Latest / Clearly Hormonal / Ep 11: Understanding Insulin Resistance During Menopause

Transcript

Ep 11: Understanding Insulin Resistance During Menopause · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
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  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health And recharge the conversations you are having with your health care providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
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  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your health care provider at your next visit.
• 0:40
  Dr. Komal Patil-Sisodia: Hi, everyone.
• 0:41
  Dr. Komal Patil-Sisodia: Welcome back to reset.
• 0:42
  Dr. Komal Patil-Sisodia: Recharge.
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  Dr. Komal Patil-Sisodia: I'm really excited to kick off the endocrine series and.
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  Dr. Komal Patil-Sisodia: Today, we're going to talk about insulin resistance.
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  Dr. Komal Patil-Sisodia: So what is insulin?
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  Dr. Komal Patil-Sisodia: Resistance.
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  Dr. Komal Patil-Sisodia: Well, in order to understand that you first have to understand how the pancreas.
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  Dr. Komal Patil-Sisodia: Crius works.
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  Dr. Komal Patil-Sisodia: The pancreas is an organ that sits kind.
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  Dr. Komal Patil-Sisodia: Kind of in the middle of our abdomen right below the ribs and it is made.
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  Dr. Komal Patil-Sisodia: Up of a bunch of different cells, but primarily beta cells that are responsible.
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  Dr. Komal Patil-Sisodia: For producing insulin.
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  Dr. Komal Patil-Sisodia: Insulin is important because it helps us.
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  Dr. Komal Patil-Sisodia: Us store and process the carbohydrates that were, that.
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  Dr. Komal Patil-Sisodia: We're consuming so that we have good energy sources.
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  Dr. Komal Patil-Sisodia: And.
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  Dr. Komal Patil-Sisodia: And as those beta cells start to malfunction, that's when you start developing.
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  Dr. Komal Patil-Sisodia: Insulin resistance pre-diabetes and then either type one or type two diabetes.
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  Dr. Komal Patil-Sisodia: Beatty's depending on how the cells are malfunctioning.
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  Dr. Komal Patil-Sisodia: So think of it.
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  Dr. Komal Patil-Sisodia: Think.
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  Dr. Komal Patil-Sisodia: Have your pancreas, like a factory assembly line.
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  Dr. Komal Patil-Sisodia: The beta cells are.
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  Dr. Komal Patil-Sisodia: We're working really hard to produce insulin and it, they package it up and they send it off to.
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  Dr. Komal Patil-Sisodia: To go deal with the carbs either to store them or to help the body utilize them.
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  Dr. Komal Patil-Sisodia: As an energy source.
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  Dr. Komal Patil-Sisodia: So how does the pancreas malfunction.
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  Dr. Komal Patil-Sisodia: Well, there are a lot of different ways, including auto immune attacks.
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  Dr. Komal Patil-Sisodia: Um, this development of insulin resistance as our body composition shifts around.
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  Dr. Komal Patil-Sisodia: Around medications can do it.
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  Dr. Komal Patil-Sisodia: There are other disease conditions that can burn.
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  Dr. Komal Patil-Sisodia: Out the pancreas and cause the beta cells to malfunction, but really the two.
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  Dr. Komal Patil-Sisodia: Two major buckets that they fall under are going to be the auto immune attack.
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  Dr. Komal Patil-Sisodia: And.
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  Dr. Komal Patil-Sisodia: And then the development of insulin resistance because of.
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  Dr. Komal Patil-Sisodia: Stress on those beta cells as our bodies change.
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  Dr. Komal Patil-Sisodia: So I'll describe both of those.
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  Dr. Komal Patil-Sisodia: Those two.
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  Dr. Komal Patil-Sisodia: An auto-immune attack is when your white blood.
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  Dr. Komal Patil-Sisodia: Cells that are normally supposed to take care of bacteria and viruses.
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  Dr. Komal Patil-Sisodia: And keep you healthy and keep your body functioning.
