I Am 25 Years Old and Insulin-Resistant but Not Diabetic? At Least, Not Yet.
Physically Fit but Metabolically Unfit
As I hit the quarter-century mark, the pertinent question remains. Will I or will I not scale the centenarian marathon and enjoy the company of my great-grandchildren. Unfortunately, the reality seems bleak as I am speaking right now! Turns out 2 months ago, I was found to be an insulin-resistant phenotype.
Am I unhealthy? Looks like I am physically fit
By all metrics, no, I can run a sub 4 hour 42.195 km marathon. My deadlift Personal Record is right now 130 kg, my bench is 70 kg, and my squats 80 kg. I currently weigh around 79 kg with 22% body fat. Not extremely impressive but by normal standard, I would consider myself above average.
What about my genetics?
Now, this is where things get interesting, you look at my family history from my mum`s side and my dad`s side. They are all riddled with chronic diseases. You name it and we have it: Cerebrovascular disease, cardiovascular disease, neurodegenerative disease & last but not least cancer.
What about my nutrition?
For the past 25 years, it is no secret that I have had disordered eating. I said it right, I don`t have an eating disorder, but I definitely have disordered eating. Being of Indian descent, I was also blessed with food that was mightiest on the lips but naughtiest on the hips. While I had my fair share of indulgences in my youthful days, it is true that this could have definitely contributed to my insulin resistance along with my genetics.
What is insulin?
Very simply insulin helps your body dispose of glucose into your muscle or convert your glucose to glycogen, a form of storage molecule. Lack of insulin or improper functioning of insulin causes your body to have too much sugar in your bloodstream, and this can cause severe complications that can go from renal failure to diabetic coma to severe dehydration.
What is insulin resistance and how is it different from diabetes?
A lot of people tend to confuse Type 2 diabetes with insulin resistance but rather it is a continuum starting with extra-release of insulin to nonalcoholic fatty liver disease, all the way to type 2 diabetes. It lays at the center of a lot of conditions and in fact, has been associated with hyperlipidemia, elevated uric acid, cancer, polycystic ovarian disease. In essence, if you end with any chronic disease, there is most definitely a chance that you are insulin resistant. So in simple terms, type 2 diabetes is an extreme form of insulin resistance where glucose disposal has gone awry leading to elevated blood glucose and inefficient glucose disposal.
According to some experts in the field, 1/4 to 1/2 of the population is insulin resistant though many of us will go with it without symptoms.
How do you diagnose Insulin resistance and diabetes?
Least Accurate: HbA1C
HBA1C tries to estimate the average blood glucose by looking at the amount of sugar that is chemically linked to your Haemoglobin. The basic idea is that the more sugar has been linked to your haemoglobin, the higher your average blood glucose level.
While the HBA1C test gives a pretty good idea whether or not one is diabetic (140mg/dl), it does not provide much insight how far away are you from it or your trajectory to diabetes and other metabolic disease given its lack of data about insulin.
It also has some other disadvantages as given its dependency on red blood cells, it might provide some faulty readings for some people having different traits of red blood cells. For example, some people have longer lifespan red blood cells ( >90 days), providing a longer average value while the truth is the insulin release and average glucose might in fact be less than that if adjusted.
The next thing would be that the HBA1C test does not give an indication of how things evolve over time but rather it is a snapshot of the action in progress. The analogy would be that of a car, trying to determine how fast a car by taking a picture of the wheels and trying to see whether the markings on the tires give any indication. A much easier way to do it would be to look at the car running, a take multiple pictures thereby looking at what happens to the wheel at different points in time.
The analogy would be that of a car, trying to determine how fast a car by taking a picture of the wheels and trying to see whether the markings on the tyres give any indication. A much easier way to do it would be look at the car running and take multiple pictures thereby looking at what happens to the wheel at different points in time.
More Accurate: Oral Glucose Tolerance Test
The OGTT provides a much clearer idea of the underlying picture (or video) by looking at how glucose and insulin change over time. The basic premise of this idea is to administer a fasted patient with a sugary drink and to measure insulin and glucose in 30-minute intervals. The ideal case would be that your glucose and insulin level rises and falls concurrently as time goes by.
Most Accurate: Euglycemic — Hyperinsulinemic Clamp (EHC)
As its name suggests, the EHC clam operates by fixing your glucose level and measuring how much does your insulin changes as time goes by. While this procedure is highly intrusive and requires the expertise of trained personnel and constant monitoring of physicians, it is by far the gold standard way of determining your insulin sensitivity/resistance.
Given that it is done in controlled settings, the experimenter can precisely measure and control for different hormones (glucagon, somatostatin) that affect your glucose level other than insulin which in this experiment is your measured variable. Similar to the oral glucose tolerance test (OGTT), several blood draws are done at precise time points
With a little bit of data exploration and model manipulation, the experiments allow us to calculate the HOMO-IR (Homeostatic Model of Insulin Resistance) value. It marks for both the presence and extent of any insulin resistance that you might currently express with metrics as follows :
1–4 — Insulin Resistance
5 — Normal
5–10 — Insulin Sensitive
My results
HBA1C ( Not diabetic or prediabetic)
My current HBA1c is around 5.1%.
OGTT ( Not pre-diabetic yet but cause for concern)
Whilst by a normal reading, it looks like my body is responsive to insulin, the cause for concern may be the high volume of insulin release compared to my friend. To this reading there are two insights that can be obtained :
- I have responsive insulin but it looks like for the same amount of glucose lots of insulin is released.
- It looks like my body likes to conserve my glucose (high insulin value) which might really explain why I put on weight so easily and I tend to have a slower metabolism. One secondary use of insulin is for lipogenesis. This provides a suitable strategy for me; maybe by limiting the release of insulin, I can lose weight much faster.
Euglycemic Clamp
Homo-IR value — 1.133
Gloom but real truth: I am insulin resistant with my score really being on the lowest end of the spectrum.
Parting Thoughts
I am now definitely sure that I am insulin resistant, now the more important question is what I should do about it. In the next post I will lay out different strategies that I have adopted from sleep, nutrition to exercise to talk about how I deal with my insulin resistance.
Caveat:
This post is only meant to share with you my experience. In no way, would I want you to believe that I am an expert but rather a steward of this idea. This post is for general information purposes only and not intended for medical advice or treatment. You can find me on Instagram and facebook with the fb id here & here and leave me a feedback on my posts.
