Insulin resistance - A metabolic health crisis - Health News

Insulin resistance is becoming a major health crisis in India, acting as a root cause for type 2 diabetes, obesity, and metabolic syndrome. A study on lipid profile levels by Metropolis Healthcare released last year reveals that one in three Indians shows lipid abnormalities, which is a key marker of insulin resistance.

“It is a real concern that requires sustained attention or priority,” says Dr Srirangam Vamshi, endocrinologist, Apollo Clinic, Hyderguda, Hyderabad.

Incidentally, growing awareness and conversation around the clinically significant condition has triggered an explosion of information. “The proliferation of health information online has created a rather paradoxical situation. While it has increased the awareness of insulin resistance and metabolic health, it also carries the risks that are associated with self-diagnosis and self-medication,” observes Dr Kalyan Kumar Gangapadhyay, endocrinologist at CMRI, Kolkata.

High burden, serious concern

“The burden of insulin resistance in India is extremely high. It has become a major public health concern which has led to the country being called as the ‘diabetes capital’ of the world,” says Dr Vamshi. “India is one of the seven countries in the International Diabetes Federation, Southeast Asia Region, and it has the second highest number of adults with diabetes in the world.”

So, what exactly is insulin resistance? “When we eat, the sugar in the food goes into the blood, from the blood it goes into the cells. Insulin has the key which opens the door and lets the sugar into the cells. Now if there is insulin resistance the door is jammed. So the insulin is unable to open the door properly. This is called insulin resistance,” explains Dr Gangapadhyay.

This most commonly occurs when a person is overweight. “The body fights the insulin resistance by producing more insulin to overcome this, and after a point the body fails to produce more insulin – and then the blood sugars begin to go up resulting in diabetes,” he adds.

Dr Gangapadhyay calls the state of insulin resistance in the country a “metabolic health crisis”. “Insulin resistance begets diabetes and diabetes is a killer, and that too a silent killer because a majority of the patients with diabetes do not have any symptoms initially,” he says.

Vulnerable sections

“If left untreated, insulin resistance can cause high damage to your health, as it is the foundational cause of numerous severe and chronic conditions, most notably type 2 diabetes and cardiovascular disease,” warns Dr Vamshi. “The continuous strain on the body due to this can lead to widespread organ and nerve damage over time. If left untreated, it may additionally cause metabolic syndrome, nonalcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS) in women, and organ damage.”

He shares that certain groups defined by age and rural-urban divide can be more vulnerable or susceptible to insulin resistance. “Vulnerability does depend on demographic markers like age and urban lifestyle or rural lifestyle, along with genetic predisposition. Middle-aged and older adults are more susceptible to this but sedentary or urban lifestyles and poor diets are causing it to affect young people as well,” says Dr Vamshi. Additionally, family history, genetic disposition, and pre-existing conditions like obesity or PCOS can lead to the condition across age groups, he adds.

Further deliberating on the causes of the high burden, Dr Gangapdhyay says, “Indians have got more fat in their tummies than their Caucasian counterparts and the tummy fat is the worst among all fats in promoting insulin resistance.” Although there are no clear symptoms pointing to insulin resistance, Dr Gangapadhyay says it may be a cause for concern if a person is overweight or obese.

Citing a study done in four regions of India representing the south, west, east and north with a combined population of 213 million people, Dr Gangapdhyay says that it revealed that about 54% of the people are actually inactive with the figure touching 65% among the urban population. “If the person has got more abdominal fat – waist circumference more than 90 cm or 35 inches for men and more than 80 cm or 31-and-a-half inches for women – that’s an indicator of abdominal obesity, more abdominal fat means there is more insulin resistance,” he shares.

One may also look out for acanthosis nigricans – “dark, velvety patches of skin most commonly found in the body folds like the back of the necks, armpits and groins. It initially feels as if there is dirt accumulation but that it is not, it is an indicator of insulin resistance,” explains Dr Gangapadhyay.

Prevention & management

“Insulin resistance can primarily be managed through intensive lifestyle modifications like diet control and physical activities along with proper medications. Consult a doctor for a correct diagnosis,” advises Dr Vamshi. Describing the process of treatment and diagnosis, he shares, “A doctor will consider your family history of diabetes, medical history, and do a physical exam for signs and symptoms. Later, they might conduct several blood tests as well to check for the consequences of insulin resistance. As there are no medications specifically approved for insulin resistance, doctors would treat the related conditions and risk factors.”

“Focus on a whole-food diet which is low in processed carbs and sugar, start regular exercise, proper sleep, and actively reduce stress. All of this will improve your body’s insulin sensitivity,” he says.

Adding to this, Dr Gangapadhyay says, “For food, it will be a good idea to replace refined white carbohydrates like white rice or maida with high-fibre whole grains like millets, which is jowar, bajra, ragi or oats, or brown rice.” He adds, “Have enough vegetables, every vegetable is good, have adequate amount of fruits as well, reduce the amount of sweets or fried food.”

Stressing on the importance of exercise in managing insulin resistance, he says, “Exercise whenever you can – walk two minutes after every one hour of sitting down, do isometric exercises. Walking after every meal has been shown to reduce the sugar surge which occurs due to food.” And last but not the least, he stresses on sleep and stress recovery.

“Losing unhealthy weight, having healthy food habits, proper sleep and adequate exercise – these three things are the cornerstones of tackling insulin resistance,” adds Dr Gangapadhyay.

BOX 1 – Possible signs to get checked