Insulin Resistance
The syndrome of insulin resistance is one of society’s major scourges. Probably half of the UK the population is insulin resistant.
It is rather ironic that the complement of genes, that in the course of our evolutionary history represented a survival advantage in allowing those individuals so endowed to be efficient in storing away excess nutrients, have come to plague us now that we lead sedentary lives and have plenty to eat.
Insulin resistance underpins a spectrum from the merely genetically predisposed to those with the stigmata of the syndrome including Type 2 diabetes. Other genetic and environmental influences interact with insulin resistance to determine its progression and presentation. It is the basis for “The metabolic syndrome” (also known as syndrome X): central obesity, dyslipidaemia (low good cholesterol), high blood pressure, coronary artery disease and abnormal blood glucose levels culminating in Type 2 diabetes. Many of the diverse manifestations of insulin resistance have not been emphasized in the metabolic syndrome notion, and most significantly include Polycystic Ovarian Syndrome (PCOS).
As much as one in every 4 women may have PCOS and the vast majority do not even suspect it. PCOS may present with central obesity, excessive body hair growth, irregular periods, amenorrhoea (no periods), acne and infertility. And if a woman gets pregnant PCOS is associated with 40% chance of spontaneous abortion in the 12 weeks of pregnancy and a risk of gestational diabetes and of pre-eclampsia.
PCOS symptoms usually first present around menarche, but can occur anytime during a woman’s reproductive life. Subtle symptoms such as hot flushes, otherwise unexplained weight gain, mood swings and ‘hypoglycaemia’ after meals may be suggestive of the diagnosis.
Given its high prevalence and its metabolic basis, I consider PCOS to be a major health hazard for women of all ages. In addition to the modes of presentation highlighted above, it is a major risk factor for diabetes, heart disease, fatty liver uterine cancer, serious sleep disorders, depression, early fetal loss, multiple pregnancies and pre-eclampsia.
As implied insulin resistance manifests in both sexes as fatty liver and sleep disorders, which their attendant biochemical abnormalities and morbidity respectively. However, what has recently got the attention of the scientific community is the strong emerging link between insulin resistance and enhanced risk for Alzheimer’s disease.
Insulin resistance can be prevented and when it becomes clinically manifest it may be managed with programs aimed at behavioral and dietary modifications as well as the use of insulin sensitizers such as metformin. We have been able to achieve remarkable results with such a program over the last year.