The problem is always insulin resistance.

The problem is always insulin resistance.

I have written (perhaps ad nauseam) about the importance of your immune system in responding to COVID-19. We have looked at all those troublesome “underlying conditions” and how they challenge the immune system. But maybe you decided that you weren’t worried about COVID -19. Ignore it maybe. Or get the vaccine, you thought, and you’re good to go.

Bad new… The vaccine may be protect you from COVID-19 but you are not necessarily “good to go”.

In my last post outlined three question you need to ask yourself.

  1. Are you over weight especially around the waist?
  2. Are your triglycerides too high and HDL too low?
  3. Do you have high blood pressure, diabetes, and/or heart issues?

You may know if you are overweight – although what you might call just overweight could actually be obesity. I rarely find a person who knows what their triglycerides are, even if they faithfully visit the doctor every year. You may know if you have full blown type 2 diabetes if you visit the doctor regularly. What you don’t know is if you are GOING have it later.

I did not just pick that list out of thin air. That list reflects what is called “metabolic syndrome.” The more this list applies to you, the more you are headed for NAFLD (non-alcoholic fatty liver disease). The next step would be cirrhosis and you do NOT want to go there.

Insulin Resistance

The actual underlying condition attached to metabolic syndrome is insulin resistance.

Insulin resistance is when insulin fails to do its assigned jobs. You cannot be healthy if you have insulin resistance. The trick is knowing if you have it.

There is no handy, one time blood test called “insulin resistance ” that tells you. You have to connect the dots. So here are the dots and how they connect.

What is insulin?

Insulin is a hormone secreted from the pancreas. Insulin is in the energy storage business. Muscles, the liver, and your fat cells all require the insulin in some way. Glucose (as in carbohydrates) and fat are the sources of energy; they both arrive at their destination through the blood.


Insulin is required to drive glucose into your muscles, and to store what’s normally a day’s worth of glucose as “glycogen.” Fat, on the other hand, flows unaided out of the blood into the muscles.

Those of us who are sedentary (not moving much) are largely using glucose for energy. Some of the unused fat can get “stranded” where it does not belong, inside the muscle cells. This condition creates insulin resistance in the muscles..

The resistance causes the pancreas to keep secreting more insulin to force the cells to take up the glucose. Blood glucose looks fine on your blood sugar meter but the amount of insulin required to achieve that is high. The resistance also greatly reduces the amount of glycogen made and stored in the muscle..

This is the beginning.


There is also glycogen storage in the liver but insulin is not required to get it there. Why? The brain requires at least some glucose and the body doesn’t want anything to interfere with its availability. If your brain isn’t working everything else is immaterial.

When glucose is needed in the blood, the liver releases some from the glycogen. However, there is such a thing as too much glucose so insulin is required to keep that release from happening inappropriately. Insulin resistance in the liver allows glucose release when it shouldn’t be happening.

Thus, the high blood sugar associated with diabetes. Insulin can no longer keep up with the demand.

When there is too much glucose floating around in the blood the liver converts the glucose to fat and ships if off to the fat cells for the storage of last resort. The “ship” is a lipoprotein and “triglycerides” (fat) are the cargo. There is also cholesterol on the ship but it is not the point of this story.


Insulin is also required to store the fat made by the liver into fat cells AND to keep the fat there when it’s not needed elsewhere.

Every person’s fat cells have a different fat capacity. The occasional person can get to 600 lbs without being diabetic. Maybe you have to take out a wall to remove them from the house but otherwise they are insulin sensitive.

Conversely some small percentage of people have very little fat capacity. So you can’t automatically assume that slender people are healthy.

At any rate you can gain weight as long as your cells will allow it. There is no special test that will tell you how much your fat cells can hold. You can keep pouring water into an 8 ounce glass as long as you want but the glass will never hold more than 8 ounces. The rest is just overflow. Eventually insulin resistance in your fat cells, just as with the water glass, will block storage AND allow fat to spill over into the blood stream.. Thus we arrive at high triglycerides.

But we also arrive at something else.

Fatty liver

The fat has to go somewhere. When it cannot be stored in your fat cells the accommodating liver begins storing the fat in and around the liver and other organs including the pancreas and heart. This is called visceral and ectopic fat and you can usually see it hanging over the belt, sometimes called a beer belly. Normal body fat is soft and flabby. Visceral fat is hard.

You now have a fatty liver.

Insulin deficiency

Your pancreas has been working hard to make enough insulin to overcome all the resistance in your muscles, liver, and fat cells. But eventually it will be overwhelmed and simply can’t make enough insulin. Then everything gets worse and worse.

What now?

As you can see this health deterioration is a continuum starting with the muscles and ending with a fatty liver, doing damage to the blood vessels, heart, and other organs all along the way – all those underlying conditions.

Next week I will outline some steps you can take to prevent deterioration and help restore your health. In other words, make that insulin resistance go away. It is impossible to healthy when you have insulin resistance.

Pat Smith is the author of “It’s All about the Food,” a book hat guides nutritious food choices as the way to avoid illness and maintain a healthy weight. Proceeds from her book benefit the Montgomery County Food Pantry. Her website is She can be contacted at, 870-490-1836. Her Facebook page is