a lot of what determines insulin
resistance is where excess weight is
stored some people tend to gain weight
in their upper body and be sort of more
apple shaped other people tend to store
their excess weight in their hips or in
their lower body and tend to be more
pear shaped it's actually the people who
tend to store weight in the what we call
the apple distribution the central
weight who tend to have much more
problems with insulin resistance because
the excess weight is being stored in the
liver and other abdominal organs
interfering with normal metabolic
function
so the best treatments for insulin
resistance are also the best treatments
for being overweight or having obesity
and also the best ways to just stay
healthy overall losing a modest amount
of weight actually is very beneficial
for insulin resistance and the best way
to achieve weight loss is through diet
and exercise while many people give up
on diet and exercise in fact relatively
simple steps like eliminating sugary
beverages including juices having
portion controlled meals that are
balanced with a mixture of carbohydrates
protein and fruits and vegetables
particularly the healthy carbohydrates
are very beneficial for insulin
resistance and actually just exercising
reduces insulin resistance even in the
absence of weight loss a lot of people
feel it's very overwhelming to start an
exercise program but actually do simple
steps like walking 30 minutes over the
course of the day even in three separate
bouts of 10-minute exercise things as
simple as parking the car farther away
taking the stairs these things really
make a difference over time and help
reduce insulin resistance so people
often wonder should i take a medicine to
treat insulin resistance well insulin
resistance isn't really a disease in and
of itself it's sort of the abnormal body
process that goes along with many other
conditions so if you have another
condition that needs a medication then
by all means medications could be used
to treat that condition the good news is
that very simple steps such as
increasing exercise healthier diet and
weight loss can dramatically improve
insulin resistance and reduce the risk
of a lot of the health conditions that
go along with it thanks for joining me
today i'm dr deborah wechsler at mass
general brigham
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