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Today we will discuss an important topic – insulin resistance: its symptoms, tests, and management strategies for such clients. This is a complex and multifaceted issue that requires attention because insulin resistance can lead to more serious diseases.

Insulin resistance is a pathological condition that develops when cells lose sensitivity to insulin and are unable to allow glucose to enter. Simply put, the problem lies in the receptors that should respond to insulin. When cells do not respond properly to insulin, organs and tissues do not receive the necessary energy, and blood sugar levels remain high. This disrupts metabolism, and if no action is taken, the situation worsens, progressing into more serious diseases, such as metabolic syndrome. This syndrome includes not only insulin resistance but also type 2 diabetes and cardiovascular diseases.

Typically, patients with insulin resistance have obesity, hypertension (high blood pressure), and accelerated atherogenesis (the process of forming atherosclerotic plaques). This condition can be illustrated with the following example. Imagine you decide to go grocery shopping, but you forget your keys at home. When you return with your bags of food, you find that the door has slammed shut, and now you can’t get inside. The keys are still inside. In this case, you cannot enter the house, even though you have the necessary food — the glucose for feeding the cells. Similarly, in the body, during insulin resistance, the cells cannot "let in" glucose to provide energy to the tissues.

People at risk of insulin resistance and, later, metabolic syndrome include the following categories:

• Sedentary individuals with poor nutrition. These people often snack on sweet and high-calorie foods: crackers, pastries, candy bars, and sweets.
• People who drink sugary sodas or soft drinks. A common scenario is when someone has breakfast at work but then "survives" until dinner with tea, soda, coffee with cookies, or candy. These habits also increase the risk of insulin resistance.
• Fast food lovers, as fast food contains a lot of hidden sugars and trans fats, which negatively impact health.
• People following plant-based diets who cannot properly balance their nutrition. Many individuals who switch to vegan or vegetarian diets mistakenly exclude all animal products, forgetting that it is essential to maintain a proper balance of proteins, fats, and carbohydrates. As a result, they often overeat carbohydrates, which can lead to insulin resistance. Despite not consuming meat, such individuals may still drink sugary beverages, eat chocolates, fruits, pasta with ketchup, and other carbohydrate-rich foods.
• People who frequently overeat or consume excessive amounts of food that is not always balanced. This can include overeating in terms of calories or a lack of proteins and fats in the diet, where carbohydrates, particularly simple carbohydrates, dominate.
• Individuals who have close relatives with hyperlipidemia (high levels of fats in the blood), obesity, type 2 diabetes, or ischemic heart disease. This hereditary predisposition places them at increased risk for insulin resistance.

Now let’s look at how insulin resistance can manifest in young individuals.
If a person exhibits these symptoms, other signs are likely to follow: chronic fatigue, poor tolerance to physical exertion, depression, and an increased risk of Alzheimer's disease (which is sometimes called type 4 diabetes). Insulin resistance at a young age can greatly influence the development of Alzheimer’s in later years. Additionally, obesity, libido problems, erectile dysfunction in men, joint health issues, and difficulties with conception may occur in both sexes. In women, this may be accompanied by polycystic ovary syndrome (PCOS), which causes anovulatory menstrual cycles, progesterone deficiency, PMS, and other unpleasant symptoms. Such women may also experience hair loss on the crown of their heads, excessive facial and body hair growth. If a woman faces such symptoms, she should undergo tests and monitor her diet to balance her nutrition.

Insulin resistance can also develop due to stress and high cortisol levels. Cortisol is the stress hormone produced by the adrenal glands. Without it, a person cannot survive: for example, without insulin or thyroid hormones, we could survive for a few hours or days, but without cortisol, only for a few minutes. This hormone activates reactions that help the person fight or flee, which was crucial in ancient times. It increases heart rate, raises blood pressure, and breaks down muscle and fat tissues, releasing amino acids and triglycerides into the liver, where they are converted into glycogen and glucose. This increases blood glucose levels, allowing the person to respond more quickly to a threat.

