Insulin
Evidence based article by L. Jones, RN, examining medical and nursing approaches to insulin resistance and reversal processes.
Insulin is a hormone our bodies *usually* produce naturally by the pancreas. Insulin helps glucose (blood sugar) enter each individual cell. Often, scientists and doctors describe insulin as “the key” that allows glucose to get into the cells, so the cells have energy.
Insulin is the body’s main anabolic hormone, meaning it is responsible for building up (growing) molecules, cells, and tissues. Insulin inhibits catabolic pathways, which are the pathways involved in breaking down molecules, cells and tissues. In the presence of insulin, your body is programmed to store glucose and body fat as fuel to use later.
Insulin: The Hidden Obstacle to Weight Loss. What is insulin?
Diabetes Mellitus
The naming of the disease “diabetes” predates the currently known pathophysiology. In Greek, “diabetes” loosely translates to “to go through,” which refers to the excessive urination experienced with all forms of diabetes. Diabetes mellitus is what we typically think of as “diabetes”. “Mellitus” is Greek for “sweet”.
When your blood sugar gets too high, your body excretes excess sugar it is unable to absorb through the urine. Both type I and type II diabetes mellitus were characterized as the same, or similar diseases, because they both involved excessively urinating glucose. However, the pathophysiologies of these diseases are quite different.
What Happens When Your Body Does Not Make Insulin?
Type I Diabetes
Type 1 diabetes is often referred to as “juvenile diabetes”. Medicine no longer uses this terminology, and for good reason. Type 1 diabetes can develop at any time in the lifespan. Today, type II diabetes is more common in children than Type I diabetes (though in generations past, type II diabetes in children was exceedingly rare).
Type I is usually caused by an autoimmune response or viral infection that attacks the pancreas, the organ that secretes insulin (in addition to digestive enzymes and other hormones). Type I diabetics are often unable to secrete insulin at all, or they can not secrete enough insulin to sustain life.
Before modern medicine, type 1 diabetes was a death sentence. Without insulin acting as “the key” to get glucose into the cells, blood sugar would go up, but the cells in the body had no way to take in the sugar and use it as fuel. With no fuel, the body would begin to burn stored body fat as fuel, leading to rapid weight loss. In a matter of weeks or months, once all usable fat stores were depleted, these patients would fall into a coma and die shortly after.
When doctors first injected these comatose patients with insulin (harvested from a pig) they miraculously woke up—with the introduction of insulin, they were able to utilize the food they ate as fuel and replenish their fat stores. This is how we got the treatment paradigm—this is why we treat diabetes mellitus with insulin.
The DSM-5 has an eating disorder specific to those with type I diabetes. It is called “diabulimia”. Type I diabetics will eat whatever they want, and then they will not take their insulin. This leads to extremely high blood glucose, rapid weight loss, and (eventually) coma and death.
High Blood Sugar, High Insulin
Type II Diabetes
Unlike type I diabetes, there is no shortage of insulin in type II diabetes. Instead of low insulin, type II diabetes is characterized by insulin resistance, a complicated condition where the cells in your body do not respond to insulin as they should. Cells in your muscles, liver, and fat uptake less insulin and blood sugar (they ‘resist’ letting insulin inside), which leads to a buildup of glucose in the blood. In response to high blood glucose, your pancreas produces even more insulin, which leads to more insulin resistance and higher blood glucose levels.
Current treatment for type II diabetes often starts with drugs such as metformin. Metformin medications are not well understood, but they appear to help your cells respond normally to insulin, and lower blood glucose. Increasingly, GLP-1s like Ozempic and Zepbound are also being used as a first-line medication. GLP-1s dramatically slow down gastric emptying (which increases the feeling of fullness) and stimulate the pancreas to produce more insulin.
The result is a severe reduction in caloric consumption due to satiety and increased insulin sensitivity. If these medications do not resolve insulin resistance and elevated blood glucose, the next step is often to treat with more insulin. More insulin results in a lower blood sugar, which is good, but will also lead to weight gain and worsening insulin resistance. Your blood sugar gets better, but the root cause of the disease becomes worse. Your diabetes progresses into worse diabetes.
Breaking the Cycle
How Do I Lower Insulin?
The Key to Improving Metabolic Health
There are several ways to lower insulin. Depending on the severity of your own personal hyperinsulinemia or insulin resistance, you may have success in employing one strategy, or you may have to fight tooth and nail, and utilize every strategy in the book in order to make any progress. Keep in mind that all the strategies below work to lower insulin, but one strategy on its own may not lower insulin enough to yield results.
