What is insulin resistance? 

Insulin resistance is when the cells and the muscles fatten and do not respond quite well to insulin. As a result, a patient will need more insulin to achieve the same effect. As you increase in insulin resistance, basically the body will try and produce more insulin. When a patient gets to a point where they are so insulin resistant that the pancreas can’t make enough insulin to overcome the insulin resistance, then things start to go wrong from a blood glucose perspective. 

What causes insulin resistance? 

Essentially, what causes a patient to become insulin resistant is: 

• Excess fat/visceral fat 
• Large waist 
• Smoking 
• Lack of exercise 
• Too much alcohol 

So, if a patient has a large tummy, they are likely going to be insulin resistant. 

What are the signs or symptoms? 

We need to be very clear; insulin resistance is not a symptom but a cause, and that is where most people tend to get it very wrong. In fact, there are very few symptoms of this problem because a patient will not generally feel ill. However, factors such as age can increase one’s risk of being insulin resistant because this group tends to pick more visceral fat. Also, a patient’s ethnic difference will determine whether they are likely to be insulin resistant and this has nothing to do with race or race wars. It is a physiological fact, and we should not shy away from talking about it for fear of upsetting the public. 

What are the treatment options? 

Insulin resistance is not a disease, it is an expression of other things that are going on in the body. We need to treat the underlying causes such a getting rid of excess fat and calories. So, to keep it simple, a patient would need to lose weight. However, losing weight in Africa and SA does not go down well with patients. This is because culturally, excess fat is viewed as a positive thing. The last thing I try and do is tell patients to lose weight. What patients are more open to is being told that they need to lose the excess weight around their stomach. Being fat is seen as a sort of cultural identity. It’s considered sexy and a sign of a good life. Sort out the cause but in the same line we need to be cognisant of culture. 

Also, an important part of healthy eating is to enjoy food. So again, in our speciality we are very careful of telling our patients what they can or can’t eat. Our approach is very much to inform patient’s that sugar, for example, is not the best food that they can eat because of its lack of nutritional benefits. One component of eating is the enjoyment, so if the food is tasteless and bland, a patient will lose interest. We must acknowledge that food fits into the whole fabric of society. We teach our patients the difference between good food choices and bad food choices. We encourage them to have the good food choices most of the time and less of the bad foods. This approach is less draconian.  

Exercise on its own will not help patient’s lose weight unless they are doing 90 minutes or more per day. Which is fine, provided that the patient has the time to do it and aren’t injuring themselves. The recommendation is that patients perform 150 minutes of aerobic exercise per week (walking, cycling, swimming) and two 30-minute sessions of resistance exercise (lifting weights). These exercises may potentially help patients to drop their blood glucose levels. 

Risk factors 

Insulin carries some risks on its own and is associated with conditions such as:  

• Cardiovascular disease 
• Type-2 diabetes 
• Non-alcoholic fatty liver disease 
• Polycystic ovarian syndrome (PCOS) 

Can insulin resistance be reduced or reversed?  

Yes, of course. Exercising for at least 30 minutes a day, maintain a healthy weight, patients who smoke should quit smoking, choose healthy low-calorie foods, and remember that hidden calories are contained in fat, alcohol, and sugar.