Understanding Hyperinsulinemia: What High Insulin Levels Mean and How to Manage Them

Insulin is a vital hormone produced by the pancreas. It helps regulate blood glucose levels by facilitating uptake into cells. While it is an essential hormone for survival, in excess, it can be associated with various health concerns.

Practitioners may consider checking this biomarker, even if hemoglobin A1c and fasting glucose are in normal ranges. Often, this is the first lab value to become elevated as someone heads towards developing type 2 diabetes. It can also be linked to other health conditions. For patients, it is important to understand the potential impact of hyperinsulinemia and discuss with your clinician about monitoring as a part of your metabolic screening.

This article will guide you through the details of hyperinsulinemia, how it presents in the body, and how to manage it with diet, lifestyle, and medication if needed.

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Understanding Hyperinsulinemia

Hyperinsulinemia is a condition in which there is too much insulin in the blood. While insulin is necessary to manage blood glucose levels, in excess, it can be associated with various health concerns.

Several conditions can contribute to high insulin levels:

• Obesity
• Polycystic Ovary Syndrome (PCOS)
• Type 2 Diabetes
• Cardiovascular Disease
• Medications (steroids, antidepressants)
• Genetic predisposition

Weight management through lifestyle modifications, including diet and exercise, is often suggested for managing hyperinsulinemia. A comprehensive review in Obesity Reviews concluded that sustained weight loss is associated with improvements in insulin sensitivity and reductions in fasting insulin levels.

Genetic research has identified specific gene variants associated with insulin resistance and hyperinsulinemia. Understanding these genetic factors can help develop targeted approaches. A study in Nature Genetics highlighted the potential of personalized strategies based on genetic profiles to support insulin sensitivity and manage hyperinsulinemia more effectively.

These can be linked to an increase in other chronic health conditions such as high blood pressure, elevated cholesterol, cardiovascular disease, and even cancer.

What Does High Insulin Mean

High insulin levels, or hyperinsulinemia, can have significant effects on the body. Physiologically, insulin plays a key role in glucose metabolism by promoting glucose uptake into cells and inhibiting the liver's glucose production. However, when insulin levels are chronically elevated, this balance may be disrupted. 

Elevated insulin can increase fat storage, particularly in the abdominal region, contributing to obesity. It can also cause the kidneys to retain sodium, which may lead to higher blood pressure. Over time, the constant high levels of insulin can affect the function of insulin receptors, reducing the efficiency of glucose uptake and potentially worsening insulin resistance.

Insulin resistance and hyperinsulinemia are closely linked in a cyclical relationship. Insulin resistance occurs when muscle, fat, and liver cells do not respond well to insulin and cannot easily absorb glucose from the bloodstream. To compensate, the pancreas secretes more insulin, leading to high insulin levels in the blood. 

This excessive insulin production is the body's attempt to maintain normal blood glucose levels. However, persistently high insulin levels may further reduce the cells' sensitivity to insulin, perpetuating and potentially worsening the cycle of insulin resistance and hyperinsulinemia.

Type 2 diabetes can occur when the pancreas eventually becomes unable to produce enough insulin to overcome insulin resistance, leading to elevated blood glucose levels. All of these factors also contribute to an increased risk of cardiovascular disease, including high blood pressure and heart attacks.

Insulin Resistance Symptoms

The most common symptoms of insulin resistance are:

• Increased hunger
• Weight gain, especially around the abdomen
• Fatigue and brain fog
• Difficulty concentrating
• Frequent urination
• Cravings for sugar or carbohydrates
• Skin changes, such as acanthosis nigricans (dark, velvety patches of skin)

Lab Tests to Measure Insulin and Glucose Levels

Hyperinsulinemia is diagnosed through blood tests ordered by your clinician. For the most comprehensive approach, it's suggested to include these key biomarkers:

• Lab tests
  • Fasting insulin test: Elevated fasting insulin levels may indicate that your body is producing more insulin than normal, which could be due to various reasons, such as a diet rich in sugar or carbs, not getting enough exercise, or taking certain medications.
  • Oral glucose tolerance test (OGTT): This test measures how well your body processes sugar 2-3 hours after consuming 50 grams of glucose.
  • Hemoglobin A1c test: Indicates how well your blood sugar has been managed over the last 90 days.
• Metabolic biomarkers to consider testing:
  • C-peptide: Elevated levels might suggest that your body is producing more insulin than usual, leading to insulin resistance.
  • Lipid profile: Assesses cholesterol and triglycerides to give insight into dietary habits.
  • High-sensitivity C-reactive protein (hs-CRP): A substance made by the liver that detects even small amounts of inflammation in the body.

