What is insulin resistance (and why does it occur)?

Insulin resistance is an important common condition that is an early indicator of the risk of developing type 2 diabetes. This video Dr Sultan explains what insulin resistance is, why insulin resistance occurs and how insulin resistance can be improved and maybe reversed.


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Video Transcript

What is insulin resistance?

So one of the things that happens to people with Type 2 diabetes or people with pre-diabetes or borderline diabetes is a long time before developing the condition they develop a thing called insulin resistance.
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I want to explain a little bit about how insulin resistance works and why it occurs because I think there are a few important aspects that are worth knowing about. So with everything with diabetes, we really start with food. If that food is excessive to our current needs we will break it down and we will store it inside a fat cell. And the way that we get particularly carbohydrates into fat cell is there is a lock on the surface of the cell called the insulin receptor. So when insulin as a lock binds to insulin which is like a key the two bind together and that actually opens a channel that allows food to get into the cell. Now if we eat excessive amounts of food then what will typically happen is that fat cell will increase in size. And if we continue to eat excessive amounts of food then that fat cell will get bigger and bigger and bigger. And eventually it will get to the point that even if the fat cell wants to just keep on growing it is constrained by its physical size, it cannot just get bigger. And at that point the fat cell is in trouble. Because it has to find a way to prevent excessive amounts of energy particularly in the form of glucose and carbohydrate from getting into the fat cell. And the way that is occurring is it changes the shape of the lock and you create this process of insulin resistance. Your fat cells become resistant to the effect of insulin so you produce a large amount of insulin just to try to open that lock.
Now over time what happens is the pancreas produces extra insulin and then eventually it cannot continue to produce the high amounts of insulin that it needs and the pancreas starts to fail and specifically the pancreatic insulin production starts to fail and the blood sugars rise.
But can insulin resistance be changed?
Well the answer is if you lose weight and you shrink your fat cell and you continue to shrink the fat cell then eventually what will happen is the lock will go back to normal and the insulin will be able to fit nicely.
And so when people talk about reversing diabetes they are really talking about sustained weight reduction that leads to improvement of the shape of the lock.
Now it may be that the pancreatic function by the time a person decides that they really want to deal with their diabetes is so diminished that they are not going to be able to produce enough insulin even with a well working lock. But nonetheless, if you can reduce insulin resistance there really is quite a profound improvement in glucose levels that a person can expect and the earlier that you deal with insulin resistance the better.
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