Why should you monitor your insulin?

Insulin in our body is like the cleaner in a hotel: when everything is working as it should, no one notices its efforts. But as soon as the system fails, and you can’t find a towel - you notice. The lost towel in the case of insulin is high sugar levels, overeating and diabetes.

The development of type II diabetes mellitus begins with prediabetes - a small increase in blood sugar levels. Normal fasting glucose levels range from 4.0 to 5.9 mmol/l (72-106 mg/Dl). Prediabetes can be diagnosed in those whose fasting glucose levels vary between 5.5–6.9 mmol/l (99-124 mg/dL), and if the fasting sugar level is above 7 mmol/l, this is full blown diabetes.

Why is type II diabetes dangerous?

It develops when cells in the body become less and less sensitive to insulin. Because of this, sugar, which usually enters the cells when exposed to insulin, begins to "wander" in the bloodstream - the level of glucose in the blood rises. Chronically elevated blood sugar, or hyperglycemia, is a dangerous condition that leads to damage to blood vessels, kidneys, and nerves. Due to the hyperglycemia that accompanies prediabetes and diabetes, you can lose your eyesight, your wounds take a longer time to heal and are more prone to infection. But the most common consequence is atherosclerosis, a vascular disease that leads to heart attacks and strokes.

Why do we need insulin?

Short and boring definition: Insulin is a peptide hormone produced by the beta cells of the islets of Langerhans in the pancreas that maintains normal blood sugar levels.

But in fact, the story of insulin is a much more interesting one. It not only regulates how cells absorb glucose from the blood, but also affects the metabolism of proteins, fats, growth and cell division in the body. In this regard, insulin levels determine whether you are at risk of obesity, whether your workouts are effective in the gym - and even whether you are at high risk of dying from cardiovascular diseases.

Insulin was discovered over 100 years ago. In 1889, scientists from Germany noticed that animals in which they removed the pancreas during the experiments developed advanced diabetes. They guessed that some fragment of the pancreas probably releases a substance that regulates glucose metabolism. When researchers found the same beta cells found in the islets of Langerhans in the pancreas and isolated the hormone they produce, they named it "insulin," from the Latin word insula, "island."

Then the experiments began. Isolated and purified insulin was first administered to diabetic dogs and then to humans. The first patient was a 14-year-old boy with diabetes - with the help of insulin injections, doctors were able to lower his blood sugar levels and reverse other biochemical changes that had already begun to occur in his body. In 1923, the pharmaceutical company Eli Lilly began commercializing insulin using a similar porcine hormone, which proved to have the most similar chemical structure to that of human insulin. In the same year, scientists who experimented with insulin on dogs received the Nobel Prize for their discovery.

Insulin is a complicated and very important hormone. And yet, it receives undeservedly little attention. Healthy people usually do not even suspect what their level of insulin is and how it can affect their well-being - after all, an insulin test is not even in the standard biochemical blood test you undergo when you go to get your yearly physical. In the best case, you will be offered to take a blood glucose or glycated hemoglobin test at the clinic. But there is a catch:

When fluctuations in insulin secretion lead to an increase in blood sugar levels, it may be too late to engage in prevention, since the insulin system has already failed.

What affects insulin levels?

The simple answer is that insulin is produced in the body in response to glucose entering the bloodstream, usually after a meal. At the same time, insulin production is a complex multi-phase process that requires precise coordination between millions of cells. In a healthy body, insulin secretion can compete with the Large Hadron Collider in terms of accuracy and consistency of processes.

‍Insulin production is a biphasic process. This means that at first:

As soon as you eat carbohydrates, there is a sharp release of a large amount of insulin. This is phase One. It is responsible for ensuring that immediately after eating you do not have too much of a jump in blood glucose.

During phase 2, there is an adjustment and maintenance of the desired level of sugar in the blood - insulin continues to be produced in smaller quantities, but for an extended period. During this period, the blood glucose level should finally decrease and return to its “baseline” values.

