June 9, 2025 • 31 mins
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Insulin resistance often precedes diabetes by 5-10 years and serves as an early warning sign of potential damage to your cardiovascular system and other organs. We explore this common condition, its risk factors, and how simple lifestyle changes can reverse it before more serious health problems develop.
• Insulin resistance occurs when muscles, liver, and fat cells fail to respond to normal levels of insulin
• The pancreas compensates by producing more insulin, eventually leading to beta cell failure
• Clinical signs include dark skin patches in body folds (acanthosis nigricans), elevated triglycerides, and increased waist circumference
• One in three Americans have prediabetes, with many also experiencing insulin resistance
• Risk factors include central obesity, sedentary lifestyle, family history, PCOS, and certain racial/ethnic backgrounds
• Sleep disturbances, chronic stress, and fatty liver disease are emerging factors linked to insulin resistance
• A 5-7% weight reduction improves insulin sensitivity by over 50%
• Regular physical activity (150+ minutes weekly) helps glucose enter cells more efficiently
• Diet modifications focusing on whole foods, limiting refined sugars, and following Mediterranean or DASH patterns show significant benefits
• "The movement is the medicine, the food is the medicine" when addressing insulin resistance
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ed Delesky, MD (00:05):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area, and I'm.
Nicole Aruffo.
I'm a nurse and we are soexcited you were able to join us
here again today.
Nicole Aruffo, RN (00:33):
So which of the three topics should we start
?
Ed Delesky, MD (00:35):
off with.
We have three topics we do.
I only know of two of them, Ithink.
Why don't we talk about whatwe're watching?
It's the beginning ofsummertime, which invites a
certain Summer's here.
It's Love Island time, whichinvites a certain.
Nicole Aruffo, RN (00:42):
Summer's, here, it's Love Island time.
Ed Delesky, MD (00:45):
Can you tell our audience a little bit about,
like what are they missing ifthey're not watching Love Island
?
Nicole Aruffo, RN (00:52):
Oh my gosh, what are you missing?
Probably the best reality TVout there.
Ed Delesky, MD (01:00):
Yeah, that's a great start.
Nicole Aruffo, RN (01:03):
So they're all in Fiji.
But the thing about Love Islandis that it's practically in
real time because they're therenow and it came out this week,
so, like, what you're watchingis stuff that happened like
two-ish days ago.
Ed Delesky, MD (01:17):
That part's really cool because a lot of
what we do and what we watch isfrom like last year, which I
think is really restricting forthe people who actually are
participating in it, like theactors and so on.
Actors, they're not actors,they're real people because it's
reality, but the real lifethere's real life.
Of course, there's no script,um, but yeah, like they're like
(01:40):
summer house, for example,they're's last summer but it's
airing this summer.
Nicole Aruffo, RN (01:45):
And then they call them the Islanders.
It's happening in real time,but they don't have their phones
or anything, so all of thisdiscourse is happening online
and they don't know about it.
Ed Delesky, MD (01:57):
Right.
Nicole Aruffo, RN (01:58):
Right, it's not like they filmed this eight
months ago and now they're homeand reading everything online
that's happening about it.
That one girl got canceled andjust got yeeted from the villa.
She did and people like peopleon tiktok and stuff were,
because she only lasted like oneand a half episodes and people
would be like, oh, she has noidea, like she's in this bubble
(02:20):
in fiji and has no idea likeshe's, she's getting canceled
and then they kicked her out ofthe villa.
Ed Delesky, MD (02:26):
Yeah, absolutely crazy.
And if we didn't say it?
It's a dating show, yeah, wherepeople are trying to quote find
love, but there's also a prizeafter it.
We joined on last season but wewatched like after the fact,
like all.
I mean what 36 of the 42episodes had already been out.
Yeah, like all.
I mean what 36 of the 42episodes had already been out.
Yeah, and we hopped in and webinged it.
(02:47):
Look, a show hates to see uscoming.
Nicole Aruffo, RN (02:50):
Honestly, an entire season of a show hates to
see us coming.
Ed Delesky, MD (02:54):
Because we are.
There's one thing we are reallyreally good at is being on that
couch and watching the heck outof something Really fast At one
time speed.
But there is some money at theend involved and, like the, one
of the other cool pieces is thatpeople vote so that when
they're watching like they vote.
I haven't participated in thevoting yet, but they vote for
(03:15):
the couple that they think but alot of the couples from last
season are still together.
Nicole Aruffo, RN (03:20):
Really, yeah, they're had, they're doing like
a whole spinoff from the seasonsix people.
Ed Delesky, MD (03:25):
So this begs for an argument.
Nicole Aruffo, RN (03:28):
I mean, love is blind, and like the money
isn't like, it's like a hundredthousand dollars that at the end
you decide.
If I forget how you are, likewhoever, I forget what the
determining factor was of if youlike, keep it all, or if you
split it between like you andthe other person, of if you like
, keep it all, or if you splitit between like you and the
other person, I mean it's stilllike a hundred thousand dollars,
but it's not like.
Ed Delesky, MD (03:48):
you know, that doesn't go that far sure not
these days, it's like a millionright, it's not like yeah, there
are other shows, I mean, andlike they do with traders too,
they're like oh, here's 250,000dollars for like people who
already have like what I imagineto be like a lot of money.
Yeah, it's, it's really fun.
Uh, it's late, though.
Nicole Aruffo, RN (04:07):
I wish they moved the start time oh my gosh,
I know well that's because theythey do it at it's nine o'clock
eastern time.
So then, like the west coastpeople are watching it at six,
so like they can't make it tooearly for them I don't know.
Ed Delesky, MD (04:21):
I just wish everything was earlier I know,
maybe we should like move tocalifornia like I by the time
this gets cut out, like this putout nba finals last night
started 8 pm and, like I'mbarely awake, we're sleepy.
We're sleepy at that point andlike now we're doing this thing
where we can't watch tv in bedon the projector, even though
(04:42):
that was like a really coolmoment for us.
We have to watch it downstairsand both of us are sleeping so
much better yeah, it's reallyannoying it's really annoying
how that works, but nonethelessthat's what we're watching
recently and any other thoughtsabout love island?
Nicole Aruffo, RN (05:00):
all right what else should we talk?
We need to talk about dinnerlast night.
Ed Delesky, MD (05:05):
Why don't you tell them about dinner a little
bit?
Nicole Aruffo, RN (05:06):
Because we always talk about things that I
make and Eddie made restaurantquality mussels last night.
Ed Delesky, MD (05:14):
I feel good about this.
Nicole Aruffo, RN (05:15):
They were so delicious.
Ed Delesky, MD (05:16):
Double garlic More garlic is always the answer
.
Nicole Aruffo, RN (05:19):
Oh yeah, always more garlic.
Ed Delesky, MD (05:22):
So I just had the idea because I was like you,
what I want to create somethingdifferent.
Put the biochem degree to use,as you would put it.
Yeah, and so we go to thegrocery store and I like this
grocery store it's weigman's,what am I kidding?
Um, and we go to the seafoodsection and they have all these
mussels on ice and I'm juststanding over there and I'm
laughing and I have no senseabout what I'm going to get
myself into and I think I justgot lucky is really what
(05:45):
happened.
But what do you mean?
