Diagnose insulineresistentie

Geschat wordt dat 25 – 35% van de bevolking in de Westerse wereld in meer of mindere mate insuline resistent is. Insulineresistentie is een stoornis waardoor insuline niet meer in staat is om er voor te zorgen dat glucose van uit de bloedbaan door de lever, de spieren en het perifere weefsel wordt opgenomen. Insulineresistentie veroorzaakt hyperinsulinemie en daardoor overgewicht. Insulineresistentie wordt door veel artsen gezien als een voorstadium van diabetes type 2.

Alle artikelen en behandelingsprotocollen zijn volgens het zelfzorg principe geschreven. Bij zelfzorg is niet de arts of specialist maar de patiënt verantwoordelijk voor het correct uitvoeren van de behandeling. Toch adviseer ik patiënten om bij gezondheidsklachten eerst een arts te raadplegen. Een juiste diagnose is ook bij een zelfzorgtraject van onschatbare waarde. Als u reeds onder behandeling bent van een arts overleg dan met uw arts voordat u voedingssupplementen gaat gebruiken.

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Wat is insulineresistentie

Insulineresistentie is een stoornis waardoor insuline niet meer in staat is om er voor te zorgen dat glucose van uit de bloedbaan door de lever, de spieren en het perifere weefsel wordt opgenomen. Reguliere artsen diagnosticeren insulineresistentie aan de hand van het glucose niveau in het bloed. We hebben in de diagnose gezien dat de insuline spiegels een betere indicatie geven dan een glucose spiegel. Insulineresistentie komt vaak voor bij, en is mogelijk de oorzaak van een groot aantal vaak voorkomende ziekten zoals:

• Diabetes type 2
• Polycistic Ovarian Syndrome (PCOS)
• Verhoogd LDL, verlaagd HDL, verhoogde triglyceriden, verhoogd Lp(a)
• Apnea (snachts voor korte tijd stoppen met ademen)
• Overgewicht door hyperinsulinemie, verhoogde vetopslag, verlaagde vetverbranding
• Verhoogde bloeddruk
• Hart en vaatziekten
• Verlaging groeihormonen en DHEA

Oorzaken van insulineresistentie

Patiënten met een bepaalde predispositie (erfelijkheid) hebben een grotere kans om insulineresistentie te ontwikkelen. Zoals Europeanen met diabetes in de familie, nakomelingen van indiaanse, Afrikaanse en Polynesische voorouders. Toch kunnen door juiste leefstijl en voedingskeuzes de ontwikkeling en de progressie van insulineresistentie voorkomen worden. De belangrijkste factoren die de kans op insulineresistentie vergroten zijn:

• Verkeerde voeding: overmatig gebruik van verzadigd vet, te weinig enkelvoudig onverzadigd vet, te veel transvetten Overmatig gebruik van vezelarme snel verteerbare koolhydraten
• Overmatige consumptie van linolzuur (zonnebloemolie)
• Onvolwaardige voeding: met gebrek aan magnesium, chroom, biotine, vanadium, l-carnitine, alfa liponzuur, zink
• Te weinig beweging
• Roken of het gebruik van nicotine producten
• Te veel stress

Conclusie tot nu toe

Een protocol voor het behandelen van overgewicht dat wordt veroorzaakt door hyperinsulinemie (insulineresistentie) zou daarom op zijn minst aandacht moeten schenken aan de volgende punten:

1. Een voedingsinterventie (verandering) waardoor de insulinespiegel wordt verlaagd
2. Een plan voor het gebruik van supplementen voor het behandelen van insulineresistentie
3. Veranderingen in de lifestyle waardoor dagelijks extra beweging mogelijk wordt
4. Een plan voor het verminderen van stress in het dagelijkse leven
5. Het verstrekken van voldoende reden om te stoppen met roken