Safety disclaimer: Low blood sugar is incredibly dangerous. If you are on medications for diabetes, you should not be utilizing any strategies listed below without first consulting your doctor. You risk very serious harm. When The Reversal Project works with clients who take antidiabetics, our team always reaches out to prescribers to ensure our client’s safety.
The key to improving type II diabetes, and losing weight, is to lower insulin. High insulin and insulin resistance not only causes body fat to be stored but also inhibits your body from burning fat as fuel. If you have too much insulin and/or insulin resistance, your body is being programmed to store fuel. Your body will not tap into fat stores to fuel your day-to-day energy needs. Instead, your body relies exclusively on the food you eat to energize you.
Often, simply lowering your calories by a modest amount does not reverse elevated insulin and insulin resistance enough to lead to weight loss. Instead of burning fat, your body will lower its metabolic rate to match the amount of calories you are eating. You will be hungry, you will be tired, and you will not lose weight, or improve your diabetes. So what do we do to lower insulin levels and make your cells more insulin sensitive? That will be what my next article is about.
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Lowering Caloric Intake
Fewer calories lead to less overall glucose absorption from the gastrointestinal tract into the bloodstream. This leads to the pancreas secreting less insulin, resulting in lower insulin levels in the body. Over time, a modest calorie deficit leads to increased insulin sensitivity and decreased insulin resistance.
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Changing What You Eat
Everything we eat can be divided into three major macronutrient categories: Fat, proteins, and carbohydrates. Each macronutrient category has a differing impact on blood sugar and insulin secretion.
Carbohydrates are a group of macronutrients made out of sugar molecules. Some are made out of one sugar molecule (such as glucose), others are made out of two sugar molecules (such as lactose or sucrose), and others are made out of a very long chain of sugar molecules. Of the three macronutrients, carbohydrates raise blood sugar and stimulate the pancreas to secrete insulin the most.
Long or short, when carbohydrates are absorbed and broken down, they increase blood sugar and stimulate the pancreas to produce insulin. In general, the smaller the molecule, the faster it is broken down, leading to a sharp, fast spike in blood glucose and insulin secretion. Longer molecules (such as what is found in grains or starchy vegetables) take longer to break down, leading to a slow, steady rise in blood glucose and insulin secretion. Fiber is the longest kind of carbohydrate chain. Most vegetables and fruits contain fiber. Fiber cannot be digested by humans and slows the digestion of other carbohydrates. Though it is a carbohydrate, it does not raise blood sugar or insulin, and protects us from blood sugar and insulin spikes when it is consumed with other carbohydrates.
Keep in mind, this is an oversimplified view of carbohydrates–how each kind of carbohydrate is broken down and processed into energy is a little different. For instance, fructose is a single sugar, but it does not raise blood sugar or stimulate insulin production. Instead, fructose is only processed by the liver.
In a metabolically healthy person, carbohydrates are broken down, and small sugar molecules are brought into the cells by insulin. When cells are insulin-resistant, glucose builds up in the blood instead of being transported into the cells. Insulin resistance is a spectrum–some individuals have high insulin resistance, and some have a small amount of insulin resistance. Therefore, different people will tolerate different quantities and types of carbohydrates. In general, lowering your carbohydrates, especially one and two-chain carbohydrates, can help reduce insulin resistance, hyperinsulinemia, and high blood sugar. Depending on the severity of your metabolic issues, you may also need to reduce medium-chain carbohydrates. You do not have to be concerned with reducing low-calorie, fiber-filled vegetables, as these protect us from insulin and blood sugar spikes.
Carbohydrates
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Protein
Protein causes a very small increase in insulin secretion. However, it will not be the rollercoaster ride of blood glucose and insulin that you get from carbohydrates. Proteins take more energy to digest than any other macronutrient, and they are also more satiating than any other macronutrient. When you plan your meals, protein should be the star of the show.
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Fat
Fat causes no increase in insulin or blood sugar. Fat is also incredibly satiating, and a small amount of fat is required to absorb many micronutrients. Note that fat is the most calorie-dense macronutrient. Though fat is necessary to sustain life, it can be easily overdone, leading to excess calorie consumption and weight gain. Measure your oils, nuts, and butter.