Well, cooking the muscles isn'tthe tough thing.
It's like cleaning them andgetting rid of what they call
the beard.
And the gravy is really wherethe finesse was, because it's
that's what the muscle is in andI feel great about it.
I mean, you routinely like makeamazing meals, superlative
(06:07):
meals for me all the time, soit's really nice that I was able
to pitch in there and make some, some red muscles.
I put the man to put it in therecipe book.
Nicole Aruffo, RN (06:17):
Yeah, that has to go to the recipe book.
And you were like I measured.
What did you say?
I measured with love.
Ed Delesky, MD (06:24):
I measured with love this time.
Nicole Aruffo, RN (06:25):
Well, now I feel like you finally get it,
like you get what I'm talkingabout when I'm like, oh, just
like a zhuzh of this, or youknow, I like to cook based off
vibes.
But then we watched that movieand she was like measure with
your heart or something, ormeasure with love.
And then my mom said that toyou like shortly after that, and
then you did it.
Ed Delesky, MD (06:45):
So now I feel like you get the cooking based
on vibes yeah, but then there'smoments where I worry like am I
gonna put too much oregano inhere and ruin it?
So that's like I had a littlebit of worry there because I was
just like pouring it in thereand I was like, is this too much
oregano?
Nicole Aruffo, RN (07:00):
but did the recipe you used?
Did you put um?
Did it call for any wine?
Ed Delesky, MD (07:05):
yeah, it did, and I didn't feel like going to
the store to getting some whitewine we have cooking wine in the
fridge that could have used it?
Yeah, did you think that itwould have added a layer of it?
Did call for wine?
Nicole Aruffo, RN (07:17):
yeah I was just curious.
It brings out like the um, thearomatics, the garlic and stuff,
that like reaction I guess.
Well, even your biochem degree,like you put it in, like after
the garlic, before the tomatoes,and then something with like
(07:40):
the acidity of the tomatoes.
Ed Delesky, MD (07:42):
It's the same thing with like vodka and a
vodka sauce, you know oh well, Imean, you know, by the time
this comes out, I will have agiant amount of fat rigatoni in
my tummy.
But this one's going to beextra because I'm pretty sure
we're going to do shrimp andspicy pork sausage oh yeah, I
forgot.
Nicole Aruffo, RN (08:01):
We had the argentinian shrimp in the
freezer yeah, so I mean thoseare also.
Ed Delesky, MD (08:06):
Maybe we can use half and save the other half
for your cumin shrimp that youlove to eat, I do.
Nicole Aruffo, RN (08:14):
What's the third thing?
Ed Delesky, MD (08:16):
well, the third thing was, uh, this awesome
concert that we went to incamden, new jersey and it's not
called bb and t anymore we wentto luke bryan, yeah that was so
fun.
That was a blast um I.
He had people standing up morethan kenny did.
Nicole Aruffo, RN (08:30):
No one sat down the entire time eddie was
not ready for all of thescreaming women around luke
bryan.
Ed Delesky, MD (08:37):
These women love luke bryan, oh my goodness,
especially at the end, when hewas like, he did a little thing,
like.
He was like oh, here's my like.
I'm a country man, I'm a simplecountry man.
Where are my country girls?
And then he went into the songand then I thought the place was
going to explode.
I was like this is crazy Simplewhite t-shirt, light wash jeans
(09:01):
and those cowboy boots andeveryone's going nuts.
I mean quite the performer,though.
I mean literally everyone wasstanding the entire time.
But we went to the bathroom forthe second time and we came
back and everyone was alreadystanding and I was like, oh, how
convenient.
We're walking back to our seatsand everyone's already standing
for us.
This is awesome, Thinking thatthere was a third like warm up
(09:24):
act.
Nicole Aruffo, RN (09:24):
Yeah, I don't know why everyone, why you guys
all thought that.
Ed Delesky, MD (09:28):
I don't know, but I was like, wow, because
they don't turn all the lightsoff.
Nicole Aruffo, RN (09:31):
It made sense because it was like nine
o'clock For an opening act Anhour and a half for like.
Ed Delesky, MD (09:36):
Is that how it works?
Like well, that's one questionI have.
Does the main artist get likean hour and a half, two hours?
Nicole Aruffo, RN (09:43):
yeah, I mean, unless you're taylor swift and
so what was taylor swift then?
She was like over three hoursis.
Ed Delesky, MD (09:50):
Was that kind of like?
Does anyone know that?
Nicole Aruffo, RN (09:52):
going in or what like how long the artist is
gonna be on for um, I think youcan usually find like the set
list online, sometimes okay andlike figure out how long it is
yeah but I'd say it's probablygenerally like an hour and a
half two hours.
Is that enough time?
Ed Delesky, MD (10:10):
I think so, yeah yeah, that is enough time I did
.
I felt it.
By the end I was like, yeah,this is good.
It was like, very like it wasall put together from start to
end.
High energy, pizza iseverything.
Those that's an expensive venue.
Yeah, that was crazy.
That's, that was more expensivethan the link.
(10:30):
I think I that was crazy.
Those two beverages for thatcost, and then pizza, a personal
pizza, $28.
I and it wasn't me, but I, ohmy God, this place was that's.
I get it, I get what they'redoing, but wow, anyway, awesome
(10:51):
concert, thank you.
High energy, that was awesome,would you go back.
I would go back absolutely yeah,luke bryan's fun.
Nicole Aruffo, RN (10:59):
Yeah, I would definitely go back he also like
um he like interacts with thecrowd.
Ed Delesky, MD (11:04):
I feel like the amount of eagles chants oh my
god but there was a really coolmoment where one of his like
bassists, I think like got upthere on the mic and led the
chant.
Nicole Aruffo, RN (11:17):
Oh yeah, because he's like from Philly or
adjacent.
Ed Delesky, MD (11:20):
Yeah, and that must have been a cool moment for
him.
As a Giants fan, I was justlike look, have their moment.
Like you're still champions?
Yeah, do your thing.
Poor kid's a.
Nicole Aruffo, RN (11:28):
Giants fan.
Ed Delesky, MD (11:30):
Look, I had my time, we won.
Listen the.
Nicole Aruffo, RN (11:32):
Eagles won the Super Bowl.
You loved it.
You were a part of the culture.
Ed Delesky, MD (11:38):
It was cool living here.
While that was happening.
I had my time as a Giants fan.
I'm still a Giants fan.
The arrow's pointing up.
Nicole Aruffo, RN (11:45):
Listen, we have pictures of us on Broad
Street when they won the SuperBowl and they're going in our
2025 album, book and evidence ofEddie being an Eagles fan will
live there forever.
Ed Delesky, MD (11:58):
No look, am I going to sit here and be a grump
and be like I'm not goingoutside when they won the Super
Bowl to see what this place islike.
I'm going to sit inside andhate like this.
Nicole Aruffo, RN (12:08):
I'm going to be a hater.
Ed Delesky, MD (12:09):
I'm going to be a hater.
No, I'm going to go outside.
I'm going to see what it lookslike because I want to see it.
So that's that looks like,because I want to see it.
So that's that.
Why don't we dive into whatwe're going to talk about today?
It's a little follow-up fromlast week to give us a little
advanced topic to get a betterunderstanding of our bodies.
