#149 - AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it
Feb 15, 2021
Dive into the complexities of insulin resistance as experts break down this pressing health issue. Discover how it’s measured and the unique ways it affects muscle and liver function. Learn about gold-standard testing methods and the euglycemic clamp test, crucial tools for assessing insulin sensitivity. Uncover the biochemical mechanisms behind glycogen synthesis blockages and the stark contrasts in fat oxidation between insulin-sensitive and resistant individuals. This insightful discussion demystifies a condition affecting millions and offers practical strategies to address it.
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insights INSIGHT
Insulin's Role
Insulin, secreted by the pancreas, acts as an anabolic hormone, promoting growth.
It drives glucose into muscles for glycogen synthesis, influences liver glycogen, and increases fat storage.
insights INSIGHT
Insulin Resistance Defined
Insulin resistance impairs insulin's ability to perform its functions, like glucose uptake in muscles.
It differs in how it manifests in muscles, fat cells, and the liver.
insights INSIGHT
Measuring Insulin Resistance (Research)
The Euglycemic clamp, a research method, measures insulin sensitivity by quantifying glucose disposal rates at fixed insulin levels.
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it’s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it.
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We discuss:
Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00);
The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15);
Practical ways to test for insulin resistance in a normal clinical setting (15:45);
How insulin resistance manifests in the muscle (23:00);
The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45);
The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45);
The fate of the ingested carbohydrate in someone who is insulin resistant (51:00);
The prevalence and clinical phenotype of insulin resistance (1:00:15);
The role of exercise in mitigating and reversing insulin resistance (1:05:00);
How insulin resistance manifests in the liver (1:09:15);
Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and
The Peter Attia Drive