As a nurse practitioner, Monica received advanced nursing education in addition to being a registered nurse. She is a fully licensed registered nurse and Advanced Practice Nurse Practitioner in the state of Connecticut and is certified by the board of the American Academy of Nurse Practitioners. Monica’s nursing work experience spans nearly two decades in the field of fertility treatment. Monica’s passion lies in taking care of the whole patient. Monica works with patients and stresses the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition – with fertility treatment.
November is National Diabetes Month, and we want to focus on Type 2 Diabetes as it is almost always preventable (or it’s onset can be delayed) by utilizing certain lifestyle strategies. Diabetes is not a foreign term when it comes to infertility, but not everyone knows why it happens, how it affects your body, and what you can do about it.
As a fertility nurse, health coach, and a person who battles insulin resistance daily, I teach the principles I live by. I understand the lifestyle shift some women and men need to take when preventing diabetes, and I know it isn’t always easy. Frankly, it’s never easy. But I’m here for you – helping you make one simple change, little by little, building up to a lifestyle that both prevents diabetes and makes you feel good.
The key to creating lasting change is understanding what’s happening. Let’s dig into it…
A Lesson in Type 2 Diabetes and Insulin Resistance
Why is Prevention So Important?
And more specifically, for our world, what does diabetes actually do to harm our fertility?
Researchers have found that women and men with elevated blood sugar and insulin resistance are at greater risk for fertility challenges. More specifically, poorly controlled hemoglobin A1c (blood sugar) levels are correlated with the following:
a longer time to achieve a pregnancy
a higher chance of miscarriage
an increased risk for birth defects in early pregnancy
What is Type 2 Diabetes?
Type 2 Diabetes is a consequence of chronic Insulin Resistance (IR) that persists and has not been managed appropriately. IR is incredibly prevalent in the U.S. population and is the predecessor not only to Type 2 Diabetes, but some researchers also believe that insulin resistance is at the root of many (if not most) chronic diseases. Before we can fully understand insulin resistance, we need to discuss insulin and its important role in the body.
What is Insulin and Insulin Resistance?
Insulin is a hormone that is produced by the pancreas. Its main job is to control how your body uses and stores blood sugar, called glucose. It basically acts as the key that allows glucose to enter the cells where it is used for energy (see first image below). During digestion, insulin stimulates muscle, fat, and liver cells to absorb glucose. The cells either use the glucose for energy or, if there is too much glucose (as in the case of over-eating), store it as fat.
Insulin resistance (IR) is a condition where the pancreas still produces adequate levels of insulin, but the cells don’t respond to it properly. This results in the pancreas over-producing insulin called compensatory hyperinsulinemia (see second image below) in an attempt to lower circulating blood glucose levels. Over time, the pancreas ‘tires’ of this excess secretion and doesn’t make enough insulin to keep blood glucose levels in the normal range. When this occurs, a person is diagnosed with Diabetes.
Images courtesy of Fertile Health, LLC.
How Does Insulin Resistance Affect the Body?
Insulin Resistance has profound effects on the body. I break it down for you here – there is much information to absorb, so take a deep breath, then dive in!
Insulin Resistance causes fat cells to expand to accommodate excess fat storage. Once they can no longer do this, they release fatty acids into the bloodstream that travel to other organs that are not equipped to handle these fats, such as the liver and skeletal muscle. The liver becomes overwhelmed with fat deposits and increases the production of triglycerides.
Also, the over-expansion of fat cells causes chronic inflammation which further promotes insulin resistance. In women with polycystic ovarian syndrome (PCOS), IR prevents the conversion of male hormones (androgens) into estrogen in the ovary, which causes an excess of androgens and inadequate levels of estrogen to trigger ovulation, resulting in irregular menstrual cycles and androgenic symptoms such as acne, excess body hair and male-pattern hair loss.
Perhaps one of the most frustrating aspects of Insulin Resistance for me, as a provider, is the vicious cycle it sparks. Once IR occurs, it can lead to overeating, which can lead to obesity, which can lead to increased inflammation, which promotes IR. And now we’re back at the beginning of the cycle.
Let me further explain: In the presence of excess weight, IR can also lead to leptin (the hormone produced that signals the brain that you are full) resistance. When the brain is resistant to leptin, hunger and satiety signals are disrupted. So, even though someone eats an adequate amount of food, the brain doesn't perceive this, leading to overeating, which can lead to excess weight, which leads to inflammation and worsening IR.
It feels like IR seems to do everything in its power to perpetuate itself.
The data is clear, though, that excess weight (particularly in the abdominal area) can cause IR to be worse, so it is very important to try to achieve a healthy weight, although even just losing 5-7% of a person’s starting weight can reduce the chance of developing diabetes.