So what are we going to talkabout today, nick?
(12:31):
Today Well, actually, I feellike this is a hot topic in the
zeitgeist we're talking aboutinsulin resistance today, right
Today, we're talking aboutinsulin resistance today, right
Today, we're talking aboutinsulin resistance, and not just
what it is, but how itcontributes to some of the
biggest problems we face,including diabetes, heart
disease, fatty liver and evensome cancers.
And we're talking about thisbecause of our discussion last
(12:55):
week about prediabetes and howcommon it is and the things we
can do.
So if you haven't taken alisten to that after you finish
this episode out, why don't yougo back and listen to that one?
So we know that from last week,approximately one in three
Americans have prediabetes andsimilar numbers is that a bunch
(13:15):
of them also have insulinresistance.
It just so happens that insulinresistance tends to be the most
common etiology or cause oftype 2 diabetes.
There are other types ofdiabetes.
There are other causes ofprediabetes, those being
autoimmune or otherabnormalities in metabolism.
(13:37):
We're just talking about whatis most common here today, so
we'll dive into what is insulinresistance.
So some basic information abouthow the body works.
Insulin is secreted or releasedby the pancreas and signals to
the body's cells that and mainlyby cells I mean like cells of
(14:00):
the muscle, the liver and fattissue and insulin says absorb
glucose for energy or storage.
So bring that glucose, thatsugar from the blood into the
cell and so in insulinresistance, these tissues muscle
, liver, fat they fail torespond to normal levels of
(14:25):
insulin.
It's almost like someone'sgoing in to wake someone up and
they like, let's say, you have alight sleeper and you can just
tap them a little bit or maybeeven walk in the room and you're
in their presence and they wakeup and they're like, oh, I'm
awake, but then you've got areally heavy sleeper and you got
to like shake them to wake themup.
That's sort of insulinresistance.
Like it takes more to get thesame response.
(14:47):
We heard what goes right in thebody when the pancreas is doing
its thing and releasing insulin, but what happens when it goes
wrong?
So when there's insulinresistance, to compensate the
pancreas produces more insulinand it's what something's called
compensatory hyperinsulinemia.
(15:08):
So because the pancreas is nowworking a little overtime,
specifically the cells in thepancreas and this is a really
cool thing when you do biochemyou can really get in the nitty
gritty and learn about, likewhat the little things are
actually doing If I'm doing thislittle like dance over here
Over time.
The beta cells these are theones that actually make the
(15:29):
insulin.
The beta cells fail, they don'tkeep up to the body's demands
for insulin, and what that doesis it leads to elevated blood
glucose and eventually, maybetype 2 diabetes, and that's how
that slippery slope goes.
So there are some clinicalclues.
We talk about this complicatedthing of insulin resistance but
(15:52):
try to simplify it the best wecan and there are certain signs
or symptoms that your doctor maylook for Something called
acanthosis nigricans.
What the heck is that?
That is a velvety discoloration.
It's usually hyperpigmentationor darkness that can happen in
some body folds under thearmpits, back of the neck.
(16:12):
Sometimes they're associatedwith skin tags.
Sometimes people get elevatedtriglycerides and a low HDL
We've talked about this in priorepisodes HDL for healthy
cholesterol, so lower levels isworse.
And the elevated waistcircumference, which is no
surprise because we've talkedabout how visceral fat is the
(16:35):
worst type of fat, because thatis fat that is around your
organs, that is fat that isgoing in the liver, that is fat
that is going around differentplaces, and this what's called
an ectopic distribution of fat,which is fat going in places
that it shouldn't, also causes alot of problems and bleeds into
(16:56):
causing insulin resistance.
So some of those things may cuein and say that even if your
fasting, glucose is normal, thatif you have those things, you
may be dealing with insulinresistance.
So then comes in the questionof who is at risk, and there are
certain risk factors that endup being really common for
(17:16):
people.
So we talk about visceral fator central obesity.
So in men, if waistcircumference which is a
particular measurement, isgreater than 40 inches, or
greater than 35 inches in women,that's a risk factor for
insulin resistance.
A sedentary lifestyle, a familyhistory of type 2 diabetes we
(17:38):
see this a lot online.
It's a very common diagnosisthat people are really trying to
hammer down and understand isPCOS, and there are some
estimates that over 70% ofpatients who have PCOS have
insulin resistance and a historyof gestational diabetes.
And there are some other riskfactors that are coming out and
(17:58):
being more well understood,including sleep disturbances,
including obstructive sleepapnea, and we even talked last
week.
Now the American DiabetesAssociation is looking at sleep
and saying if you sleep lessthan six hours a night or more
than nine, you're increasingyour risk from prediabetes to
diabetes conversion.
Nine, you're increasing yourrisk from prediabetes to
diabetes conversion.
(18:18):
Chronic stress is being lookedat as a cause of insulin
resistance and a very importantemerging, I would say, in the
medical literature this isalready well known and being
tracked, but maybe in lay mediaand common understanding
metabolic dysfunction,associated steatotic liver
disease.
If you ever hear your doctorsay that, you can ask them to
(18:40):
say it three times fast.
But this is when there's fat inthe liver and it's quickly
becoming one of the most commoncauses of liver problems in
America and deserves a lot ofattention.
But it's also intimatelyrelated to insulin resistance in
a lot of ways, and what we'realso seeing is that there are
(19:01):
racial and ethnic risks,including people in these
categories having increased riskHispanic, black, native
American and South Asianpopulations having higher
prevalences of insulinresistance, likely due to a mix
of some genetic and a lot ofsocioeconomic factors as well.
So all of our discussion so farsort of invites why the heck
(19:23):
does this even matter?
And it matters because it's avery early warning sign that
there might be silent damagehappening already.
Insulin resistance oftenprecedes diabetes by even five
to 10 years, and even duringthat time some damage might
already be happening, especiallyto the cardiovascular system,
which is the most common causeof mortality in America, and so
(19:49):
there are downstream associatedconditions that people with
insulin resistance somethingthat isn't so easily detected is
talked about type 2 diabetes,atherosclerosis, which is that
plaque buildup in the arteriesof your heart or your other
blood vessels, coronary arterydisease, hypertension, the
(20:10):
massal D or metabolic associatedliver dysfunction and some
cancers like endometrial cancer,colorectal cancer, breast
cancer, are intimately relatedto these insulin pathways as
well, and so far, we've talkedabout who's at risk, we've
talked about why it matters and,nikki, can you take us through?
(20:32):
A lot of this conversation endsup being similar to pre-diabetes
, but can you hit the highlightsabout what people can do if
they're starting to think likehuh, I looked at my labs and
some of those are a littlemessed up, or I do have a
sedentary lifestyle, or maybe mywaist circumference is.
I'm a man and my waistcircumference is greater than 40
inches.
What can someone do?
Nicole Aruffo, RN (20:57):
Well, we're probably going to sound like a
broken record here, because Ithink we've talked about this in
almost every episode relatingto this, so we're going to say
it again, because it works.
Apparently.
Number one weight loss.
We've said it once, we've saidit twice, maybe even thrice, and
(21:19):
we're going to say it againbecause just a five to seven
percent weight reductionimproves insulin sensitivity by
over 50 percent.
Second, if you can't guessphysical activity.
