Meeting the challenge of insulin resistance in general practice

‘Insulin resistance is the major determinant of cardiovascular disease in overweight/obese individuals’ (Reaven, 2005); ‘if more physicians understood that insulin resistance is a huge risk factor for ischemic heart disease, we could potentially do more to motivate our patients’ (Bertsch and Merchant, 2015); and Noakes and Sboros (2017) cite Reaven (2012) that ‘the six conditions most likely caused by high-carbohydrate diets in those with insulin resistance are obesity; arterial disease, both local (heart attack or stroke) and disseminated (type-2 diabetes); hypertension; non-alcoholic fatty liver disease (NAFLD); cancer; and dementia (Alzheimer's disease, also known as type-3 diabetes).’

Yet ‘insulin resistance is the epidemic you may have never heard of’ (Bikman, 2020: 3).

Insulin resistance is a reduced response to the hormone insulin (Bikman, 2020: 6), with insulin resistance a key component of metabolic syndrome (Gallagher and LeRoith, 2020). In metabolic syndrome the patient must have two of either hypertension, dyslipidaemia, central obesity, or low concentrations of urinary protein; and second, the patients must have insulin resistance (Bikman, 2020: p81).