26. Understanding Insulin | The Hormone That Brings Order

In this episode of Mohivate, Dr Mohi Sarawgee explores insulin beyond the usual association with diabetes, bringing clarity to one of the most important hormones in metabolism.

Insulin is not just about blood sugar. It is central to how the body uses, stores, and manages energy every day. This episode explains how insulin works, how glucose moves through the body, and how balance is maintained after every meal through a clear and practical framework.

The conversation explores insulin resistance, why it develops over time, and how it connects to prediabetes, type 2 diabetes, and other related conditions. It also outlines the role of lifestyle factors including diet, movement, sleep, and stress in shaping metabolic health.

Alongside the science, the episode also draws on a personal story and a symbolic lens to connect these ideas to everyday life, and introduces a way of thinking about insulin as a system of order and structure within the body.

A grounded, science-based look at how the body manages energy, and why understanding insulin is key to long-term health.

References:

1. Insulin Resistance and Type 2 Diabetes – CDC
https://www.cdc.gov/diabetes/about/insulin-resistance-type-2-diabetes.html

2. Insulin Resistance – StatPearls, NCBI
https://www.ncbi.nlm.nih.gov/books/NBK507839/

3. Prediabetes and Insulin Resistance – NIDDK, NIH
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

4. Insulin Resistance – Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance

Just a gentle reminder: this episode is for information, education, and inspiration only. It’s not a substitute for your doctor’s advice. For any personal health concerns, always seek guidance from your doctor.