Ed Delesky, MD (21:32):
Yeah, Getting to that 150 minutes something
greater than 150 minutes perweek is so important.
And what we're actually seeingis that there are receptors that
increase and allow glucose togo into the cell more when you
exercise.
They are upregulated when youexercise.
So go exercise because you'rereducing your insulin resistance
(21:56):
when you do so.
And then what about some dietchanges?
Nicole Aruffo, RN (22:01):
Third is diet change, again sounding like a
broken record, emphasizing wholegrains, unsaturated fats, leafy
greens and our favorite legumes.
We're actually going to make adense bean salad later today to
have for the week Low glycemicindex foods, which you can
(22:22):
Google Basically, foods that arereducing your insulin demand
and not like spiking that bloodsugar, limiting refined sugars,
especially liquid calories.
Ed Delesky, MD (22:34):
Looking at all of the soda drinkers, yes, and
juice, and juice yeah, seeminglygood fruit in liquid form, but
a lot of juice can cause someproblems and then the
mediterranean or dash stylediets are both evidence-based.
Nicole Aruffo, RN (22:53):
Um to help with this.
Ed Delesky, MD (22:54):
Yep, all of that put together can really help
and I think we're going to limita lot of the medication talk.
There are a lot of medicationsout there that can help insulin
resistance, but because insulinresistance is sort of like a
yellow flag of things that arehappening in your body, a very
early warning sign, I feel liketalking about medicines would
(23:16):
invite over-medicalizing it andsay like, yeah, let's use
medicines to detect this thingthat's happening so early, when
it's in the things that you'redoing every day.
I've been trying to say this alittle bit more in visits that,
like the movement is themedicine, the food is the
medicine when it comes to thingslike this.
So we won't talk aboutmedicines as much today.
(23:38):
There are some other lifestylefactors that affect your insulin
sensitivity, like getting theright amount of sleep helps.
We talked about this last week,we'll say it again, and so,
leaving all of that out there,what are you seeing online?
Or I want to to like this isnow, we're just chit chatting.
(23:58):
I want to talk about like I'mseeing this a lot online and
people are saying like I'mhaving a tough time losing
weight because of my insulinresistance.
Nicole Aruffo, RN (24:10):
So everything we just said, you know kind of
points to that A lot of peoplemay have this or struggle with
this.
People are like oh, I can'tlose weight.
I have it's my insulinresistance or it's my high
cortisol.
Like I can't lose weight, itmust be peace.
Like and like I have painfulwhatever.
Like I must have pcos rightwhen, like that, could be the
(24:35):
case.
Right it might be the case, butlike I don't know.
But then if you you like, doall the things.
Ed Delesky, MD (24:44):
Yeah, I think there's.
I think there's a healthy effortfor people to understand what
they're going through and thisinsulin resistance in particular
, I think, toes the line betweendisease and like pathology that
(25:05):
is happening and like I thinkthe earliest form of like what
we can describe is like theclasses of obesity, class one,
two and three.
Like these two things are veryintimately related.
Two and three like these twothings are very intimately
related.
Another another point to get athere is that like yes, these
things happen to people and atsome point people have to choose
(25:25):
to live in the solution insteadof sitting in the the problem
that is happening to them yeah,and I guess my thing with like
all the people online, they'llbe like I.
Nicole Aruffo, RN (25:38):
You know whether they self-diagnose
themselves with insulinresistance or not.
But then, they, you know, makeall these tiktoks of what
they're doing for that and, youknow, making all these healthy
lifestyle modifications which,like with or without insulin
resistance or with or withoutwhatever kind of like diagnosis,
whether it's actual orself-made those lifestyle
(26:00):
modifications are good for youand healthy regardless of any of
that.
So excellent point, Right,that's also you know I guess
they're not doing anything likesuper damaging online and
putting things out there.
Ed Delesky, MD (26:12):
Right and this is also I think this gets at a
point of the like the speed thatinformation flows again,
because there are not a lot ofmainstream tests that are
described and endorsed by a lotof medical societies at this
point but are used in practice.
Like when I was reading aboutthis, that, like we didn't
include in the formal likebreakdown was measuring fasting
(26:36):
insulin, like people ask forthat.
I've been asked for that and atthe time I didn't know much
about it.
But, like, if it's a veryfluctuating level, is one to the
different labs that run.
Labs don't have a standardreporting system for it and it's
all related to like individualmoments in time and so a lab
(27:00):
like that is fraught withmisleading information.
It could be very helpful.
It could not be and there isn'ta lot of guidance out there
right now to say one way or theother.
Neither is the triglyceride toHDL ratio, which I'm sure some
people are using and may behelpful, but triglycerides
(27:21):
fluctuate throughout the day andso, yeah, you get it when it's
fasting, but once again, there'snot a lot of formal
recommendation out there todiscuss this because it's so
early on.
We're just talking aboutpre-diabetes a lot and it covers
so many people, and the earlierstep upstream of pre-diabetes
in a lot of circumstances isinsulin resistance, and it's
(27:43):
more the pathophysiology than aactive condition.
It's like describing a processthat's happening in your body
that your body compensates foruntil it can't, and when it's
done, compensating prediabetes,and then when it's further,
decompensating diabetes.
In a lot of cases, like we saidearlier, it doesn't always
(28:04):
shake out that way.
People end up doing the thingsthat they're supposed to anyway.
Nicole Aruffo, RN (28:09):
No one's going to say, like no doctor's
going to say, it's bad if youincrease your activity and start
eating a healthier, morebalanced diet.
Ed Delesky, MD (28:18):
An analogy comes to mind when car maintenance is
a topic that I think about alot, with delivery of news and
service, but also like takingcare of it.
And if you know that every somany 10,000 miles you're
supposed to replace your brakesand you're driving your car
(28:39):
every day you're going aroundand you're just driving and
you're like, yeah, maybe at somepoint I need to replace my
brakes.
But then you go see aprofessional and, let's say, in
a different arc of life, you gosee the professional, you go see
the mechanic and then themechanic says, based on this
sign, this sign and this sign,you need to get your brakes
replaced.
There's a lot more weightbehind that.
(29:01):
Like now you're getting advicefrom someone.
They're throwing up the yellowflag saying, based on this
information I have, you need togo get your brakes replaced.
So now you get your brakesreplaced, brakes replaced, so
now you get your brakes replaced, Whereas before you didn't see
the professional, you didn't payattention to the signs and
symptoms and you didn't get yourbrakes replaced and you just
(29:22):
kind of fell by the wayside ordidn't get your oil changed,
didn't take care of your car.
In a lot of ways I think likeseeing this like.
We've known that people havemetabolic disturbances,
metabolic syndrome, which has avery wide definition, and people
are just out there living likethis, and the best ways we can
describe this pathology is class1 obesity.
(29:43):
Class 2 obesity, prediabetes.
This captures it even earlierthan all of that, and maybe it's
like going to the mechanic andpeople are like oh yeah, you
have come to the doctor's office.
I'm concerned, you have somelevel of insulin resistance.
We need to be really thoughtfulabout this.
So that's where we're taking it.
Today, we're talking aboutinsulin resistance.
(30:04):
Hopefully you're able to learnsomething.
Recognize that insulinresistance isn't a disease.
