How is insulin resistance managed?

From the Guidelines

Insulin resistance is best managed through a combination of lifestyle modifications, including a healthy diet, regular physical activity, and weight loss, as well as medications such as metformin, which is typically the first-line treatment. The primary approach to managing insulin resistance involves adopting a healthy diet low in refined carbohydrates and high in fiber, regular physical activity (aim for at least 150 minutes of moderate exercise weekly), and weight loss of 5-10% of body weight for overweight individuals 1. Regular physical activity, such as aerobic and resistance exercise, is recommended to decrease insulin resistance, with a goal of at least 30 minutes of moderate-intensity exercise per day, most days of the week 1. Weight loss is also an important component of managing insulin resistance, with modest weight loss (5-10% of body weight) shown to improve insulin sensitivity and reduce the risk of developing type 2 diabetes 1. Medications such as metformin, which works by reducing liver glucose production and improving insulin sensitivity, are also effective in managing insulin resistance, and are typically started at a dose of 500mg daily and gradually increased to 1000mg twice daily as tolerated 1. Other medications, such as thiazolidinediones and GLP-1 receptor agonists, may also be used to enhance insulin sensitivity and improve glycemic control. Regular monitoring of blood glucose levels is essential, with a target fasting glucose below 100 mg/dL and HbA1c below 5.7%. These interventions are effective because insulin resistance develops when cells become less responsive to insulin's effects, leading to elevated blood glucose levels and compensatory insulin production, which lifestyle changes and medications help to correct by improving cellular insulin sensitivity and reducing glucose production. Some key points to consider when managing insulin resistance include:

• Adopting a healthy diet low in refined carbohydrates and high in fiber
• Engaging in regular physical activity, such as aerobic and resistance exercise
• Achieving weight loss of 5-10% of body weight for overweight individuals
• Using medications such as metformin to improve insulin sensitivity and reduce glucose production
• Regularly monitoring blood glucose levels to assess the effectiveness of treatment and make adjustments as needed.

From the FDA Drug Label

Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes mellitus, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization

Management of Insulin Resistance:

• Metformin improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
• With metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin response may decrease.
• The use of metformin can help manage insulin resistance by decreasing hepatic glucose production and improving glucose tolerance. 2 2

From the Research

Management of Insulin Resistance

Insulin resistance can be managed through various lifestyle and nutritional interventions. The key factors that contribute to insulin resistance include diet, exercise, smoking, and stress, which can be modified through lifestyle changes 3.

Lifestyle Interventions

Lifestyle interventions play a critical role in managing insulin resistance. These interventions include:

• Diet and exercise, which can improve insulin sensitivity and reduce the risk of developing type 2 diabetes and cardiovascular disease [(4,5)]
• Weight reduction, which can improve insulin resistance, hyperglycemia, hypertension, and dyslipidemia 4
• Increased physical activity, which can improve insulin sensitivity and reduce the risk of developing type 2 diabetes and cardiovascular disease 5

Nutritional Interventions

Nutritional interventions can also play a role in managing insulin resistance. These interventions include:

• Minerals such as magnesium, calcium, potassium, zinc, chromium, and vanadium, which appear to have associations with insulin resistance or its management 3
• Amino acids, including L-carnitine, taurine, and L-arginine, which might also play a role in the reversal of insulin resistance 3
• Other nutrients, including glutathione, coenzyme Q10, and lipoic acid, which also appear to have therapeutic potential 3

Pharmacological Interventions

While there are no medications specifically approved to treat insulin resistance, various pharmacological agents can be used to improve insulin sensitivity, including:

• Metformin, insulin secretagogues, alpha-glucosidase inhibitors, thiazolidinediones, and insulin 4
• These medications can be used in combination with lifestyle and nutritional interventions to manage insulin resistance and reduce the risk of developing type 2 diabetes and cardiovascular disease 4

Early Intervention

Early intervention is critical in preventing the progression of insulin resistance to type 2 diabetes and cardiovascular disease. Treatment should start at the earliest stage possible, when comorbidities are still reversible, and includes personalized dietary advice and counseling, as well as an exercise program 6. A lifestyle intervention focused on physical activity can prevent deterioration in insulin sensitivity in individuals with impaired glucose tolerance over a three-year period 5.