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Insulin Resistance and Pre-Diabetes

What is insulin resistance?

Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy.

The body’s digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time.

Insulin resistance increases the chance of developing type 2 diabetes and heart disease. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.
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What causes insulin resistance?

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.

Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.
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Metabolic Syndrome

Metabolic syndrome is defined as the presence of any three of the following conditions:

Source: Grundy SM, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735–2752.

Similar definitions have been developed by the World Health Organization and the American Association of Clinical Endocrinologists.
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What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007.

People with pre-diabetes are at increased risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes. Type 2 diabetes is sometimes defined as the form of diabetes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, in which the pancreas makes little or no insulin.

Studies have shown that most people with pre-diabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with pre-diabetes also are at increased risk of developing cardiovascular disease.
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What are the symptoms of insulin resistance and pre-diabetes?

Insulin resistance and pre-diabetes usually have no symptoms. People may have one or both conditions for several years without noticing anything. People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Other possible sites for dark patches include elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.
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How are insulin resistance and pre-diabetes diagnosed?

Health care providers use blood tests to determine whether a person has pre-diabetes but do not usually test for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood. However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most doctors’ offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. If tests indicate pre-diabetes or metabolic syndrome, insulin resistance most likely is present.

Diabetes and pre-diabetes can be detected with one of the following tests:

People whose test results indicate they have pre-diabetes should have their blood glucose levels checked again in 1 to 2 years.
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Risk Factors for Pre-diabetes and Type 2 Diabetes

The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45.
Risk factors for pre-diabetes and diabetes—in addition to being overweight or obese or being age 45 or older—include the following:

If test results are normal, testing should be repeated at least every year. Health care providers may recommend more frequent testing depending on initial results and risk status.
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Can insulin resistance and pre-diabetes be reversed?

Yes. Physical activity and weight loss help the body respond better to insulin. By losing weight and being more physically active, people with insulin resistance or pre-diabetes may avoid developing type 2 diabetes.

The Diabetes Prevention Program (DPP) and other large studies have shown that people with pre-diabetes can often prevent or delay diabetes if they lose a modest amount of weight by cutting fat and calorie intake and increasing physical activity—for example, walking 30 minutes a day 5 days a week. Losing just 5 to 7 percent of body weight prevents or delays diabetes by nearly 60 percent. In the DPP, people aged 60 or older who made lifestyle changes lowered their chances of developing diabetes by 70 percent. Many participants in the lifestyle intervention group returned to normal blood glucose levels and lowered their risk for developing heart disease and other problems associated with diabetes. The DPP also showed that the diabetes drug metformin reduced the risk of developing diabetes by 31 percent.

People with insulin resistance or pre-diabetes can help their body use insulin normally by being physically active, making wise food choices, and reaching and maintaining a healthy weight. Physical activity helps muscle cells use blood glucose for energy by making the cells more sensitive to insulin.
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Body Mass Index (BMI)

BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI table below to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, follow these steps:

The number at the top of the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes.

The BMI table has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age and sex in addition to height and weight. Information about BMI in children and teens, including a BMI calculator, is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults.

Body Mass Index Table

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Body Mass Index Table 1 of 2

 

Normal

Overweight

Obese

BMI

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

Height
(inches)

Body Weight (pounds)

58

91

96

100

105

110

115

119

124

129

134

138

143

148

153

158

162

167

59

94

99

104

109

114

119

124

128

133

138

143

148

153

158

163

168

173

60

97

102

107

112

118

123

128

133

138

143

148

153

158

163

168

174

179

61

100

106

111

116

122

127

132

137

143

148

153

158

164

169

174

180

185

62

104

109

115

120

126

131

136

142

147

153

158

164

169

175

180

186

191

63

107

113

118

124

130

135

141

146

152

158

163

169

175

180

186

191

197

64

110

116

122

128

134

140

145

151

157

163

169

174

180

186

192

197

204

65

114

120

126

132

138

144

150

156

162

168

174

180

186

192

198

204

210

66

118

124

130

136

142

148

155

161

167

173

179

186

192

198

204

210

216

67

121

127

134

140

146

153

159

166

172

178

185

191

198

204

211

217

223

68

125

131

138

144

151

158

164

171

177

184

190

197

203

210

216

223

230

69

128

135

142

149

155

162

169

176

182

189

196

203

209

216

223

230

236

70

132

139

146

153

160

167

174

181

188

195

202

209

216

222

229

236

243

71

136

143

150

157

165

172

179

186

193

200

208

215

222

229

236

243

250

72

140

147

154

162

169

177

184

191

199

206

213

221

228

235

242

250

258

73

144

151

159

166

174

182

189

197

204

212

219

227

235

242

250

257

265

74

148

155

163

171

179

186

194

202

210

218

225

233

241

249

256

264

272

75

152

160

168

176

184

192

200

208

216

224

232

240

248

256

264

272

279

76

156

164

172

180

189

197

205

213

221

230

238

246

254

263

271

279

287

 

Body Mass Index Table 2 of 2

 

Obese

Extreme Obesity

BMI

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

 

 

Height
(inches)

Body Weight (pounds)

 

 

58

172

177

181

186

191

196

201

205

210

215

220

224

229

234

239

244

248

253

258

 

 

59

178

183

188

193

198

203

208

212

217

222

227

232

237

242

247

252

257

262

267

 

 

60

184

189

194

199

204

209

215

220

225

230

235

240

245

250

255

261

266

271

276

 

 

61

190

195

201

206

211

217

222

227

232

238

243

248

254

259

264

269

275

280

285

 

 

62

196

202

207

213

218

224

229

235

240

246

251

256

262

267

273

278

284

289

295

 

 

63

203

208

214

220

225

231

237

242

248

254

259

265

270

278

282

287

293

299

304

 

 

64

209

215

221

227

232

238

244

250

256

262

267

273

279

285

291

296

302

308

314

 

 

65

216

222

228

234

240

246

252

258

264

270

276

282

288

294

300

306

312

318

324

 

 

66

223

229

235

241

247

253

260

266

272

278

284

291

297

303

309

315

322

328

334

 

 

67

230

236

242

249

255

261

268

274

280

287

293

299

306

312

319

325

331

338

344

 

 

68

236

243

249

256

262

269

276

282

289

295

302

308

315

322

328

335

341

348

354

 

 

69

243

250

257

263

270

277

284

291

297

304

311

318

324

331

338

345

351

358

365

 

 

70

250

257

264

271

278

285

292

299

306

313

320

327

334

341

348

355

362

369

376

 

 

71

257

265

272

279

286

293

301

308

315

322

329

338

343

351

358

365

372

379

386

 

 

72

265

272

279

287

294

302

309

316

324

331

338

346

353

361

368

375

383

390

397

 

 

73

272

280

288

295

302

310

318

325

333

340

348

355

363

371

378

386

393

401

408

 

 

74

280

287

295

303

311

319

326

334

342

350

358

365

373

381

389

396

404

412

420

 

 

75

287

295

303

311

319

327

335

343

351

359

367

375

383

391

399

407

415

423

431

 

 

76

295

304

312

320

328

336

344

353

361

369

377

385

394

402

410

418

426

435

443

 

 

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, National Institutes of Health, 1998.
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Can Ambulatory Reversal Program help reverse insulin resistance or pre-diabetes?

Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes.
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Points to Remember

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