• Therapeutic Cataract & Refractive
  • Lens Technology
  • Glasses
  • Ptosis
  • Comprehensive Eye Exams
  • AMD
  • COVID-19
  • DME
  • Ocular Surface Disease
  • Optic Relief
  • Geographic Atrophy
  • Cornea
  • Conjunctivitis
  • Myopia
  • Presbyopia
  • Allergy
  • Nutrition
  • Pediatrics
  • Retina
  • Cataract
  • Contact Lenses
  • Lid and Lash
  • Dry Eye
  • Glaucoma
  • Refractive Surgery
  • Comanagement
  • Blepharitis
  • OCT
  • Patient Care
  • Diabetic Eye Disease
  • Technology

Insulin resistance is more important than you think


In the city of Chicago, there’s a 95-year-old retired pathologist and professor with a wry smile on his face. More than 50 years ago, Joseph Kraft, MD, identified that many tinnitus patients were in fact pre-diabetic.1 Back then this was a leaner America, and far fewer citizens had diabetes. Of course, much has radically changed.

In the city of Chicago, there’s a 95-year-old retired pathologist and professor with a wry smile on his face. More than 50 years ago, Joseph Kraft, MD, identified that many tinnitus patients were in fact pre-diabetic.1 Back then this was a leaner America, and far fewer citizens had diabetes. Of course, much has radically changed.

Most modern citizens today have become  one or more of the following: sedentary “screen huggers,” stress-induced overeaters, sweetened beverage and processed food consumers, poor quality manufactured/restaurant food aficionados and multiple pharmaceutical takers that further reduce the nutrients needed to process banquets of ubiquitous  sugar and protein.

More from Dr. Richer: How diet and nutrition affect disease

IR, poor health, and poor vision

Insulin resistance (IR) is the inability of insulin to exert its metabolic functions on cells and is considered the seminal initiating characteristic of type 2 diabetes.2 IR results in hyperinsulinemia, with some 60 percent of pancreatic beta cells nonfunctional at the time of type 2 diabetes diagnosis.3

By 2020, 52 percent of Americans will have or be well along their way to developing pre-diabetes.4 These two inter-related stealth processes likely lead to virtually all modern health problems. They directly and indirectly contribute to a vast array of metabolic diseases, including all inflammatory conditions, all vascular diseases, gestational and type 2 diabetes, non-alcoholic fatty liver disease, kidney disease, dementia, and epithelial cancers of the breast, colon, lung, prostate.5,6

More from Dr. Richer: Why ODs should care about sugar

In its earliest stages, IR and hyperinsulinemia manifest as hunger, difficulty concentrating, lethargy, visceral abdominal obesity, and high blood pressure.2  Subtle vision and eye changes such as non-optical blurring, poor low contrast vision, and foveal dysfunction manifesting as short wavelength (blue) color vision defects-lower focal ERG amplitudes and longer ERG latency can be present before retinopathy.7 By the time one’s blood sugar is erratic and/or elevated, the pathological damage of pre-diabetes is well along. IR and hyperinsulinemia cause all the sequela of diabetes up to 24 years sooner.8

Next: Push away from the table


Push away from the table

I’ve devoted two previous columns to diabetes and some positive steps our government is taking to confront it through minimization of refined sugar/simple carbohydrates, moderate protein intake, and promotion of exercise. Those laudable steps are embodied within the new 2016-2020 USDA “eating recommendations.”

But what if an even better way exists? Nephrologist Jason Fung, MD, believes that pushing away from the table, or not eating, is the simplest, least expensive, least time-consuming, and most effective way to reset our cellular response to insulin.9 This way has been practiced by all major religions for thousands of years as a means to physical and spiritual health. It can even be accomplished intermittently over short periods of time ranging from 12 to 18 hours.

More from Dr. Richer: Improve and protect the next patient with diabetes

9 ways to decrease insulin resistance

1. Decrease high fructose corn syrup, refined (simple) carbohydrates, excess protein (induces hepatic gluconeogenesis)

2.Increase exercise, activity, movement

3. Intermittent fasting (12–18 hours)

4. High-fat diet (non-insulinemic)

5. High-fiber diets

6. Vinegar before meals

7. Coffee with meals to prevent sugar spiking

8. Minerals, spices, herbs, such as:

• Chromium

• Ceylon cinnamon

• Berberine

• Tumeric

• Resveratrol

9. Optimize intestinal flora for a healthy GI microbiome


Next: Optometry, once again


Optometry, once again

Conventional early diabetes diagnosis and treatment focuses on monitoring blood sugar and considers elevated insulin largely irrelevant, even in patients with traditional risk factors of increased waist circumference, high body mass index, family history, and so on. Unfortunately, this clinical approach is no longer aligned in science,10 although it is creating great monetary rewards and expectations for multiple stakeholders.

