I-CARE

Insulin Resistance

A Guide to Managing Insulin Resistance, Metabolic Syndrome and Type II Diabetes

Insulin resistance has emerged in the last 50 years as the world’s most common disorder and the single largest cause of loss of life. Also known as ‘metabolic syndrome, it leads to conditions like high blood pressure, high blood sugar, excess body fat around the waist, and abnormal triglyceride and cholesterol levels. As this document makes clear, insulin resistance and type II diabetes are largely reversible through adopting healthy lifestyles.

Treatments
  • Intermittent fasting/time-restricted eating:
    This is the most efficient and effective way to lower insulin levels and restore insulin sensitivity. In addition, fasting has a profound benefit on the immune system, partly by stimulating the clearing of damaged cells (autophagy), damaged mitochondria (mitophagy), and misfolded and foreign proteins. Fasting also improves mitochondrial health and increases stem cell production, and is the most effective method to achieve sustained weight loss.

    Cautions and contraindications

    Avoid fasting if:

    • You are malnourished or underweight
    • You have anorexia nervosa/bulimia
    • You have type I diabetes (true insulin deficiency)
    • You are under 18 years of age
    • You are pregnant or breastfeeding

    Use caution and seek the advice of a healthcare provider if:

    • You have type II diabetes (as you will likely have to adjust your diabetic medications)
    • You have chronic diseases and take multiple medications
    • You have gout
  • Low-carbohydrate (ketogenic) diet:
    Aim for a diet high in saturated fat, mono-unsaturated fat, and Omega-3 fatty acids. The carbohydrate content of a meal should not exceed 25 grams.
  • Berberine: 1000-1500 mg total daily dose (take 500 mg two or three times daily or 600 mg twice daily)
    Once metabolic stability is achieved, it may be possible to reduce the dose of berberine to 500 mg once or twice daily.

    Cautions and contraindications

    • Berberine is remarkably safe; the only adverse events include transient gastrointestinal symptoms (diarrhea, flatulence).
    • As berberine lowers blood glucose and lowers blood pressure, these parameters should be monitored.
    • Berberine should not be taken in patients taking cyclosporine as this combination will increase cyclosporine levels (absolute contraindication). Berberine may alter the metabolism of the following drugs, which should be used with caution (monitor effects): anticoagulants, dextromethorphan, tacrolimus (Prograf), phenobarbitone and sedative drugs (see https://www.webmd.com/vitamins/ai/ingredientmono-1126/berberine).
    • Berberine is contraindicated during pregnancy, breastfeeding, and in neonates and children.
    • If you are scheduled for surgery, please notify your anesthesia team if you are taking Berberine. You may need to stop taking Berberine one week prior to surgery.
  • Metformin: 500-1000 mg twice daily
    The dose of metformin will likely need to be reduced in type II diabetics as insulin resistance improves during the induction phase.

  • Magnesium: A starting dose of 100 to 200 mg daily is suggested, increasing the dose as tolerated up to 300 mg (females) to 400 mg daily