Sometimes, when you eat high glycemic foods—those that cause your blood glucose levels to skyrocket, such as sweets—due to the high amounts of insulin, your blood sugar can drop even below its “starting” level. When this happens, you will begin to feel the desire to eat again, preferably with another cake / cookie / sweet fruit - in order to quickly replenish your glucose reserves and return your levels to normal.

This explains why the abuse of sweets can eventually lead to obesity and type II diabetes.

Sudden spikes in blood sugar levels, followed by a large surge of insulin, contribute to the storage of fat in the body. And when sugar drops sharply, you begin to crave sweets again - and this leads to frequent snacking. The cycle repeats itself over and over again, and the person may not even notice how they gained a dozen extra pounds.

But it's not all about the complex and confusing process of insulin production. The concentration of insulin in the blood after food intake continues to fluctuate all the time - about once every 5-15 minutes. Remember the islets of Langerhans in the pancreas, where insulin is secreted? So, we have millions of these islets, and all of them need to somehow “agree” among themselves in order to produce exactly as much insulin as required.

Impaired coordination between the islets of Langerhans is one of the causes of failures in insulin production. Can this well-coordinated mechanism fail? There are many factors at play here - from the work of the nervous system to the influence of certain drugs.

Also, problems with insulin can occur if the hormone is formed when it is not needed - that is, when food enters the body, but there are no carbohydrates in it.

This can happen when the vagus nerve is affected - it sends information to the brain about what smells, sounds, tastes and visual signals we receive from the outside world. For example, you see, smell or swallow food - the vagus nerve tells the brain that it's dinner time and insulin needs to be released. But here's the surprise - on the plate there is only scrambled eggs, the amount of carbohydrates in which tends to zero. As a result, insulin begins to idly fire  at the cells, trying to deliver glucose to them, but glucose is not there. Cells "resist" and become less sensitive to insulin - and this is the first step to sustained issues.

Of course, this does not mean that dishes in which there are no carbohydrates are generally harmful. But...

The situation can become critical if you abuse the carbohydrate-free and low-carb diets. If on such a diet you give up and eat something sweet (most likely, this will happen, let's be realistic), it will be more difficult for glucose to penetrate into the cells, and it will remain senselessly “hanging out” in the blood.

Scientists have sounded the alarm lately due to the popularity of the keto diet, a very low-carb, high-fat diet. It turns out, paradoxically, that such diets are a risk factor for type II diabetes, precisely because the body, practically deprived of glucose for a long time, ceases to digest it normally and to respond adequately to insulin. However, these studies have been conducted on mice. When it comes to humans, scientists prefer to draw conclusions with big reservations.

The nervous system can also influence the secretion of insulin. Stress, exercise, and other irritants can either decrease or increase hormone production—regardless of diet.

The dynamics of insulin indicators, in addition to carbohydrates, is determined by other components of food. For example, the amino acid arginine, which is found in many plant proteins, such as nuts and soy, stimulates insulin production. And a chronically increased amount of free fatty acids - a breakdown product of fats - in the blood, which can occur due to "therapeutic starvation" for a day or more, suppresses insulin secretion.

We have already said quite a lot about what can affect the increase or decrease in the level of insulin in the blood. But how does this affect the body as a whole?

Insulin is involved in the metabolism of all macronutrients - proteins, fats, carbohydrates. This is a kind of “accumulator” hormone: it helps the liver store glucose in the form of glycogen, provides adipose tissue with new triglycerides, and allows muscles to grow due to protein synthesis.

Normally, insulin maintains a balance in the body. If you consume exactly as many calories as you spend, then glucose will be temporarily stored in the muscles and liver to provide you with energy throughout the day, and fats and proteins from food will be used to maintain adequate levels of muscle and fat mass.

But let's say you eat more than you should and gain weight. Adipose tissue at the cellular level changes the body's sensitivity to insulin. Then you are more likely to have problems with insulin regulation.

The fat mass will continue to grow, and the muscles, on the contrary, will become weaker and begin to lose volume. Perhaps you will constantly feel hungry, notice problems with memory and concentration, and during the next examination, the doctor will point you to a chronic inflammatory process in the body.

What is happening, and most importantly, how to stop it?