Additional Testing for Comprehensive Assessment

From a functional medicine standpoint, our bodies are integrated systems where one area of imbalance can affect another. For individuals diagnosed with hyperinsulinemia, it's important to consider testing for other related conditions for the most comprehensive care.

• Testing for related conditions
  • Liver function tests (ALT, AST): The liver is a key player in glucose control, regulating blood sugar levels through glycogen storage and gluconeogenesis. Elevated levels may indicate non-alcoholic fatty liver disease and increase the risk of overall metabolic dysfunction.
  • Kidney function tests (creatinine, eGFR): The chronic effects of hyperinsulinemia on the kidneys may contribute to the long-term risk of developing chronic kidney disease (CKD). This damage is exacerbated by other factors associated with insulin resistance, such as high blood pressure, which can affect the small blood vessels in the kidneys. Over time, this damage can reduce the kidneys' ability to filter waste from the blood, potentially leading to the need for dialysis or kidney transplantation.
  • Thyroid function tests (TSH, T3, T4): Thyroid dysfunction can directly impact appropriate insulin secretion. For example, in hypothyroidism, the reduced metabolic rate can lead to impaired insulin secretion from the pancreas. A study found that people with insulin resistance often have higher levels of TSH (thyroid-stimulating hormone), which is indicative of subclinical hypothyroidism.

How to Lower Insulin and Glucose Levels

Managing this condition may include both diet and lifestyle modifications as the foundation for managing hyperinsulinemia. 

Diets

• Low-carb and ketogenic diets: Studies have shown that reducing carbohydrate intake can significantly lower insulin levels. Low-carb diets, such as the ketogenic diet, may help decrease blood glucose levels, reducing the demand for insulin. Research published in the Journal of Clinical Endocrinology & Metabolism demonstrated that individuals on low-carb diets showed improved insulin sensitivity and lower fasting insulin levels.
• High fiber diets: Increasing dietary fiber intake has been associated with improved insulin sensitivity. Fiber-rich foods like vegetables, fruits, whole grains, and legumes can slow glucose absorption, reducing insulin spikes. Research in Diabetes Care indicated that high-fiber diets lead to lower fasting insulin levels and better glycemic control.
• Intermittent fasting: Intermittent fasting, which involves cycling between periods of eating and fasting, has gained attention for its potential to improve insulin sensitivity. A study in the New England Journal of Medicine found that intermittent fasting can reduce insulin resistance and lower fasting insulin levels, making it a promising approach for managing hyperinsulinemia.

Exercise 

Regular physical activity is often suggested to help manage insulin levels. Regular aerobic exercise, such as walking, running, or cycling, is well-documented for its ability to enhance insulin sensitivity. A study in the Journal of Applied Physiology found that consistent aerobic exercise significantly lowers fasting insulin levels and improves glucose uptake by muscles. Aim for at least 150 minutes of moderate exercise per week.

Resistance training, including weight lifting and body-weight exercises, may help manage hyperinsulinemia. Research in Diabetes & Metabolism Journal showed that resistance training increases muscle mass, which enhances glucose uptake and reduces insulin resistance.

Medications

Medical interventions may be necessary, especially if symptoms are severe and have started to affect other organs. Supplements can also provide added benefits to modulate insulin activity.

