PCOS, Insulin Resistance And Exercise Training

1st part: What is insulinresistance?

Insulin resistance, a condition where the cells in the body do not properly respond to insulin, is one of the most insidious and also the most underestimated conditions. It is highly linked to modern nutritional habits and a sedentary lifestyle. It may lead to infertility, endocrine consequences like PCOS, Type 2 diabetes mellitus, digestive and cardiovascular problems. It is strongly correlated with the so-called Metabolic Syndrome, and also one of its symptoms: it includes (abdominal) obesity, hypertension, dyslipidemia with low high-density lipoproteins (HDL) and abnormal glucose tolerance. But you can act against it! Insulin resistance, even prediabetes may be reversible and very dependent on the lifestyle – what we can change on.

What is insulin?

Insulin is a polypeptide hormone produced by the pancreas. When we consume carbohydrates, the broken down carbs, in the form of sugar molecules (glucose) enter the bloodstream. If the blood sugar level starts to rise, the brain sends a message to the pancreas to release insulin. Despite the believes not only carbohydrates indicate insulin response. Some amino acids are able to increase insulin secretion independently of carbohydrate intake.

Insulin (and only insulin) allows the cells of the body to take up energy from the glucose. The sugar-consuming organs like fat, liver or muscles contain little “gates” for letting in the sugar into the cell, the so-called insulin receptors. It is a transmembrane receptor that is activated by insulin.

Why is too much sugar bad for you?

If the person consumes too much sugar, sugary or highly processed (fast release or high GI) food, this forces the pancreas to continuously overwork, meanwhile the insulin receptors start to become less sensitive, resistant to the presence of insulin. If there are more and more insulin-resistant cells in the body, the pancreas again has to release more insulin (overworking). It is clearly a vicious circle. This finally may lead to an exhausted pancreas that is not able anymore producing an adequate amount of insulin, so that is why the untreated insulin resistance may lead to Type 2 Diabetes. Up to 35 percent of the population is insulin resistant and some estimates, for example, sports scientist Professor Tim Noakes put that number as high as 60 percent. It means that every second people, females and males, have a higher chance to develop Type 2 Diabetes. And that’s why we should pay more attention to prevention.

What are the symptoms of insulin resistance?

Insulin resistance has no specific symptoms for a while. The possibility of having insulin resistance may persist if the client:

  • Feeling weakness, drowsiness, fatigue, concentration disorder, rapid heartbeat after a meal
  • Failed at weight loss despite a lifestyle change (and s/he has predominantly abdominal, visceral overweight)
  • Night sweats, frequent awakening in the middle of the night
  • Menstrual disorder
  • Infertility (for both women and men)
  • PCOS (polycystic ovary syndrome)
  • Hyperandrogenism (increased facial and body hair growth, acne, male pattern baldness)
  • Non-alcoholic Fatty liver
  • Hypertension
  • Dyslipidemia

Factors influencing the development of insulin resistance

  • Genetic factors
  • Poor nutrition: skipping meals, constant dieting, consuming more food at the same time, excessive carbs, high energy intake, poor diet, fat, saturated fatty acids and preference of simple carbohydrates
  • Sedentary lifestyle, lack of regular exercise
  • Increased stress
  • Sleep disorders
  • Vitamin D deficiency

Diagnostics

In the diagnostics of insulin resistance, there are two main clinical practice methods. Homeostasis Model Assessment, as often referred to, the HOMA index is calculated by the fasting blood glucose and insulin levels. The disadvantage of this method is that it provides information about the metabolism at a given moment, namely in the fasting state and most likely about the insulin resistance of the liver. But the insulin secretion and blood glucose control are a dynamic process which depends, among other things, on the glycemic index of the food consumed, the glycemic load, food preparing technology and mealtime. That is why the OGTT (Oral Glucose Tolerance Test) would be better detection of insulin secretion and blood glucose change as it is used to test the insulin sensitivity of the liver and muscle tissue, and can be determined by carbohydrate metabolism disorders. The test starts with a fasting glucose test, typically in the early morning hours. Then the client has to consume 8 ounces of syrup that contains 75 grams of sugar. In the next two hours the healthcare provider draws blood at the one- and two-hour marks, or in every 30 minutes. Ideally, blood sugar AND insulin level are also measured in order to detect insulin resistance even in an early stage when blood sugar level changing is still physiological, but the insulin level already shows problems in the glucose metabolism. Unfortunately, OGTT+insulin is not a widely used testing method in Ireland.

