March 22, 2023

Dr. Christopher Gardner explains the basics of glucose regulation and strategies to monitor and address insulin resistance in this video. One of the most important factors in a healthy metabolism is glucose homeostasis. Many of us have heard of too low of glucose, or hypoglycemia, and the opposite, too much glucose or hyperglycemia. Insulin is one of the key hormones responsible for avoiding these two extremes and maintaining glucose homeostasis.

One of the most important factors in a healthy metabolism is glucose homeostasis i’m sure a lot of you have experienced or heard of having too low of a glucose or hypoglycemia so that’s going to be hunger or shakiness or sweating and the opposite side of that is too much glucose in your blood hyperglycemia so that’s going to be thirst or fatigue or blurred vision

These are all things you want to avoid insulin is one of the key hormones responsible for maintaining glucose homeostasis let’s take a look at how this happens in the body insulin is made by the pancreas and is secreted into the blood when glucose appears after eating a typical meal for most cells in the body insulin is like a key that is needed to open a door in

The cell that allows glucose to be taken up into the cell and removed from the blood at that point the glucose might be used by the cell for immediate energy needs or stored as glycogen for later energy needs insulin also has an interesting role related to the storage of fat in fat cells typically the body uses combinations of glucose and fat for energy needs

Energy needs are typically low when we are eating a meal hopefully you’re sitting and relaxed while eating you’re not up and running about so when glucose is being absorbed and insulin is being released one of the messages this hormone has for fat cells is hey fat cells save your stored fat no reason to release that now we just ate plenty of available glucose

Around to meet our minimal energy needs at the moment save the fat for energy needs later well for people with a healthy metabolism that’s sensitive to insulin this all works well but for some people particularly those who are overweight and possibly pre-diabetic a condition referred to as insulin resistance occurs this can have an impact on both glucose and fat

Regulation for the glucose what this can mean is that insulin has become inefficient at telling cells to open the door to let the glucose in glucose levels stay elevated in the blood the pancreas senses this and it makes more insulin at least initially the extra insulin will then be enough to convince the cells to let glucose in but as the situation continues

It may require more and more and more insulin to get the same amount of glucose into the cells glucose concentrations in the blood may look normal but this comes as a result of having elevated insulin in the blood and that insulin has other effects so with insulin resistance the fat cells don’t get the message to keep storing their fat when there’s insulin in

The blood and this is particularly true for visceral fat that’s the fat that surrounds the organs in the belly area the insulin may be trying to encourage the fat cell to keep storing fat but it’s as if the fat cell responds by saying what what was that i can’t hear you did someone say more fat was needed okay releasing more fat now and that fat leaves the fat

Cell circulates in the blood looking for a muscle cell that might need energy but it was a mistake there weren’t any muscles looking for fat energy the fat circulates in the blood for a while but when none of the cells take it up the liver eventually takes it out of the blood and the liver then packages the fat up in a lipoprotein particle and sends it back

To be stored in the fat cell where that fat cell might take it up but then release it again by mistake again and if the muscle cells don’t need it the liver picks it up again and sends it back can you see the vicious circle going on here this can lead to hypertriglyceridemia high triglyceride levels in the blood this is one of the classic indicators of insulin

Resistance for clinicians it’s good to check up on glucose for your patients but there’s more to it than that for those who might have pre-diabetes or be headed to type 2 diabetes or have metabolic syndrome another way to monitor this is to be checking up on insulin levels or triglyceride levels so for this insulin resistance situation you can be catching that

Early on before this heads into type 2 diabetes and from a dietary perspective this is pretty straightforward this just means being extra vigilant about added sugars and refined grains getting those out of the diet those are the things that spike the glucose and spike the insulin and that leads to the insulin resistance so you want to be replacing those with a

Combination of whole grains vegetables and beans on the one hand those are good quality carbohydrates instead of low quality carbohydrates and on the other side you could substitute those refined grains and added sugars with avocados nuts and seeds fatty fish good olive oil on a salad so those would be high fat substitutions for the low fat carbohydrates those

Would be your strategies for addressing this you

Transcribed from video
What is insulin resistance? Why does it happen? [Dr. Christopher Gardner] By Stanford Center for Health Education