The Ideal Plate to Lower Insulin Levels
From looking at this, you can see that the two types of food that minimally impact insulin are fiber and fat, and though protein impacts insulin a little, its hunger-crushing powers will serve you very well. Keep this in mind when you are constructing your plate. Your plate should be mostly protein (which likely already has fat in it) and low-calorie vegetables. Examples include a salmon salad, chicken with vegetables, or a vegetable omelet.
We have essential micronutrients, we have essential fatty acids, and essential amino acids. There are no essential carbohydrates. You don’t need them. You may need the micronutrients packaged within the carbohydrates, but you don’t need the carbohydrates, and you can get most of those micronutrients from low-calorie, fibrous vegetables.
People with metabolic issues tend to do much better when they completely (or almost completely) cut out one and two-chain carbohydrates, and restrict medium-chain carbohydrates from grains and root vegetables. Either cut out your non-fibrous carbohydrates entirely, or at the very least cut them in half. If you are going to have carbohydrates, make sure to pair them with other foods.
Proteins, fat, and fiber all slow down the breakdown of carbohydrates and the secretion of insulin. So when you feel you must have carbohydrates, make sure to pair your carbohydrates with protein, fat, or low-calorie vegetables.
How many non-fiber carbohydrates are too many? This will entirely vary based on the individual. Some will be able to see progress with a sugar reduction. Others may require a lifetime of very few carbohydrates.
Give Your Body Time To Burn Off Excess Blood Glucose
When you go periods of time without eating, your body begins to burn the glucose it has stored in the liver and muscles. This store of glucose is replaced by the glucose in your blood, thus lowering blood glucose. Once your blood glucose is low enough, your pancreas pauses insulin production. The low insulin level allows your body to burn body fat as fuel and convert some of that fat into glucose.
This is why intermittent fasting and time-restricted eating have become very popular in many different health spaces. It allows your body time to naturally lower insulin and blood glucose levels, and tap into its own fat stores. Studies have found that intermittent fasting and time-restricted eating improve insulin sensitivity, even when the same number of calories is consumed.
How long should I fast? Again, this will entirely depend on the individual. I usually have people start with redistricting their food intake to a ten-hour period per day (this means if you have breakfast by 8 am, you will need to complete dinner by 6 pm). I encourage two or three meals, no snacks. Three meals a day with snacks in between is not evidence-based nutrition–it is snack company propaganda. Every time you eat, it is an opportunity for your insulin and blood sugar to spike. Also consider that most convenient “snack” foods are highly processed.
They put just enough sugar, fat, salt, and unnatural flavorings in them to get you hooked–food manufacturers call it the “bliss point.” It may not taste overly sweet or salty, or give you a creamy mouth feel, but it sure is easy to down an entire bag, isn’t it? If you are grabbing a snack on the go, it is very likely not a healthy snack, even if it is marketed as healthy. If you are sitting down for a whole meal that was prepared at home, it is much more likely to be unprocessed.
If your blood sugar does not get to a reasonably low level before the next meal or snack, your blood sugar will slowly build up throughout the day, leading to elevated insulin and insulin resistance. If you absolutely must have a snack, consider making your next meal earlier, or choose something that will not spike your insulin (a hard-boiled egg, a small handful of nuts, avocado, or a few slices of deli meat). Skipping breakfast or dinner is a lot for some people, but skipping your snacks is a reasonable, easy, and healthy first step to take.
As you can imagine, injecting yourself with insulin from a vial will not lower your insulin and help you lose weight. It will raise your insulin levels, make your insulin resistance worse, and cause weight gain.
There are other medications that do help combat insulin resistance. Keep in mind, all of these medications are prescription only. If you want medication therapy to help manage your insulin resistance, you will need to talk to your doctor.
Medications
Metformin has been around for a long time. In most cases, insurance covers the cost, and generic, low-cost brands are available too. Metformin decreases the amount of sugar glucose your liver produces, decreases glucose absorption in the small intestine, and makes cells more responsive to insulin.
The combined decrease in glucose production and absorption, along with increased insulin sensitivity, leads to lower blood sugar. Metformin is not FDA-approved for weight loss, but often patients experience modest weight loss.
Metformin is often used as a first-line drug for type II diabetes. This is because it is effective, inexpensive, and targets the root cause of high blood glucose (insulin resistance). Metformin is not a replacement for a healthy lifestyle, but it can be an important tool in your diabetes reversal toolbox.