However, in modern conditions, stress often does not involve physical activity, leading to the accumulation of chronic stress, which in turn promotes insulin resistance and type 2 diabetes. More than 1 billion people in the world suffer from excess weight, and the incidence of diabetes is growing, especially among people aged 20-39. For example, in the US, this figure has reached 23%. In general, more than 60% of people are overweight, and the number of individuals with insulin resistance continues to rise. It’s important to learn how to work correctly with such clients.

The diagnosis of insulin resistance is always complex and is not limited to just a few symptoms. We assess several factors, such as body mass index (BMI), which in individuals with insulin resistance is typically in the average or above-average range. The exceptions are asthenic individuals (often short women), who may still have symptoms of insulin resistance. Attention should also be given to darkened, rough patches of skin on the elbows, knees, armpits, and groin area. Darkening in these areas, especially if there is a condition called acanthosis nigricans on the neck, is also a sign of insulin resistance.

People with poor tolerance to physical exertion, especially cardio, and those who tire quickly may also be at risk for insulin resistance. Symptoms of hypoglycemia, such as irritability, weakness, and blurriness in vision, may indicate issues with carbohydrate metabolism. Individuals who wake up frequently at night or suffer from night terrors may also have high cortisol levels and insulin resistance.

Special attention should be given to women with polycystic ovary syndrome (PCOS), as this condition is often associated with insulin resistance. A low-carbohydrate diet can help these women conceive more quickly and reduce the risk of complications. Pregnancy is also a form of physiological insulin resistance, and it is crucial to monitor carbohydrate intake to prevent gestational diabetes, which can lead to type 2 diabetes and metabolic syndrome in the future.
In elderly individuals, diabetes and insulin resistance can lead to dementia and Alzheimer's disease.

The topic of insulin resistance in adolescents and children is particularly relevant, especially in light of diets that often do not consider the quality and composition of foods. Insulin resistance can be linked to improper nutrition, frequent snacking, and the consumption of foods that increase blood sugar levels, which is especially important for parents who may not always pay attention to their children's diet.

When it comes to insulin resistance, several factors need to be considered:

• External examination: Visible signs such as stretch marks (red striae), the "apple-shaped" body type, where the middle part of the torso increases while the legs remain slim, may indicate this problem. It's also important to assess body changes related to cortisol and stress levels.
• Diet analysis: It's essential for the client (or their parents) to send photos of everything they eat, including snacks and drinks. Beverages containing sugar or milk can raise insulin levels, so it's important to recommend drinking only water, unsweetened tea, or coffee without additives.
• Adjusting daily routine: For individuals with insulin resistance, having a proper sleep schedule is crucial. It's recommended to go to bed before 10-11 PM to ensure normal melatonin production—a hormone that regulates all processes in the body, including the synthesis of other hormones. Lack of sleep affects hormonal balance and can lead to digestive issues, mood swings, lack of motivation, and even affect workouts.
• Monitoring glucose levels: Diagnosing insulin resistance may also involve monitoring blood sugar levels. This can be done using devices like Freestyle Libre or a traditional glucometer. It's important to measure glucose levels in the morning on an empty stomach, immediately after meals, and an hour after eating to understand how the body responds to food and what glucose levels remain in the blood.

In this context, working with a nutritionist and trainer becomes important, as they can help clients correctly manage their diet, lifestyle, and physical activity to normalize insulin levels and prevent further health issues.

Example of a diet that a client might send:
The person wakes up in the morning, has oatmeal with fruit and drinks juice. A couple of hours later, at work, they feel hungry, go to a café with colleagues, where they have coffee with pastries or a croissant. For lunch, they choose cutlets with potatoes, and an hour or two before the end of the workday, they have a coffee break with tea and candies. For dinner, they have pasta.