It's more like an alarm bell,and the good news is like this
is totally reversible and wedon't need perfect change.
We just need somethingconsistent and something
positive.
So so thank you for coming backto another episode of your
checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
(30:25):
Make sure you check out ourwebsite, send us an email, find
us on Instagram, Make sure youfollow the show so that you can
get notifications when our nextepisode comes out and, most
importantly, stay healthy, myfriends.
Until next time.
Make sure you follow the showso that you can get
notifications when our nextepisode comes out.
And, most importantly, stayhealthy, my friends, Until next
time.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you and goodbye Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
(30:46):
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
(31:06):
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area, and I'm.
Nicole Aruffo.
I'm a nurse and we are soexcited you were able to join us
here again today.
Nicole Aruffo, RN (00:33):
So which of the three topics should we start
?
Ed Delesky, MD (00:35):
off with.
We have three topics we do.
I only know of two of them, Ithink.
Why don't we talk about whatwe're watching?
It's the beginning ofsummertime, which invites a
certain Summer's here.
It's Love Island time, whichinvites a certain.
Nicole Aruffo, RN (00:42):
Summer's, here, it's Love Island time.
Ed Delesky, MD (00:45):
Can you tell our audience a little bit about,
like what are they missing ifthey're not watching Love Island
?
Nicole Aruffo, RN (00:52):
Oh my gosh, what are you missing?
Probably the best reality TVout there.
Ed Delesky, MD (01:00):
Yeah, that's a great start.
Nicole Aruffo, RN (01:03):
So they're all in Fiji.
But the thing about Love Islandis that it's practically in
real time because they're therenow and it came out this week,
so, like, what you're watchingis stuff that happened like
two-ish days ago.
Ed Delesky, MD (01:17):
That part's really cool because a lot of
what we do and what we watch isfrom like last year, which I
think is really restricting forthe people who actually are
participating in it, like theactors and so on.
Actors, they're not actors,they're real people because it's
reality, but the real lifethere's real life.
Of course, there's no script,um, but yeah, like they're like
(01:40):
summer house, for example,they're's last summer but it's
airing this summer.
Nicole Aruffo, RN (01:45):
And then they call them the Islanders.
It's happening in real time,but they don't have their phones
or anything, so all of thisdiscourse is happening online
and they don't know about it.
Ed Delesky, MD (01:57):
Right.
Nicole Aruffo, RN (01:58):
Right, it's not like they filmed this eight
months ago and now they're homeand reading everything online
that's happening about it.
That one girl got canceled andjust got yeeted from the villa.
She did and people like peopleon tiktok and stuff were,
because she only lasted like oneand a half episodes and people
would be like, oh, she has noidea, like she's in this bubble
(02:20):
in fiji and has no idea likeshe's, she's getting canceled
and then they kicked her out ofthe villa.
Ed Delesky, MD (02:26):
Yeah, absolutely crazy.
And if we didn't say it?
It's a dating show, yeah, wherepeople are trying to quote find
love, but there's also a prizeafter it.
We joined on last season but wewatched like after the fact,
like all.
I mean what 36 of the 42episodes had already been out.
Yeah, like all.
I mean what 36 of the 42episodes had already been out.
Yeah, and we hopped in and webinged it.
(02:47):
Look, a show hates to see uscoming.
Nicole Aruffo, RN (02:50):
Honestly, an entire season of a show hates to
see us coming.
Ed Delesky, MD (02:54):
Because we are.
There's one thing we are reallyreally good at is being on that
couch and watching the heck outof something Really fast At one
time speed.
But there is some money at theend involved and, like the, one
of the other cool pieces is thatpeople vote so that when
they're watching like they vote.
I haven't participated in thevoting yet, but they vote for
(03:15):
the couple that they think but alot of the couples from last
season are still together.
Nicole Aruffo, RN (03:20):
Really, yeah, they're had, they're doing like
a whole spinoff from the seasonsix people.
Ed Delesky, MD (03:25):
So this begs for an argument.
Nicole Aruffo, RN (03:28):
I mean, love is blind, and like the money
isn't like, it's like a hundredthousand dollars that at the end
you decide.
If I forget how you are, likewhoever, I forget what the
determining factor was of if youlike, keep it all, or if you
split it between like you andthe other person, of if you like
, keep it all, or if you splitit between like you and the
other person, I mean it's stilllike a hundred thousand dollars,
but it's not like.
Ed Delesky, MD (03:48):
you know, that doesn't go that far sure not
these days, it's like a millionright, it's not like yeah, there
are other shows, I mean, andlike they do with traders too,
they're like oh, here's 250,000dollars for like people who
already have like what I imagineto be like a lot of money.
Yeah, it's, it's really fun.
Uh, it's late, though.
Nicole Aruffo, RN (04:07):
I wish they moved the start time oh my gosh,
I know well that's because theythey do it at it's nine o'clock
eastern time.
So then, like the west coastpeople are watching it at six,
so like they can't make it tooearly for them I don't know.
Ed Delesky, MD (04:21):
I just wish everything was earlier I know,
maybe we should like move tocalifornia like I by the time
this gets cut out, like this putout nba finals last night
started 8 pm and, like I'mbarely awake, we're sleepy.
We're sleepy at that point andlike now we're doing this thing
where we can't watch tv in bedon the projector, even though
(04:42):
that was like a really coolmoment for us.
We have to watch it downstairsand both of us are sleeping so
much better yeah, it's reallyannoying it's really annoying
how that works, but nonethelessthat's what we're watching
recently and any other thoughtsabout love island?
Nicole Aruffo, RN (05:00):
all right what else should we talk?
We need to talk about dinnerlast night.
Ed Delesky, MD (05:05):
Why don't you tell them about dinner a little
bit?
Nicole Aruffo, RN (05:06):
Because we always talk about things that I
make and Eddie made restaurantquality mussels last night.
Ed Delesky, MD (05:14):
I feel good about this.
Nicole Aruffo, RN (05:15):
They were so delicious.
Ed Delesky, MD (05:16):
Double garlic More garlic is always the answer
.
Nicole Aruffo, RN (05:19):
Oh yeah, always more garlic.
Ed Delesky, MD (05:22):
So I just had the idea because I was like you,
what I want to create somethingdifferent.
Put the biochem degree to use,as you would put it.
Yeah, and so we go to thegrocery store and I like this
grocery store it's weigman's,what am I kidding?
Um, and we go to the seafoodsection and they have all these
mussels on ice and I'm juststanding over there and I'm
laughing and I have no senseabout what I'm going to get
myself into and I think I justgot lucky is really what
(05:45):
happened.
But what do you mean?
Well, cooking the muscles isn'tthe tough thing.
It's like cleaning them andgetting rid of what they call
the beard.
And the gravy is really wherethe finesse was, because it's
that's what the muscle is in andI feel great about it.
I mean, you routinely like makeamazing meals, superlative
(06:07):
meals for me all the time, soit's really nice that I was able
to pitch in there and make some, some red muscles.
I put the man to put it in therecipe book.
Nicole Aruffo, RN (06:17):
Yeah, that has to go to the recipe book.
And you were like I measured.
What did you say?
I measured with love.
Ed Delesky, MD (06:24):
I measured with love this time.