Treatment

As insulin resistance and diabetes are complex problems, each case should be treated individually, in a collaboration with an expert team including an endocrinologist, gynecologist, personal trainer and dietitian (and psychologist/life coach if needed). Insulin-altering medication like Metformin and dietary supplements like inositol can also be added to the therapy in some cases. The most important element of the treatment is a well-balanced diet and regular physical exercise. Proper activity can increase insulin sensitivity for at least 16 hours post-exercise. A good composition of aerobic and resistance training programme, at least 3-4 times per week is recommended for insulin-resistant persons.

As a Personal Trainer with more than 10 years of experience in training women with insulin resistance, prediabetes and other hormonal disorders I can help you to create your own bespoke exercise programme which can improve your insulin sensitivity.

Copyright © Gina Prónay-Zakar, curvyfitness.ie, 2020. All rights reserved.

References

 Abel, E., O’Shea, K. and Ramasamy, R. (2012). Insulin Resistance: Metabolic Mechanisms and Consequences in the Heart. Arteriosclerosis, Thrombosis, and Vascular Biology, [online] 32(9), pp.2068-2076. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646067/ [Accessed 20 Dec. 2018].

 American Heart Association: About Metabolic Syndrome, Editorial Board. (2002). American Heart Journal, [online] 143(5), p.3A. Available at: https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome [Accessed 20 Dec. 2018].

Wilcox G, Insulin and Insulin Resistance, Clin Biochem Rev. 2005 May; 26(2): 19–39. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1204764/ [Accessed: 24-01-2019]

 Lee SH et al. Insulin in the nervous system and the mind: Functions in metabolism, memory, and mood, Mol Metab. 2016 Aug; 5(8): 589–601. Avalaible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021669/ [Accessed 10 Feb. 2019].

 Dimitriadis, George et al, Insulin effects in muscle and adipose tissue, Diabetes Research and Clinical Practice , Volume 93 , S52 – S59 Avalaible at: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(11)70014-6/pdf [Accessed 10 Feb. 2019].

 Mesarwi, Omar et al. “Sleep disorders and the development of insulin resistance and obesity” Endocrinology and metabolism clinics of North America vol. 42,3 (2013): 617-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767932/ [Accessed 08 Feb. 2019].

 Al-Shoumer K, Al-Essa TM, Is there a relationship between vitamin D with insulin resistance and diabetes mellitus? Published at World Journal of Diabetes (2015) Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515445/

Michael J. Quon; Limitations of the Fasting Glucose to Insulin Ratio as an Index of Insulin Sensitivity, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 10, 1 October 2001, Pages 4615–4617, https://doi.org/10.1210/jcem.86.10.7952 Avalaible at: https://academic.oup.com/jcem/article/86/10/4615/2848886 [Accessed 01 Feb. 2019].

 M Stumvoll et al: Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 23:295–301, 2000 Available at: http://care.diabetesjournals.org/content/23/3/295.short [Accessed 01 Feb. 2019].

 Borghouts LB1, Keizer HA. Exercise and insulin sensitivity: a review.Int J Sports Med. 2000 Jan;21(1):1-12, https://www.ncbi.nlm.nih.gov/pubmed/10683091 (Accessed 20-12-2018)

Weickert, M. (2012). Nutritional Modulation of Insulin Resistance. Scientifica, [online] 2012, pp.1-15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820526/ [Accessed 1 Feb. 2019].

Breyer H. Zentai A (2016): Lifestyle treatment of insulin resistance and PCOS, Uj Dieta, [online] 2015, pp. 2-4. Available at: https://mdosz.hu/hun/wp-content/uploads/2016/03/ud_2015-2-3_final.pdf

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