What are the causes of insulin resistance?

[HICHAM_T2]

What are the causes of insulin resistance?

 

[Deleted Account]

I think this explains it very well:
http://www.diabetes.co.uk/insulin-resistance.html

 

[HICHAM_T2]

Thanks
If I have understood well

When the body becomes resistant to insulin, it tries to cope by producing more insulin. People with insulin resistance are often producing too more insulin than healthy people.

That mean Diamicron is problem for me not solution
I respond to metformin well

 

[HICHAM_T2]

I wish I can do that

 

[Hotpepper20000]

For some women a hormonal disorder called PCOS or poly cystic ovarian syndrome causes insulin resistance.

 

[Grateful]

The more I read about insulin resistance (IR) the more complex it seems.

It is clear that in Type 2 diabetes, the main issue (in the early stage of the disease) is insulin resistance. What "causes" this is up for debate, as the link provided by @helensaramay explains. What's for sure is that IR is associated with various lifestyle and other factors (also explained in the link).

We go into a vicious circle, as the pancreas responds to IR by producing even more insulin. If this cycle goes on for too long, the pancreas can eventually give up the battle in the case of a long period of badly controlled T2D.

However the whole mechanism behind the development of IR, and the direction of the cause-and-effect mechanisms, seem very mysterious to me. Whoever can figure that one out is probably a contender for a Nobel Prize!

That mean Diamicron is problem for me not solution.

I am not sure how you came to this conclusion about Diamicron (member of Gliclazide class). Can you explain?

 

[kokhongw]

What are the causes of insulin resistance?

Consider these papers
2008
http://www.diabetes.co.uk/forum/blo...-hyperinsulinemia-the-cart-or-the-horse.1919/

2011 Barbara Corkey
http://www.diabetes.co.uk/forum/blo...nemia-cause-or-consequence.1895/#comment-2391

2016 Dr Jason Fung, Amy Berger
http://www.diabetes.co.uk/forum/blo...insulin-resistance-scope-of-the-problem.1920/

 

[kokhongw]

Thanks
If I have understood well

When the body becomes resistant to insulin, it tries to cope by producing more insulin. People with insulin resistance are often producing too more insulin than healthy people.

That mean Diamicron is problem for me not solution
I respond to metformin well

Yes, you are coming to a logical conclusion that Dr RA Defronzo put forth in his 2009 paper...
http://www.diabetes.co.uk/forum/blo...e-treatment-of-type-2-diabetes-mellitus.1897/

Insulin resistance in muscle and liver and β-cell failure represent the core pathophysiologic defects in type 2 diabetes. It now is recognized that the β-cell failure occurs much earlier and is more severe than previously thought. Subjects in the upper tertile of impaired glucose tolerance (IGT) are maximally/near-maximally insulin resistant and have lost over 80% of their β-cell function.
In addition to the muscle, liver, and β-cell (triumvirate), the fat cell (accelerated lipolysis), gastrointestinal tract (incretin deficiency/resistance), α-cell (hyperglucagonemia), kidney (increased glucose reabsorption), and brain (insulin resistance) all play important roles in the development of glucose intolerance in type 2 diabetic individuals.
Collectively, these eight players comprise the ominous octet and dictate that:
1) multiple drugs used in combination will be required to correct the multiple pathophysiological defects,
2) treatment should be based upon reversal of known pathogenic abnormalities and not simply on reducing the A1C, and
3) therapy must be started early to prevent/slow the progressive β-cell failure that already is well established in IGT subjects.

A treatment paradigm shift is recommended in which combination therapy is initiated with diet/exercise, metformin (which improves insulin sensitivity and has antiatherogenic effects), a thiazolidinedione (TZD) (which improves insulin sensitivity, preserves β-cell function, and exerts antiatherogenic effects), and exenatide (which preserves β-cell function and promotes weight loss).

Sulfonylureas are not recommended because, after an initial improvement in glycemic control, they are associated with a progressive rise in A1C and progressive loss of β-cell function.

 

[HICHAM_T2]

Yes, you are coming to a logical conclusion that Dr RA Defronzo put forth in his 2009 paper...
http://www.diabetes.co.uk/forum/blo...e-treatment-of-type-2-diabetes-mellitus.1897/

Thank you sir for all this information

 

[Kentoldlady1]

The more I read about insulin resistance (IR) the more complex it seems.