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  Dr. Komal Patil-Sisodia: Normally go wonky.
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  Dr. Komal Patil-Sisodia: And all of a sudden they start to malfunction and they go over to your pancreas and think, oh, Oh, gosh.
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  Dr. Komal Patil-Sisodia: Hey pancreas.
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  Dr. Komal Patil-Sisodia: I think you're going to be my new enemy.
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  Dr. Komal Patil-Sisodia: Um, They look at the pancreas almost as if they were looking at a bacteria.
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  Dr. Komal Patil-Sisodia: Or a virus and they start to attack it well in the auto-immune attack.
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  Dr. Komal Patil-Sisodia: Back on the pancreas.
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  Dr. Komal Patil-Sisodia: They preferentially aim for the beta cells, which.
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  Dr. Komal Patil-Sisodia: Is unfortunate because the beta cells are what are producing insulin.
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  Dr. Komal Patil-Sisodia: And when that auto-immune attack.
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  Dr. Komal Patil-Sisodia: Tax starts.
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  Dr. Komal Patil-Sisodia: The beta cells are slowly killed off and our ability.
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  Dr. Komal Patil-Sisodia: To produce insulin goes down and that is really what leads to type one.
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  Dr. Komal Patil-Sisodia: Diabetes.
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  Dr. Komal Patil-Sisodia: And if you, uh, we'll talk about that more in a subsidy.
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  Dr. Komal Patil-Sisodia: Subsequent episode, but that auto-immune attack is one way that beta cells.
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  Dr. Komal Patil-Sisodia: Those are taken out of the picture.
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  Dr. Komal Patil-Sisodia: The second way is when our body.
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  Dr. Komal Patil-Sisodia: The composition starts changing, and this can be for a multitude.
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  Dr. Komal Patil-Sisodia: Of reasons.
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  Dr. Komal Patil-Sisodia: If you are less active, if you were eating more, if you're going through.
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  Dr. Komal Patil-Sisodia: Uh, big hormonal shifts, like developing hypothyroidism, where.
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  Dr. Komal Patil-Sisodia: You're not metabolizing as quickly, or if you are going through.
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  Dr. Komal Patil-Sisodia: Changes like menopause or low testosterone.
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  Dr. Komal Patil-Sisodia: What all, what?
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  Dr. Komal Patil-Sisodia: Can lead to shifts in our body composition.
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  Dr. Komal Patil-Sisodia: And when I say that I.
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  Dr. Komal Patil-Sisodia: I mean that our ability to hold onto muscle mass goes down and our.
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  Dr. Komal Patil-Sisodia: Our ability to gain fat mass starts going up.
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  Dr. Komal Patil-Sisodia: And normally when.
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  Dr. Komal Patil-Sisodia: You see those types of shifts?
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  Dr. Komal Patil-Sisodia: The FATMAX that we would.
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  Dr. Komal Patil-Sisodia: Gain.
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  Dr. Komal Patil-Sisodia: On our arms or legs, that's known as subcutaneous.
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  Dr. Komal Patil-Sisodia: Fat, unfortunately, especially in peri-menopause.
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  Dr. Komal Patil-Sisodia: We start.
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  Dr. Komal Patil-Sisodia: To see, wait a weight gain around the middle or fat mass accumulation.
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  Dr. Komal Patil-Sisodia: Around the middle.
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  Dr. Komal Patil-Sisodia: And instead of sitting under the skin, like it would.
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  Dr. Komal Patil-Sisodia: For your arms or legs.
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  Dr. Komal Patil-Sisodia: It actually goes inside your abdominal cavity.
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  Dr. Komal Patil-Sisodia: Katie and starts packing around your, um, Starts packing around all of.
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  Dr. Komal Patil-Sisodia: Your different organs inside your abdomen.
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  Dr. Komal Patil-Sisodia: And we call that visceral fat.
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  Dr. Komal Patil-Sisodia: Visceral fat is very inflammatory.
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  Dr. Komal Patil-Sisodia: It actually.
