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Beyond Blood Sugar - Mastering Insulin: Understanding Insulin's Role and Resistance

Part 3


Insulin, the master regulator of blood sugar, plays a critical role in keeping your body functioning optimally. But sometimes, things get complicated. This blog post, inspired by Ben Bikman's insights, dives into the world of insulin, exploring insulin resistance, its causes, and strategies for potential prevention and reversal. We'll also delve into the fascinating concept of insulin resistance as a two-sided coin, and how it can manifest differently in various cell types, contributing to conditions like NAFLD and PCOS.


Understanding Insulin Resistance

Traditionally, insulin resistance is viewed as a pathological condition where cells become less responsive to insulin's signal. This leads to:

  • Chronic Hyperglycemia: Uncontrolled insulin resistance leads to chronically high blood sugar levels, a hallmark of type 2 diabetes.

  • Metabolic Disruption: Insulin resistance disrupts various metabolic processes, contributing to weight gain, fatty liver disease, and other health problems.


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However, the story doesn't end there. Insulin resistance exists at the cellular level, with some cells being more resistant than others as we learned in the Part 1 of this blog series on Insulin. This creates a metabolic imbalance. For example:

  • Fat Cells: Fat cells can become particularly insulin resistant. While this might be seen as a protective mechanism to prevent sugar overload, it also promotes fat storage. This can lead to weight gain and contribute to conditions like polycystic ovary syndrome (PCOS).

  • Muscle Cells: Muscle cells, on the other hand, often remain more insulin sensitive. This means they continue to respond to insulin's signal, taking up glucose from the bloodstream for energy.


The Domino Effect of Excess Glucose

When you consume carbohydrates, your body breaks them down into glucose, which enters the bloodstream. Ideally, insulin helps your cells absorb this glucose for energy. But in insulin resistance, this process gets disrupted. Here's how excess circulating glucose contributes to fatty liver and further fuels insulin resistance:

  • The Liver's Dual Role: The liver plays a central role in sugar management. It acts like a storage depot, taking up excess glucose and converting it into glycogen (a storage form of glucose) when blood sugar levels rise.

    • Glucose Influx: Dietary carbohydrates are broken down into glucose, which enters the bloodstream.

    • Glucose Clearance: The liver plays a crucial role in clearing excess glucose from the bloodstream and maintaining healthy blood sugar levels.

    • Glucose Storage: The liver stores excess glucose as glycogen, a readily available energy source, when blood sugar levels rise.

  • Storage Capacity Overload: However, the liver's glycogen storage capacity is limited (5-6% of the liver weight = ~120gms) When excessive glucose floods the bloodstream due to insulin resistance, the liver becomes overwhelmed.

  • The Fatty Transformation: With glycogen storage maxed out, the liver resorts to converting the remaining excess glucose into fat. This fat gets deposited in liver cells, leading to a condition called non-alcoholic fatty liver disease (NAFLD).


The Insulin Resistance Wrench - A Vicious Cycle

In insulin resistance, the body struggles to utilize glucose effectively due to reduced responsiveness to insulin. This creates a situation where:

  • High Blood Sugar: Glucose accumulates in the bloodstream because cells are less receptive to insulin's signal for uptake.


The development of NAFLD creates a vicious cycle that worsens insulin resistance:

  • Liver Dysfunction: A fatty liver becomes less efficient at its metabolic functions, including regulating blood sugar and properly responding to insulin. This further impairs the body's ability to clear glucose from the bloodstream, perpetuating high blood sugar levels.

  • Increased Inflammation: Fatty liver disease is often accompanied by chronic low-grade inflammation. This inflammation can disrupt insulin signaling throughout the body, not just in the liver, making both fat cells and other tissues more resistant to insulin's effects.


Excess circulating glucose, a hallmark of insulin resistance, plays a significant role in the development of fatty liver. This fatty liver, in turn, worsens insulin resistance at both the liver and fat cell level, creating a vicious cycle that can significantly impact overall metabolic health.


Credit: Freepic-brgfx


The Classic View of Insulin and Fat Cells

  • Insulin as the "Unlocking Key": Traditionally, insulin acts like a key that unlocks fat cells, allowing glucose (sugar) from your bloodstream to enter for storage.

  • Insulin Resistance and Missed Messages: When fat cells become insulin resistant, they become less responsive to insulin's signal. This might seem counterintuitive for fat gain, because the "unlocking" mechanism seems to be malfunctioning.


