Skin Concerns
What is Insulin Resistance and How Does it Impact Skin Health?
BY
Anjali Tiscia
Oct 30, 2024
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Insulin resistance is a metabolic condition that has been gaining more attention in recent years, likely due to its growing prevalence in modern society. You may know it as a risk factor for developing Type 2 Diabetes or its association with conditions like Polycystic Ovary Syndrome (PCOS). Despite becoming more and more common, many people aren’t aware that they may be living with it. That’s why we’re taking a closer look at what insulin resistance is, how it affects not only the body but also the skin, and most importantly, what steps can be taken to address it.
What is Insulin?
Before we delve into insulin resistance, it is important to first understand what insulin is. Insulin is a hormone produced by the pancreas that plays a vital role in regulating our blood glucose (sugar) levels. It allows glucose, derived from the foods we eat, to enter the body’s cells from our bloodstream, where it is either used for energy or stored for future use. This process makes insulin essential for maintaining balanced blood sugar levels and overall metabolic health.
What is Insulin Resistance?
Insulin resistance occurs when the cells in our muscles, fat, and liver no longer respond effectively to insulin. In an attempt to maintain balanced blood sugar levels, the body compensates by producing more and more insulin. During this stage, blood tests may show normal blood sugar levels, but insulin levels will be elevated. Over time, this increased demand places significant stress on the pancreas. Eventually, the pancreas may struggle to keep up with the high demand for insulin, leading to a decrease in insulin production and a rise in blood sugar levels. As insulin levels drop and blood sugar levels rise, the risk of developing Type 2 Diabetes increases significantly.
How do we Become Resistant to Insulin?
A combination of genetic and lifestyle factors can increase the risk of developing insulin resistance. While genetics may predispose someone to the condition, lifestyle choices often play a key role in whether it manifests. For example, a family history of diabetes can elevate the risk, as can having PCOS, with research showing that approximately 70–90% of women with PCOS experience insulin resistance.
Lifestyle factors, particularly diet, are significant contributors. Diets high in refined carbohydrates and saturated fats can lead to repeated spikes in blood sugar levels, prompting the pancreas to produce more insulin over time. Eventually, the cells become less responsive to insulin. Additionally, excessive consumption of these foods can lead to weight gain, especially around the abdomen - a factor strongly linked to insulin resistance.
Physical inactivity and chronic stress also play a role in the development of insulin resistance. We’ll explore these lifestyle factors in more detail below.
How to Know if You Have Insulin Resistance
Insulin resistance can remain undetected for years, as its signs and symptoms are often subtle or non-specific. It is not routinely screened for in standard medical check-ups, but it can be requested. In our clinic, we recommend requesting a combination of tests for a comprehensive assessment. These include:
Fasting Insulin Test: Measures baseline insulin levels.
HbA1c Test: Reflects average blood sugar levels over the past 2–3 months.
Fasting Plasma Glucose Test: Indicates fasting blood sugar levels.
Oral Glucose Tolerance Test (OGTT) with Interval Insulin: Evaluates how the body processes glucose over time.
Fasting Lipid Test: Assesses cholesterol and triglyceride levels.
These tests can help determine whether someone has insulin resistance, impaired glucose tolerance, or Type 2 Diabetes.
In addition to test results, we also monitor for visible signs such as Acanthosis Nigricans - darkened, velvety patches of skin, particularly around the neck and armpits - and skin tags, which often appear in similar areas. However, it’s important to note that many individuals with insulin resistance may have no noticeable symptoms, making early testing and prevention key.
How Does Insulin Resistance Impact Our Skin?
Insulin resistance is a metabolic condition and so is frequently discussed in relation to impacts on blood sugar levels, liver function and cholesterol levels, however it can also have a profound effect on the health of our skin. Let’s explore some of the key ways in which insulin resistance can impact the skin:
Acne:
Acne is a complex condition influenced by multiple factors, but research shows that insulin resistance and elevated insulin levels can significantly contribute to its development and severity. In fact, one study found that 67–81% of acne patients had insulin resistance, a much higher rate than those without acne.
