The underlying problem in Type 2 or adult-onset diabetes is insulin resistance. Insulin resistance is not routinely tested but can manifest in the skin. Read on to see if someone you know may be at risk for diabetes.
Many are unaware that they have the beginnings of Type 2 diabetes. Years before a person is diagnosed with diabetes, insulin resistance (IR) comes first. The mechanism and the consequent diseases of insulin resistance are elaborated in this article. The damage to the body brought about by IR is hidden but cumulative as time goes on. Therefore it makes sense to know that someone has insulin resistance as early as possible, but there is a problem.
There is no regular blood test that you can get to check for insulin resistance. The fasting blood sugar (FBS) and (HbA1c) recommended to screen for diabetes can detect elevated blood sugar. However, it does not test for insulin resistance. In the early stages of IR, the body produces more insulin (hyperinsulinemia) to lower blood sugar.
The high insulin level maintains the blood sugar level at normal levels. Therefore, the screening test for diabetes could be in the normal range. Thus, IR can remain undetected for years and continue its damage. Insulin resistance and hyperinsulinemia coexist. Measuring the insulin response to carbohydrate intake is the way to test for insulin resistance.
The Difficulty in Detecting Insulin Resistance by Blood Work
Insulin levels in the blood can fluctuate from minute to minute, so a single blood insulin level is not a reliable indicator of blood insulin.
To measure insulin continuously, the Hyperinsulinemic Euglycemic clamp technique and the Homeostatic Model Assessment – Insulin Resistance HOMA-IR measure insulin resistance. Both methods require a continuous intravenous infusion of insulin or glucose while monitoring the blood sugar level. They are more complicated and need more expertise to be done, and that is why they are used only in research laboratories.
A Simple and Inexpensive Way to Detect Insulin Resistance
The presence of psoriasis, acne and acanthosis nigricans are indicators of insulin resistance. The high insulin levels that come with IR trigger many other body processes.
Acne
Signaling proteins called cytokines cause an increase in skin cell production and defective maturation in psoriasis. Growth factors like insulin-like growth factor-1 (IGF-1) promote increased cell production. High insulin levels also lead to higher levels of male hormones (androgens), leading to more oil deposits in acne. The excess fat is food for microorganisms found in the skin like the bacteria Propionibacterium acnes and yeast called Malassezia furfur that causes inflammation.
Acanthosis Nigricans
The crucial metabolic pathway called the mTORC1 (mammalian target of rapamycin complex 1) is also activated by the excess nutrients in acanthosis nigricans. The mTORC1 makes cellular production in the skin layers go to hyperdrive. In the deeper layers of the skin, the increased cell production results in thickening making it look dark. At the skin surface, the uncontrolled growth of skin cell produces microscopic finger-like projections called papillomas that gives the dark patch a velvety feel.
Skin Tags
In skin tag formation, the high insulin-like growth factor -1 (IGF-1) triggers the accumulation of excess skin cells. Usually, Insulin-like growth factor-binding protein 3 (IGFBP-3) binds IGF-1 to control cell production. IR leads to a decrease in IGFBP-3. The combination of both leads to excess skin that becomes a skin tag.
Someone with any of the above skin lesions may have the beginnings of Type 2 diabetes. They should consult with a physician to see if further testing is needed like fasting blood sugar or hemoglobin A1c.
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References:
- González-Saldivar et al., Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management Dermatol Ther (Heidelb) 2017 Mar; 7(1): 37–51. Published online 2016 Dec 5. doi: 10.1007/s13555-016-0160-3
- Napolitano et al., Insulin Resistance, and Skin Diseases. The Scientific World Journal
Volume 2015, Article ID 479354, 11 pages. http://dx.doi.org/10.1155/2015/479354
Photo Credits:
- Psoriasis Author: en:User: Marnanel Wikimedia
- Neck acanthosis from An. Bras. Dermatol. vol.87 no.1 Rio de Janeiro Jan./Feb. 2012
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