Referenties

1. Implications of the hyperinsulinaemia-diabetes-cancer link for preventive efforts
   Recent epidemiological evidence points to a link between non-insulin dependent diabetes mellitus type II (NIDDM) and cancer of the colon, liver, pancreas, breast and endometrium. This appears to be due to the long period of hyperinsulinaemia which precedes the clinical phase of NIDDM
2. Hyperinsulinemia in polycystic ovary disease
   Hyperinsulinemia and insulin resistance seem to be commonly associated with PCOD.
3. Insulin resistance, lipid and fatty acid concentrations in 867 healthy Europeans. European Group for the Study of Insulin Resistance (EGIR).
   After adjustment for the effects of age, sex, obesity and intercentre variability, regression analysis showed relationships between triglycerides and markers of insulin sensitivity. There were significant correlations between triglycerides and fasting plasma glucose (P < 0.0001), fasting plasma insulin (P < 0.0001) and mean glucose infusion rate at steady state (M-value, P < 0.0001).
4. The severity of obstructive sleep apnoea is associated with insulin resistance
   It was found that insulin resistance is related to the severity of sleep anoea.
5. Intracellular hyperinsulinism: a metabolic characteristic of obesity with and without Type 2 diabetes: intracellular insulin in obesity and Type 2 diabetes
   In conclusion, monocytes from obese patients with and without Type 2 diabetes mellitus, present increased intracellular insulin concentrations and these conditions are associated with a significant impairment of insulin receptor processing. Increased intracellular insulin concentration in cells from these patients may be necessary in order to overcome insulin resistance.
6. Markers of capacity to utilize fatty acids in human skeletal muscle: relation to insulin resistance and obesity and effects of weight loss
   These data suggest that in obesity-related insulin resistance, the metabolic capacity of skeletal muscle appears to be organized toward fat esterification rather than oxidation and that dietary-induced weight loss does not correct this disposition.
7. Skeletal muscle fatty acid metabolism in association with insulin resistance, obesity, and weight loss
   The findings suggest that triglyceride accumulation in skeletal muscle in obesity derives from reduced capacity for fat oxidation and that inflexibility in regulating fat oxidation, more than fatty acid uptake, is related to insulin resistance.
8. Relationship between insulin resistance and cardiac sympathetic nervous function in essential hypertension
   These findings indicate that insulin resistance is significantly related to activation of the cardiac sympathetic nervous function associated with left ventricular hypertrophy in patients with essential hypertension..
9. Hyperinsulinemia as an independent risk factor for ischemic heart disease
   High fasting insulin concentrations appear to be an independent predictor of ischemic heart disease in men..
10. Growth hormone in obesity
    In spite of this, treatment with biosynthetic GH has been shown to improve the body composition and the metabolic efficacy of lean body mass in obese patients undergoing therapeutic severe caloric restriction. GH and conceivably GHRPs might therefore have a place in the therapy of obesity..
11. Dehydroepiandrosterone: the "missing link" between hyperinsulinemia and atherosclerosis?
    Recent evidence indicates that the adrenal steroid dehydroepiandrosterone (DHEA) exerts multiple antiatherogenic effects and also suggests that hyperinsulinemia may reduce serum DHEA and DHEA-sulfate levels by decreasing production and enhancing metabolic clearance..
12. Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff
    These cross-sectional findings in nondiabetic men with coronary artery disease suggest that increased consumption of saturated fatty acids is associated independently with higher fasting insulin concentrations..
13. Dietary fat intake and risk of type 2 diabetes in women
    These data suggest that total fat and saturated and monounsaturated fatty acid intakes are not associated with risk of type 2 diabetes in women, but that trans fatty acids increase and polyunsaturated fatty acids reduce risk. Substituting nonhydrogenated polyunsaturated fatty acids for trans fatty acids would likely reduce the risk of type 2 diabetes substantially.
14. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment
    Increasing intakes of refined carbohydrate (corn syrup) concomitant with decreasing intakes of fiber paralleled the upward trend in the prevalence of type 2 diabetes observed in the United States during the 20th century.
15. Magnesium transport induced ex vivo by a pharmacological dose of insulin is impaired in non-insulin-dependent diabetes mellitus
    These data suggest that insulin resistance and magnesium depletion may result in a vicious cycle of worsening insulin resistance and decrease in intracellular Mg(2+) which may limit the role of magnesium in vital cellular processes.
16. Supplemental-chromium effects on glucose, insulin, glucagon, and urinary chromium losses in subjects consuming controlled low-chromium diets
    These data demonstrate that consumption of diets in the lowest 25% of normal chromium intake lead to detrimental effects on glucose tolerance, insulin, and glucagon in subjects with mildly impaired glucose tolerance..
17. Biotin supplementation improves glucose and insulin tolerances in genetically diabetic KK mice.
    Compared to controls, biotin treatment lowered post-prandial glucose levels, and improved tolerance to glucose and insulin resistance. Serum immunoreactive insulin levels in biotin-treated mice were like the controls.
18. Effects of vanadyl sulfate on carbohydrate and lipid metabolism in patients with non-insulin-dependent diabetes mellitus
    We conclude that VS at the dose used was well tolerated and resulted in modest reductions of fasting plasma glucose and hepatic insulin resistance. However, the safety of larger doses and use of vanadium salts for longer periods remains uncertain.
19. Effect of L-carnitine on post-stress metabolism in surgical patients
    But they could lead to the following conclusions: Carnitine obviously reduces the insulin resistance.
20. Improvement of insulin-stimulated glucose-disposal in type 2 diabetes after repeated parenteral administration of thioctic acid
    This is the first clinical study to show that a ten day administration of TA is able to improve resistance of insulin-stimulated glucose disposal in NIDDM.
21. Investigation of the relationships between zinc and obesity
    Clinically, zinc was found to be correlated with thyroid hormone conversion and insulin resistance. Although the true metabolic role of zinc in obesity is still obscure.
22. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus
    Evidence has been provided that morphological changes in muscle, particularly the capillary density of the muscle, are associated with changes in fasting insulin levels and glucose tolerance. Furthermore, significant correlations between glucose clearance, muscle capillary density and fibre type have been found in humans during a euglycaemic clamp.
23. Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus
    In conclusion, chronic cigarette smoking seems to markedly aggravate insulin resistance in patients with NIDDM.
24. Long-term use of nicotine gum is associated with hyperinsulinemia and insulin resistance
    These findings suggest that nicotine is the major constituent in cigarette smoke that leads to insulin resistance, metabolic abnormalities associated with the insulin resistance syndrome, and increased cardiovascular morbidity. Thus, the use of nicotine replacement therapy during smoking cessation should be transient and limited.
25. Psychosocial stress and the insulin resistance syndrome
    Thus, even though insulin resistance is presumably to some extent genetically determined, these results suggest that considering psychosocial stress may be beneficial in understanding IRS risk-factor clustering.

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