by Nate Widom
Diabetes and insulin resistance impact the same organs, causing imbalances in blood sugar levels and often displaying similar symptoms. But what sets them apart? I spoke with Ashley Boyer, RD and Certified Diabetes Care and Education Specialist, to delve into the distinctions.
When we eat, our food is broken down into several key compounds required to keep us energized and sustain life. One of these compounds is glucose. When consumed, glucose (or blood sugar) will want to enter the many cells inside our body to be converted to usable energy. However, that glucose needs some assistance to actually move from the blood into the cells. That’s where insulin comes in—it’s a hormone your pancreas creates. “I always think of insulin as a key that unlocks the door to the cells, and then the cell can open up and allow sugar to enter,” Ashley describes.
If this process works as intended, you’ll feel properly energized after consuming food. Unfortunately, some experience disruptions in this process, leading to insulin resistance, prediabetes, or diabetes. All these conditions not only negatively affect your energy levels but can spiral into a plethora of other adverse effects.
If this key, or insulin, doesn’t work as intended, glucose will circulate in the body where it can cause tons of damage as blood sugar levels rise. Not only that, but there will also be lots of excess insulin, too, signaling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat.
Insulin Resistance
If you’re insulin resistant, nothing initially is technically wrong with your glucose level, the pancreas, or the insulin the pancreas makes. The process works as usual until the glucose approaches the cell—that’s where the issue lies. Once the glucose shows up, the cells partially block that glucose from entering. Some can enter, but less than what normally should.
Researchers theorize that insulin resistance is typically caused by excess visceral fat, which surrounds your cells and organs. However, Ashley stresses that excess fat isn’t always thought to be the root cause—resistance is also linked to PCOS, metabolic dysfunction, and cardiovascular disease. One study of 6,200 Americans ages 18-44 without diabetes found that forty percent of the group had insulin resistance, but half of those who did weren’t obese.1
While some people with insulin resistance experience few or no complications, for others, it can progress into prediabetes and, eventually, type 2 diabetes. Here’s how it works:
- A Damaged Pancreas – Insulin resistance can signal the pancreas to work harder to make more insulin. “It’s like beating up the pancreas—the pancreas becomes a punching bag essentially,” Ashley mentions. This can overwork the pancreas and thus damage it.
- Progression to Diabetes – If the pancreas becomes damaged, it may produce less insulin, leading to prediabetes and type two diabetes over time. This progression can happen quickly, slowly, or not at all. It depends on the person! However, Ashley mentions that people whose insulin resistance leads to diabetes usually have a genetic predisposition and family history of it.
- Kidney Damage – Chronic kidney disease can also develop over time when insulin resistance produces high blood sugar. This is because sugar must be filtered by the kidneys, which can overwork and damage them.
Insulin resistance can also cause other adverse outcomes, including:
- Heart health problems
- High cholesterol & blood pressure
- Atherosclerosis: A condition where plaque surrounds the arteries, leading to heart issues, blood clots, & strokes.
- Nerve damage, especially in the feet and extremities
- Acne
- Menstrual cycle issues
- Hirsutism: a condition where excess hair appears on your body, primarily affecting women
Diabetes
There are two main types of diabetes. Both require insulin to be carefully injected or pumped into the body. Both result from issues with the pancreas.
Type 1
In Type 1 Diabetes, the beta cells in the pancreas simply don’t function, leading to little to no insulin release. Most people who get Type 1 diabetes get it through genetics during childhood, but the disease can develop at any point in life. It doesn’t matter whether they lived a healthy lifestyle or not. Unlike type 2 diabetes, type 1 is considered an autoimmune disease.
Type 2
Type 2 is different. Here, the pancreas originally made insulin as intended but has become damaged and slowed production, slowly generating much less (or none at all). This is caused by many factors including health history, genetics, diet, age, activity, and other things. It must be noted that poor lifestyle choices don’t necessarily mean you’ll end up getting type 2 diabetes. Usually, genetics plays a part in the equation.
Prediabetes
Then there’s prediabetes. It is just what it sounds like—it’s a condition that’s less severe and comes before diabetes. “Essentially, prediabetes just hasn’t taken you to diabetes yet,” Ashley explains. Your blood sugar level dictates whether you are considered prediabetic or diabetic; put simply, blood sugar levels in prediabetics are elevated but not as elevated as in those with diabetes. More importantly, prediabetes can very well develop into diabetes if left untreated, and it’s much harder to reverse diabetes through healthy lifestyle changes than prediabetes.