Nicole Aruffo, RN (06:25):
Well, now I feel like you finally get it,
like you get what I'm talkingabout when I'm like, oh, just
like a zhuzh of this, or youknow, I like to cook based off
vibes.
But then we watched that movieand she was like measure with
your heart or something, ormeasure with love.
And then my mom said that toyou like shortly after that, and
then you did it.
Ed Delesky, MD (06:45):
So now I feel like you get the cooking based
on vibes yeah, but then there'smoments where I worry like am I
gonna put too much oregano inhere and ruin it?
So that's like I had a littlebit of worry there because I was
just like pouring it in thereand I was like, is this too much
oregano?
Nicole Aruffo, RN (07:00):
but did the recipe you used?
Did you put um?
Did it call for any wine?
Ed Delesky, MD (07:05):
yeah, it did, and I didn't feel like going to
the store to getting some whitewine we have cooking wine in the
fridge that could have used it?
Yeah, did you think that itwould have added a layer of it?
Did call for wine?
Nicole Aruffo, RN (07:17):
yeah I was just curious.
It brings out like the um, thearomatics, the garlic and stuff,
that like reaction I guess.
Well, even your biochem degree,like you put it in, like after
the garlic, before the tomatoes,and then something with like
(07:40):
the acidity of the tomatoes.
Ed Delesky, MD (07:42):
It's the same thing with like vodka and a
vodka sauce, you know oh well, Imean, you know, by the time
this comes out, I will have agiant amount of fat rigatoni in
my tummy.
But this one's going to beextra because I'm pretty sure
we're going to do shrimp andspicy pork sausage oh yeah, I
forgot.
Nicole Aruffo, RN (08:01):
We had the argentinian shrimp in the
freezer yeah, so I mean thoseare also.
Ed Delesky, MD (08:06):
Maybe we can use half and save the other half
for your cumin shrimp that youlove to eat, I do.
Nicole Aruffo, RN (08:14):
What's the third thing?
Ed Delesky, MD (08:16):
well, the third thing was, uh, this awesome
concert that we went to incamden, new jersey and it's not
called bb and t anymore we wentto luke bryan, yeah that was so
fun.
That was a blast um I.
He had people standing up morethan kenny did.
Nicole Aruffo, RN (08:30):
No one sat down the entire time eddie was
not ready for all of thescreaming women around luke
bryan.
Ed Delesky, MD (08:37):
These women love luke bryan, oh my goodness,
especially at the end, when hewas like, he did a little thing,
like.
He was like oh, here's my like.
I'm a country man, I'm a simplecountry man.
Where are my country girls?
And then he went into the songand then I thought the place was
going to explode.
I was like this is crazy Simplewhite t-shirt, light wash jeans
(09:01):
and those cowboy boots andeveryone's going nuts.
I mean quite the performer,though.
I mean literally everyone wasstanding the entire time.
But we went to the bathroom forthe second time and we came
back and everyone was alreadystanding and I was like, oh, how
convenient.
We're walking back to our seatsand everyone's already standing
for us.
This is awesome, Thinking thatthere was a third like warm up
(09:24):
act.
Nicole Aruffo, RN (09:24):
Yeah, I don't know why everyone, why you guys
all thought that.
Ed Delesky, MD (09:28):
I don't know, but I was like, wow, because
they don't turn all the lightsoff.
Nicole Aruffo, RN (09:31):
It made sense because it was like nine
o'clock For an opening act Anhour and a half for like.
Ed Delesky, MD (09:36):
Is that how it works?
Like well, that's one questionI have.
Does the main artist get likean hour and a half, two hours?
Nicole Aruffo, RN (09:43):
yeah, I mean, unless you're taylor swift and
so what was taylor swift then?
She was like over three hoursis.
Ed Delesky, MD (09:50):
Was that kind of like?
Does anyone know that?
Nicole Aruffo, RN (09:52):
going in or what like how long the artist is
gonna be on for um, I think youcan usually find like the set
list online, sometimes okay andlike figure out how long it is
yeah but I'd say it's probablygenerally like an hour and a
half two hours.
Is that enough time?
Ed Delesky, MD (10:10):
I think so, yeah yeah, that is enough time I did
.
I felt it.
By the end I was like, yeah,this is good.
It was like, very like it wasall put together from start to
end.
High energy, pizza iseverything.
Those that's an expensive venue.
Yeah, that was crazy.
That's, that was more expensivethan the link.
(10:30):
I think I that was crazy.
Those two beverages for thatcost, and then pizza, a personal
pizza, $28.
I and it wasn't me, but I, ohmy God, this place was that's.
I get it, I get what they'redoing, but wow, anyway, awesome
(10:51):
concert, thank you.
High energy, that was awesome,would you go back.
I would go back absolutely yeah,luke bryan's fun.
Nicole Aruffo, RN (10:59):
Yeah, I would definitely go back he also like
um he like interacts with thecrowd.
Ed Delesky, MD (11:04):
I feel like the amount of eagles chants oh my
god but there was a really coolmoment where one of his like
bassists, I think like got upthere on the mic and led the
chant.
Nicole Aruffo, RN (11:17):
Oh yeah, because he's like from Philly or
adjacent.
Ed Delesky, MD (11:20):
Yeah, and that must have been a cool moment for
him.
As a Giants fan, I was justlike look, have their moment.
Like you're still champions?
Yeah, do your thing.
Poor kid's a.
Nicole Aruffo, RN (11:28):
Giants fan.
Ed Delesky, MD (11:30):
Look, I had my time, we won.
Listen the.
Nicole Aruffo, RN (11:32):
Eagles won the Super Bowl.
You loved it.
You were a part of the culture.
Ed Delesky, MD (11:38):
It was cool living here.
While that was happening.
I had my time as a Giants fan.
I'm still a Giants fan.
The arrow's pointing up.
Nicole Aruffo, RN (11:45):
Listen, we have pictures of us on Broad
Street when they won the SuperBowl and they're going in our
2025 album, book and evidence ofEddie being an Eagles fan will
live there forever.
Ed Delesky, MD (11:58):
No look, am I going to sit here and be a grump
and be like I'm not goingoutside when they won the Super
Bowl to see what this place islike.
I'm going to sit inside andhate like this.
Nicole Aruffo, RN (12:08):
I'm going to be a hater.
Ed Delesky, MD (12:09):
I'm going to be a hater.
No, I'm going to go outside.
I'm going to see what it lookslike because I want to see it.
So that's that looks like,because I want to see it.
So that's that.
Why don't we dive into whatwe're going to talk about today?
It's a little follow-up fromlast week to give us a little
advanced topic to get a betterunderstanding of our bodies.
So what are we going to talkabout today, nick?
(12:31):
Today Well, actually, I feellike this is a hot topic in the
zeitgeist we're talking aboutinsulin resistance today, right
Today, we're talking aboutinsulin resistance today, right
Today, we're talking aboutinsulin resistance, and not just
what it is, but how itcontributes to some of the
biggest problems we face,including diabetes, heart
disease, fatty liver and evensome cancers.
And we're talking about thisbecause of our discussion last
(12:55):
week about prediabetes and howcommon it is and the things we
can do.
So if you haven't taken alisten to that after you finish
this episode out, why don't yougo back and listen to that one?
