INSULIN RESISTANCE AND HOMA INDEX

Early detection | prevention/treatment

Insulin resistance is when the blood sugar-lowering hormone insulin has less effect than expected. It is also called pre-diabetes and is the preliminary stage to type 2 diabetes.

While the insulin deficiency in type 1 diabetes (= so-called juvenile form of diabetes) is absolute, i.e. no insulin is released at all, the insulin deficiency in type 2 is relative. This means that although insulin is basically released, the effect of the body's own insulin is too weak to normalise blood sugar. The causes of this are not exactly clear. However, it is assumed that it is caused by a combination of several factors.

In the development of insulin resistance, obesity is of outstanding causal importance. Free fatty acids have long been discussed as mediators between the excessive body fat and insulin resistance, but more recently also certain protein molecules that are released from the fatty tissue (similar to hormones from glands) and interfere with the insulin signal in other tissues (e.g. liver, muscle).

Diet also plays an overriding role. Large quantities of sugary foods and drinks, as well as highly processed and thus nutrient-poor foods, contribute greatly to this form of sugar metabolism disorder.

In addition, our predominantly sedentary lifestyle and the associated lack of exercise is another risk factor for the development of insulin resistance. In the meantime, there are numerous indications that regular exercise increases the insulin sensitivity of the cells and thus counteracts insulin resistance.

Insulin resistance not only leads to disturbances in glucose balance, but is also involved in the development of lipid metabolism disorders, high blood pressure and atherosclerosis. It is thus seen in very close connection with cardiovascular diseases.

Diagnosis of insulin resistance
In insulin resistance, blood glucose levels are slightly elevated after meals and insulin levels are highly elevated. The fasting glucose value is usually still within the normal range for a long time. Since pre-diabetes usually runs without symptoms, it therefore remains undetected for a long time. The impaired glucose utilisation can be detected with the help of the sugar load test and with the calculated laboratory value HOMA.Index as a measure of the estimated insulin resistance.

OUR OFFER FOR THE EARLY DETECTION OF INSULIN RESISTANCE

• Urine test for glucose (sugar)(part of the preventive health check-up 35+)
• Fasting blood glucose (70-110 mg/dl) (part of the preventive health check-up 35+)
• Blood glucoseprofile (blood glucose values before and after meals, if necessary also only one value 1-2 hours after a main meal)
  Even after a carbohydrate/sugar-containing diet, the blood glucose values must not rise significantly (ideal value approx. 70-140mg/dl).
• Sugar load test (oral glucose tolerance test)
  Sensitive standardised test for the early detection of diabetes, in which blood sugar is determined twice in the practice (fasting, 1 hour and 2 hours after drinking a standardised dextrose solution).
• HOMA index Laboratory test to determine insulin resistance (lack of effect of the body's own insulin), useful in cases of obesity, unfulfilled desire to have children, abnormal blood glucose values)
  oGTT - Download PDF

Our measures to prevent/ treat insulin resistance

Weight reduction
The best treatment (and prevention) of insulin resistance is still to achieve a normal body weight, i.e. the body mass index (weight in kg divided by height in m to the power of two) should be less than 25. We advise you on your goals.

Nutrition
We give initial individual nutritional advice and refer you to professional nutritional counselling by dieticians.

Exercise
Another important step is to exercise more and regularly. Muscle training counteracts insulin resistance and uses up glucose. Everything counts: Climbing stairs, going for a walk, even going on a fitness programme. We can give you general advice on this and apply for reimbursement of costs for functional sports/rehab sports.

Lack of sleep and shift work can also contribute to insulin resistance.

Medication
Metformin, a drug well known from diabetes therapy, clearly improves insulin action and reduces the risk of diabetes in a preventive approach. We will advise you on the basis of your laboratory values and your risk factors whether drug therapy is an option for you.