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  Dr. Komal Patil-Sisodia: Makes it harder for your beta cells to function and make enough?
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  Dr. Komal Patil-Sisodia: Enough insulin for your body to deal with the carbohydrates that you're consuming.
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  Dr. Komal Patil-Sisodia: And so think about it this way.
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  Dr. Komal Patil-Sisodia: And this goes back to.
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  Dr. Komal Patil-Sisodia: Um, you know, this concept of visceral fat in the pancreas is an assembly line.
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  Dr. Komal Patil-Sisodia: If you're, if you're at a normal body weight, right.
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  Dr. Komal Patil-Sisodia: And you eat a cookie.
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  Dr. Komal Patil-Sisodia: And I'm totally making numbers here, so don't hold me to this.
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  Dr. Komal Patil-Sisodia: But.
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  Dr. Komal Patil-Sisodia: It may be that your body needs to make like two units of insulin to cover that cookie.
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  Dr. Komal Patil-Sisodia: That you're eating.
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  Dr. Komal Patil-Sisodia: So fast forward and say you gained 20 or 30 pounds.
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  Dr. Komal Patil-Sisodia: Lbs.
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  Dr. Komal Patil-Sisodia: And all of a sudden you have all this extra visceral fat around your middle.
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  Dr. Komal Patil-Sisodia: Your beta cells have to work harder because you need more.
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  Dr. Komal Patil-Sisodia: Insulin to cover the same carbs that you're eating.
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  Dr. Komal Patil-Sisodia: So for example, if you eat.
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  Dr. Komal Patil-Sisodia: Eat that same cookie at 20 or 30 pounds heavier.
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  Dr. Komal Patil-Sisodia: Your pancreas.
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  Dr. Komal Patil-Sisodia: This could have to make anywhere between four to eight units of insulin to cover that same.
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  Dr. Komal Patil-Sisodia: Same cookie.
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  Dr. Komal Patil-Sisodia: So the beta cells become stressed out because if they're in a.
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  Dr. Komal Patil-Sisodia: Factory assembly line and they are continuing to make insulin.
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  Dr. Komal Patil-Sisodia: They have to do it faster.
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  Dr. Komal Patil-Sisodia: And make more in.
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  Dr. Komal Patil-Sisodia: In order to cover the same amount of carbs.
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  Dr. Komal Patil-Sisodia: And I am totally dating myself.
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  Dr. Komal Patil-Sisodia: Myself by saying this, but if you ever seen that episode of, I love Lucy where Lucy.
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  Dr. Komal Patil-Sisodia: And Ethel are working in the chocolate factory.
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  Dr. Komal Patil-Sisodia: Think about.
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  Dr. Komal Patil-Sisodia: What happens to the assembly line?
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  Dr. Komal Patil-Sisodia: Through the course of that scene when it is.
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  Dr. Komal Patil-Sisodia: Is moving at the right speed.
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  Dr. Komal Patil-Sisodia: They're able to package the chocolates.
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  Dr. Komal Patil-Sisodia: It's up into the boxes and, you know, make the boxes look nice and send.
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  Dr. Komal Patil-Sisodia: And them on to the end of the assembly line.
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  Dr. Komal Patil-Sisodia: But when Lucy accidentally.
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  Dr. Komal Patil-Sisodia: Flips the switch and the assembly line has to work faster.
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  Dr. Komal Patil-Sisodia: All of a sudden.
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  Dr. Komal Patil-Sisodia: Than everything goes haywire.
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  Dr. Komal Patil-Sisodia: You're just like your body is not able to pack.
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  Dr. Komal Patil-Sisodia: Package and produce insulin quickly in that episode, Luther, Lucien.
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  Dr. Komal Patil-Sisodia: Lucy and Ethel are not able to take those chocolates, put them in the box package.
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  Dr. Komal Patil-Sisodia: Them nicely, everything goes sideways.
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  Dr. Komal Patil-Sisodia: And so the same thing is happening to your body.