So we know that from last week,approximately one in three
Americans have prediabetes andsimilar numbers is that a bunch
(13:15):
of them also have insulinresistance.
It just so happens that insulinresistance tends to be the most
common etiology or cause oftype 2 diabetes.
There are other types ofdiabetes.
There are other causes ofprediabetes, those being
autoimmune or otherabnormalities in metabolism.
(13:37):
We're just talking about whatis most common here today, so
we'll dive into what is insulinresistance.
So some basic information abouthow the body works.
Insulin is secreted or releasedby the pancreas and signals to
the body's cells that and mainlyby cells I mean like cells of
(14:00):
the muscle, the liver and fattissue and insulin says absorb
glucose for energy or storage.
So bring that glucose, thatsugar from the blood into the
cell and so in insulinresistance, these tissues muscle
, liver, fat they fail torespond to normal levels of
(14:25):
insulin.
It's almost like someone'sgoing in to wake someone up and
they like, let's say, you have alight sleeper and you can just
tap them a little bit or maybeeven walk in the room and you're
in their presence and they wakeup and they're like, oh, I'm
awake, but then you've got areally heavy sleeper and you got
to like shake them to wake themup.
That's sort of insulinresistance.
Like it takes more to get thesame response.
(14:47):
We heard what goes right in thebody when the pancreas is doing
its thing and releasing insulin, but what happens when it goes
wrong?
So when there's insulinresistance, to compensate the
pancreas produces more insulinand it's what something's called
compensatory hyperinsulinemia.
(15:08):
So because the pancreas is nowworking a little overtime,
specifically the cells in thepancreas and this is a really
cool thing when you do biochemyou can really get in the nitty
gritty and learn about, likewhat the little things are
actually doing If I'm doing thislittle like dance over here
Over time.
The beta cells these are theones that actually make the
(15:29):
insulin.
The beta cells fail, they don'tkeep up to the body's demands
for insulin, and what that doesis it leads to elevated blood
glucose and eventually, maybetype 2 diabetes, and that's how
that slippery slope goes.
So there are some clinicalclues.
We talk about this complicatedthing of insulin resistance but
(15:52):
try to simplify it the best wecan and there are certain signs
or symptoms that your doctor maylook for Something called
acanthosis nigricans.
What the heck is that?
That is a velvety discoloration.
It's usually hyperpigmentationor darkness that can happen in
some body folds under thearmpits, back of the neck.
(16:12):
Sometimes they're associatedwith skin tags.
Sometimes people get elevatedtriglycerides and a low HDL
We've talked about this in priorepisodes HDL for healthy
cholesterol, so lower levels isworse.
And the elevated waistcircumference, which is no
surprise because we've talkedabout how visceral fat is the
(16:35):
worst type of fat, because thatis fat that is around your
organs, that is fat that isgoing in the liver, that is fat
that is going around differentplaces, and this what's called
an ectopic distribution of fat,which is fat going in places
that it shouldn't, also causes alot of problems and bleeds into
(16:56):
causing insulin resistance.
So some of those things may cuein and say that even if your
fasting, glucose is normal, thatif you have those things, you
may be dealing with insulinresistance.
So then comes in the questionof who is at risk, and there are
certain risk factors that endup being really common for
(17:16):
people.
So we talk about visceral fator central obesity.
So in men, if waistcircumference which is a
particular measurement, isgreater than 40 inches, or
greater than 35 inches in women,that's a risk factor for
insulin resistance.
A sedentary lifestyle, a familyhistory of type 2 diabetes we
(17:38):
see this a lot online.
It's a very common diagnosisthat people are really trying to
hammer down and understand isPCOS, and there are some
estimates that over 70% ofpatients who have PCOS have
insulin resistance and a historyof gestational diabetes.
And there are some other riskfactors that are coming out and
(17:58):
being more well understood,including sleep disturbances,
including obstructive sleepapnea, and we even talked last
week.
Now the American DiabetesAssociation is looking at sleep
and saying if you sleep lessthan six hours a night or more
than nine, you're increasingyour risk from prediabetes to
diabetes conversion.
Nine, you're increasing yourrisk from prediabetes to
diabetes conversion.
(18:18):
Chronic stress is being lookedat as a cause of insulin
resistance and a very importantemerging, I would say, in the
medical literature this isalready well known and being
tracked, but maybe in lay mediaand common understanding
metabolic dysfunction,associated steatotic liver
disease.
If you ever hear your doctorsay that, you can ask them to
(18:40):
say it three times fast.
But this is when there's fat inthe liver and it's quickly
becoming one of the most commoncauses of liver problems in
America and deserves a lot ofattention.
But it's also intimatelyrelated to insulin resistance in
a lot of ways, and what we'realso seeing is that there are
(19:01):
racial and ethnic risks,including people in these
categories having increased riskHispanic, black, native
American and South Asianpopulations having higher
prevalences of insulinresistance, likely due to a mix
of some genetic and a lot ofsocioeconomic factors as well.
So all of our discussion so farsort of invites why the heck
(19:23):
does this even matter?
And it matters because it's avery early warning sign that
there might be silent damagehappening already.
Insulin resistance oftenprecedes diabetes by even five
to 10 years, and even duringthat time some damage might
already be happening, especiallyto the cardiovascular system,
which is the most common causeof mortality in America, and so
(19:49):
there are downstream associatedconditions that people with
insulin resistance somethingthat isn't so easily detected is
talked about type 2 diabetes,atherosclerosis, which is that
plaque buildup in the arteriesof your heart or your other
blood vessels, coronary arterydisease, hypertension, the
(20:10):
massal D or metabolic associatedliver dysfunction and some
cancers like endometrial cancer,colorectal cancer, breast
cancer, are intimately relatedto these insulin pathways as
well, and so far, we've talkedabout who's at risk, we've
talked about why it matters and,nikki, can you take us through?
(20:32):
A lot of this conversation endsup being similar to pre-diabetes
, but can you hit the highlightsabout what people can do if
they're starting to think likehuh, I looked at my labs and
some of those are a littlemessed up, or I do have a
sedentary lifestyle, or maybe mywaist circumference is.
I'm a man and my waistcircumference is greater than 40
inches.
What can someone do?
Nicole Aruffo, RN (20:57):
Well, we're probably going to sound like a
broken record here, because Ithink we've talked about this in
almost every episode relatingto this, so we're going to say
it again, because it works.
Apparently.
Number one weight loss.
We've said it once, we've saidit twice, maybe even thrice, and
(21:19):
we're going to say it againbecause just a five to seven
percent weight reductionimproves insulin sensitivity by
over 50 percent.
Second, if you can't guessphysical activity.
Ed Delesky, MD (21:32):
Yeah, Getting to that 150 minutes something
greater than 150 minutes perweek is so important.
And what we're actually seeingis that there are receptors that
increase and allow glucose togo into the cell more when you
exercise.
They are upregulated when youexercise.
So go exercise because you'rereducing your insulin resistance
(21:56):
when you do so.
And then what about some dietchanges?
Nicole Aruffo, RN (22:01):
Third is diet change, again sounding like a
broken record, emphasizing wholegrains, unsaturated fats, leafy
greens and our favorite legumes.