More diabetes: Keeping up with the latest in diabetic eye disease research

Managing IR and hyperinsulinemia has the potential to increase both the quantity and quality of life of our patients while decreasing morbidity and mortality.  Optometrists examine the human eye with both low tech and increasingly high tech instrumentation. Multispectral retinal imaging, OCT angiography, and clinical adaptive optics are just a few of the technologies that should allow us to detect microvascular pathology and hence IR and hyperinsulinemia before an official diagnosis of diabetes.11.12 By addressing early systemic, visual, and ocular manifestations of IR and hyperinsulinemia, induced by our ever-challenging modern lifestyle, we have the means to change a profession and a nation for the better.

More: The importance of multidisciplinary care for diabetes



1. Kraft JR, Wehrmacher WH. Diabetes-a silent disorder. Compr Ther. 2009 Fall-Winter;35(3-4):155-9.

2. Diabetes.co.uk. Insulin Resistence. Available at: http://www.diabetes.co.uk/insulin-resistance.html. Accessed 6/8/16.

3. Praveen EP, Chouhan S, Sahoo J, Goel SK, Dwivedi SN, Khurana ML, Kulshreshtha B, Ammini AC .Effect of different insulin response patterns during oral glucose tolerance test on glycemia in individuals with normal glucose tolerance. Diabetes Technol Ther. 2016 May;18(5):316-26.

4. United Health Center for Health Reform and Modernization. The United States of Diabetes: Challenges and opportunities in the decade ahead. Working Paper 5, November 2010. Available at: http://www.unitedhealthgroup.com/~/media/uhg/pdf/2010/unh-working-paper-5.ashx. Accessed 6/8/16.

5. Crofts, C, Zinn, C, Wheldon, M, Schofield, G. Hyperinsulinemia: A unifying theory of chronic disease? Diabesity. 2015;1(4):34-43.

6. Breen DM, Giacca A. Effects of insulin on the vasculature. Curr Vasc Pharmacol. 2011 May;9(3):321-32.

7. Dhamdhere KP, Schneck ME, Bearse MA Jr, Lam W, Barez S, Adams AJ.

Assessment of macular function using the SKILL Card in adults with type 2 diabetes mellitus. Invest Ophthalmol Vis Sci. 2014 May 13;55(6):3368-74.

8. Dankner R, Chetrit A, Shanik MH, Raz I, Roth J. Basal state hyperinsulinemia in healthy normoglycemic adults heralds dysglycemia after more than two decades of follow up. Diabetes Metab Res Rev. 2012 Oct; 28(7):618-24.

9. Fung, J. Therapeutic fasting. 2016. Available at: https://www.youtube.com/watch?v=ETkwZIi3R7w. Accessed 6/9/16.

10. King GL, Park K, Li Q. Selective Insulin Resistance and the Development of Cardiovascular Diseases in Diabetes: The 2015 Edwin Bierman Award Lecture. Diabetes. 2016 Jun;65(6):1462-71.

11. Burns SA, Elsner AE, Chui TY, , Vannasdale DA Jr, Clark CA, Gast TJ, Malinovsky VE, Phan AD. In vivo adaptive optics microvascular imaging in diabetic patients without clinically severe diabetic retinopathy. Biomed Opt Express. 2014 Feb 27;5(3):961-74.

12. Richer, S Gelb K, Sherman J, Gold J, Zimmer C. Multi-spectral imaging of subclinical microaneurysms is correlated with insulin resistance parameters and vitamin D liver reserve status. Poster presented at: Association for Research in Vision and Ophthalmology (ARVO) annual meeting; 2016 May 5; Seattle, WA.


Related Videos
Dr. Mohammad Rafieetary
Stuart Richer, OD, PhD, provides an overview of his AOA 2022 presentation titled, "Alzheimer's disease: diagnostic criteria, prevention, and lifestyle management."
© 2024 MJH Life Sciences

All rights reserved.