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poly 47 sec What to know about insulin resistance Experts discuss condition, its early signs and when to take them seriously BY KNVUL SHEIKH If you've spent time online recently, you've likely heard of insulin resistance. People using injectable drugs like Ozempic talk about it. Fitness enthusi- asts suggest exercise routines to re- verse it. Influencers market supple- ments that supposedly counter it. But what exactly is insulin resistance and how do you know if you have it? A CRUCIAL HORMONE Insulin is a hormone (secreted by the pancreas that is crucial for converting food into energy, or storing that energy for later. When your blood glucose levels rise after a meal, the pancreas responds by producing insulin. The insulin, in turn, helps cells use the sugar and brings the amount of glucose in your bloodstream back to a normal range. When you are insulin resistant, your body does not respond to insulin after meals as effectively as it should. This means your cells don't take in enough glucose. The pancreas then produces more insulin to help the process along. Eventually, the pancreas becomes un- able to keep up. "After a number of years, your blood sugar starts to stay high after you eat, and that ultimately leads to what we call pre-diabetes," said Dr. Ruchi Mathur, an endocrinologist at Cedars-Sinai hospital in Los Angeles. A fasting blood glucose level between 100 to 125 mg/dL is considered pre-dia- betes. If your glucose levels remain un- treated and become higher than 125 mg/ dL, you would be diagnosed with Type 2 diabetes. WHO SHOULD BE CONCERNED According to the Centers for Disease Control and Prevention, 37.3 million Americans have diabetes and another 96 million or more than a third of American adults - have pre-diabetes. Because insulin resistance is a precur- sor to both, researchers estimate the number of people with insulin resist- ance to be much higher. "Most people don't even know that they have it," said Dr. Mary Vouyiouklis Kellis, an endocrinologist at Cleveland Clinic in Ohio. People with certain genetic condi- tions, such as myotonic dystrophy or lipodystrophy, often have insulin resist- ance. But more frequently, people de- velop insulin resistance as a result of a mix of social and biological factors, Dr. Kellis said. For example, if you have a family history of Type 2 diabetes, you may be more likely to have insulin re- sistance. If you've been diagnosed with high fat in your blood, such as high tri- glycerides, high LDL cholesterol or low HDL cholesterol, you may also be at higher risk. Black, Hispanic, American Indian, Alaska Native and Asian people are known to have a higher risk. Data suggests that insulin resistance also increases with age, as pancreatic function declines. It is also more likely to occur in people who are less physically active or have a poor diet. Certain medications temporarily in- crease the risk of insulin resistance, in- cluding a class of steroids called gluco- corticoids, some antipsychotics and some H.I.V. medicines, Dr. Kellis said. Some metabolic or hormonal diseases are associated with insulin resistance as well, including high blood pressure, heart disease, nonalcoholic fatty liver disease and polycystic ovary syndrome, or PCOS. EARLY SIGNS TO LOOK FOR Doctors rely on many of the same cues and blood tests used for pre-diabetes. and diabetes - like those that check your glucose levels or hemoglobin A1C to determine if you have insulin re- sistance. "It's a bit of art and science," Dr. Mathur said. The United States Preventive Serv- ices Task Force recommends that all adults 35 to 70 years old be tested for pre-diabetes if they are overweight or obese. The American Diabetes Associa- tion also suggests screening adults who have other risk factors for diabetes, such as a close relative with Type 2 dia- GETTY IMAGES betes, a diagnosis of PCOS, a history of gestational diabetes or clinical condi- tions associated with diabetes. According to the A.D.A., all adults should start getting tested at age 45, even if they don't have any risk factors. And if your results are normal but you notice symptoms or develop any risk factors for diabetes, you should ask to get retested at least every three years Often, there are no obvious signs until months or years after your body has been struggling to manage insulin and blood sugar levels. When they do ap- pear, some of the earliest indicators tend to be related to how your body reacts af- ter meals. YOU