How to Treat Insulin Resistance and Avoid Type 2 Diabetes
To put it simply, the goal of treating IR is to make the cells more sensitive to insulin.
There are a few medications that can help with this, but the primary way is through lifestyle changes, and listed below are the most important and research-based strategies:
Eat in a way that minimizes glucose (and insulin) spikes. Limit sugar and overly processed foods (such as chips, crackers, and cookies) as each time you ingest these, they cause an increase in glucose and, therefore, insulin. When making a meal or snack, start with a healthy animal or plant-based protein, add fruit or vegetables, and healthy fat (if not in the protein) such as an apple with almond butter. When choosing your carb, make sure it is as close to its natural form as possible. Think brown rice instead white rice and whole wheat pasta instead white pasta, and so on. Here a couple diet suggestions:
An adaptation of The Mediterranean diet, which encourages moderate intake of monosaturated fats (like those contained in extra virgin olive oil and avocados) is one that is often recommended for those with IR. The addition of Omega 3 fatty acids (found in oily fish such as salmon or an Omega 3 supplement) and avoiding trans fats (such as those found in processed food in your pantry) are also important as saturated fat can hinder the ability of insulin to allow glucose to enter the cells.
Some researchers maintain that a mostly plan-based diet is best for the prevention and/or reversal of diabetes, but this has been disputed and might be difficult for some to follow. It is clear, though, that assuring you have adequate ‘color’ every meal (fruits and vegetables) is an important nutritional component for everyone but particularly if you have IR.
Our Nutritionist, Jill Hickey, put together a real diet plan to end all diet plans, check it out here.
Start and maintain a regular movement practice. Exercise is the greatest insulin-sensitizing agent, even in the absence of weight loss. Regular exercise activates skeletal muscle (which is the key site for removing glucose from the bloodstream), therefore enhancing the uptake of glucose out of the circulation and into the cells, where it belongs. The type of movement is not important, as long as you like it enough to do it most days of the week. A regular practice should include both cardio and strength training. Here's a tip on maintaining a regular schedule:
Like any new habit, getting started is hard. Physical activity becomes more rewarding the more you do it. So, at first it may seem tough to exercise every day, but after a few regular sessions, your body and brain will start to crave it. Setting up your environment for success and/or creating a visual cue can help (like putting a yoga mat near your bed, packing a gym bag, or putting sneakers near the door).
In need of a fitness guide to calm your Insulin Resistance?
Get adequate sleep. By adequate, we mean uninterrupted, quality sleep. Poor sleep contributes to inflammation which forces cells to create substances that make them more resistant to insulin (exactly the opposite of what we are hoping to achieve). Most people require 8-10 hours of quality sleep, but the amount that you need is individual. Here are some tips that encourage quality sleep.
Identify and cultivate stress-management strategies. Chronic stress affects all body systems and generates a cascade of hormones (like adrenaline and cortisol) that are insulin antagonists, so they ‘work against’ insulin. Because a fertility journey itself can generate stress, it is always helpful to investigate what methods of stress release work best for you. Personally, we recommend exercise as your main form of stress release as the body produces the above hormones to prepare you for “fight or flight,” meaning the body wants to mobilize you when stressed, but here are some other options:
Meditation/mindfulness - If you are new to this practice, we suggest using some apps that have guided meditation (such as Calm, 10% Happier, or Insight Timer). Remember that this is a practice, so you are not expected to “be good” at clearing your mind right away. The goal is when you get distracted to just go back to thinking about your breath. You can’t do it incorrectly, as long as you are doing it.
Therapy or life-coaching - There is evidence that counseling and support during a fertility journey can lower levels of stress hormones and inflammatory markers. RMA has in-house counselors and coaches on staff who are experienced with (and passionate about) working with patients or couples in the preconception period.
Find other ways to innervate your senses - There is a temptation to overeat in response to stress which can cause excess weight and, as we’ve learned, worsen IR. There are many other ways to “nourish” your body’s other senses, though, in addition to eating. Some recommendations are hot tea (especially peppermint or cinnamon), using aromatherapy or scented candles, listening to music or a podcast, or reading a great book. If you find yourself in the kitchen when you’re not hungry ask yourself “What am I feeling right now?” If the answer is not true hunger, leave the kitchen and try one of the above suggestions.
Start a gratitude practice.One of the best ways to reduce anxiety is to practice a sense of gratefulness on a regular basis. You can do this by journaling or just stating three things you were grateful for that day before you go to sleep. We like journaling because it has the added benefit of getting any stressful thoughts out of your head and onto a piece of paper.
You Can Fight Insulin Resistance and Type 2 Diabetes
Insulin resistance, although prevalent, is treatable and/or manageable. Following a healthy lifestyle plan will support weight loss and improve your metabolic profile (your inside environment) which can improve the health of your pregnancy and your baby.