Meet Insulin Resistance

That's insulin's number one enemy. Insulin resistance is a decrease in the sensitivity of different cells of the body, primarily in muscle and adipose tissue, to insulin.

When the body begins to absorb insulin poorly, compensatory hyperinsulinemia develops - that is, an increase in the level of insulin in the body.

Insulin resistance and hyperinsulinemia by themselves are not yet a sign of diabetes or even prediabetes. If the level of sugar with all this is normal, then the body is still coping. The problem is that excess insulin is almost wasted, the receptors for this hormone become less and less sensitive, which means that it will become more and more difficult for your body to maintain this delicate balance.

And if nothing is done, diabetes is almost inevitable from this point

Signs of insulin resistance

Approximately 60-70% of the glucose that enters our body with food is “eaten up” by the muscles with the help of insulin. Then, during the course of the day, as we move and work our muscles, glycogen is broken down back into simple sugars, which gives us energy.

So, if you don’t have enough energy in general, or you feel energized when you eat, only to experience a strong decline in energy immediately after - that may be a sign of insulin resistance.

Moreover, insulin not only provides the muscles with "long-term" energy, but also protects their tissues from decay. This is because if the body does not have enough energy - for example:

When glucose does not penetrate well into cells due to insulin resistance - it begins to use the muscles as an energy resource, breaking them down into amino acids.

And if you play sports, good muscle sensitivity to insulin ensures their rapid growth.

With insulin resistance, accordingly, you begin to lose muscle mass. It is gradually replaced by adipose tissue, and the body becomes less tight.

But that's not all - an increase in the amount of adipose tissue "feeds" insulin resistance. Adipose tissue cells secrete various substances - in particular, interleukin 6 (IL-6) and the energy metabolism hormone leptin - that make cells even less sensitive to insulin.

A typical presentation of insulin resistance: an eternally tired person with energy spikes and dips, coinciding in time with meals, who has found excess fat on their body and cannot get rid of it.

Passing the test

An insulin resistance test is not likely to be prescribed to you at the doctor’s office, unless you suffer from a serious form of obesity. Doctors can also check insulin resistance if they have already found deviations in your glucose level - but that may be too late! So you have to be proactive.

The most common insulin resistance index is called HOMA-IR. It is considered like this:

HOMA-IR = fasting glucose * fasting insulin / 22.5

Calculating the index is not difficult, but the issues have to do with its interpretation. The fact is that doctors have not yet come to a consensus on which HOMA-IR indicator should be considered the norm. But most experts agree that HOMA-IR less than one can be considered optimal, HOMA-IR> 2 is a reason to start worrying, and an index above 3 is already serious insulin resistance.

What to do?

For starters, take a breath. After all, stress increases the production of cortisol, and excess cortisol is another factor that increases the risk of insulin resistance.

If you have found insulin resistance, you need to conduct further examinations - to find out for what (possible) reasons insulin sensitivity has decreased and what changes in the body have already occurred in connection with this.

Insulin resistance causes chronic inflammation in the body, so inflammatory markers such as C-reactive protein and the already mentioned IL-6 should be measured. Imbalances in insulin can be linked to changes in other hormone levels, so it's worth checking at least cortisol and thyroid hormones.

Suppose, after all the tests, insulin resistance turned out to be your main problem, and this is due - according to the classics - to malnutrition and weight gain. What can be done about it?

Step One: Physical Activity

The best and most basic way to fight insulin resistance, as trite as it sounds, is to increase physical activity.

Physical activity increases insulin sensitivity almost instantly - this result is manifested within 72 hours after training. And if you exercise regularly, then insulin resistance will decrease in the long term. According to research, every additional 500 calories expended during training during the week reduces the risk of developing type II diabetes by 9%.

Any physical activity will do. You can pedal a bicycle or exercise bike for 30-60 minutes a day, you can work out with a barbell, on simulators, or choose high-intensity interval training - when you do just a few sets of 30-60 seconds, but perform complex exercises at a fast pace.

If you choose aerobic exercise, you can increase your insulin sensitivity even if you don't run until you're out of breath.