FEEL HUNGRY OR TIRED ALL THE TIME Be- cause your body isn't absorbing glucose efficiently, you may not get much of an energy boost from your food. As a result, you may feel excessively fatigued and your brain may keep signaling that you need to eat more sweet or carbohydrate- rich meals. YOU'VE GAINED WEIGHT When your body starts to run out of places to store excess glucose in the liver and muscles, it starts converting the extra sugar into fat. This can compound the problem: More body fat can make insulin resistance worse. Research shows that visceral fat, in particular, which surrounds the organs in your abdomen, releases fatty acids, hormones and pro-inflammatory mole- cules into your blood. Long-term inflam- mation and an increase in circulating fat are associated with insulin resistance. While waist size can't be used to diag- nose health issues, doctors do use it to screen for possible risks. Men with a waist circumference of more than 40 inches (about 100 centimeters) and non- pregnant women whose waist circum- ference is more than 35 inches (88 centi- meters) are considered to have a higher risk of insulin resistance. You can still have high levels of harm- ful fat in your cells even if your waist is smaller, said Dr. Gerald I. Shulman, a professor of medicine at Yale and a co- director of the university's Diabetes Re- search Center. YOU NOTICE DARKENED SKIN PATCHES OR SKIN TAGS Some people with more ad- vanced insulin resistance also develop skin tags or a condition called acantho- sis nigricans. This can look like dark patches in body folds like on the back or side of your neck, in your armpits or in your groin, Dr. Shulman said, adding that doctors often see these skin changes in people with PCOS who have insulin resistance. YOUR PERIOD ISN'T REGULAR "Women's cy- cles are a close marker of their health," Dr. Mathur said. If you notice that your menstrual cycle is becoming irregular, or have other signs that indicate PCOS, such as increased acne or facial hair, a doctor may evaluate you for hormonal imbalances as well as insulin resistance. YOU DRINK MORE WATER OR URINATE MORE II insulin resistance progresses, elevated blood sugar levels may force your kid- neys to start working harder and you may feel the urge to drink more and uri- nate more. If you think something's off, and you suspect it could be linked to insulin re- sistance, tell your doctor, Dr. Mathur said: "You know your body better than anybody else." NICHOLAS SANSONE FOR THE NEW YORK TIMES NICHOLASSANSONE FOR THE NEW YORK TIMES During more vigorous exercise, you're probably better off wearing a lighter outer layer a water-resistant windbreaker can work fine. "Even with my best Gore-Tex rain jacket," Mr. Over- holt said, "if you're sweating a ton in a rain jacket, it's going to be pretty gross in there." One of the most effective fea- tures for staying cool is pit zips, or zip- pers under your armpits. While some experts recommended waterproof shoes, others said that water tends to pool inside them. All the experts agreed that merino wool socks were the best way to keep your feet warm and comfortable. Exercising in the rain can increase the risk of chafing, so the experts recom- mended covering parts of the body that tend to rub against each other (like your thighs) or fabric (like your heels) with a balm such as Body Glide beforehand. USE YOUR SURROUNDINGS Experts advised ditching city streets for a park, if you can. "Trees are a natural umbrella," Ms. Sestoso said. Try to work out on paved surfaces. and avoid moving quickly on grass, mud or leaves, which can become slick. And consider the puddles a natural obstacle moving around them can "in- crease your balance, increase your agil- ity, and really work on some of those fast-twitch muscle fibers," Dr. Fung said. course- REMEMBER TO DRINK FLUIDS Even if you're drenched, you still need to hydrate to make up for the fluid your body is losing, said N'Namdi Nelson, an exercise physiologist at NYU Langone's Sports Performance Center "When it's raining outside, it's much harder to assess the amount of sweat you're giving off," Mr. Nelson said. Make sure to drink fluids before, during and after a workout, he said. ee 何事も運動に KNOW WHEN TO HEAD INSIDE "Stay indoors if there is a high risk of thunderstorms and lighting," Ms. Ses- toso said, or if there are high winds, which can bring down power lines and tree branches. She also recommended keeping a towel and dry change of clothes in your car, to warm up after your rainy adventure.