Transcript

SPEAKER_00 0:04

Hi everyone, welcome back to Mohivate. I'm Dr. Mohi Saraugi, a GP by profession, but here I'm swapping prescriptions for perspective. Today I want to begin with a story from my medical school days. And don't worry, it's not about exams or someone fainting in the anatomy lab. It's the kind of story that stays with you long after the lecture ends. When I was a medical undergrad student in Romania, one of my professors told us a story I've never forgotten and shared with people many times since. Her uncle was a well-known gynecologist in Romania sometime around the 1930s or 1940s. Now this was a very different time. Romania, like much of Europe, was living through years of war and political upheaval. Education carried enormous prestige. And if you were a gynecologist, well, let's just say you were doing extremely well. As my professor used to joke, gynecology is one specialty that tends to guarantee repeat customers for generations. So her uncle was successful, respected, and as she liked to add with a smile, not entirely unaware of how impressive he was and quite fond of reminding the world of it. Now back then in Romania, very few people owned cars. Owning a car meant you were wealthy, influential, a person of status. And of course, her uncle had one. Along with the car and his professional reputation came a healthy amount of pride. You know the type, the kind of person who walks into a room and the room immediately knows that they have arrived. So one day he was traveling outside the city when his car broke down. Now today, if your car breaks down, you'd call roadside assistance, open Google Maps, and the problem usually gets solved fairly quickly. But this was mid-20th century Romania. No phones, no roadside services, just you and a broken machine. So he waited, hoping another car might pass by. Nearly two hours passed before finally another car appeared and stopped. A man stepped out. Without asking many questions, he opened the hood and got to work. Within moments, he was half under the car fixing the engine himself. After some time, the engine started again. Problem fixed. My professor's uncle was grateful, of course, but remember, people with cars in those days usually had money and he felt that offering cash would have been awkward. So he did something very doctor-like. He took out his visiting card and handed it over with the ease of someone used to being needed. If you or anyone in your family ever needs a gynecologist, he said, please remember me. Which, when you think about it, is quite a confident thing to say to someone who has just crawled under your car and fixed your engine. The man accepted the card politely. Before leaving, the doctor added one more line. At least tell me your name, he said. So if you come to my clinic one day, I will remember you. The man replied simply, My name is Mihai. The doctor then asked for his full name, and at that moment the doctor froze because the man standing in front of him, the man who had just repaired his car by the roadside, was Mihai I, King Michael I of Romania. Mihai, by the way, is simply how the name Michael is said in Romanian. No entourage, no announcements, no ceremony. Just a king with mechanical skills and the willingness to help a stranger. Titles, status, and pride have a remarkable way of shrinking when humility shows up. Naturally, the doctor was stunned and he asked the question most of us would probably ask, Your Majesty, how do you know how to fix cars? King Mihai reportedly answered simply. Titles may one day mean nothing. But skills and education will always remain useful. When my professor told us this story in class, one of the first questions someone asked was the obvious one. Did he really not recognize the king? After all, kings do appear in newspapers. My professor laughed and said she wasn't entirely sure. Perhaps her uncle simply didn't expect to see a monarch crawling under a car by the roadside. Or perhaps he just wasn't paying very much attention. I remember looking up King Mihai later because I was so intrigued by the story. And it turned out he really did have a keen interest in mechanics and aviation. History remembers him for something far more dramatic. During World War II, he made one of the boldest political moves of the era, arresting Romania's wartime dictator and switching Romania to the Allied side almost overnight. In the years that followed, he lost his throne, lived much of his life in exile, and yet remained widely respected. And whether every detail of that roadside story happened exactly that way or not, the lesson stayed with me. Humility. Sometimes the most powerful education doesn't come from textbooks. It comes from stories about the way people live. I've been fortunate in my life to meet people who have left me with stories like this. Stories worth carrying and sharing forward. Because medicine at its best is not just about science. It is also about perspective. And strangely enough, the ideas of humility, discipline, and structure remind me of something happening inside our bodies every single day. A small hormone whose job is not to show off but to keep order, to manage the metabolic chaos that happens after every meal. That hormone is insulin. A few weeks ago on Mohivate, we began a series on understanding metabolism. Today we take the next step. Today we talk about one of the most important hormones in metabolism, insulin. And we are going to understand it in a slightly different way through science, through a story, and through a symbol. Because sometimes the best way to understand science is to see the human story hidden inside it. And somewhere between a broken car, King Mehai, and the biology of metabolism, you might discover a way of understanding insulin that I hope you'll never forget. So let's begin. When most people hear the word insulin, the first thing that comes to mind is diabetes and that's understandable. But insulin's role in the body is far bigger than that. Insulin is one of the master regulators of metabolism. If metabolism is