Simple Mental Model for Insulin Resistance

The best feature of my exam room at Wellness Garage the glass "white board" that I inherited and repurposed from the gym that used to occupy our space.

Many times per day, I find myself drawing the same diagram:

or more neatly drawn and shared with our Diabetes Reversal Group:

I have written about Insulin Resistance before:

• Insulin Resistance - a silent killer - what you need to know
• Is Diabetes Reversible - Part I
• Is Diabetes Reversible - Part II
• Is Diabetes Reversible - Part IIII

Insulin resistance is, in my opinion, the single greatest health issue of our time, and is increasing at epidemic rates.

When I review the mental model for insulin resistance with our members here is a quick summary of what I share:

Metabolic health is one of the most important drivers of optimal health.

Weight gain and metabolic health are tightly related: poor metabolic health leads to increased fat which further worsens metabolic health.

Dysfunction in metabolic health manifests as insulin resistance - the process where the pancreas must release higher and higher levels of insulin in order to maintain blood sugars.

Insulin resistance can happen in multiple organ systems: muscle, fat, liver as well as the pancreas itself.

The initial phase of insulin resistance is marked by normal blood sugar levels but increasing insulin levels - the simplest biomarker for this is the TG/HDL ratio which generally increases with hyperinsulinemia.

By the time the fasting blood sugar becomes abnormal - insulin levels are often 2-3 x normal - at the same time approximately 50% of the pancreatic beta cells are no longer functioning. In most people it takes 10 -15 years to reach this point.

This marks the beginning of the second phase of insulin resistance, that of decreasing insulin production from the pancreas, and mildly abnormal blood sugars. We call this pre-diabetes.

Type II Diabetes is diagnosed when fasting blood sugars are greater than 7.0 mmol/L.

At this point, pancreatic beta cell function has been reduced over 80%.

Insulin resistance is a major risk factor for cardiovascular disease, cancer, dementia, liver failure, kidney failure in addition to being the cause of Type II Diabetes.

Risks for insulin resistance include: age, genetics, obesity - especially visceral obesity, sedentary behavior, stress, poor sleep and of course poor nutrition.

I will be blogging more on this in the future as we prepare to digitize our Diabetes Reversal program.

In the meantime, if you have Type II Diabetes, pre-diabetes, metabolic syndrome or insulin resistance (and you live within driving distance of our clinic in White Rock), you may be interested in our Group Diabetes Reversal Program