THE INSULIN CONNECTION

Course overview

Resistance to insulin is a widespread and growing problem that is taking a toll on the health and well-being of our nation. It is currently estimated that approximately one quarter to one third of adult Americans are clinically insulin resistant. And many children, especially overweight children, are now insulin resistant as well. This is a concern because insulin resistance has emerged as a major factor in the development and progression of a number of common, chronic diseases. This is the case because when tissues become resistant to insulin, the pancreas responds by putting out more insulin to compensate. Hyperinsulinemia can overwhelm the body, putting people at risk for a whole range of conditions including: type 2 diabetes, heart attacks, strokes, liver disease, certain cancers and even cognitive decline. Because insulin resistance usually develops long before these diseases appear, identifying and treating insulin-resistant patients has potentially great preventive value. The "Insulin Connection" course starts out by providing an overview of the key functions of the hormone insulin. It then defines what it means to be resistant to insulin and describes various methods that can be used to assess whether a person has become insulin resistant. The course describes possible causes of insulin resistance, both hereditary and acquired. Two major acquired causes that are emphasized in this course are obesity (especially abdominal or visceral obesity) and sedentary lifestyle. This course then explores the consequences of insulin resistance, i.e. what happens when various tissues (eg. muscle, fat, liver, brain, endothelium) become resistant to this hormone. This course addresses the clinical impact of insulin resistance. It provides the mechanisms whereby insulin resistance serves as a precursor to chronic diseases such as type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, cognitive decline and certain cancers. Finally, the "Insulin Connection" course outlines steps that can be taken to reverse insulin resistance or improve insulin sensitivity. Numerous lifestyle measures are covered. The role of weight loss is addressed. The importance of adopting a high quality diet is stressed and specific characteristics of the recommended diet are outlined. The role and value of regular physical activity is emphasized. The link between quality sleep and insulin sensitivity is covered. In addition to lifestyle measures, pharmacologic interventions that can be used to reduce insulin resistance are outlined. Finally, the role of bariatric surgery in promoting weight loss and improving insulin sensitivity is described. Clinicians should make it a priority to aggressively identify patients with insulin resistance and assist them in making necessary lifestyle modifications and adopting appropriate treatment. By doing so, we can greatly reduce the clinical impact of this widespread and growing problem.