Insulin resistance: help is at hand

2022. January 24.

You are not feeling well, you’ve started to gain weight and can’t lose it even though you are dieting, you have become more tired and sweaty, you get irritated by things for no good reason and sometimes you can't control your appetite - these are the typical complaints that a patient with insulin resistance presents at the endocrinology clinic. These symptoms were described by Dr. Illés Gyula Balogh, Dr. Rose Private Hospital’s endocrinologist and gynecologist, who has had many positive experiences helping infertile couples, indeed often his patients become pregnant after a few months’ treatment, hence his desk is decorated with countless mugs bearing baby photos. We discussed the identification, testing, dangers and healing of insulin resistance with him.

Dr. Balogh Illés Gyula

We asked endocrinologist and gynecologist Dr. Illés Gyula Balogh, about the identification, examination, dangers and healing of insulin resistance.

How does an investigation of suspected insulin resistance begin?

First, we determine the Body Mass Index (BMI), body fat percentage and blood pressure, and the patient is sent for lab testing. A common typical complaint in women is greasy hair, possibly hair loss, or else they experience hair growth. During the investigation, we make an endocrine hormone profile, in which we look at thyroid and adrenal hormones, and testosterone levels in women experiencing hair loss. A glucose tolerance test and insulin level measurement must be done too. In the vast majority of cases there can be two or three minor reasons behind the complaints which, if remedied, can significantly reduce and improve these complaints.

What are these two or three reasons?

For example, insulin resistance, hypothyroidism and ovarian dysfunction are present at the same time. I am thinking of polycystic ovary syndrome: the polycystic ovary’s follicles are ripe but not ruptured, and the substances there cause the hormonal abnormality. If we interrupt this process and reverse it, the sufferer can leave the clinic completely healed.

What treatment do you give to your patients?

We try to correct all the discrepancies and, in addition, try to introduce a lifestyle change: if insulin resistance is confirmed, certain foods are removed from the patient's diet. Examples are fast-absorbing carbohydrates, including sweets, sugar, potatoes. Alcohol should be reduced to zero. Quite a few compromises are acceptable to this end.

Are there any other suggestions regarding lifestyle?

Exercise and sports are important, however, being overweight always makes sports risky because it can overload the joints. If the patient is in poor condition, declaring themself to be lacking energy and tired, then a prompt to exercise is usually unsuccessful. So, it is much more effective if you manage to achieve weight reduction, because after that the patient wants to play sports of their own accord. So, we don’t start right away with running around Budapest’s Margaret Island, you have to gently guide the patient in that direction.

Is there any drug therapy in addition to lifestyle changes?

If necessary, medication may be used, either in the form of a tablet or an injection. If, after a successful examination, the patient receives treatment that is appropriate for the diagnosis, he or she will feel significantly better after one month and feel encouraged to continue.

This disease does not develop overnight…

It has a process: Dad can no longer fit into his graduation suit after ten years because his body size has changed, so his body has been affected by effects that have pushed him in that direction. The situation is similar for ladies. The reversal is not quick either, hence with constant support and weight loss of up to a few kilograms per month, a very, very good result can be achieved. It is known that if the patient follows their diet, the intestinal flora will change significantly after six months, and after that it will not be difficult to follow the diet as the body will not want the foods it is used to.

What do you mean by the transformation of intestinal flora?

If the carbohydrate-degrading protozoa do not get carbohydrate, they obviously perish from the intestinal flora, so the composition of the intestinal flora changes. The change can be monitored too, via stool tests that examine the intestinal flora. From the results, conclusions can be drawn as to whether the intestinal flora may play a role in the development of bodily symptoms. These are exciting new research directions.

It’s also referred to as a fashionable illness. Is this true of insulin resistance?

Nowadays, we encounter these types of complaints more often. It can be observed, for example, after Covid lockdowns: the number of patients with this type of complaint was much higher than before, as the stress caused by confinement, fear of illness, or even teleworking and distance learning, are very stressful for people, and sports opportunities may be reduced. This can already cause somatic symptoms in some people.

What causes the development of insulin resistance?

During insulin resistance, the body does not process sugar properly, and blood sugar often stays higher than necessary. This is usually examined with a glucose tolerance test: if the body does not produce the initial baseline value after two hours with a certain load, ergo it is not able to recover completely, then this indicates that this problem is likely to exist, and the glucose tolerance test is usually supplemented with insulin level tests. Together, these two tests indicate even more accurately whether this problem is real or not. To maintain normal blood sugar levels, the body produces extremely high levels of insulin which, after decades with the pancreas overburdened, leads to diabetes.

Is this type 2 diabetes?

Yes. Exhaustion of the pancreas, i.e., a decrease in the ability to produce insulin, occurs.

Is there a difference between the sexes?

It occurs in both women and men. It can cause infertility in women, so they are much more sensitive to it, hence they see a doctor sooner than men. Examination of infertility often reveals that the other half of the couple needs to be treated. If you are overweight, you may want to investigate the cause. It’s not at all certain that the right attitude is to say don’t eat as much and play sports. You cannot break this vicious circle on your own, so you may need medical help. If someone feels that they are in this vicious circle, it is advisable to see a doctor to start the investigation as soon as possible.