 Hey guys, this is Dr. Ahmed Ergin. I am the founder of SugarMDs and I'm an endocrinologist and a diabetes educator. Now today I'm going to answer a frequently asked question, which is insulin resistance, pre-diabetes, metabolic syndrome, what are they? Are they all the same things? Like there's a lot of confusion out there and some people say you either have diabetes or you don't. Pre-diabetes is a made-up word. That is probably a huge population that we are dealing with and they're not even aware of this problem that they have actually insulin resistance or pre-diabetes, and how to really remedy that problem, how to get rid of it. I think understanding the problem itself is the first way to understand what to do next, how to prevent or cure the problem. So before we get started, please subscribe, push that like button and we will get it going. So guys, insulin resistance. As you can tell, insulin resistance means that your body is resisting insulin. So why is your body resisting insulin? Like what is your body's problem with insulin? Like your resisting means like you're somebody's trying to push the door and you're at the backside of the door and you're trying to push back. Does your body not like the insulin? It's interesting because why would your body not like the insulin? Because it is something that's really necessary for your body. But think like this. If you have like a one person, two person coming to your home, you're having a good time, a two person comes and a third person comes and then the fifth comes and then suddenly you have 20 people in your house, and then you're like, oh my god, you're pulling your hair. What am I gonna do with these people? And then guess what? They don't want to go in. They want to sleep over and the next day they want to breakfast and next on the next day, they're like invading your house. So that is insulin resistance. What happens? Next time they come in, you hold the door. They're like, you're not coming in here, dude. So basically your body becomes insulin resistant when there is too much insulin. Of course, there are reasons why your body makes so much insulin and that's not the insulin problem or sugar problem to begin with. The problem starts when our body starts to make a lot of fat. The fat cells inside our body starts getting distended and they start getting into stress from too much fat being packed into those cells. Now, I'm not blaming anybody here for being overweight or anything like that. Most of the time is genetically determined that even some studies show that, you know, you put two different rats, for example, with different genetic background and they give them the same food. One becomes three times heavier than the other. The other stays as skinny as it was before. So how do you explain that? Of course, genetics. The microbiome in your gastrointestinal system also plays a major role. So people even talking about stool transplantation nowadays to treat obesity and insulin resistance. So it's not just what you eat or drink. It's not just your diet. It is sometimes a genetic makeup. So if you have people in your family with obesity or insulin resistance or PCOS and pre-davities, diabetes, you name it. If you have these things in your family, that means that you're prone to it. That means that you have to take extra precaution. It's like if you have a fair complexion, unlike me, that means that you're high risk for a skin cancer. So I may have more liberty to go out in the sun than you. Don't be jealous. That's OK. You know, fair complexion is a good thing. You know, a lot of people want to have fair complexion. The thing is that gives you less liberty when it comes to sun. You have to take extra measures to prevent that happen. Same thing applies to insulin resistance. If you have family history, then you have to take some extra measures. You have to be a little bit extra careful. You have to exercise a little bit more. You have to have a better lifestyle. Maybe it is something actually good for you that pushes you to do better in your life. Bottom line is insulin resistance is mostly genetically determined, but also environment being overweight, overeating, lack of exercise, etc. will definitely put you to insulin resistance stage. And then the pre-diabetes comes and then the diabetes comes. And these are pretty much a similar thing. This is just a spectrum where everything starts with insulin resistance. And then it leads to pre-diabetes. And these are all definitions. Your body doesn't say, oh, yeah, well, I have pre-diabetes now. What am I going to do to define and to categorize things? We make these things up. So we call you pre-diabetic. We call you diabetic. We call you severe diabetic, whatever. So the bottom line is it just shows you the severity of the problem. So when you have pre-diabetes, that means that your body is not even able to keep up with the insulin requirements anymore. And then you become diabetic. Let's move on to the tests we diagnose, the insulin resistance, pre-diabetes and diabetes. A lot of people will check insulin levels. Now, to be honest with you, insulin levels does not always come high in insulin resistant people. It requires a lot of practice and understanding of the test results. So insulin levels are a little tricky test. C-peptide is another one that's a little tricky test that a lot of people order and they don't even know what they're looking at. So make sure that an endocrinologist actually looks at those tests for you. They are the people who are going to give you the best answers. When it comes to the common tests we do, we have something called A1c. Like as you know from the previous videos, if you want to check it out right there, you can definitely try to understand A1c better. But if the A1c is between 5.7 and 6.5, we define that as pre-diabetes. Now again, this is our definition. So if your A1c is 5.6, you're almost there. So you definitely have some insulin resistance because typically A1c of normal people is, you know, right around 4.8 to 5.1 from 5.2. If you are going about 5.2, you know, 5.5, 5.6, you're kind of getting close to that pre-diabetic stage, which means that right now your insulin resistance. We do also two-hour glucose tolerance test, which is, I think, the gold standard test. It just tells you how your body can really tolerate a big load of glucose. So in this case, you know, if you are exceeding more than 140 by two hours, but less than 200, we call that pre-diabetes. If you're exceeding 200 any time during the test, typically at two hours mark, then we call this a diabetes. What else do we do? Fastened blood sugars, right? So fastened blood sugars, if you are between 100 and 126 in the mornings, you know, repeatedly, that also puts you at