Not all insulin resistance is a disease

Diabetes mellitus and related metabolic disorders are becoming one of the most serious challenges facing modern medicine. However, not all insulin resistance is a disease and must be treated. Prof. Dr. Mitko Mitkov, head of the Clinic of Internal Medicine with the Department of Endocrinology at the University Hospital "Pulmed" - Plovdiv, tells the newspaper "24 Chasa" about the causes, risk groups and possibilities for prevention.

Prof. Dr. Mitkov is a specialist in endocrinology and internal medicine with over 30 years of clinical experience in the diagnosis and treatment of diabetes mellitus, thyroid diseases, pituitary and adrenal disorders, reproductive problems, as well as hormonal and metabolic disorders. He is a long-time lecturer at the Department of Endocrinology of the Medical University of Plovdiv. In 2023, he was awarded the prestigious award "Doctor of the Year" by the Bulgarian Medical Union for his long-term activity and contribution to the development of the specialty "Endocrinology and Metabolic Diseases". He is also a member of the League of Doctors Whom Bulgarians Trust, in the initiative of the newspaper "24 Chasa".

Diabetes – a silent pandemic

According to Prof. Mitkov, the pandemic nature of diabetes mellitus and prediabetes has been talked about for years, but raising the alarm is not enough. Data shows that the number of patients with diagnosed diabetes, both globally and in Bulgaria, is growing at a rate significantly higher than initially predicted. Even more worrying is the fact that at least half of people with actual diabetes do not know that they are sick. In the case of prediabetes, the prevalence is even higher, which makes them a serious public health problem.

Who are the risk groups and when should we get tested?

The risk of developing diabetes and other metabolic diseases increases with age. The World Health Organization has long defined clear screening criteria aimed at early detection of individuals at increased risk. The main groups include people who are overweight or obese, patients with cardiovascular disease, arterial hypertension, low HDL cholesterol or elevated triglycerides.

The risk group also includes women with polycystic ovary syndrome, gestational diabetes or who have given birth to a fetus weighing more than 4 kilograms, as well as people taking medications that increase blood sugar. According to WHO criteria, all people over the age of 35 are subject to screening even in the absence of symptoms. With normal results, the tests should be repeated at least once every three years.

Can diabetes be prevented?

Prof. Mitkov emphasizes that when we talk about prevention, we mean type 2 diabetes. Unlike type 1 diabetes, which requires mandatory insulin treatment, type 2 diabetes is preventable in a large percentage of cases or at least can be significantly delayed. In certain situations, it is even possible to achieve remission.

This is especially true for people with prediabetes, metabolic syndrome, or a family history of the disease. Early diagnosis and early initiation of adequate treatment are key to preventing severe complications of the disease.

Insulin resistance – myths and reality

In recent years, the term "insulin resistance" has become extremely popular, but not all insulin resistance is a disease. It can also be a normal physiological condition at certain periods of life. The problem arises when physiological insulin resistance becomes pathological.

Although insulin resistance can lead to numerous metabolic disorders, Prof. Mitkov is categorical that the main "culprit" in most cases is our lifestyle. It is this that causes the appearance or deepening of pathological insulin resistance.

The role of chronic stress

Stress is an important factor in the development of insulin resistance. Even Hans Selye, considered the father of stress theory, described stress as a nonspecific response of the body to various stimuli. Regardless of the type of stressor, the body activates similar adaptation mechanisms, including insulin resistance.

In acute stress, this response is physiological and temporary. After the stressful event passes, insulin sensitivity is restored. However, when stress becomes chronic, a transition to pathological insulin resistance occurs, accompanied by adverse metabolic consequences.

How can we protect ourselves from insulin resistance?

There are currently no specifically approved medications for the treatment of isolated insulin resistance. Treatment is directed at cases in which it is part of or leads to clinically significant metabolic disease. Prof. Mitkov is categorically against self-prescribed tests and therapies, as they often lead to misinterpretations and unnecessary medication.

What each person can and should do on their own is work on modifiable risk factors. Losing weight is crucial – even a 5 to 7 percent loss can significantly improve insulin sensitivity. Regular physical activity, tailored to individual capabilities, is also key – from moderate-intensity activities such as brisk walking, cycling and swimming, to more intense aerobic and strength training, for at least 30 minutes a day, five days a week.

Nutrition should be balanced and low-calorie, with a good example being the Mediterranean-type diet. It is recommended to limit refined carbohydrates, increase fiber intake, as well as optimize sleep and effectively manage stress.

According to Prof. Mitkov, it is precisely these seemingly simple, but consistently implemented lifestyle changes that are the most powerful means of preventing metabolic disorders and their complications.

Editor Ina Dimitrova