Hyperinsulinemia

Overview

What is Hyperinsulinemia? 

Hyperinsulinemia can be defined as excess insulin relative to what is required to maintain normal glucose. Insulin is a hormone made by the pancreas that helps control blood sugar by moving glucose into cells. If the body doesn’t respond well to insulin, it produces more to keep blood sugar levels normal. This condition often comes before type 2 diabetes and is tied to insulin resistance. It can also lead to other health problems like obesity, glucose intolerance, heart disease, and polycystic ovary syndrome (PCOS). However, hyperinsulinemia is typically seen in obese women and may be reversed with weight loss alone, restoring ovulatory function.

Causes

Hyperinsulinemia happens when the body produces too much insulin because the cells don’t respond well. Here are the main hyperinsulinemia causes:

Insulin Resistance

The biggest cause. When muscle, fat, and liver cells don’t respond to insulin properly, glucose can’t easily enter the cells, so the pancreas makes more insulin.

Obesity: Extra fat, especially around the belly, is linked to insulin resistance. Although the exact mechanisms are still unclear, hyperinsulinemia seems to play a role in raising BP in obese persons.

Lack of Exercise: Not being active can lead to insulin resistance.

Poor Diet: Eating a lot of refined carbs and sugars can cause insulin resistance.

Genetic Factors

A family history of insulin sensitivity or type 2 diabetes makes hyperinsulinemia more likely. People with inborn genetic defects of insulin release have congenital hyperinsulinism. However, certain genetic and lifestyle risk factors make it more likely that you’ll develop hyperinsulinemia.

Polycystic Ovary Syndrome (PCOS)

A common hormonal issue in women that is often connected to insulin resistance.

Metabolic Syndrome

A combination of conditions like high blood pressure, high blood sugar, extra belly fat, and abnormal cholesterol levels increase the risk of heart disease, stroke, and type 2 diabetes.

Certain Medications

Corticosteroids: Used for inflammation but can cause insulin resistance.

Antipsychotics: Some mental health drugs can lead to weight gain and insulin resistance.

Hormonal Disorders

Cushing’s Syndrome: Too much cortisol can increase insulin resistance.

Acromegaly: Too much growth hormone can interfere with insulin.

Obstructive Sleep Apnea: This sleep disorder is linked to insulin resistance and hyperinsulinemia.

Stress: Ongoing stress can increase cortisol, leading to insulin resistance.

Non-Alcoholic Fatty Liver Disease (NAFLD): Excess fat in the liver can cause insulin resistance and hyperinsulinemia.

Why is my insulin high?

Your insulin might be high because your body is resistant to insulin, causing your pancreas to produce more to keep blood sugar levels normal. This can be due to factors like obesity, a sedentary lifestyle, or a poor diet. 

Symptoms

You may not witness obvious symptoms of hyperinsulinemia at first, but it often comes with conditions related to insulin resistance. Here are some common signs and hyperinsulinemia symptoms:

• Increased Hunger
• Weight Gain
• Fatigue
• Difficulty Concentrating
• Increased Fat Storage
• Frequent Urination
• Dark Skin Patches
• High Blood Pressure
• Increased Thirst
• High Blood Lipids

Hyperinsulinemia usually doesn’t cause noticeable symptoms in people with insulin resistance. In people who have insulinomas, hyperinsulinemia may lead to low blood sugar, a condition called hypoglycemia. Hypoglycemia associated with elevated insulin levels makes certain disorders unlikely, such as defects in gluconeogenesis, free fatty acid synthesis and ketogenesis, growth hormone deficiency, and cortisol deficiency.

What is Insulin Secretion? 

Insulin secretion is the process by which the pancreas releases insulin, a hormone that regulates blood glucose levels by facilitating the uptake of glucose into cells. This process is primarily triggered by increased blood glucose levels after eating, ensuring that glucose is utilized for energy or stored for future use. However, Excessive insulin secretion may lead to hypoglycemia in insulinomas and noninsulinoma pancreatogenous hypoglycemia syndrome, but these conditions are uncommon compared with dysregulated hyperinsulinemia, which does not cause hypoglycemia.

Diagnosis

Hyperinsulinemia diagnosis involves checking insulin normal levels in the blood and looking for signs of insulin resistance and related conditions. Here are the main ways your primary care physician diagnoses it:

Fasting Insulin Levels Test

This test measures insulin levels after not eating for 8 to 12 hours.