A Confusing Relationship
It’s incorrect to think if you have insulin resistance that you will inevitably develop diabetes. “Not everyone with insulin resistance has diabetes, nor does everyone with diabetes have insulin resistance,” Ashley explains. Though, again, type 2 diabetes and prediabetes can result from insulin resistance.
The A1C Test
Most commonly, diagnoses of diabetes and prediabetes are made based off A1C levels. The test does not require any fasting, and it measures your blood glucose during a 2-3 month period.
In the A1C test:
- A blood sugar of less than 5.7% is considered normal.
- A blood sugar of 5.7% to 6.4% is considered prediabetic.
- A blood sugar of 6.5% or higher is considered diabetic.
Blood sugar levels are prone to fluctuate, especially after eating, which is why it’s important to conduct proper testing. Besides the A1C test, other options include the Fasting Plasma Glucose (FPG), Oral Glucose Tolerance (OGTT), and the Random (or Casual) Plasma Glucose Test. Each test needs to be repeated to be conclusive. Should you need a test, talk to your doctor to see what’s most practical.
The Shared Symptoms
Although different diseases, diabetes, prediabetes, and insulin resistance all can lead to high blood sugar. Therefore, symptoms of high blood sugar can be shared between the two conditions. However, it needs to be noted that high blood pressure is twice as likely to affect a person with diabetes than without it.2 These symptoms of high blood sugar include:
- Excess hunger
- Excess thirst
- Excess urination
- Unintended weight changes
- Blurred vision
- Increased infection and slow-healing sores
- Headaches
- Skin tags
Not only that but the excess blood sugar can be stored as fat.
Here’s What You Can Do
Live A Healthy Lifestyle
If you have insulin resistance, a form of diabetes, or both, or want to help prevent these conditions, Ashley recommends what she’d recommend for everyone. “Strength, cardio, stress management, sleep—those are really important things.” Particularly, Ashley stresses that you should pay attention to your sleep and eating patterns and manage stress as best you can. Lack of sleep, frequent stress, and skipping meals will all raise blood sugar. “You want to keep your body insulin-sensitive, meaning it makes it easier for the insulin that is there [in your body] to be used,” she describes.
Healthy lifestyle changes will improve your condition, but the amount of improvement depends on the status of your pancreas.
- If you’re insulin-resistant or prediabetic, a healthy lifestyle can often reverse your condition because your pancreas still works (although at a lower capacity).
- If you have Type 1 or Type 2 diabetes, the pancreas is severely weakened or may not work at all. In this case, a healthy lifestyle would help manage your symptoms and prevent it from worsening. Unfortunately, it’s extremely rare for someone to completely reverse diabetes without proper management and treatment.
Get Tested
Lab work will show your blood sugar levels, but lab work is always recommended whether you have these conditions or not. “If you’re at a higher risk, if you have a family history, if you’re over 45, if you have any risk factors, you should get tested, especially if you have any symptoms,” Ashley explains. More specific tests are available, too, like fasting insulin or oral glucose tolerance tests. Cholesterol and triglyceride levels can also be tested and may indicate insulin resistance.
Look into a Continuous Glucose Monitor (CGM)
CGMs can show your blood sugar levels in real time, so you can see how certain foods can affect them. It’s now becoming a trend for people who are insulin-resistant or simply want to lose weight to use CGMs. However, they’re expensive unless covered under insurance—they are generally covered only for people diagnosed with diabetes.
In conclusion, diabetes and insulin resistance share similarities and can coincide with one another but are distinct. However, embracing a healthy lifestyle with proper nutrition, activity, sleep, and stress management could be the tools to manage these conditions or prevent them from happening to you.
You may be at higher risk for type 2 diabetes if you:
- have prediabetes
- are overweight
- have a family history of type 2 diabetes
- engage in physical active less than three times per week
- have given birth to a baby greater than 9 lbs.
- have non-alcoholic fatty liver disease
- are of African American, Hispanic, Latino, Asian, Pacific Islander, Native American, or Alaskan descent
References:
- academic.oup.com/jcem/article/107/1/e25/6362635
- hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetes-and-high-blood-pressure