We're actually going to make adense bean salad later today to
have for the week Low glycemicindex foods, which you can
(22:22):
Google Basically, foods that arereducing your insulin demand
and not like spiking that bloodsugar, limiting refined sugars,
especially liquid calories.
Ed Delesky, MD (22:34):
Looking at all of the soda drinkers, yes, and
juice, and juice yeah, seeminglygood fruit in liquid form, but
a lot of juice can cause someproblems and then the
mediterranean or dash stylediets are both evidence-based.
Nicole Aruffo, RN (22:53):
Um to help with this.
Ed Delesky, MD (22:54):
Yep, all of that put together can really help
and I think we're going to limita lot of the medication talk.
There are a lot of medicationsout there that can help insulin
resistance, but because insulinresistance is sort of like a
yellow flag of things that arehappening in your body, a very
early warning sign, I feel liketalking about medicines would
(23:16):
invite over-medicalizing it andsay like, yeah, let's use
medicines to detect this thingthat's happening so early, when
it's in the things that you'redoing every day.
I've been trying to say this alittle bit more in visits that,
like the movement is themedicine, the food is the
medicine when it comes to thingslike this.
So we won't talk aboutmedicines as much today.
(23:38):
There are some other lifestylefactors that affect your insulin
sensitivity, like getting theright amount of sleep helps.
We talked about this last week,we'll say it again, and so,
leaving all of that out there,what are you seeing online?
Or I want to to like this isnow, we're just chit chatting.
(23:58):
I want to talk about like I'mseeing this a lot online and
people are saying like I'mhaving a tough time losing
weight because of my insulinresistance.
Nicole Aruffo, RN (24:10):
So everything we just said, you know kind of
points to that A lot of peoplemay have this or struggle with
this.
People are like oh, I can'tlose weight.
I have it's my insulinresistance or it's my high
cortisol.
Like I can't lose weight, itmust be peace.
Like and like I have painfulwhatever.
Like I must have pcos rightwhen, like that, could be the
(24:35):
case.
Right it might be the case, butlike I don't know.
But then if you you like, doall the things.
Ed Delesky, MD (24:44):
Yeah, I think there's.
I think there's a healthy effortfor people to understand what
they're going through and thisinsulin resistance in particular
, I think, toes the line betweendisease and like pathology that
(25:05):
is happening and like I thinkthe earliest form of like what
we can describe is like theclasses of obesity, class one,
two and three.
Like these two things are veryintimately related.
Two and three like these twothings are very intimately
related.
Another another point to get athere is that like yes, these
things happen to people and atsome point people have to choose
(25:25):
to live in the solution insteadof sitting in the the problem
that is happening to them yeah,and I guess my thing with like
all the people online, they'llbe like I.
Nicole Aruffo, RN (25:38):
You know whether they self-diagnose
themselves with insulinresistance or not.
But then, they, you know, makeall these tiktoks of what
they're doing for that and, youknow, making all these healthy
lifestyle modifications which,like with or without insulin
resistance or with or withoutwhatever kind of like diagnosis,
whether it's actual orself-made those lifestyle
(26:00):
modifications are good for youand healthy regardless of any of
that.
So excellent point, Right,that's also you know I guess
they're not doing anything likesuper damaging online and
putting things out there.
Ed Delesky, MD (26:12):
Right and this is also I think this gets at a
point of the like the speed thatinformation flows again,
because there are not a lot ofmainstream tests that are
described and endorsed by a lotof medical societies at this
point but are used in practice.
Like when I was reading aboutthis, that, like we didn't
include in the formal likebreakdown was measuring fasting
(26:36):
insulin, like people ask forthat.
I've been asked for that and atthe time I didn't know much
about it.
But, like, if it's a veryfluctuating level, is one to the
different labs that run.
Labs don't have a standardreporting system for it and it's
all related to like individualmoments in time and so a lab
(27:00):
like that is fraught withmisleading information.
It could be very helpful.
It could not be and there isn'ta lot of guidance out there
right now to say one way or theother.
Neither is the triglyceride toHDL ratio, which I'm sure some
people are using and may behelpful, but triglycerides
(27:21):
fluctuate throughout the day andso, yeah, you get it when it's
fasting, but once again, there'snot a lot of formal
recommendation out there todiscuss this because it's so
early on.
We're just talking aboutpre-diabetes a lot and it covers
so many people, and the earlierstep upstream of pre-diabetes
in a lot of circumstances isinsulin resistance, and it's
(27:43):
more the pathophysiology than aactive condition.
It's like describing a processthat's happening in your body
that your body compensates foruntil it can't, and when it's
done, compensating prediabetes,and then when it's further,
decompensating diabetes.
In a lot of cases, like we saidearlier, it doesn't always
(28:04):
shake out that way.
People end up doing the thingsthat they're supposed to anyway.
Nicole Aruffo, RN (28:09):
No one's going to say, like no doctor's
going to say, it's bad if youincrease your activity and start
eating a healthier, morebalanced diet.
Ed Delesky, MD (28:18):
An analogy comes to mind when car maintenance is
a topic that I think about alot, with delivery of news and
service, but also like takingcare of it.
And if you know that every somany 10,000 miles you're
supposed to replace your brakesand you're driving your car
(28:39):
every day you're going aroundand you're just driving and
you're like, yeah, maybe at somepoint I need to replace my
brakes.
But then you go see aprofessional and, let's say, in
a different arc of life, you gosee the professional, you go see
the mechanic and then themechanic says, based on this
sign, this sign and this sign,you need to get your brakes
replaced.
There's a lot more weightbehind that.
(29:01):
Like now you're getting advicefrom someone.
They're throwing up the yellowflag saying, based on this
information I have, you need togo get your brakes replaced.
So now you get your brakesreplaced, brakes replaced, so
now you get your brakes replaced, Whereas before you didn't see
the professional, you didn't payattention to the signs and
symptoms and you didn't get yourbrakes replaced and you just
(29:22):
kind of fell by the wayside ordidn't get your oil changed,
didn't take care of your car.
In a lot of ways I think likeseeing this like.
We've known that people havemetabolic disturbances,
metabolic syndrome, which has avery wide definition, and people
are just out there living likethis, and the best ways we can
describe this pathology is class1 obesity.
(29:43):
Class 2 obesity, prediabetes.
This captures it even earlierthan all of that, and maybe it's
like going to the mechanic andpeople are like oh yeah, you
have come to the doctor's office.
I'm concerned, you have somelevel of insulin resistance.
We need to be really thoughtfulabout this.
So that's where we're taking it.
Today, we're talking aboutinsulin resistance.
(30:04):
Hopefully you're able to learnsomething.
Recognize that insulinresistance isn't a disease.
It's more like an alarm bell,and the good news is like this
is totally reversible and wedon't need perfect change.
We just need somethingconsistent and something
positive.
So so thank you for coming backto another episode of your
checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
(30:25):
Make sure you check out ourwebsite, send us an email, find
us on Instagram, Make sure youfollow the show so that you can
get notifications when our nextepisode comes out and, most
importantly, stay healthy, myfriends.
Until next time.
Make sure you follow the showso that you can get
notifications when our nextepisode comes out.
And, most importantly, stayhealthy, my friends, Until next
time.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you and goodbye Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
(30:46):
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
(31:06):
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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