Insulin has been linked to acne through its role in promoting androgen production, which increases sebum (oil) production - a key factor in acne severity. Additionally, insulin resistance triggers inflammation, which can further aggravate and worsen acne.
It has also been shown that adopting a low glycaemic index (GI) diet, which minimises blood sugar and insulin spikes, can improve acne severity while simultaneously enhancing insulin sensitivity. This finding underscores the importance of dietary choices in managing insulin levels - we discuss this in detail a little later in this blog.
Premature Ageing and Skin Conditions:
Insulin resistance has been linked to premature ageing, both in the body as a whole and the skin specifically. Research in animal models has shown that lower insulin levels are associated with longer lifespans. Likewise in humans, insulin resistance and high insulin levels are connected to an increased risk of age-related diseases and accelerated skin ageing.
This link is thought to stem from the heightened inflammation caused by insulin resistance. Chronic inflammation not only contributes to premature skin ageing but also plays a role in skin conditions like psoriasis and eczema. For example, one study found that insulin resistance directly contributed to the overproduction and abnormal development of keratinocytes, a hallmark feature of psoriasis.
Acanthosis Nigricans:
Acanthosis Nigricans is characterised by dark, thickened patches of skin that commonly appear on the neck, armpits, groin, or under the breasts. It is one of the most common skin signs associated with insulin resistance and should prompt further investigation if noticed. However, it’s important to note that not everyone with insulin resistance will develop this condition. The good news is that with proper management of insulin resistance, these patches can gradually lighten and, in some cases, disappear entirely.
Skin Tags:
Skin tags, or Acrochordons, are small, soft growths of skin that are harmless and painless but can be cosmetically bothersome to some individuals. These growths are often found on the neck, underarms, and groin and are frequently associated with Acanthosis Nigricans.
While skin tags are common in people with insulin resistance, it’s important to note that not everyone with insulin resistance will develop them. However, their presence, particularly alongside other symptoms like obesity and darkened skin patches, may warrant further investigation into potential metabolic conditions such as insulin resistance or prediabetes.
Impaired Skin Barrier:
Insulin resistance and elevated insulin levels have been linked to a weakened skin barrier, compromising its ability to protect and repair itself. A study conducted in mice found that severe obesity and impaired insulin signalling were associated with reduced skin barrier function. This was due to lower levels of structural proteins like keratins and desmosomal proteins, which are essential for maintaining skin integrity. In skin keratinocytes - the cells responsible for producing keratin - impaired insulin signalling decreased keratin production and impaired the skin barrier function.
What Can we do About it?
Insulin resistance undeniably has a wide range of negative effects on both the body and the skin specifically. It can lead to visible signs like skin tags and darkened patches of skin in certain areas. Over time, it contributes to more significant damage, including premature ageing, inflammatory skin conditions, acne, and a weakened skin barrier.
While genetics can increase the risk of developing insulin resistance, it is our lifestyle that often determines whether it presents. The good news is that with the right lifestyle adjustments, insulin resistance can be prevented and even reversed. A study examining participants with insulin resistance demonstrated that a one-year diet and exercise intervention led to a significant reduction in insulin resistance. Let’s explore some of these key strategies in detail:
Diet:
Excess belly weight is a key risk factor for insulin resistance, but certain dietary patterns can also be a risk factor, independent of weight. Diets high in refined, high GI foods like white bread, pasta, pastries, sugary drinks, and foods rich in saturated and trans fats (e.g. red meat, butter, and deep-fried items) have been linked to reduced insulin sensitivity, elevated blood sugar and insulin levels, and microbiome imbalances that promote metabolic issues like obesity and insulin resistance.
