First, let me give a quick explanation of insulin resistance. Insulin resistance means that the body is not responding as well to insulin-the insulin made by the body itself, or insulin injected as a treatment for diabetes-as well as it should. Someone with insulin resistance may require two or three times (maybe even more) the amount of insulin to keep blood sugar normal as someone who has normal responsiveness to insulin.
Precisely what causes insulin resistance has been a major focus of research in diabetes for several decades. Insulin resistance is clearly the result of abdominal obesity. Fat cells in and around the internal organs of the abdomen make a variety of chemicals that are associated with insulin resistance, so the greater the abdominal obesity-the greater the waist circumference-the more insulin resistant someone is going to be and the greater his or her likelihood of having diabetes.
So obesity causes insulin resistance. The question is whether, in turn, insulin resistance also causes obesity, thereby leading to a viscous cycle. To some extent, this is probably the case. One concern here is that insulin is an anabolic hormone, meaning a hormone that promotes energy storage, including fat storage. When you take in calories, some of those calories are going to be stored as fat, and insulin is an important part of this process. Obviously if you don’t take in the calories, you will not store the fat, so those with insulin resistance can still lose weight if they reduce their calorie intake and increase their calorie expenditure through exercise. The weight loss then leads to improved insulin sensitivity, and the problem becomes steadily less severe as someone loses weight.
If someone who is insulin resistant has difficulty losing weight despite good dietary and lifestyle habits, metformin may be of help. Metformin is a medication used to treat diabetes, and it works, in part, by enhancing the body’s responsiveness to insulin. The drugs tend to suppress appetite somewhat, and those taking metformin have a fall in blood sugar as well as a decline in insulin levels. This medication sometimes helps people lose weight, and it is generally safe to take as long as you do not have kidney problems. It is available generically and is not very expensive.