何事も運動に
「あめでも運動」でした。
How to love an outdoor workout on a rainy day
BY DANIELLE FRIEDMAN
When the skies open, most people run for cover. But some run for fun.
The benefits of exercising in the rain -whether you're jogging, hiking or strength training-often outweigh the annoyances, experts say, if you're stra tegic about both your workout and your mind-set.
Learning to move through obstacles, both mental and physical, is key to ath- letic training, said Trisha Steidl, a run- ning coach for Olympic hopefuls in Washington State and the president of the Seattle Running Club. "Being out in nasty conditions is a fantastic way to get comfortable being uncomfortable."
There isn't much scientific research specifically about exercising in the rain, but experts say a few benefits can be in- ferred. For starters, navigating a slick, sloshy path requires agility and focus, building strength and balance with mus- cles you don't normally use, said Ben Fung, a physical therapist in San Diego.
"It's not a controlled environment," he said, which will better equip you for other physical challenges than if you train only in a gym.
And no, working out in the rain does- n't increase your odds of catching a cold, said Dr. Cindy Lin, a professor of sports medicine at University of Washington Medical Center: "To the contrary, there is evidence that moderate-intensity ex- ercise, whether in the rain or not, boosts our immune system."
WEAR THE RIGHT GEAR
Experts advise dressing in layers to help keep you warm and dry. Start with a base of moisture-wicking fabric to help sweat evaporate, said Jillian Sestoso, the head of outdoor expeditions for Out- siders, a social club in New York that of fers group hikes, runs and other activi- ties. "My favorite base layer is merino wool, year round," she said.
Top that with a water-repellent outer layer, ideally a jacket with a hood. The key is to find a garment that protects you from outside moisture (rain) while releasing the sweat your body produces, said Lex Overholt, a senior outerwear designer for REL
If you're going for an easy hike, where rain will be a bigger obstacle than sweat, a three-layer breathable rain jacket may be most comfortable, he added.
CHOLAS TUNE PER THE NEW YORK TIMES
MEDICAS SAMSUNE FOR THE NEW YORK TIME
During more vigorous exercise, you're probably better off wearing a lighter outer layer a water-resistant windbreaker can work fine. "Even with my best Gore-Tex rain jacket," Mr. Over holt said, "if you're sweating a ton in a rain jacket, it's going to be pretty gross in there." One of the most effective fea- tures for staying cool is pit zips, or zip- pers under your armpits.
While some experts recommended waterproof shoes, others said that water tends to pool inside them. All the experts agreed that merino wool socks were the best way to keep your feet warm and comfortable.
Exercising in the rain can increase the risk of chafing, so the experts recom- mended covering parts of the body that tend to rub against each other (like your thighs) or fabric (like your heels) with a balm such as Body Glide beforehand.
USE YOUR SURROUNDINGS Experts advised ditching city streets for a park, if you can. "Trees are a natural umbrella, Ms. Sestoso said.
Try to work out on paved surfaces, and avoid moving quickly on grass, mud or leaves, which can become slick. And consider the puddles a natural obstacle course moving around them can "in- crease your balance, increase your agil- ity, and really work on some of those fast-twitch muscle fibers," Dr. Fung said.
REMEMBER TO DRINK FLUIDS
Even if you're drenched, you still need to hydrate to make up for the fluid your body is losing, said N'Namdi Nelson, an exercise physiologist at NYU Langone's Sports Performance Center
"When it's raining outside, it's much harder to assess the amount of sweat you're giving off," Mr. Nelson said. Make
sure to drink fluids before, during and
after a workout, he said.
KNOW WHEN TO HEAD INSIDE
何事
"Stay indoors if there is a high risk of thunderstorms and lighting" Ms. Ses- toso said, or if there are high winds, which can bring down power lines and tree branches. She also recommended keeping a towel and dry change of clothes in your car, to warm up after your rainy adventure.
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then