What are the best ways to improve insulin resistance?

Best Ways to Improve Insulin Resistance

Regular exercise and weight loss are the most effective interventions for improving insulin sensitivity, with a combination of aerobic and resistance training providing optimal results.

Exercise Interventions

Aerobic Exercise

• Perform at least 150 minutes per week of moderate-intensity aerobic activity 1, 2
• Exercise sessions should ideally last at least 10 minutes each 1
• Distribute activity over at least 3 days per week with no more than 2 consecutive days without exercise 2
• Benefits to insulin sensitivity can last up to 72 hours after exercise 2

Resistance Training

• Engage in 2-3 sessions per week on non-consecutive days 1, 2
• Include at least one set of five or more different exercises involving large muscle groups 1
• Clinical trials have provided strong evidence for the A1C-lowering value of resistance training 1
• Resistance exercise improves insulin sensitivity to about the same extent as aerobic exercise 1

Combined Approach

• The combination of aerobic and resistance exercise provides an additive benefit for insulin sensitivity 1, 2
• More intensive exercise programs show significantly greater improvements in insulin sensitivity (23% increase) compared to modest exercise programs (9% increase) 3

Dietary Interventions

Weight Loss

• For overweight and insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance 1
• Aim for 5-7% weight loss through structured programs that emphasize lifestyle changes 1
• Reduce energy intake by 500-1,000 calories less than estimated for weight maintenance 1

Dietary Composition

• Reduce intake of saturated and trans fatty acids 1
• Increase dietary fiber intake 3
• Consider the timing of meals (chrononutrition):
  • Consume most calories and carbohydrates at lunch time and early afternoon
  • Avoid late evening meals
  • Maintain consistent meal timing 4
• Consider meal sequencing: consume vegetables and salads first, followed by protein, then starchy foods 4

Pharmacological Options

Metformin

• Improves insulin sensitivity by decreasing hepatic glucose production and increasing peripheral glucose uptake and utilization 5
• Does not affect insulin secretion but may decrease fasting insulin levels 5

Thiazolidinediones (e.g., Pioglitazone)

• Enhance cellular responsiveness to insulin and increase insulin-dependent glucose disposal 6
• Improve hepatic sensitivity to insulin 6
• May cause weight gain and exacerbate lipid accumulation in skeletal muscle despite improving whole-body insulin sensitivity 7

Monitoring Progress

• Monitor A1C levels - an A1C range of 5.7-6.4% identifies individuals at high risk for diabetes and cardiovascular outcomes 1
• For those with A1C >6.0%, more aggressive interventions and vigilant follow-up should be pursued 1
• Self-monitoring of blood glucose can help identify when changes in treatment are necessary 2

Important Considerations

• Benefits of exercise on insulin sensitivity diminish rapidly when exercise is discontinued, emphasizing the need for consistent activity 2
• The combination of exercise with appropriate nutrition provides optimal results 2
• For those with diabetic complications (retinopathy, neuropathy), exercise modifications may be necessary 1
• Individuals taking insulin or insulin secretagogues may need to adjust medication doses or carbohydrate intake before exercise to prevent hypoglycemia 1

While both exercise and pharmacological interventions can improve insulin sensitivity, lifestyle modifications should be the primary approach, with medications considered as adjunctive therapy when lifestyle changes alone are insufficient.