• Metformin: A widely prescribed medication for type 2 diabetes, it is effective in lowering insulin levels and improving insulin sensitivity. A study in the Journal of Clinical Investigation demonstrated that metformin reduces hepatic glucose production and improves peripheral insulin sensitivity.
• Thiazolidinediones: Another class of medications that can help improve insulin sensitivity in the body's tissues, particularly in the liver, muscle, and adipose (fat) tissue. This effect helps lower blood glucose levels by making the body's cells more responsive to insulin, thereby enhancing glucose uptake from the bloodstream.
• GLP-1 agonists: Glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide and exenatide, have been shown to lower insulin levels by enhancing insulin secretion in a glucose-dependent manner and slowing gastric emptying. Research in The Lancet highlighted the effectiveness of GLP-1 receptor agonists in improving glycemic control and reducing insulin resistance.

Supplements

• Berberine: Berberine has been shown to support insulin sensitivity by activating AMP-activated protein kinase (AMPK). AMPK is like a “fuel gauge” for your cells. If your energy is low, AMPK turns “on” and tells the body to burn stored fat and improve glucose utilization.  This activation of AMPK enhances glucose uptake in cells, reduces insulin resistance, and decreases glucose production in the liver.
• Chromium: Chromium is an essential trace mineral that supports insulin's action by improving the insulin signaling pathways. It does this by increasing the activity of insulin receptors, facilitating better glucose uptake into cells, and thereby reducing the amount of insulin needed to regulate blood sugar levels.

How to Reduce Blood Sugar Levels Immediately

Suggestions for immediately supporting healthy blood sugar levels include:

• Avoid sugary, processed foods as much as possible. 
• Focus on whole foods, including lean proteins, healthy fats, and fiber-rich vegetables.
• Eat smaller, more frequent meals to help regulate blood sugar and insulin levels.
• Take a 15 minute walk right before and after, if possible, to support healthy insulin levels.
• Focus on adequate hydration to support healthy blood glucose levels by reducing vasopressin.

Long-term Strategies for Managing Insulin Resistance

Managing insulin resistance effectively may require a combination of lifestyle changes, medical interventions, and ongoing monitoring.

Dietary Modifications

• Focus on a Balanced Diet: Prioritize a diet rich in whole foods, including vegetables, fruits, whole grains, lean proteins, and healthy fats. These foods have a lower glycemic index, which helps to stabilize blood sugar levels.
• Incorporate Healthy Fats: Include healthy fats in your daily diet, such as olive oil, avocados, nuts, and seeds, which can support insulin sensitivity and reduce inflammation.

Stress Management

• Reduce Chronic Stress: Chronic stress can increase cortisol levels, which may affect insulin resistance. Incorporate daily stress-reducing techniques such as meditation, deep breathing exercises, or yoga.
• Get Adequate Sleep: Poor sleep can negatively impact insulin sensitivity. Aim for 7-9 hours of quality sleep per night, and maintain a consistent sleep schedule.

Regular Monitoring Recommendations

• Monitor Fasting Blood Glucose and Insulin Levels: Regularly check these biomarkers to ensure they remain within a healthy range. This can help track the effectiveness of lifestyle changes, supplements, and medications.
• Monitor Hemoglobin A1c: This blood test provides an average of your blood glucose levels over the past 3 months and is crucial for long-term management of insulin resistance. The ideal goal is less than 5.7%.
• Regular Health Check-ups: Regular visits to a healthcare provider for blood tests and assessments of other risk factors, such as blood pressure and lipid profiles, are essential for managing insulin resistance.

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Key Takeaways

• Managing hyperinsulinemia is a long-term commitment. A multifaceted approach that includes dietary modifications, physical activity, and pharmacological treatments is often suggested for the best health outcomes.
• A comprehensive assessment is recommended as hyperinsulinemia is connected to an increased risk of cardiovascular disease, obesity, PCOS, hypothyroidism, and type 2 diabetes.
• A two-pronged lifestyle approach can support healthy insulin levels while assisting patients with more time-intensive treatments, such as stress reduction.
• Ongoing research continues to uncover new insights and strategies to support insulin sensitivity and reduce the health risks associated with high insulin levels. Individuals with hyperinsulinemia should work closely with healthcare professionals to develop a personalized plan based on the latest scientific evidence.