The battle against insulin resistance — a hallmark of type 2 diabetes — has shifted with the use of GLP-1 agonists, not only for their weight loss properties but also for their role in managing blood glucose levels.
Medications like GLP-1 agonists are indispensable for individuals with established type 2 diabetes. However, before reaching the threshold of diabetes, lifestyle interventions can have a life-changing impact. The Four Pillars — nutrition, exercise, sleep, and stress management — are foundational to metabolic health.
What is insulin resistance?
Insulin resistance is a decrease in the body's ability to respond to the action of insulin in transporting glucose from the bloodstream into cells, which leads to elevated blood glucose levels.
You can think of insulin as a key for glucose channels in cells — when the key works, glucose can enter cells with no problem. With insulin resistance, the insulin key can’t unlock the glucose channels, leading to a buildup of glucose in the blood. This sets the stage for metabolic dysfunction and the development of type 2 diabetes.
What medications are used to treat insulin resistance?
While there are no drugs specifically for insulin resistance, several medications commonly used for treating type 2 diabetes exert effects that increase insulin sensitivity. These insulin-sensitizers include GLP-1 agonists, metformin, and TZDs. Studies have shown these drugs can help lower blood glucose levels and potentially reverse insulin resistance.
GLP-1 agonists for insulin resistance
GLP-1 agonists, like Ozempic, imitate the action of the hormone glucagon-like peptide-1 (GLP-1). One method of action to help with insulin sensitivity is that GLP-1 agonists stimulate feelings of satiety, or fullness, after eating [1]. They also increase the release of insulin after eating, which helps lower blood sugar. These drugs also slow gastric emptying (the movement of partially digested food from the stomach to the small intestine), which blunts glucose spikes after a meal. Research suggests GLP-1 agonists improve glycemic control and may aid in weight loss for some people, indirectly improving insulin sensitivity [1, 2].
Metformin for insulin resistance
Metformin is a widely prescribed oral anti-diabetic drug [3]. It lowers glucose production in the liver and decreases glucose absorption from food in the intestines, enhancing insulin sensitivity and glucose uptake in cells.
In addition to being used to treat type 2 diabetes, metformin has been shown to help with prediabetes and impaired glucose tolerance, addressing the core issue of insulin resistance [4]. Research and interventions have shown that metformin can effectively reduce the progression of prediabetes to type 2 diabetes in many people, especially those who are younger and overweight or obese [5].
TZDs for insulin resistance
Thiazolidinediones (TZDs), also called glitazones, are insulin sensitizers that increase glucose uptake by adipose and muscle tissues [6]. TZDs can activate specific receptors on the nucleus inside cells, leading to changes in the expression of certain genes that control fat storage. This action of TZDs increases the storage of fatty acids in fat tissue, leading to less fat available for energy and an increased reliance on glucose. This effectively lowers blood glucose levels and can decrease insulin resistance.
Should you use medication or lifestyle interventions for insulin resistance?
For those diagnosed with type 2 diabetes, medications such as GLP-1 agonists, metformin, and TZDs are often essential. They play a critical role in managing blood sugar and decreasing the risk of complications such as neuropathy, retinopathy, and cardiovascular disease, which are associated with prolonged elevated blood glucose levels. The goal of medication is to manage type 2 diabetes by maintaining blood glucose levels within a target range, reducing insulin resistance, and mitigating symptoms.
However, for individuals on the trajectory toward type 2 diabetes (but do not yet have it), evidence suggests that intensive lifestyle interventions may be equally, if not more, effective than medication [7]. This underlines the power of lifestyle changes in altering the course of prediabetes and metabolic dysfunction. Veri takes this evidence and distills these lifestyle interventions into actionable guidelines as the Four Pillars of metabolic health.
By integrating the Four Pillars with continuous glucose monitors (CGMs), people throughout the metabolic health spectrum can take proactive, informed steps toward improving their metabolic health.
The immediate feedback from CGMs lets individuals understand their personal glucose responses to different foods and activities, leading to more tailored and effective lifestyle shifts.
- Nutrition: A diet low in refined sugars and rich in fiber, whole grains, and healthy fats can improve glycemic control and insulin sensitivity. Make your meals insulin resistance friendly. Personalized nutrition plans can be fine-tuned using CGM data to control blood sugar spikes and find out which foods you should eat and which you should avoid.
- Physical activity: Regular exercise increases insulin sensitivity, which means cells are better able to use available insulin to take up glucose during and after activity. Both aerobic and resistance training enhance insulin sensitivity. CGMs can illustrate the beneficial effects of exercise on your glucose levels and see what type of physical activity is best for you.
- Sleep quality: Quality sleep is vital. Research links adequate sleep to improved insulin sensitivity, while sleep deprivation can exacerbate insulin resistance and impair glucose metabolism. When you use a CGM, you can track the effects of your sleep schedule on your glucose levels — and use this data to make tweaks to your sleep hygiene.
- Stress reduction: Chronic stress contributes to poor metabolic health. Stress can trigger the release of hormones such as cortisol, increasing blood glucose levels and promoting insulin resistance. CGMs can elucidate these trends, encouraging stress management practices to maintain stable glucose levels. Techniques such as mindfulness, yoga, and meditation can improve insulin sensitivity by reducing the stress hormone cortisol.
Key takeaways
- GLP-1 agonists, metformin, and TZDs can effectively manage glucose levels and insulin sensitivity and are crucial for those with type 2 diabetes.
- Preventing and potentially reversing insulin resistance relies on our everyday lifestyle choices. The Four Pillars ofnutrition, physical activity, sleep, and stress management serve as a guide for where to focus our efforts.
- While lifestyle interventions are key whether or not you’re taking medication, they may be a better fit if you don’t have Type 2 diabetes but are on the road toward it. In fact, proactively making adjustments to your lifestyle may be all you need to reverse your insulin resistance — and help you avoid the need for medication. Remember, metabolic health is a spectrum – identifying your place on the spectrum allows you to work on improving your health before you have a diagnosis.
- Continuous glucose monitoring (CGM) is a valuable tool to complement lifestyle interventions when managing and reversing insulin resistance. CGM provides real-time feedback on how your choices affect your blood glucose levels, enabling you to make informed decisions that could improve your metabolic health.
References:
- https://academic.oup.com/pmj/article/96/1133/156/6842784
- https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.1978
- https://www.ncbi.nlm.nih.gov/books/NBK518983/
- https://link.springer.com/article/10.1007/s40265-015-0416-8
- https://diabetesjournals.org/spectrum/article/31/4/336/32436/Metformin-and-Type-2-Diabetes-Prevention
- https://link.springer.com/article/10.1007/s11892-019-1270-y
- https://www.nejm.org/doi/full/10.1056/nejm200105033441801