the way the body manages energy, then insulin is one of the key hormones that keeps that system running smoothly. Every time we eat, especially carbohydrates, the body begins breaking food down into smaller components. One of those components is glucose. Glucose is a simple sugar and it is one of the primary fuels our body uses for energy. Your muscles use it when you move. In fact, muscle is one of the largest sites of glucose use, which is why movement, especially strength training, plays such an important role in how the body responds to insulin. Your organs depend on it, and your brain relies heavily on glucose as its main energy source. After a meal, glucose enters the bloodstream. At that point, cells need a signal. Storage needs coordination. The body needs a way to decide what gets used, what gets stored, and where it all goes. And this is where insulin enters the story. Insulin is a hormone that helps move glucose from the bloodstream into the cells where it can be used or stored. It is produced by the beta cells of the pancreas, an organ that sits quietly behind the stomach. The pancreas performs many roles. One of its key roles is to produce digestive enzymes that help break down food. Another important role is to regulate blood sugar through hormones, and among these, insulin is the most important. When glucose levels rise after a meal, the pancreas senses it within minutes and releases insulin into the bloodstream. Insulin's message is simple: energy has arrived, let's use it properly. And when this system works well, it helps keep blood sugar within a healthy range. Once insulin is released, it begins assigning roles, deciding what gets used, what gets stored, and where it goes. In muscle, glucose is used for energy or stored for later use. In the liver, it is stored as glycogen, which is used between meals when the body needs energy. In fat tissue, excess glucose is stored as energy reserves for longer-term use. Insulin also reduces glucose production by the liver when it is not needed, and it plays a role in protein synthesis and tissue repair. The entire process happens seamlessly many times a day. You eat, glucose rises, insulin response, cells take in the fuel, balance is restored. Most of the time, this system works so well that we don't even notice it. So insulin is more than just a sugar hormone. It helps the body decide what to do with the energy we take in. But metabolism is not just about what happens after one meal, it is about what happens over time. And that's where things begin to change. So let's understand this simply. Imagine your body has places where glucose, the sugar from food, can be stored. Think of it like a container. Every time you eat, glucose enters the bloodstream, and insulin helps move that glucose into the body's cells where it can be used or stored. If that glucose is being used regularly through movement, daily activity, good sleep, and overall metabolic balance, then the container is constantly being emptied and everything stays in balance. But if more glucose keeps coming in than the body is using, over time that container slowly begins to fill until one day there's no space left. Meal after meal, day after day, year after year. And the body does not have an unlimited capacity to store glucose. So when the next meal arrives and glucose enters the bloodstream, it can no longer move easily into the cells. And when it cannot move where it is meant to go, it begins to remain in the bloodstream. That is what we measure as high blood glucose. At this stage, insulin is still present. In fact, the body often produces more insulin to try to manage the situation, but the storage spaces are already full. So the signal becomes harder for the cells to respond to. And this is what we call insulin resistance, a state where the cells in the muscle, liver, and fat do not respond properly to insulin. As a result, glucose cannot move into cells as efficiently as it should. So the problem is not just high sugar in the blood, it's that the body is no longer able to use and store glucose efficiently. So, what determines how quickly that container fills? Several factors influence this: diet patterns, frequent intake of refined carbohydrates, and excess calories, physical inactivity when muscles are not using glucose regularly, sleep disruption, which affects insulin sensitivity, chronic stress, which alters hormonal balance, genetics, and even ectopic fat deposition, where excess fat begins to accumulate in places like the liver and muscles. In the early stages, the body tries to compensate. You can think of insulin as knocking on the door of the cell. At first, the door opens easily. Over time, as the cells become more filled, the door opens more slowly. So the pancreas responds by knocking louder, producing more insulin. And for years, this compensation can keep blood glucose levels looking normal, which means something important. A person can be metabolically struggling long before diabetes is ever diagnosed. And often there are no symptoms at all. That is part of the problem. But when symptoms do show up, they can include increased thirst, passing urine more often, especially at night, blurred vision, slower healing of cuts and wounds, and sometimes subtle changes in energy that people don't immediately connect to blood sugar. And this brings us to a stage known as prediabetes. It is the biological equivalent of a warning light. The system is telling us that the current pattern cannot continue indefinitely. Clinically, prediabetes means blood glucose levels are higher than normal but not yet in the range of diabetes. But more importantly, it reflects that insulin resistance has been building for years. The pancreas has been compensating by producing more insulin. So prediabetes is not a sudden event, it is the visible tip of a long metabolic story. The encouraging part is that this system is dynamic and in many cases it can be improved and even reversed. We'll explore this in more detail in a separate episode. Now, the interesting part is this. Once