INSULIN RESISTANCE

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INSULIN RESISTANCE

• HILDEGARD STRYDOM
• REGISTERED DIETITIAN

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INSULIN RESISTANCEWhat is the function of
insulin?Insulin is released from the ß-cells of
the Islets of Langerhans in the pancreas after
eating, and then binds with receptors in cells to
allow the cells to unlock and let glucose enter
the cells from the blood stream.
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Carbohydrate digestion
STORAGE!
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Insulin Resistance

• Definition Decreased sensitivity of muscle,
  adipose and hepatic cells to insulin
• ?Normal amounts of insulin are inadequate to
  produce a normal insulin response
• ? High levels of insulin needed to balance blood
  glucose levels

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• Insulin resistance in
• Fat cells hydrolysis of stored triglycerides ?
  elevated levels of free fatty acids in plasma
• Muscle cells reduced glucose uptake
• Liver cells reduced glucose storage
• Elevated blood glucose levels
• ? Metabolic syndrome and Type II Diabetes

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Causes of insulin resistance

• Sedentary lifestyle obesity (Chronic disease of
  lifestyle)
• Haemochromatosis
• Polycystic ovarian syndrome (PCOS)
• Hypercortisolism (Steroid use or Cushings
  disease)
• Drugs rifampicin, isoniazid, olanzapine,
  risperidone, progestogens, many antiretrovirals,
  possibly alcohol
• Genetic causes

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Testing for insulin resistance

• Gold standard Hyperinsulinemic euglycemic clamp
• Fasting Insulin levels HOMA index
• Fasting blood glucose levels
• ATPIII 6,1 -7,1 mmol/L
• ADA 5,6 mmol/L
• Metabolic Syndrome
• ATPIII ?TG, ?HDL, HT, abdominal obesity,
  ?fasting glucose

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Insulin Resistance - A Spectrum of Disease
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Why is insulin resistance dangerous?

• After eating, a lot of insulin is needed (much
  more than in normal metabolism) to signal the
  body to allow glucose to enter insulin sensitive
  tissues.
• Hypoglycaemia after the meal
• Hyperglycaemia as pancreatic ß-
• cells are unable to produce enough
• insulin ? DMII
• Fat storage

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The good news!

• Insulin Resistance can be reversed by diet and
  exercise!
• The right diet to correct insulin resistance
  must release small amounts of glucose at a time
  and thus need only small amounts of insulin.
• Remember! The amount of glucose in the blood will
  be determined by the type of carbohydrates eaten

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ALL Carbohydrates
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Carbohydrate digestion
STORAGE!
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g
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g
g
g
g
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Definition
Glyc(a)emic Index
Glucose
List
Blood
Rating of foods according to their actual effect
on blood glucose levels
GI
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High GI (gt 70) Glucose enters blood at high
speed, rapid rise in blood glucose (10-60
minutes) Intermediate GI (gt55lt70)
Intermediate rise in blood glucose (2
hours) Low GI (lt55) Low blood glucose level
after carbohydrate consumption, lower blood
glucose levels maintained for longer (3
hours)
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Effect of High GI foods
STORAGE!
stomach
EASIER FAT STORAGE !
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Poor Blood Glucose Control
Blood glucose concentration
High GI foods

• Energy highs lows? tiredness
• Increased appetite cravings
• Irritable, headaches
• Reduced mental performance
• Increased fat storage
• Risk of Illnesses

Time (hrs)
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Effect of Low GI foods
Low GI food
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g
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Better Blood Glucose Control
Blood glucose concentration

• Body fat loss

• Decreased appetite cravings
• Better mental performance
• Sustained energy

Low GI foods
Time (hrs)
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REMEMBER!

• Only use SAs own GI list
• Look at Brand names
• Dont assume GI
• GI is useless if the right amounts are not taken-
  consider the glycemic load (GL)!

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GI LIST

• HI GI
• Flour
• Bread
• Rice cakes
• Potatoes
• Corn flakes, Special K
• Mealiemeal /Mabella
• Tiger Oats
• Sports drinks
• Sweets
• Watermelon

• INTMD GI LOW GI
• Rye bread Seed loaf
• Basmati Rice Provita
• Baby potatoes Tastic/OMS brown rice
• Bokomo Oats Pasta (durum wheat)
• Sugar All Bran Flakes
• Tropical Fruit High Fibre Bran
• Low GI Muesli
• Legumes
• Milk Yoghurt
• Deciduous Citrus
• fruits

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Prevent insulin resistance

• Maintain normal weight
• Eat mainly intermediate and low GI carbohydrates
• Reduce fat intake
• Exercise regularly
• Test your blood glucose levels annually