Glucose/Insulin Metabolism in Health and Disease
Mastering the Metabolic Syndrome

Glucose is our major source of energy. Proteins and fats cannot be used to produce energy until first transformed into glucose by biochemical processes in our bodies. Glucose is taken in to the cells of our body and transformed into smaller molecules that are the final common pathway for energy production.

Our cells require insulin in order to facilitate the uptake of glucose. Insulin is a hormone secreted by our pancreas. It is secreted in response to a rise in glucose in our serum. It activates “insulin receptors” on our cell walls. These receptors signal our genetic material to produce molecules that transport glucose into our cells where it is processed.

When glucose insulin function becomes inefficient there is an increased risk to diabetes and a variety of other chronic health problems such as obesity, hypertension, heart attack, stroke and cancer.

In Type 1 Diabetes the pancreas fails to make an adequate amount of insulin. In Type 2 diabetes the pancreas makes an adequate amount of insulin but the cells of the body lose their sensitivity to the insulin message and blood sugar rises. Ultimately, the pancreas loses its ability to make insulin and the blood sugar stays elevated because of an inadequate amount of insulin. Dysfunction of glucose insulin metabolism is not an on or off phenomena. It is not true that we either have the problem or we don’t. We are talking about a continuum from optimal function to overt illness.

There are a variety of names given to this phenomenon. Dr. Gerald Reaven was one of the first scientists to describe the problem. He referred to the reduced sensitivity of the cells to the insulin message as “insulin resistance”. This meant that while a person makes enough insulin, the insulin receptors on the cell membranes have a reduced sensitivity to the insulin message. As a result the person must make an excessive amount of insulin in order to control blood sugar, (glucose levels in the blood). He named the clinical pattern of individuals with the problem; Syndrome X. This name has evolved to Metabolic Syndrome.  Individuals with Metabolic Syndrome have a constellation of findings, which include central obesity, (fat tissue around the waist and within the abdominal cavity), hypertension, high triglycerides, and low HDL cholesterol. These individuals are at increased risk of developing diabetes, arteriosclerosis, heart attack, and stroke.

About 20-30% of the population is genetically predisposed to insulin resistance. Some but not all of these people will develop the pattern of abnormal physical findings, laboratory findings and diseases characterized by Metabolic Syndrome. A predisposition means that there is a greater chance that the problem of insulin resistance will develop during an individual’s lifetime. Not everyone with the predisposition will develop the problem.

Factors that can lead to the manifestation of insulin resistance in a predisposed individual include stress, diet, and activity level. This means that susceptible individuals can be identified and can minimize the adverse health consequences of insulin resistance with appropriate life style changes.

Insulin Resistance can lead to Type 2 diabetes with the adverse consequences of heart disease, stroke, kidney disease, eye diseases, and peripheral artery insufficiency.

Insulin Resistance is a factor in other health problems that can occur without the development of overt Diabetes. These problems include Obesity, Hypertension, Arteriosclerosis, Heart Attack, Stroke, Cancer, and Accelerated Aging.

Historical Factors that Suggest Insulin Resistance

A family history of diabetes, premature heart disease, hypertension, blood fat abnormalities, menstrual irregularity, infertility or Polycystic Ovary Disease may indicate a personal vulnerability to insulin resistance/metabolic syndrome.

A personal history of diabetes, premature heart disease, hypertension, blood fat abnormalities, menstrual irregularity and or fertility problems, or Polycystic Ovary Disease may be associated with insulin resistance. Individuals who have problems with weight control often have insulin resistance as contributing factor to the problem.

Signs and Symptoms of Insulin Resistance

• Difficulty in controlling or maintaining body weight despite good dietary practice

• Obesity of the central type; the waist circumference is greater than the hip circumference

• (Measure your abdominal circumference at the level of the belly button, (umbilicus), measure your hip circumference at the widest point of the hips)

• Hypertension, (systolic blood pressure greater than 140, diastolic blood pressure greater than 90)

• Fatigue one to three hours after eating

Insulin Resistance is not a disease. It is an abnormality of normal metabolism. As such, it does not have classical disease symptoms. As noted above, it can be a contributing factor to many chronic diseases.

Laboratory Findings in Insulin Resistance

• Elevation of fasting and two-hour post-prandial blood sugar, (the blood sugar obtained two hours after eating)

• Most individuals with adult onset diabetes had insulin resistance prior to the onset of their diabetes and have insulin resistance as part of their diabetic problem.

• Elevations in fasting insulin and two-hour post-prandial insulin

• When insulin levels are inappropriately elevated in comparison to the blood sugar we can diagnose insulin resistance.

• We will typically do a two-hour glucose/insulin tolerance test when we suspect insulin resistance.

• Protein C is a remnant particle of insulin. When elevated it suggests insulin resistance and excess circulating insulin.

• Lipid, (blood fat), abnormalities associated with insulin resistance include

• Elevated Triglycerides

• Low HDL levels

• An increase in small dense LDL particles these are a sub-fraction of the undesirable transport protein for cholesterol that significantly increases risk to heart disease even when cholesterol is relatively low.

• Coagulation abnormalities associated with insulin resistance include

• Increased levels of fibrinogen

• Elevated PAI-1, (plasminogen activator inhibitor-1)

• The cumulative effect of these abnormalities is to make the blood stickier and to promote arteriosclerosis.