The Twist: Alternative Pathways for Fat Storage

Even though insulin resistance reduces the fat cell's response to insulin, fat storage can still occur through alternative pathways:

  • Free Fatty Acids: Dietary fats and fats released from breakdown of stored fat (triglycerides) circulate in the bloodstream as free fatty acids. Fat cells have transporters that allow these free fatty acids to enter the cell independent of insulin.

  • Increased Sugar Availability: In some cases of insulin resistance, overall blood sugar levels might be elevated due to the body's struggle to clear glucose from the bloodstream. Even with reduced insulin sensitivity, fat cells can still take up some glucose for storage.

The Net Effect: Fat Gain Wins

Despite some resistance to insulin, the combined effects of free fatty acid uptake and potentially some remaining glucose uptake can still lead to overall fat storage and weight gain. Here's why:

  • Persistent Sugar Influx: Chronically high blood sugar levels, a hallmark of insulin resistance, can overwhelm the fat cells' reduced responsiveness. Even with some resistance, the sheer amount of sugar in the bloodstream can force its way into fat cells for storage.

  • Metabolic Flexibility Matters: Healthy cells are metabolically flexible, meaning they can utilize both glucose and fat for energy. In insulin resistance, this flexibility can be impaired. Fat cells might become more adept at storing fat but less efficient at burning it for energy, further contributing to fat gain.


Understanding the Complexities

The relationship between insulin resistance and fat storage is multifaceted. While insulin resistance reduces the fat cell's response to insulin for glucose storage, alternative pathways and a high sugar environment can still lead to fat gain. This highlights the importance of addressing the root causes of insulin resistance, such as excessive sugar intake and chronic stress, to promote overall metabolic health and manage weight.


Insulin Resistance and PCOS: A Complex Dance

PCOS is a hormonal disorder affecting women and can be linked to this cellular-level insulin resistance. Here's how:

Increased Androgen Production

  • High insulin levels in the bloodstream can stimulate the ovaries to produce more androgens (male hormones) like testosterone.

  • Normally, androgens are present in small amounts in females, but in PCOS, their levels become elevated.

  • Excess androgens can disrupt the development and maturation of eggs within follicles, leading to irregular ovulation, a hallmark symptom of PCOS.


Increased Insulin-like Growth Factor (IGF) Production

  • Hyperinsulinemia can also lead to increased production of a hormone called Insulin-like Growth Factor (IGF-1) by the liver.

  • IGF-1 can further stimulate androgen production in the ovaries, contributing to the hormonal imbalance seen in PCOS.


Impaired Insulin Signaling

  • In some women with PCOS, there might be an underlying issue with insulin signaling within the ovaries.

  • This can lead to a situation where the ovaries are exposed to the high insulin levels in the blood, but the cells don't respond effectively, potentially contributing to abnormal hormone production.

  • Insulin resistance in fat cells promotes fat storage, particularly around the midsection. This excess fat tissue can further worsen insulin resistance, creating a vicious cycle.

  • Chronic insulin resistance can contribute to low-grade inflammation, further disrupting hormonal balance and potentially worsening PCOS symptoms.

Credit: Freepik-pikisuperstar


Optimizing Insulin Sensitivity for Overall Health

By understanding the nuances of insulin resistance at the cellular level, we can develop a more targeted approach to improving insulin sensitivity and potentially managing metabolic conditions caused by excess insulin.

  • Dietary Strategies: Limit processed carbohydrates and sugary drinks, which can overwhelm the system and contribute to insulin resistance. Focus on whole, unprocessed foods with a balanced glycemic load.

  • Exercise for Cellular Benefit: Regular physical activity, particularly strength training, improves insulin sensitivity in muscle cells, helping them utilize glucose for energy.

  • Stress Management: Chronic stress hormones like cortisol can worsen insulin resistance. Explore stress-reduction techniques like yoga, meditation, or deep breathing.

  • Quality Sleep: Aim for 7-8 hours of quality sleep each night. Poor sleep can disrupt hormones that regulate blood sugar and insulin sensitivity.

  • Consult a Healthcare Professional: Consulting a healthcare professional is crucial to develop a personalized treatment plan that may include specific dietary modifications and lifestyle changes to manage both insulin resistance and other metabolic conditions.


The concept of insulin resistance as a two-sided coin, coupled with the understanding of varying cellular responses, provides a deeper perspective on metabolic health. By addressing the underlying causes of insulin resistance and adopting a holistic approach, we can promote healthy insulin function, support overall metabolic health, and potentially improve these conditions.

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