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  Dr. Komal Patil-Sisodia: Your beta cells cannot make enough.
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  Dr. Komal Patil-Sisodia: Good quality insulin fast.
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  Dr. Komal Patil-Sisodia: Fast enough.
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  Dr. Komal Patil-Sisodia: And when you don't have enough insulin, To deal with the carbo.
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  Dr. Komal Patil-Sisodia: Hydrates that you're consuming, the blood sugar starts to rise.
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  Dr. Komal Patil-Sisodia: So that is the first.
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  Dr. Komal Patil-Sisodia: Step of insulin resistance and that is you need more insulin.
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  Dr. Komal Patil-Sisodia: To cover the same amount of carbs that you're eating.
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  Dr. Komal Patil-Sisodia: So, how does this.
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  Dr. Komal Patil-Sisodia: Get worse in peri-menopause.
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  Dr. Komal Patil-Sisodia: Well, as our body composition starts.
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  Dr. Komal Patil-Sisodia: Starts shifting because estrogen levels are decreasing.
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  Dr. Komal Patil-Sisodia: Basically what happens is this insulin resistance is getting worse.
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  Dr. Komal Patil-Sisodia: Right?
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  Dr. Komal Patil-Sisodia: We know.
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  Dr. Komal Patil-Sisodia: In peri-menopause that that decrease in estrogen is making us.
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  Dr. Komal Patil-Sisodia: Uh, gain more weight around our middle and we're not able to hold on to.
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  Dr. Komal Patil-Sisodia: That muscle mass.
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  Dr. Komal Patil-Sisodia: And it's interesting because women who are diagnosed with.
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  Dr. Komal Patil-Sisodia: With either type one or type two diabetes, they're actually thought to go through menopause earlier.
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  Dr. Komal Patil-Sisodia: They already have issues with their beta cells.
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  Dr. Komal Patil-Sisodia: And now with these body composition changes their insulin.
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  Dr. Komal Patil-Sisodia: Insulin resistance is getting worse.
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  Dr. Komal Patil-Sisodia: So what I very commonly see in my practice.
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  Dr. Komal Patil-Sisodia: This is that women who have type one or type two diabetes.
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  Dr. Komal Patil-Sisodia: Actually start getting worse insulin resistance, meaning it becomes harder to.
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  Dr. Komal Patil-Sisodia: Control their blood sugars.
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  Dr. Komal Patil-Sisodia: As they go through menopause.
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  Dr. Komal Patil-Sisodia: And we'll talk about this a.
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  Dr. Komal Patil-Sisodia: A little bit more.
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  Dr. Komal Patil-Sisodia: Um, as far as I know, there's no link.
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  Dr. Komal Patil-Sisodia: To insulin resistance or at least not links found in studies.
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  Dr. Komal Patil-Sisodia: I have my own theories.
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  Dr. Komal Patil-Sisodia: Uh, to gestational diabetes.
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  Dr. Komal Patil-Sisodia: So if you.
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  Dr. Komal Patil-Sisodia: Develop diabetes while you were pregnant.
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  Dr. Komal Patil-Sisodia: Um, does this get worse?
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  Dr. Komal Patil-Sisodia: And peri-menopause.
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  Dr. Komal Patil-Sisodia: And I think the answer to that as mixed officially, the studies don't show it.
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  Dr. Komal Patil-Sisodia: But my clinical practice would disagree with that strongly.
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  Dr. Komal Patil-Sisodia: So.
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  Dr. Komal Patil-Sisodia: So, what are the things that you
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  To sum up insulin resistance.
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  Is where your body has to produce more insulin in order to keep your blood.
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  Blood sugar's normal or at whatever baseline they're at.
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  When.
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  When we go through perimenopause and menopause because our body composition.
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  Is changing and we're getting more visceral fat.
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  Insulin resist.
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  goes up, meaning we need to make more insulin to keep.
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  Dr. Komal Patil-Sisodia: can do to monitor for this?
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  Dr. Komal Patil-Sisodia: So number one, pay.