It is quite possible to exercise at a calm pace, without greatly increasing the oxygen consumption of the lungs - and it will still be effective. In practice, this means that even race walking - yes, even a regular walk - is a means to combat insulin resistance.

But it is best to combine several types of exercise. It makes sense to supplement aerobic exercise at least occasionally with strength training - this way you will increase insulin sensitivity faster and more efficiently.

So, if you also start to control your diet to start losing weight, training will bring you even more benefits in the fight against insulin resistance.

Step Two: adjust your diet and start losing weight

The research is clear: even a little extra weight increases the risk of diabetes by an average of three times. So if your body mass index is above 25, it's time to lose weight — unless, of course, you agree to accept the high probability of diabetes in the future.

By the way, even if you do not lose weight during training, physical activity still continues to positively affect insulin sensitivity.

Insulin resistance, as it turned out, exercise and weight loss influence independently - and complement each other's effects.

The body mass index (BMI) is calculated as follows: weight in kilograms is divided by the square of height in meters. For example: 74/(1,752) = 24.2. Norms for adults are different in different countries; usually the indicator from 18.5 to 25 is considered normal.

We will not list the recommendations on healthy eating in detail — you can read them in detail here or here. Here are the main ones.

• Count calories. You have to spend more than you eat — there are no other "secrets of losing weight".
• Learn the glycemic index of the foods you eat. Find a table on the Internet — and, if possible, choose those with the lowest values of this index (the glycemic index reflects the rate at which the consumption of foods leads to an increase in blood glucose; example of the table).
• If your kidneys are fine, make sure that protein makes up 15-20% of the total caloric content of your diet.
• Eat whole-grain foods, vegetables with a high fiber content. For every 1000 kcal you eat, you should have at least 14g (0.5oz) of fiber (its main source is vegetables and fruits).

Regarding the consumption of simple carbohydrates, in particular, added sugar — something that is not part of the food in its natural form. Food with a lot of simple carbohydrates and added sugar has an extremely high glycemic index — this causes strong fluctuations in blood glucose and insulin levels. And this, as we have already explained, leads to fat storage, increased cravings for sweets and snacks, as a result — to insulin resistance and a high risk of diabetes.

Reducing the intake of simple carbohydrates is useful for the prevention of insulin resistance, even if the total calorie content of your diet corresponds to your energy expenditure, you have a normal BMI and you often exercise.

But all this does not mean that you need to give up sweets altogether. To reduce the risk of insulin resistance, scientists recommend making sure that added sugar is no more than 10% of the calorie content of your diet. WHO experts also advise to strive for a figure of 5% — this is about 25 grams of added sugar per day: in their opinion, such a restriction in sweets will bring additional benefits to your health.

Step Three: Get some sleep

It's a fact: lack of sleep seriously reduces insulin sensitivity. Moreover:

Insulin resistance is affected by both lack of sleep for a long period of time, and just one night without sleep.

So try, if possible, to sleep the recommended 7-9 hours a day.

Is insulin really to blame?

It happens that you do everything you need to reduce the level of insulin — and the effect is zero. Or it is there, but rather insignificant — and disappears as soon as you loosen your grip a little.

In this case, it may be suspected that problems with insulin are not directly related to carbohydrate metabolism and excess weight. Even if you do have excess weight, it is possible that it is a consequence, and not the cause of insulin resistance. And your insulin sensitivity has decreased due to some other factors.

We said above that, having discovered insulin resistance, it is worth carefully examining. But some ignore this advice — and immediately run to lose weight and go to the gym. Others pass all the tests — but they show only small, subclinical, deviations from the norm. And they can be ignored — until you realize that all other measures do not work.

So, you need to figure out what else — besides insulin sensitivity — is wrong in your body.

Burned out at work: stress, cortisol and insulin

As we have already mentioned, stress increases the level of cortisol in the body, and that, in turn, negatively affects insulin sensitivity.

Moreover, chronic stress increases cravings for food — especially fatty and sweet — and the level of the hormone leptin, which, in turn, increases the risk of insulin resistance.

So, perhaps you need to reduce your stress level or at least the amount of cortisol that is produced in response to stress — and then the insulin level and sensitivity to it will return to normal by themselves.