the pre-diabetes stage. Again, you know, if you are like 98, that is still not good. I'm not saying that, you know, 100 is a, you know, stuck cut off. Again, these are our definitions. Normally people wake up with anywhere from 80 to 90. So if you are waking up with 95, you know, you should probably start thinking about what to do about that before it hits 100. Don't wait until your blood sugar is 100 or 120 or whatever. Don't put numbers like that. It's all in a scale. So just look at this. It's like a temperature, right? Sometimes, you know, some people will think that 90 is hot. Some people will think that 100 is hot. Some people will think that 85 is hot. What are the other risk factors? So we talked about obesity. We are going to talk about medications. So if you're on steroids, if you are on certain agents, like some antipsychotics, that can also make you gain weight easily and can definitely push you towards that insulin resistance. It's interesting that even birth control pills can make you insulin resistant. So that's why some people gain weight on birth control pills, not everybody. But I think if you are prone to it, personally, if you're prone to be insulin resistant, then those birth control pills can potentially increase your weight and cause insulin resistance. If you have HIV, if you're taking medications for HIV, that can definitely increase your insulin resistance as well. And sometimes people talk about the stress as well, right? So if you're really stressed out and your cortisol levels are all ramped up, it definitely increases your risk of diabetes as well. So when you are stressed out, you don't really eat well. You don't exercise and cortisol levels are high. Definitely can put your body under stress and can push you towards insulin resistance and diabetes. So we always tell people, you know, sleep well, make sure your sleep is perfect. Actually, that's very important for insulin resistance. If you do not sleep well, you are going to have insulin resistant. Make sure that your diet is very clean and make sure you're exercising like aerobic exercise at least five times. These are very important for you to avoid even getting there, even to start the insulin resistance problem. So if you make it as a lifestyle. So what are the diseases or syndromes that are associated? You can actually tell that you're insulin resistant by knowing that you have something else. So they may not tell you that. But if you have PCOS, that means you have insulin resistance. If you have fatty liver, unless it is from something else like alcoholic or something like that, you know, some other infiltrative disease. If you have fatty liver and abdominal obesity, yes, you have insulin resistance. If you have low HDL, which is like for guys less than 40, for women less than 50. Or if you have high triglycerides, which is more than 150, you have insulin resistance. You don't have to fit into criteria like just because you have insulin resistance doesn't mean that you have to have PCOS or just because you have insulin resistance or just because you have a high triglyceride doesn't mean that you are insulin resistant. So insulin resistance is a syndrome that comes with multiple things, but not necessarily. So your genetic makeup determines a lot of things. So I know a lot of insulin resistant people with the great cholesterol level, just because their cholesterol levels are determined by genetics as well. As a result, you know, that's when we look at the patient, we look at everything together, try to find all the clues. Diseases don't come necessarily in a package. Now what is interesting, a lot of people find out that they're insulin resistant after they have a heart attack. So, or they become diabetic after they have a heart attack. Now most people don't understand that the diabetes is a vascular disease. You know, that means that actually insulin resistance is causing the heart attack, not the diabetes. So that is a huge misunderstanding that a lot of people have and they wait until they become diabetic to do something. But the problem is a lot of those people end up having a heart attack or end up having a heart disease before the heart attack, but some sort of heart disease when they're diabetic. So statistics also show that two-thirds of diabetics die from heart attacks. So what else do you need to know? So as a result, our priority when we treat insulin resistance, or prediabetes, or diabetes, whatever it may be, the bottom line is we are trying to prevent a cardiovascular problem which could be heart attack or stroke. Now, what kind of fat can actually increase insulin resistance? Well, you guessed it right, the abdominal fat. The abdominal circumference is very important. So if you have more than 40 inches for men and 35 inches for women, your risk of insulin resistance is very high. So ironically, the fat under your skin actually is not a bad fat. So the brown fat also is not a bad fat. We want to avoid the fat that accumulates around your abdomen. Yes, that is very difficult to get rid of and very easy to gain. And unfortunately, those unhealthy carbs that we love causes that. If you're not using those unhealthy carbs like in an exercise mode, or if you're not like going and having a marathon or something, you are not burning it. They all turn into fat and they go right to your belly. Now, what are the other signs or symptoms of metabolic syndrome or insulin resistance? Definitely, you will probably be very prone to high blood pressure. You will be very prone to have high cholesterol. Obtomalopiasity is a given. You may have fetal liver disease. And as we discussed, you will probably have some sort of cardiovascular disease sooner or later. Another problem with insulin resistance is people with insulin resistance tend to develop more cancers than patients who do not have insulin resistance or people who do not have insulin resistance. And the reason for that is insulin is a growth hormone. Growth hormone means that it makes a lot of things in your body grow. If you have a little, for example, a little pimple, a little tag on your skin, it may get bigger and bigger and bigger because even benign tissues in your body will grow due to insulin resistance. So when we see skin tags, for example, in people's body, we know that they have some sort of insulin resistance or prone to it. And the cancers are the same way. So if there's a little cancer that's trying to grow in there, insulin will feed into that cancer. Now, how to beat the insulin resistance and prediabetes? That will be a topic of another video. And I hope you guys like this video. And if you do so, please subscribe and please push that notification button and like and share us. And we will see you in the next video.