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Ask Dr. Mike: Insulin Resistance & Can Cold Hands Cause the Flu?

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans. Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

Could you talk about insulin resistance?

According to the Centers for Disease Control and Prevention, 29.1 million Americans have diabetes. Type-1 diabetes is typically diagnosed in early childhood and occurs when your body doesn't produce insulin. Type-2 diabetes occurs when your body doesn't use insulin properly.

Insulin is an essential hormone in your body that plays a major role in keeping your metabolism functioning properly.

Insulin resistance typically occurs in type-2 diabetics and happens when the cells in your body become resistant to insulin. This causes you to use a higher dose of insulin, which causes your pancreas to overcompensate and your blood sugar to spike.

What is the best way to find out if you have insulin resistance?

If you're concerned about your insulin levels, you can ask your doctor to preform a glucose tolerance test. Before your test, you will have to fast overnight. When you arrive at the lab where your test will be done, you're given a sugary solution. This will allow doctors to measure the impact of the sugary solution on your blood sugar level. The more insulin resistance there is, the greater the spike will be.

Is getting a cold or even the flu linked to whether or not I get cold outside?

When it's cold outside, you may think that if your body temperature drops, if you get the chills, or if your hands and feet are cold that it can cause you to get sick. However, this is untrue.

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it. so he can provide you with support and helpful advice.

RadioMD Presents:Healthy Talk | Original Air Date: February 13, 2015
Host: Michael Smith, MD

It’s time to “Ask Dr. Mike” on Healthy Talk. Do you have a question about your health? Dr. Mike can answer your questions. Just email: This email address is being protected from spambots. You need JavaScript enabled to view it. or call now: 877-711-5211. The lines are open.

One more time, that’s 877-711-5211. Give me a call. Of course, you can always send your email questions to: This email address is being protected from spambots. You need JavaScript enabled to view it. . So, here’s a question from a listener, Ilena Novac, she says… Now, this is a long question, so I’m going to break it up, Ilena, into different parts. I hope you’re okay with that.

The first question, then, is from Ilena: “Could you talk, please, about insulin resistance?” Yes. Okay. So, insulin resistance. We know that sugar is an issue in this country. Diabetes is on the rise, pre-diabetes is almost epidemic. We’re overweight, high sugar levels and it’s just messing up how insulin functions in the body. So, let’s talk about insulin resistance for a second. Insulin resistance is very simply the hallmark of type 2 diabetes, okay? So, in type 1 diabetes, the patient doesn’t make any insulin. The pancreas just can’t do it. So, there’s no insulin. Now, why is that bad? Well, you need insulin to take the sugar—the glucose that’s in your blood—and put it inside the cell so the cell can use it as energy or, in some cases, store it. You can store it as glycogen or store it as fat. So, sugar has to get inside the cell and it’s insulin that brings it inside. So, in type 1 diabetics, there is no insulin. So, sugar can just build, build, build up, build up in the blood. Major, major problems, okay?

In type-2 diabetes, though, the person—is making insulin. They’ve made insulin all their life but the problem is, the insulin stops working. Or, it’s not really the insulin, it’s the cell itself. The cells become resistant to the effects of insulin—insulin resistance.
Why does that happen? Why does a cell become resistant to insulin? Why does the cell say, “I don’t like you any more insulin. I’m not going to let you work. I’m not going to let you influence me.” And, of course, if that happens—if insulin can’t do its job—sugar builds up in your blood. Type 2 diabetes--the build-up of sugar in your blood--why does that happen? Why does a cell not allow insulin to work? Well, there are a lot of different theories. Most likely, what happens is when you have had a lifetime of eating sugary foods. Every time you eat a sugary meal, a high carb meal, especially the simple sugars, not only do you spike sugar level, you also spike insulin because for a certain amount of sugar that’s all of a sudden being dumped into your bloodstream from your gut, your pancreas has to dump about the same amount of insulin to get that sugar from the blood into the cell. So, every time you spike sugar, you spike insulin. The theory is over a lifetime, that spiking of insulin—it just kind of makes the cell a little bit less influenced by it. It’s like the cell just says, “Oh, there’s insulin spiking again. Oh, whatever.” It’s like the cell just stops responding to it. It’s probably more of a protective mechanism to control how much sugar is actually coming in the cell. There’s actually an insulin receptor that can be down regulated on the surface of the cell when there’s too much insulin.