you understand how the system works, managing it becomes much simpler than it sounds. And we'll come to that towards the end. At this point, it's also helpful to understand that not all diabetes is the same. There are two main types that we commonly talk about. In type 1 diabetes, the body does not produce insulin because the immune system mistakenly attacks the insulin-producing beta cells in the pancreas. Without insulin, glucose cannot enter the cells properly, even though there's plenty of it in the bloodstream. So the body is surrounded by energy but unable to use it. And that is why people with type 1 diabetes require insulin from outside the body for survival. In type 2 diabetes, insulin is still being produced, often even more than normal in the early stages. But the body's cells do not respond to insulin as effectively. And over time, as the system becomes more strained, blood glucose levels begin to rise. So while type 1 diabetes is primarily a problem of insulin absence, type 2 diabetes develops when the body becomes resistant to insulin, and over time, the pancreas is no longer able to produce enough insulin to keep blood glucose levels in a healthy range. And what we have been describing so far, this gradual filling of storage, this reduced response to insulin is the process that leads to prediabetes and type 2 diabetes. It develops over time as the system works harder and eventually cannot keep up. And it's also important to understand that insulin resistance does not exist only in diabetes. We see it across several other conditions. It plays a role in polycystic ovary syndrome where insulin resistance can influence hormonal balance. It is part of metabolic syndrome where blood sugar, blood pressure, cholesterol, and weight begin to interact with each other. And we see it in non-alcoholic fatty liver disease. Insulin and metabolic health are part of a much larger story. One, we will keep exploring step by step on Mohivate. So remember this insulin resistance is not just about sugar. It reflects how the body is managing energy as a whole. And when you step back and look at this whole system, how the body manages energy, how it responds over time, how it adapts, compensates, and eventually begins to struggle, you begin to understand why we call insulin a master regulator. And as we move forward, there's one idea I want you to carry with you. Because once you begin to understand the system, everything starts to feel a little simpler and harder to ignore. As doctors, we will always help you manage conditions when they arise. But this is what shapes your health long before that and even after. Every system that works well over time has something that keeps it in order. Solar systems have it, economies have it, hospitals have it, and your body has it too. Now, this is where I want to introduce a way of thinking about it that might feel a little unexpected. A metaphor that may sound unusual at first, but sometimes a good metaphor stays with us longer than an explanation. If metabolism were a solar system, insulin would be Saturn. Saturn has fascinated people for centuries. It is often described as a planet of structure. Its rings move in precise patterns, and its gravity organizes everything around it. It doesn't create energy. The sun does that. Saturn organizes what already exists. And in many ways, insulin does the same. Saturn is often called the cosmic teacher, one that values patience and doesn't rush. It reflects back the patterns we repeat. And when those patterns don't change, it has a way of reminding us. And that should sound familiar because this is exactly how metabolism works. Now, astrology is not endocrinology, but I did warn you Saturn would show up in one of these episodes. As a symbol, this comparison is surprisingly useful. Across many traditions, Saturn has often been associated with discipline, structure, boundaries, timing, and consequences. And in that symbolic sense, insulin behaves in many ways like Saturn. Saturn represents structure. Insulin brings structure after food intake. Saturn represents boundaries. Insulin regulates how much glucose stays in the bloodstream. Saturn represents timing. Insulin coordinates what is used now and what is stored for later. Saturn represents consequences. And metabolically, when insulin signaling is repeatedly ignored, the body eventually reflects that. In a way, it's the same pattern we saw earlier the container slowly filling over time until one day it has no space left. Saturn represents delayed gratification and insulin stores energy for later use. And just like that, metabolism is not reacting to one decision. It is responding to what we do repeatedly. And the body, much like life, responds not to what we intend but to what we consistently do. So when we think about managing insulin, what we are really looking at is the way we live day to day. And insulin responds to the same principles every time: discipline, patience, consistency, and accountability. The willingness to take responsibility for our actions and for what we repeatedly do. Along with that, humility, the understanding that the body works in its own way and responds best when we respect it. So if you take one thing from today, let it be this. Your body reflects the patterns you live, often more than the intentions you set. And perhaps that's the real connection between everything we've spoken about today. A king who understood the value of skill and humility over status. A planet that represents structure and time, and a hormone that keeps everything in balance when our actions follow a little more discipline and rhythm in how we move, eat, rest, and take care of ourselves over time. I hope something today stirred a thought, gave you a smile, or simply made you pause. Whatever time it is where you are, I hope you carry a little feel good factor with you. Thank you for listening. I'm Dr. Mohi. Until next time, remember sometimes coming home to yourself is simply about respecting the process and giving it the time and patience it rightfully deserves.