How to test for Insulin Resistance, 4 ways

Insulin resistance affects nearly all women with PCOS. Some experts say 70% while others would argue it affects all women with PCOS to some degree. You can have insulin resistance and not PCOS. Why is this? No one for sure knows why women develop PCOS. Some research indicates there may be a gene that is turned on by environmental factors. Insulin Resistance left untreated will lead to diabetes and higher chances of heart disease. If you missed my first post entitled, Insulin Resistance and PCOS: What You Need To Know, please check it out here.

What is Insulin Resistance?

High blood sugars or eating too many carbs too often leads to insulin being unable to open and shut the door with the key. Insulin is the signal to the cell to open the door and let glucose or sugar into the cell to be converted to energy. Because the cells are being told to open the door over and over, it becomes “resistant” to the signal. The pancreas then releases more insulin to force the door open (hyperinsulinemia). Causing more resistance to open the door, and a vicious cycle occurs.

How is this different from Type 2 Diabetes?

Once the cells are unable to use the glucose, it remains in the bloodstream. The body senses the high glucose and tells the pancreas to secrete more insulin to deal with the excess glucose. Eventually, over years, the pancreas is unable to keep up. The glucose levels remain high in the bloodstream, and diabetes is then diagnosed by a blood test. When someone is diagnosed as diabetic, the pancreas makes little or no insulin because it can not do it anymore. Medications lower the glucose in the blood to allow the cells to use it. Uncontrolled diabetes can wreak havoc on the body and lead to hardened arteries in the heart, eyes, legs, and kidneys. You can refer to my previous post on the causes of insulin resistance.

What Tests Should I Get to Check For Insulin Resistance?

If you have PCOS, then you want to ask your doctor for tests that look at both insulin and glucose levels. These include:

Fasting glucose or fasting insulin
HBA1C level
Oral Glucose Tolerance Test

Fasting Glucose or Insulin
It is more common for your doctor to order a fasting glucose level. Not all offices can order a fasting insulin level. Although fasting insulin levels are more accurate. You should fast for about 12 hours before the lab draw.
Normal fasting glucose is below 100. A level over 126 is considered Diabetic.
A normal fasting glucose/insulin ratio of less than 4.5 is diagnostic of insulin resistance. Some would argue it is a better measure than the other tests listed.

HbA1C
This test is a measure of long-term glucose levels in the blood. It is a reflection of what your blood glucose levels have been over the last three months. It is commonly used to monitor diabetics and their response to medications. Your lab value should be less than 5.7 to be normal.

Oral Glucose Tolerance Test
This test is done by having you ingest 75 grams of sugar and then get your blood drawn at each hour for 2 hours, 1st draw when fasting.
Less than 140 mg/dl is normal,
If you are between 140 to 200 mg/dl then you have insulin resistance
If you are greater than 200 mg/dl then you are diabetic.

Metabolic Syndrome and Insulin Resistance

You should also check for metabolic syndrome if you have insulin resistance. Metabolic syndrome is a collection of symptoms that put you at higher risk for chronic diseases such as diabetes, heart disease, and cancer. You have to have 2 of the following criteria to get a diagnosis of metabolic syndrome. The criteria are:

High blood pressure.
High abdominal: waist ratio or central obesity of greater than 40 inches.
HDL or good cholesterol lower than 40mg/dl for men, 50mg/dl for women.
Triglycerides greater than 150mg/dl.

If you have metabolic syndrome, there is a high chance you are also insulin resistant. So get these labs done yearly as well as a good exam with blood pressure and weight check.

Cholesterol Panel
Comprehensive Metabolic Panel
CBC
Vitamin B12 and D

10 Tips to Naturally Reduce Insulin Resistance

Reducing your insulin resistance is not about eating fewer carbs and working out harder. It is about incorporating diet and lifestyle hacks to slowly reverse insulin resistance. It took time for your body to develop it, so it will take time for it to reverse. Diet and lifestyle modifications may work better than medications according to some researchers. Expect it to take about 3-6 months to see changes in your blood work. Let's break down the 10 tips into two categories.

Diet

Eat Enough Fiber

Fiber is crucial for the bacteria in the gut. Adequate fiber intake is at least 25 to 30 grams of soluble fiber a day. Foods that are rich in fiber include oatmeal, legumes, flaxseeds, and vegetables. A healthy gut leads to insulin sensitivity and weight loss.

Build a balanced plate

Pairing carbs with protein and ideally fat will allow them to slowly absorb into the bloodstream. Causing less of a spike in blood sugar and less insulin resistance to develop.

Consume carbs in moderation

Low carb or keto diets are generally not sustainable for most people. Instead, find out your carb tolerance. Start with a moderate carb allowance like 100 grams/day, and adjust depending on what your blood sugar levels are in response to that carb level. Over time, you will find your sweet spot of the right amount of carbs that work for you.

Choose low glycemic index carbs or complex carbs.

The GI is a scale that measures a food's ability to raise blood sugar. Complex carbs are more nutritious and contain fiber, facilitating the slow absorption of carbs into the bloodstream. Refined carbs absorb quickly and cause blood sugar spikes.

Add antioxidants like cinnamon and green tea to your diet.

Antioxidants lower oxidative stress in the body and fight insulin resistance. Cinnamon has been studied in women with PCOS and found to lower insulin levels significantly over 12 weeks. It also decreases inflammation which is a driver of PCOS symptoms.

The data is mixed on green tea, but overall looks promising.

LIFESTYLE

Reduce your stress.

Stress wreaks havoc not only on insulin resistance but also inflammation. Chronic stress will cause insulin resistance which cascades into more inflammation and then more insulin resistance. The result is high blood sugar levels that are stored in fat.

Prioritize sleep.

Adults need 7 to 9 hours of sleep a night. Poor sleep causes hormone disruptions in cortisol. This spike leads to weight gain and inflammation that can make hormonal imbalances worse.

Exercise Daily

An active lifestyle reduces insulin resistance. If you have a sedentary lifestyle, then start by moving your body every 1.5 hours. Even 10 minutes every few hours will improve your levels. The best time to move your body is right after a meal, as it will lower your blood glucose levels. The more steps you take, the better result you will get. A 2006 study demonstrated people who were sedentary (less than 150 minutes of exercise/week) were twice a likely to have metabolic syndrome.

Consider Intermittent Fasting.

Intermittent fasting has been shown in recent studies to help start weight loss in those that are obese or maintain weight in those at risk for diabetes (like PCOS). It is an eating plan where you designate a fasting time frame and an eating time frame. Data suggests that the body needs a 12-hour fasting window each day to rest and replenish. If you extend this window, you can gain the benefits of weight loss and decreasing insulin resistance. Do you want to learn more about IF, check out this podcast episode?

Get Adequate Magnesium Daily.

Magnesium deficiency is common in the U.S. due to the standard American diet. But Magnesium is critical because it is necessary for many reactions in the body. It plays a role in insulin signaling and glucose regulation. Low magnesium levels are associated with chronic diseases such as diabetes and heart disease. Women should be getting 320 mg of magnesium/day. Magnesium-rich foods include cashews, spinach, pumpkin seeds, sunflower seeds, halibut, and dark chocolate.