So, if you take a Petri dish, Ilena, of cells—like say, muscle cells—and you just flood it with insulin, you can actually measure the number of insulin receptors and how they decrease when you just flood that Petri dish with insulin. So, it’s probably some sort of protective mechanism, but, ultimately, what insulin resistance is, it’s just too many sugar spikes, too many insulin spikes. The cells throughout your body just get sick of it. They bring back those receptors. They down regulate those receptors so there are less of them on the surface and insulin can’t do its job. That’s insulin resistance. Hallmark of Type II Diabetes. I hope I explained that okay.

Now, the next question Ilena has is, “Well, what is the best way to find out if someone has insulin resistance?”

Well, the gold standard for diagnosing type 2 diabetes, which ultimately is caused from insulin resistance, is glucose tolerance testing. This is where, you know, you fast overnight and you come into the lab and you drink, I think it is 100 grams of a sugary solution, okay? And that’s just going to measure the impact of that sugary solution on your blood sugar level. Now, obviously, if you drink anything sugary, you’re going to spike your sugar a little bit, but the more insulin resistance there is—meaning the less insulin is working--the less effective insulin is, the greater those spikes. That’s all it is. The key hour is the 2-hour mark. So, you drink that sugary solution and they’ll measure your blood sugar at 1 hour and at 2 hours and at 3 hours, and 4 hours. The normal pattern is a little bit of a spike and then it comes down. You know, by the time you’re done with the test at 4 hours, its back to normal. That would be somebody that doesn’t have insulin resistance.

But, if you have insulin resistance, the spike initially is going to be greater and it’s going to hang up there longer. Right? It’s not going to come down. So, at the 2-hour mark, if your blood sugar level is still spiking over 200, that’s insulin resistance. It’s just that simple. It just means the insulin’s not working and it’s the best way to do it. Now, what some labs are doing, Ilena, is they’re just checking insulin at that same time as well because insulin’s spiking through that process as well. So, you can also do what is called an insulin tolerance test and that’s perfectly fine as well. But, the gold standard is glucose tolerance testing. I know more and more people are talking about insulin tolerance testing, but glucose tolerance testing is just fine. I don’t need to do another test. I don’t have to check another lab like insulin, add the cost to it, when if I just follow glucose spiking, I already have enough information. There’s no reason to really check insulin during that. If, at the 2-hour mark your sugar is still spiking over 200, that’s insulin resistance, I don’t need to look at anything else. That’s the gold standard.

She gives me some numbers here. Ilena says that her fasting insulin was less than 3. That’s good. A fasting insulin of less than 3 is good. If you have insulin resistance, think about this for a second. One of the ways your body is going to overcome insulin resistance—to break that resistance—is to make more and more of the insulin. So, people with insulin resistance tend to have fasting insulin levels that are in the 8, 9 range. Well, Ilena, you’re less than 3, so that’s actually good news. Now, you’ve given me some other numbers here. You say that your non-fasting insulin—maybe during a glucose tolerance test, maybe—was greater than 50. Now, I don’t know if that was at 1 hour or 2 hours or whatever, but that is kind of high. So, that has me a little worried. So, I might suggest for you, Ilena, at least at this stage, maybe a couple of natural things that have been shown to help the body with insulin resistance. Green tea extract and lipoic acid—two nutrients that have some decent research behind them for helping people break insulin resistance and then, you know what? There’s a prescription drug that’s not bad. It has good effect, very low side effects. That’s Metformin. I think Metformin is a good drug in these kinds of cases. A low dose—about 750 mg a day. I am an integrative medicine guy. I mean, I do whatever’s best for a person whether it’s Western, Eastern. It doesn’t matter to me. So, green tea, lipoic acid, maybe a smidge of Metformin in there might be helpful. So, that’s insulin resistance—the hallmark of type 2 diabetes.

I only have 60 seconds left, so I’m going to do a quick question here. “Is getting a cold…” Oh, okay. “Is getting a cold or even the flu linked to whether or not I get cold from being outside?” So, basically, cold feet, cold hands, you know, getting the chills outside in the cold air. Does that increase the risk of cold or flu? Ultimately, most of the research says “no”, but there was an interesting study, and I don’t have it in front of me, that came out talking about cold feet may actually increase the risk of the flu, but, for the most part, no. Keep your immune system strong whether you’re cold or hot. Doesn’t matter.

This is Healthy Talk on RadioMD. I’m Dr. Mike. Stay well.