Hormone Series Insulin 1 of 3: Introducing Insulin and Insulin Resistance

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Dr. Aaron Hartman

February 22, 2022


Insulin is one of the top three hormones in the hormone hierarchy that affect all other hormones. The other hormones at the top of the hierarchy are cortisol (adrenal hormones) and thyroid hormones. These are the most important hormones that are absolutely required for life and they affect all the hormones in our body.
Without addressing insulin, cortisol, and thyroid the other secondary hormones will not be balanced regardless of what medications or supplements you take.


What is Insulin?

Insulin, secreted by the pancreas, plays an important role in blood sugar regulation. Acting like a key, insulin unlocks our cells to allow sugar (or glucose) to enter and either be used for fuel or stored as fat. When our body senses a rise in glucose, the pancreas secretes insulin and allows our muscle cells to take in glucose to be used for fuel and our fat cells to take in glucose to be stored for the future. Without insulin, glucose would continue to rise in our blood stream, literally making our blood “sticky” and wreaking havoc throughout the body, all the while depriving our cells of energy.


What is Insulin Resistance?

When our cells begin to ignore insulin and get a little sluggish at allowing glucose to enter, we call this insulin resistance. Although the pancreas produces insulin, the cells don’t respond well. Glucose rises in the blood stream, stimulating the pancreas to secrete more and more insulin. Eventually, this can progress to type 2 diabetes.

Insulin resistance is actually incredibly common. We tend to think about diabetes and insulin resistance together, but diabetes is an extreme version of insulin resistance.

How are Insulin Resistance, Prediabetes, and Type 2 Diabetes Diagnosed?

Diabetes (Type 2) is defined as an A1C at 6.5 or higher or fasting glucose over 125.
Prediabetes is defined as an A1C between 5.7 and 6.4 or fasting glucose between 101 and 125.
Insulin resistance is when your fasting glucose is between 85 and 100 and your A1C is less than 5.7 – even less than 5.5 in some individuals. Optimal A1C is less than 5.0. To diagnose insulin resistance, ideally we would check fasting insulin as well.
80% of the population in the United States has insulin resistance.
Yes, you read that correctly. 15% of our population currently is diabetic, 35% is pre diabetic, and another 30% is insulin resistant.

Is Insulin Resistance Really That Important?

The short answer is, absolutely yes. Insulin resistance affects your physical, mental, and emotional health as well as your risk of death.
If your fasting blood sugar (glucose) is over 85, your risk for dying of a cardiovascular disease is increased by 40%.
Insulin resistance is also linked with a 6-10% decrease in the volume of certain parts of the brain like the hippocampus, which is involved in learning, memory, and emotion. So insulin resistance can affect your memory, emotions, and the regulation of hormones.
Insulin resistance is a major issue in the health of our population.
The standard party line that a fasting glucose of less than 100 is not important is 100% wrong.
Why doesn’t our current healthcare system see insulin resistance as a problem? In our current, insurance-based system, we tend to focus on disease, not health and wholeness. We tend to focus on the severe ends of the spectrum and not consider the coming warning signs when people have increased risk but haven’t met the predetermined threshold for disease. Most healthcare providers just don’t worry about that. This is where personalized medicine (i.e. functional medicine) shines.

What are some of the symptoms of insulin resistance?

  • Fertility issues
  • Irregular periods
  • Irritability
  • Bowel irregularities that cycle from constipation to diarrhea
  • Water retention or edema
  • Weight gain
  • Brain fog

Do these sound a little bit like sex hormone issues that we’ve discussed around estrogen, testosterone, or progesterone? Or do they sound similar to adrenal or thyroid issues? That’s because hormones are all interconnected. You can’t just focus on one area and be an “expert” on thyroid or an “expert” on adrenals. We have to address all of these factors to allow the body to heal.

What Causes Insulin Resistance?

  • Processed foods
  • Excessive caloric intake
  • Nutrient deficiency
  • Chronic stress
  • Excessive alcohol consumption
  • Nicotine
  • Oral hormone replacement therapy
  • Oral contraceptives
  • Insufficient sleep quantity or quality

Current literature shows that half of all chronic disease in our country can be directly related to eating processed foods.
Processed foods are one of the major causes for insulin resistance, as are excessive caloric intake and nutritional status. It’s amazing to think that over half of our country is vitamin D deficient, and between 60-80% of our population has B vitamin deficiencies.
Chronic stress can also drive up cortisol, which can cause insulin resistance. Even oral hormones and oral contraceptives, especially the progesterone in these, can drive insulin resistance. High progesterone during pregnancy can affect sugar levels, which is one of the reasons why the oral glucose challenge test is done at around 28 weeks of pregnancy. Finally, thyroid imbalances, low DHEA, and sleep issues can all promote insulin resistance.

How Do We Treat Insulin Resistance?

What is the current conventional therapy for insulin resistance? Actually, there isn’t one. The typical protocol is to wait to intervene until someone is diabetic, when they have an A1C of 6.5 or higher and/or fasting glucose of 126 or higher. Some providers will be a little more aggressive and try to treat prediabetes to prevent it from progressing into diabetes. But for those people that have just insulin resistance with “normal” glucose in that 85 to 100 range, there is currently, no conventional therapy.
In our next post, I’ll discuss the functional medicine approach to insulin resistance, and how you can begin making some basic changes to reregulate this critical hormone for your health, well-being, and overall longevity.
If you’d like to learn more about hormones, please refer to the other articles in this series and to some of the books on our recommended reading list.
Take care and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.


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