The Treatment of Insulin Resistance

Dietary Measures

Obesity is a contributing factor to the manifestation of Insulin Resistance but it does not cause insulin resistance Weight loss, no matter how modest, will improve glucose insulin metabolism. In individuals who are obese we recommend modest calorie restriction to achieve a gradual and sustained weight loss.

Please see our section on Diet and Nutrition for general recommendations.

The basic principles of a good diet include:

Modest calorie intake

Carbohydrates should contribute 40-50% of total calories. Emphasize foods that are unprocessed and low in refined sugar and refined starches. Minimize calories from candy, soft drinks, pastries and dairy desserts. Do not add sugar to beverages or breakfast cereals. Minimize calories from refined carbohydrate sources such as white flour, white rice and potatoes. Avoid snack foods such as pretzels, corn chips, potato chips, etc.

Fats should provide an important source of calories, (up to 30%). Try and minimize saturated fats found in processed meats, feed lot fed animals, fried foods, baked goods and rich dairy desserts. Fats from vegetable sources such as olive oil, nuts and seeds are considered healthful. Fats from deep-sea fish and sea vegetables are considered healthful. 

Protein is essential to good health. The idea that a diet rich in protein will prevent obesity or improve insulin resistance has not been verified by scientific studies. Protein can be obtained from red meat, poultry, seafood, and vegetable sources. A varied diet that emphasizes, foods that are organic and unprocessed is most desirable.

Exercise

A modest exercise program will improve metabolism and aid in preventing the expression of Insulin Resistance in individuals at risk. Walking for 30 minutes per day is adequate. For those who cannot walk I recommend riding a stationary bicycle for 30 to 45 minutes. The benefit of exercise only exists while you are exercising regularly. Consistency is the key to achieving benefit.

Dietary Supplements that may improve Insulin Resistance:

Vitamins

• An Anti Oxidant multivitamin will reduce oxidative stress and reduce the adverse health effects of insulin resistance. I recommend a product called SEVAK in a dose of 2 capsules at breakfast and 2 capsules at lunch.

• Biotin is a B vitamin that may be helpful in a dose of 5000-10,000 micrograms per day. It should be taken with Alpha Lipoic Acid.

• Alpha Lipoic Acid in a dose of 200-400 mgs twice daily with meals will help improve insulin resistance.

Minerals

• Calcium emphasize food sources. Consider a modest supplementation of 600 mgs per day in addition to food sources unless there is another indication for higher doses such as bone loss.

• Chromium this is a trace mineral that has been shown to improve blood sugar and insulin resistance. The therapeutic dose is 400-800 micrograms per day.

• Magnesium Magnesium deficiency is common in our country. We recommend supplementation with 200-400 mgs per day.

• Vanadium this is a trace mineral. The minimal daily requirement is not large. The dose needed to improve glucose insulin metabolism in not nutritional but pharmacological, (5 mgs. per day). It should be used under the supervision of a health care practitioner.

• Zinc the recommended dose is 30 mgs. per day. I do not currently recommend this product because the long term safety data is not established.

Fats:  Certain fats can improve cell membrane sensitivity to insulin.

• Eicosapentaenoic acid, (EPA), is derived from fish oil. The recommended dose is 3-6 grams per day in divided doses.

• Conjugated Linoleic Acid this is a fat derived from animal sources. It has been shown to improve insulin sensitivity, improve glucose transport across the cell membrane and lower triglycerides. The recommended dose is 2 grams three times per day with meals.

Nutrients: There are “conditionally essential” nutrients that are helpful in optimizing glucose metabolism.

• Lipoic acid in a dose of 300-1200 mgs per day in divided doses

• Coenzyme Q 10 in a dose of 100 mgs per day

• L-Carnitine in a dose of 500 mgs two times per day

• Taurine in a dose of 500 mgs two times per day

• Milk Thistle and Panax Ginseng, (Korean Ginseng), are herbal products that are helpful in improving glucose metabolism

Ultraglycemics is a nutritional food product that can be used as a snack and or a meal substitute. It is specifically designed for people who have problems with glucose insulin metabolism.

Hormonal Factors that may affect Insulin Resistance

Stress is a natural part of life. Chronic, persistent stress is an important contributing factor to poor health, chronic illness and accelerated aging. With chronic persistent stress a hormonal pattern evolves that increases insulin sensitivity. The adrenal gland makes cortisol, which is a catabolic hormone. Among other actions, it increases glucose and creates an environment where insulin resistance can manifest. Catabolic hormones increase with chronic stress, chronic illness and the aging process. Anabolic hormones are made by the adrenal gland as well. The dominant anabolic hormone is DHEA. DHEA is a precursor to the sex hormones such as testosterone and estrogen. Other metabolites of DHEA support optimal thyroid function and immune function. DHEA declines with chronic stress and the aging process. When the DHEA level is low, careful supplementation with physiological doses may improve body composition, general well-being and glucose insulin metabolism.

Insulin Resistance is present in 20-30% of the population. It is a contributing factor to a variety of chronic health problems and the aging process. Individuals with Insulin Resistance can be identified. The problem can be managed through life style modification and appropriate nutritional supplementation.