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Blood Sugar Regulation and Insulin Resistance

Normal Blood Sugar Response

When we eat carbohydrates, they are broken down into glucose which gets absorbed into the bloodstream. This glucose then needs to be shuttled around the body to be used as energy in areas like the muscle (to move) and brain (to think). This glucose “shuttle” is called insulin. Insulin is not just a “sugar bus” however, it also has major influences on fat mobilization and synthesis, protein metabolism, mitochondrial function, adrenal and sex hormone metabolism, oxidative stress and inflammatory response.1

Insulin Resistance aka “Pre-Pre-Diabetes”

Almost 50% of adults have pre-diabetes or diabetes. Diabetes is usually not a stand-alone disease. In fact, the single biggest risk factor for coronary artery disease (CAD) is insulin resistance.1 Most people are aware that diabetes occurs from “too much sugar” but it does not happen overnight and here’s why…

When glucose levels are chronically elevated, our cells become insensitive to the action of insulin. In other words, insulin is knocking on the door but no one is answering, resulting in too much sugar being left in the bloodstream. In response, the pancreas, if able, will secrete more insulin to get rid of the excess sugar which results in a high insulin state, called hyperinsulinemia. As author of the book Diabetes without Drugs, Suzy Cohen, functional pharmacist, iterates: “your cells (the inside) are not getting the energy they need so they are saying ‘we need more insulin!’ because your body is frantically saying GET THE SUGAR INSIDE THE CELLS”.2 After years of elevated blood sugar, the body can no longer keep up and it begins to rise and that is when the diagnosis of diabetes is made.

Problems with High Insulin

Insulin is an essential hormone that affects almost every organ in the body including the liver, muscle, brain, bone, kidneys, blood vessels and adipose (fat) tissue.3 Insulin is our primary fat storage hormone. When the body has to keep releasing insulin in response to high blood sugar, there tends to be more storage of fat around the midsection, also called “visceral fat”. This type of fat is particularly dangerous because not only does it surround vital organs, but it’s also an organ itself, releasing its own hormones, causing a cascade of abnormalities.1,3

Insulin also acts on your brain to increase appetite, suppress the breakdown of fat, and make the body more likely to store energy as fat.4 Hyperinsulinemia can cause changes in LDL cholesterol patterns leading to negative cardiovascular outcomes.1 Other problems associated with hyperinsulinemia include hormone dysregulation (estrogen dominance, PCOS, infertility), systemic inflammation, and cancer.1

The Conventional Approach: Why it Doesn’t Work

The conventional approach to address diabetes is fraught with issues.5 Many practitioners wait until a fasting blood glucose is above 126 mg/dL before they start addressing it. However, the response to high blood sugar is to release more and more insulin. Long before blood sugar is too high, insulin is too high. Yet, this value is not routinely checked.5

How Do I Know if I have Insulin Resistance?

Since many doctors only check blood glucose levels, many times early signs of insulin resistance are missed in a vast majority of patients.6 You can ask your doctor for a 2-hour Insulin Glucose Challenge Test. This should be done fasting, with blood sugar and insulin levels checked at fasting, then again at one and two-hour intervals.6 According to the American Diabetes Association, a value above 140mg/dL after one hour and >200mg/dL after two hours is considered to be impaired glucose tolerance or pre-diabetes.7 Fasting blood sugar levels should be less than 100mg/dL,7 but even values between 90-100mg/dL could indicate a progression to a pre-diabetic state. Fasting insulin is the most practical way to measure insulin resistance and can detect problems before disease occurs.8 Ideally, fasting insulin should be less than 5 uIU/mL and not rise above 30 uIU/mL after one and two hours.6,9 Other markers of insulin resistance may include elevated triglycerides, AST, increased waist circumference, and BMI.10

Stay tuned for a follow-up blog where we will discuss the functional medicine approach to preventing and reversing insulin resistance.


Our team of Functional Pharmacists at PharmToTable would love to talk to you about managing your blood sugar. Book an appointment or schedule a free 15-minute discovery call today!

Written by Dr. Katie Johnstone, PharmD, CHC


  1. Saxena, S. Functional Approaches to Cardiometabolic Diseases. Applying Functional Medicine in Clinical Practice. Sept 2019.
  2. Cohen, S. Diabetes without Drugs. Rodale Inc. 2011.
  3. Thomas, DD, et al. Hyperinsulinemia: An Early Indicator of Metabolic Dysfunction. J Endocr Soc. 2019. Sep 1; 3(9): 1727-1747.
  4. Wilcox, G. Insulin and Insulin Resistance. Clin Biochem Rev. 2005 May; 26(2): 19-39 
  5. Kresser, C. Functional Medicine and Diabetes: How to Treat the Root Cause. May 2019.
  6. Hyman, M. The One Test Your Doctor Isn’t Doing That Could Save Your Life: Accessed on 4/25/21
  7. American Diabetes Association: diagnosing diabetes and learning about pre-diabetes Accessed on 5/5/21
  8. Singh, B, Saxena, A. Surrogate markers of insulin resistance. World Journal of Diabetes. 2010 May; 1(2):36-47
  9. Fauci AS, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 17th Edition. New York: McGraw Hill Medical; 2008. Adapted from American Diabetic Association, 2007
  10. McAuley, K, et al.  Diagnosing Insulin Resistance in the General Population. Diabetes Care. 2001 March; 24(3):460-464

1 thought on “Blood Sugar Regulation and Insulin Resistance

  1. […] prevention and treatment through diet and lifestyle changes. In part 1 of this blog post, we discussed the pathophysiology of blood sugar imbalance and insulin resistance. In part 2, we will focus on small changes you can make to prevent or reverse insulin […]

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