High insulin levels during fasting can show hyperinsulinemia, especially if there are signs of insulin resistance.

Oral Glucose Tolerance Test (OGTT)

You drink a sugary drink, and blood tests are taken to check glucose and insulin levels.

High insulin levels during this test can indicate hyperinsulinemia, especially if glucose levels are normal or slightly high.

Hemoglobin A1c (HbA1c) Test

 This test shows average blood sugar levels over a few months.

Elevated HbA1c levels might suggest long-term hyperinsulinemia and insulin resistance.

Insulin Resistance Assessment

Physicians use tests like HOMA-IR or QUICKI to indirectly measure insulin resistance based on fasting insulin and glucose levels.

Blood Glucose Levels

Monitoring fasting and after-meal glucose levels helps understand overall glucose metabolism and insulin response.

Additional Tests

Depending on the situation, physicians may do more hyperinsulinemia tests for diagnosis like checking cholesterol levels, and liver function or looking for conditions like PCOS.

There’s also no common test to check for excess insulin levels specifically, especially since insulin levels can vary widely throughout the day.

What is Impaired Glucose Tolerance? 

Impaired Glucose Tolerance (IGT) is a pre-diabetic state of hyperglycemia characterized by blood sugar levels that are elevated beyond normal but not high enough to be classified as diabetes. It indicates an increased risk of developing type 2 diabetes and cardiovascular diseases. IGT is typically diagnosed through an oral glucose tolerance test (OGTT), where blood sugar levels are measured before and two hours after consuming a glucose-rich beverage.

Risk Factors for Hyperinsulinemia

Risk factors for hyperinsulinemia include obesity, particularly central obesity, a diet high in refined carbohydrates and sugars, a sedentary lifestyle, and genetic predisposition. Insulin resistance, often associated with conditions like polycystic ovary syndrome (PCOS) and metabolic syndrome, also contributes to hyperinsulinemia. Additionally, certain medical conditions, such as type 2 diabetes and hypertension (insulin increases sodium retention by the renal tubules ), as well as chronic stress and sleep disturbances, can increase the risk of developing hyperinsulinemia. However, hyperinsulinemia is treated through diabetes medication. 

Does Few Hours of Fasting Affect My Insulin Level? 

After a few hours of fasting, insulin levels fall, and increased lipolysis creates free fatty acids and glycerol. Fatty acids do not cross the blood-brain barrier and, therefore, are not used by the brain. However, fatty acids are used by the heart and muscles.

Treatment

How to Treatment Hyperinsulinemia? 

Hyperinsulinemia treatment focuses on fixing the main problem, which is often insulin resistance, and managing related issues to prevent problems like diabetes and heart disease. Here are the ways, you can treat hyperinsulinemia:

Healthy Diet: Switching to a balanced diet with less sugary and fatty foods, and more whole grains, fruits, veggies, lean proteins, and good fats like those in avocados and nuts.

Regular Exercise: Getting active most days, aiming for 150 minutes a week of moderate exercise. This helps your body use insulin better.

Weight Management: Losing extra weight, especially around the belly, by eating better and exercising.

Stress Relief: Finding ways to manage stress like meditation, yoga, or relaxation techniques.

Insulin-Sensitizing Drugs: Some medicines can improve insulin sensitivity, like metformin, often used for diabetes and insulin resistance.

Medications for Lipids and Blood Pressure: If you have high cholesterol or high blood pressure, you might need meds to control them and lower your heart disease risk.

Treating PCOS: If you have PCOS along with hyperinsulinemia, you may need hormone treatments or other meds.

Taking Care of Liver Health: If you have fatty liver disease, losing weight and changing your diet can help.

Regular Check-Ups: Checking blood sugar, insulin, cholesterol, and other levels regularly to see how treatment is working.

Taking Care of Obesity: Treating obesity with lifestyle modifications, dietary changes, medication or bariatric surgery improves hyperinsulinemia.

When To See A Doctor

If you notice signs of high insulin like unexpected weight gain, feeling hungrier than usual, or always tired, visit your primary care physician right away. Especially if you’re overweight, not very active, or have family members with diabetes, get checked by a primary care physician. Regular check-ups and tests can help catch and manage hyperinsulinemia early.

Disclaimer

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about Hyperinsulinemia or any other medical condition, please see a primary care physician for an accurate hyperinsulinemia diagnosis and personalized treatment suggestions.