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  Dr. Komal Patil-Sisodia: Pay attention to your body.
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  Dr. Komal Patil-Sisodia: If you notice that you're losing muscles it muscle.
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  Dr. Komal Patil-Sisodia: In your arms or legs, right?
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  Dr. Komal Patil-Sisodia: That can be the first sign.
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  Dr. Komal Patil-Sisodia: That your body.
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  Dr. Komal Patil-Sisodia: Composition is shifting.
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  Dr. Komal Patil-Sisodia: If you start noticing that you are gaining weight.
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  Dr. Komal Patil-Sisodia: Around your middle.
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  Dr. Komal Patil-Sisodia: That's the next thing that happens and that's.
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  Dr. Komal Patil-Sisodia: Really where insulin resistance starts.
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  Dr. Komal Patil-Sisodia: So if you have a family history, Of, uh, obesity, prediabetes, diabetes, any of those things.
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  Dr. Komal Patil-Sisodia: You should start getting screened to see if you have insulin resistance and a lot.
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  Dr. Komal Patil-Sisodia: Of times that all is very similar to the screening for prediabetes or diabetes.
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  Dr. Komal Patil-Sisodia: And you can talk to your primary care provider about that.
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  Dr. Komal Patil-Sisodia: And then.
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  Dr. Komal Patil-Sisodia: If you already have prediabetes or diabetes, my next set of instruction.
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  Dr. Komal Patil-Sisodia: Structions to you is to pay attention to your blood sugars.
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  Dr. Komal Patil-Sisodia: You may be doing all of the same things, you know, exercising and the same.
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  Dr. Komal Patil-Sisodia: Amount eating the same foods, but your blood, if your blood sugars are just getting worse and worse and.
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  Dr. Komal Patil-Sisodia: Worse.
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  Dr. Komal Patil-Sisodia: That is a sign that peri-menopause star is.
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  Dr. Komal Patil-Sisodia: Starting to shift your insulin resistance and make your insulin resistance.
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  Dr. Komal Patil-Sisodia: Worse.
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  Dr. Komal Patil-Sisodia: And this means that you need to.
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  Dr. Komal Patil-Sisodia: Talk to your doctor.
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  Dr. Komal Patil-Sisodia: Doctor about hormone replacement therapy and adjusting or starting.
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  Dr. Komal Patil-Sisodia: Any medications to deal with the insulin resistance, you should always, always, always.
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  Dr. Komal Patil-Sisodia: Always do both.
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  Dr. Komal Patil-Sisodia: I cannot stress that.
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  Dr. Komal Patil-Sisodia: Enough.
• 9:45
  Dr. Komal Patil-Sisodia: Um, so these are my, these are my call to action.
• 9:48
  Dr. Komal Patil-Sisodia: Make sure you have a great primary care doctor.
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  Dr. Komal Patil-Sisodia: Dr.
• 9:50
  Dr. Komal Patil-Sisodia: Endocrinologist, gynecologist that you were talking to about these things.
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  Dr. Komal Patil-Sisodia: Number to pay attention to your body, pay attention to your body.
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  Dr. Komal Patil-Sisodia: Composition and how that is shifting and the number three advocate for yourself when you.
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  Dr. Komal Patil-Sisodia: You are going in to see your doctor so that you're getting the appropriate test to screen.
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  Dr. Komal Patil-Sisodia: And for insulin resistance.
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  Dr. Komal Patil-Sisodia: Because really when you come in to see us as patients, we are reliant.
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  Dr. Komal Patil-Sisodia: On you to tell us what your symptoms are.
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  Dr. Komal Patil-Sisodia: So that's.
• 10:15
  Dr. Komal Patil-Sisodia: All for today on insulin resistance for a reset recharge, the endocrine series.
• 10:19
  Dr. Komal Patil-Sisodia: Uh, tune in for the next episode while we talk, uh, where we talk about pre-diabetes.
• 10:23
  Dr. Komal Patil-Sisodia: Thanks.