What is wrong with this diet?
This diet contains too many simple carbohydrates, which can cause a sharp spike in blood glucose, leading to impaired metabolism and energy production. However, it lacks sufficient protein, despite its presence in lunch and dinner dishes. The diet also shows a deficiency in fiber, proteins, and healthy fats, which are important for the normal functioning of the body.
What can be improved?
Breakfast:
To avoid blood glucose spikes, I would add protein to the oatmeal. This can be eggs, meat, fish, or protein powder. It's also important to add healthy fats—like avocado or nuts. Instead of regular oatmeal, you could add a spoonful of collagen, which will help increase the amino acids and protein in the diet.
Lunch:
Replace some of the carbohydrates with vegetables. You can keep the potatoes with the cutlets, but you should increase the vegetable intake—for example, adding a salad with greens, tomatoes, cucumbers, or stewed vegetables like broccoli or cauliflower. It's important to remember that fiber is an essential element for digestion and normalizing metabolism.
Dinner:
I would replace the pasta with vegetable pasta (e.g., zucchini or carrot pasta), which can be stewed with shrimp and tomatoes. It's important to ensure the sauce is homemade and does not contain sugar. This will be a healthier alternative to traditional pasta with high-calorie sauce.

What should be considered when it comes to carbohydrate metabolism?
Laboratory tests:
To assess carbohydrate metabolism, attention should be paid to insulin levels, glycated hemoglobin, and triglycerides in the blood. If insulin resistance is suspected, this client should be referred to a nutritionist or doctor for further diagnosis and treatment, as this condition requires a comprehensive approach under professional supervision.

Insulin:
Insulin is a hormone that helps cells absorb glucose. The normal insulin level in the blood is up to 10 units per milliliter. If it is above 24, this may indicate the development of type 2 diabetes. It's important not to wait for this moment, as elevated insulin and glucose levels can already lead to diabetes. However, this condition can be compensated with proper nutrition and treatment before it progresses to the diabetes stage, when insulin injections are prescribed. The diabetes diagnosis is usually made too late, when medication intervention is inevitable.

Triglycerides:
Triglycerides are fat molecules found in the blood. The normal level of triglycerides is between 1.2 and 1.7 mmol/L. If the level is higher, it signals that the diet contains too many carbohydrates and fats, which may lead to cardiovascular disease and obesity. If triglycerides are below 1.2, this could indicate a deficiency of fats in the diet, which will also negatively impact the body, including reduced cognitive function and hormonal imbalances. It's important to maintain a balanced intake of both carbohydrates and fats for proper metabolism.

Glucose monitoring:
For accurate diagnosis and monitoring of metabolism, devices like Freestyle Libre can be used. This system is for continuous glucose monitoring, consisting of a small sensor that is attached to the skin. It reads glucose levels in the interstitial fluid and transmits data to a smartphone. This allows real-time monitoring of glucose levels and helps to immediately see how certain foods or physical activities affect blood sugar levels.

How Freestyle Libre works:

• The sensor is placed on the back of the upper arm.
• It measures glucose levels through interstitial fluid and sends data to a mobile device via an app.
• The device allows for 24/7 monitoring of blood sugar levels without the need for finger pricks for blood sampling.
• When using Freestyle Libre, fluctuations in sugar levels after meals can be noticed, which helps to adjust the diet.

What to do if a client cannot see a doctor?
Using Freestyle Libre:
If a client suspects a carbohydrate metabolism disorder but cannot see a doctor, recommend using the Freestyle Libre device for continuous glucose monitoring. This allows them to track how different foods and physical activity affect blood sugar levels and adjust their diet in real time. The advantage of Freestyle Libre is that it helps avoid frequent finger pricks, and glucose data is always accessible on a mobile device.

Working with a nutritionist or dietitian:
If seeing a doctor is not possible, recommend that the client consult with a nutritionist or dietitian, who can help adjust their diet and provide nutritional advice based on the suspected issue. Proper nutrition will help stabilize blood sugar levels and improve metabolism.

Nutrition plan and physical activity:
If consulting a specialist is not feasible, provide the client with a nutrition plan focused on slow-digesting carbohydrates (vegetables, whole grains), proteins (meat, fish, eggs), healthy fats (nuts, avocado, olive oil), and fiber (vegetables, greens). It is also important to increase physical activity, such as walking more or incorporating cardiovascular exercises, which will improve cellular sensitivity to insulin.

Self-diagnosis based on symptoms:
If the client cannot undergo medical tests, ask about possible symptoms, such as persistent fatigue, thirst, frequent urination, or slow wound healing. These symptoms may indicate metabolic issues that require attention. However, it is important to remember that only a doctor can provide an official diagnosis.