Here are some tips to help reduce cortisol levels:

• Do yoga: daily, at least an hour a day.
• Cuddle with loved ones for at least 15 minutes a day.
• Go to training, but do it with medium intensity. Too hard training can, on the contrary, increase cortisol.
• Listen to classical music.
• Attend relaxing massage sessions.
• Drink less coffee (or choose decaffeinated coffee).
• Buy a fluorescent lamp with a brightness of 10,000 lux and sit in front of it every day in winter, even better — to be in the sun more often.
• Sleep well (read more about healthy sleep here).

Take adaptogens: Rhodiola rosea extract, ginseng, eleutherococcus, ginkgo biloba and the already familiar ashwagandha.

Does it make sense to buy a blood glucose meter?

There are no available home remedies to monitor the level of insulin and its fluctuations yet. But there is an alternative in the form of a glucose meter: you can monitor changes in blood sugar levels, and this will indirectly indicate the work of insulin and the sensitivity of cells to it.

But how exactly to use a blood glucose meter to get some clear results and understand how you should proceed?

Basically, of course, the point of using a glucose meter by people without diabetes is to adjust nutrition. For clarity, let's give an example of how biohacker Natta Vannissorn, PhD in molecular genetics, did it.

To begin with, she measured her blood sugar on an empty stomach, and then began to eat low—carb dishes — for example, meat with vegetables -- and watch how the amount of blood glucose changes and how quickly it returns to the baseline level. To do this, she took measurements with a blood glucose meter about once every 30-60 minutes, and then built graphs.

As expected, after meat and vegetables, the blood glucose level rose slightly and quickly returned to normal. Even the addition of rice (= carbohydrates) to this dish did not cause strong glucose peaks.

Then Natta began experimenting with more "dangerous" carbohydrates — namely, potatoes. She ate it in different forms — both freshly cooked and hot, and chilled after cooking.

It turned out that in any form, potatoes cause a sharp rise in blood sugar levels — again, quite expected. But here's what's interesting: hot potatoes quite quickly cause a drop in glucose levels below the baseline, or hypoglycemia — and from this state the biohacker began to shake a little, and she needed to eat urgently (preferably sweet).

And we have already found out that such jumps in glucose and, accordingly, insulin are not good for the body. So, it makes sense to avoid foods that cause such a reaction — like hot potatoes. At the same time, chilled potatoes are safer — perhaps because starch takes a slightly different form when cooled, which affects the release of insulin after eating.

In any case, even if you yourself can't figure it all out, records of what you ate and how your blood sugar level changed — before eating, after 30 minutes, after 2 hours — can be very useful. You can show them to your endocrinologist or nutritionist, and the doctor may advise you something to correct your diet. You can also use modern measurement and maintenance tools offered by companies like Aspect which combine glucose monitoring and coaching to help you achieve you goals.

How do I give up sugar?

We have already mentioned above that WHO recommends reducing the amount of added sugar in the diet — up to 10%, and preferably up to 5% of the total caloric intake of food. In terms of the pure amount of sugar, this is 25-50 grams — and this includes all the sugar that manufacturers add to various ready-made dishes. And they add it almost everywhere.

Biohackers offer a tough method (attention — not recommended for people prone to eating disorders!): just stop eating food with added sugar. And sweeteners. By any means. You need to give up everything that contains sucrose, fructose, honey, agave syrup, sucralose, aspartame and even stevia. You can eat whole fruits, but fruit juices should also be removed from your diet.

They promise that the result — in the form of a serious reduction in cravings for sweets — will be felt if you last 30 days.

Prepare for a "sugar hunger strike": a few days before it, get rid of all the food with added sugar at your home — eat or distribute. Then think over the menu for the next month and buy the right products.

Here are some ideas of what you can eat instead of food with sugar:

• oatmeal with unsweetened peanut paste and/or berries;
• protein shake (without sweetener) with milk and banana;
• sweet potato (sweet potato).

They say that if you try cookies after such a "hunger strike", it will be so cloying that you won't even be able to chew it to the end. Don't you want to check for yourself?

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