Metformin
GLP-1 Agonists (Ozempic, Tirzepitide, etc)
GLP-1s are the new superstar of the weight loss industry. Technically, GLP-1 medications, like Ozempic or Zepbound, trigger the pancreas to secrete more insulin in the presence of high blood sugar. However, GLP-1s also delay the movement of food into the stomach and signal the brain to reduce hunger, both of which increase the feeling of satiety. The reduction in calories that can be achieved with the hunger-suppressing effects of GLP-1s can lead to a net decrease in insulin secretion. These medications rapidly lower blood glucose by three mechanisms: Increasing satiety, thereby decreasing calorie consumption, increasing the release of insulin by the pancreas, and suppressing glucagon production (the hormone that signals your liver to make glucose and release it into the body). In metabolically healthy people, glucagon is secreted when your blood sugar is low, which prevents hypoglycemia when you skip a meal. In people with diabetes or other metabolic issues, glucagon is often secreted even in the presence of high blood sugar.
GLP-1s rapidly reverse weight gain and insulin resistance, and help your body burn fat as fuel. It is not all roses and sunshine, however. It is not an “easy” fix. You still have to change your diet and lifestyle. You can “out-eat” a GLP-1 prescription. GLP-1s are expensive (up to $1200 per month) and often not covered by insurance. GLP-1s are in high demand, and there is usually a supply shortage. GLP-1s rapidly reduce your muscle mass, and some studies indicate they do this more than any other weight loss method, which is very bad news for long-term metabolic health. Most people decide to stop taking GLP-1s eventually, and typically, this results in the weight coming back.
GLP-1s are likely going to be an important tool for weight loss, obesity, and metabolic health for many people. However, GLP-1s are not effective on their own. You still must change your eating habits. You can “out-eat” a GLP-1, and due to the delayed gastric emptying, this can lead to very unpleasant GI symptoms.
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Exercise
Muscles need energy to function. The more muscle tissue you have, the more energy your muscles will need. When you have excess blood sugar after a meal, one of the first places your body sends the blood glucose is the muscle tissue. The more you work your muscles, the more sugar from the blood will have to replace the sugar your muscles use.
Consistency is key. Just 20 minutes of activity a day will yield more results than being a gym rat for a few weeks before you hurt yourself and give up. Resistance training to prevent muscle loss as you age will help prevent age-related metabolic slowdown. Gentle cardiovascular exercise (such as walking, bike riding, or swimming) will strengthen your heart and help ensure a lifetime of good mobility. Both will lead to a modest reduction in blood glucose and increased insulin sensitivity.
If you want to do more intensive exercise, you can. More intense exercise will lead to more blood glucose being burned. But start small and sustainable, and work up to a higher activity level. Remember, mobility is a key factor in longevity. Your joints need to last you your entire life. If more intense exercise puts you at increased risk of injury, it is likely not worth it.
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Weight Loss Surgery
Weight loss surgeries are likely the most drastic weight loss option, and involve weeks to months of recovery. Usually, weight loss surgery involves making the stomach smaller to increase feelings of satiety, and more extreme surgeries also involve bypassing the upper part of the small intestine, which is responsible for nutrient absorption. Often, the extreme reduction in calories results in type II diabetes reversal within a week of surgery. Just like with medications, you can “out eat” your weight loss surgery. For every person I know who has a successful weight loss story post op, I know another who essentially re-stretched out their stomach.
As with all surgeries, you have a risk of complications, such as infection. Post op, patients need to be on supplements and a special diet for the rest of their lives. Often, they are unable to tolerate certain foods and struggle with chronic gastrointestinal issues (nausea, vomiting, diarrhea). Prior to surgery, most surgeons will have you go through counseling and attempt to lose a significant amount of weight to be sure you are dedicated to change.
Many people with type II diabetes or other metabolic issues are overweight, but many are not. Bariatric surgery is only available to patients who are of a larger body size.
In Conclusion
Implementing change in your life is difficult. Sticking with the changes you have made for life is even more difficult. All changes can feel very overwhelming to try to implement. What do I do first? What is most important? How do I start?
Pick something on the list you know you can do NOW, TODAY. Go for walks 20 minutes a day, stop eating late at night, increase your protein, cut sugars out of your diet, or focus on cutting your non-fibrous carbohydrates in half. Just pick one thing, give it a few weeks to make it a habit. Come back to this article in a month and pick something else to try. You can do it.
The Reversal Project is here to provide information and education on how to improve metabolic health, as well as provide you with support for sustainable, lifelong changes. Invest in your health and book a consultation today.