Today I had an appointment with Judith Townsend, the Physician’s Assistant who works with Dr. Louis Arrone, in New York City. Dr. Arrone is an expert in medications to treat obesity. I go there with the intention of trying medications to help me reduce my weight, which is an approach I haven’t yet tried. When I last had my blood tested (about 2 months ago), my glucose was a little high (114), and while my primary care physician felt that was fine as long as I continued to be vigilant about exercise and nutrition, Judith was alarmed. In response, she prescribed metformin for me, which makes the  liver more efficient at processing glucose and helps it to lower blood glucose. I have been taking it for about a month, and am in the process of getting used to it. I think Judith was hoping that it would decrease my cravings for sugary foods and reduce my appetite and therefore my weight. Although I have just begun to notice a decrease in my appetite and my cravings for sugar (YAY!), my weight was basically the same as it was a month ago.

Today, I got a lecture from Judith about my poor pancreas, which really cares that my blood glucose levels are too high, and therefore futilely keeps pumping out insulin to try and reduce it (high blood glucose levels are toxic to the body’s cells). Alas, due to insulin resistance, the cells in my body (primarily in my liver, skeletal and cardiac muscle and adipose tissue) that routinely take up glucose in response to insulin are not responding to the insulin because THEY JUST CAN’T TAKE IT ANYMORE. They are saying to the increased levels of insulin that keep trying to bind to the receptors on my body’s cells, “get lost, we’re sick of you already!” (by decreasing or “downregulating” the number of insulin receptors on their surfaces). They’ve shut the door in the insulin’s face. But my poor pancreas just can’t hear what the liver and muscle cells are saying, and can’t tell that they’ve rejected the insulin that it works so hard to make. So it keeps churning out insulin. Eventually, if I continue to ingest too much sugar, the cells in my pancreas that manufacture the insulin (called beta cells) will just get tired and wear out, like a treadmill that has been left on constantly for months. Then my pancreas will never make its own insulin again (I think – I have to look into this), and my blood glucose will shoot up to levels that will eventually kill my organs and me, unless I inject synthetic insulin (as do most people being treated for type 2 diabetes). According to my blood work, my insulin levels have always been in the normal range. However, this is not conclusive evidence that I am not insulin resistant.

My question is, is Judith an alarmist? If one is clinically defined as obese, does it necessarily mean that one is insulin resistant? If I maintain my weight (my BMI is roughly 36, I am not morbidly obese), do regular moderate exercise, watch what I eat and monitor my glucose levels by getting my blood tested every 6 months or so, will I necessarily become diabetic? I eat a lot of healthy foods – lean protein, fruits and vegetables, whole grains, but I also need my chocolate. Is this an attempt to scare me straight? How much is Judith’s concern motivated by actual scientific evidence and how much is it motivated by cultural bias against obesity, which all of us carry around with us, just like unwanted extra pounds? Time will tell. I guess the clock is ticking for me.