Although diet should not be a ‘one-size fits-all’ approach, the research does show certain dietary patterns and foods that can help prevent and reverse insulin resistance. Research highlights the benefits of a Mediterranean diet, which emphasises extra virgin olive oil, vegetables, fruits, nuts, legumes, wholegrains, and moderate amounts of oily fish, poultry, eggs, and dairy, while limiting red meat. This diet has been shown to improve blood sugar control and insulin sensitivity. Similarly, a high-protein, low-refined carbohydrate diet featuring lean proteins like fish and chicken, along with non-starchy vegetables and low-GI wholegrains, can also support metabolic health.
Real-world data further supports these dietary approaches. A study of 128 patients with prediabetes or Type 2 Diabetes following a low-carb diet for an average of 23 months found significant results: 93% of prediabetic participants normalised their HbA1c levels, and 46% of those with Type 2 Diabetes achieved drug-free remission.
Movement:
Regular physical activity, including both resistance and aerobic exercise, is highly effective in improving insulin sensitivity. Exercise enables muscles to use glucose more efficiently, with research indicating that glucose uptake by muscles can increase by up to 50-fold during physical activity, and this occurs without the need for insulin.
A single session of mild-intensity exercise (approximately 50% VO2 max) has been shown to improve insulin sensitivity by 35% the following day. While this effect is short-term, consistent regular exercise has significant long-term benefits for insulin sensitivity and overall metabolic health.
The impact of physical activity on preventing Type 2 Diabetes has also been demonstrated in a large-scale study of over 3,000 high-risk participants. The study compared three groups: one followed an intensive lifestyle change program involving 150 minutes of exercise per week and a calorie-restricted diet, another group took Metformin, and the third received a placebo. After three years, participants in the lifestyle change group reduced their risk of developing Type 2 Diabetes by 58%, compared to a 31% reduction in the Metformin group. Even after 15 years, the lifestyle group maintained a 27% lower risk of developing Type 2 Diabetes compared to placebo participants, highlighting the lasting benefits of sustained lifestyle interventions.
Adequate Sleep:
Poor or insufficient sleep has been shown to negatively affect insulin sensitivity and blood sugar regulation, mainly due to increased cortisol levels and elevated pro-inflammatory markers. This can set the stage for insulin resistance, particularly when poor sleep becomes chronic.
A study investigating the effects of sleep restriction found that limiting sleep to 6.2 hours or less per night over six weeks led to a 14.8% increase in insulin resistance among pre- and postmenopausal women. The impact was even more pronounced for postmenopausal women, who experienced a 20.1% increase in insulin resistance.
It is therefore important to aim for 7-9 hours of quality sleep per night, and practice good sleep hygiene by keeping a regular sleep schedule and limiting screen time and caffeine and alcohol consumption before bed.
Stress Management:
When the body experiences stress, it releases hormones such as cortisol and adrenaline as part of the stress response. While this is beneficial in short bursts, chronic stress can impair insulin sensitivity and elevate blood sugar levels, contributing to insulin resistance over time.
Research indicates that mindfulness practices like meditation, yoga, and deep breathing exercises can positively impact insulin sensitivity. These interventions have been shown to lower HbA1c levels (a marker of long-term blood sugar control) and reduce circulating insulin levels, improving overall metabolic health. Incorporating these stress-reducing practices into our daily routine can be an effective complement to dietary and lifestyle strategies for managing insulin resistance.
Consider Supplements:
For the management of insulin resistance, some doctors may prescribe medications like Metformin. This is generally seen as a temporary measure to be used alongside dietary and lifestyle modifications. However, many individuals prefer to manage insulin resistance without medication, and doctors often recommend a first-line approach focussed on improving diet and lifestyle. When working with clients on these diet and lifestyle modifications, we may also recommend certain supplements to complement dietary and lifestyle suggestions for the management and treatment of insulin resistance. These may include Berberine, Myo-Inositol, Omega-3s, Chromium, Magnesium, Probiotics, etc.
It is essential to note that supplements should not be started without guidance from a qualified health professional who can assess your individual needs, ensure safety, and determine the correct dosage. Supplements are most effective when combined with a nutrient-dense diet, regular physical activity, restful sleep and stress management practices.