It is clear that in Type 2 diabetes, the main issue (in the early stage of the disease) is insulin resistance. What "causes" this is up for debate, as the link provided by @helensaramay explains. What's for sure is that IR is associated with various lifestyle and other factors (also explained in the link).

We go into a vicious circle, as the pancreas responds to IR by producing even more insulin. If this cycle goes on for too long, the pancreas can eventually give up the battle in the case of a long period of badly controlled T2D.

However the whole mechanism behind the development of IR, and the direction of the cause-and-effect mechanisms, seem very mysterious to me. Whoever can figure that one out is probably a contender for a Nobel Prize!



I am not sure how you came to this conclusion about Diamicron (member of Gliclazide class). Can you explain?

Could not agree more. The root cause is so far not known. I have both hypothyroidism and t2d. As do most of the women in my mums family. This is not just an unlucky coincidence. We also have loads of other autoimmune nasties. If only it were as simple as being fat, or thin, or inactive... But the actual CAUSE is not any of these things. But I think we are getting closer to finding out.

I too, wold like to know yor problem with diamicron?

 

[HICHAM_T2]

I have four days without Diamicron but no deference just same results 114mg/dl. 116 mg/dl
I'm not a doctor but I think it's wrong to be described by a doctor like my case

 

[Grateful]

I have four days without Diamicron but no deference just same results 114mg/dl. 116 mg/dl.

I suppose, in your place, it would be a question of deciding which order to do things. Based on the information in your signature I personally would want to try something like this:

1. High HbA1c. Doctor prescribes Metformin and Diamicron (Gliclazide class).
2. Strong effort with diet/exercise. This is the stage you are now.
3. (Future hope) Progressive reductions in HbA1c (could take a few months, or could take longer).
4. (Future hope) Improvement is big enough so doctor now agrees to drop Diamicron. Now taking only Metformin.
5. (Future hope) Successive HbA1c tests shows good control is being maintained despite dropping Diamicron.
6. (Optional) Continue efforts, see if the Metformin can be dropped (with doctor approval)

But that is just what I would do if I were you. Doing it the way you are doing it now ("trying everything at once") could work just as well but it would muddle the factors because I would not be sure which things are the most important (diet? exercise? drugs?). There might also be increased risk in dropping a drug without medical advice.

I forgot to ask earlier: How long have you been taking the Gliclazide?

Congratulations again on strongly working to take control of your Type 2 diabetes.

 

[kokhongw]

I have four days without Diamicron but no deference just same results 114mg/dl. 116 mg/dl
I'm not a doctor but I think it's wrong to be described by a doctor like my case

when diagnosed 310mg/dl 2009 (age 30). the weight = 83KG
29-09-2017 HBA1C 12.80%
Blood Sugar 29-09-2017 282mg/dl Now 106 to 123
the weight = 60KG
Length = 186cm
Drug = Metformin + diamicron (Gliclizaide)

From your signature you have lost significant amount of weight over a very short time. I would suggest that you do some squats/push ups/weights to maintain/regain your muscle mass. This would also allow you to increase your complex carbs intake without having to worry too much about raising your glucose level too much.

 

[HICHAM_T2]

From your signature you have lost significant amount of weight over a very short time. I would suggest that you do some squats/push ups/weights to maintain/regain your muscle mass. This would also allow you to increase your complex carbs intake without having to worry too much about raising your glucose level too much.

How ?

 

[HICHAM_T2]

In looking at your stats it appears you had a normal BMI of 23 and very high BG 9 years ago. More recently you continued to have a high BG and a significantly lower BMI of around 17.

During this 9 year period did your BG remain at high levels AND were you attempting to lose weight or did it just "fall off"? I see your most recent BG is looking much better. That's good. But, a lot may have happened between 2009 and 2017 and it would be helpful to understand it better.

Assuming you have limited body fat you might want to consider macro nutrients of about 100gm carbs, 90gms protein and 200gms fat to get to a 2,300 calorie intake. That number is with mild activity. Increasing activity as Kokhongw suggested would require higher levels of calories, perhaps by increasing protein and fats. Building muscle through resistance training (low rep) will help to lower IR and bring up your BMI. You would do well to research and come up with your own numbers; mine are only examples.

BMI is a poor measure of health but, in this case, it is adequate enough to use as a talking point. The macro values are starting points based on my best guess using the limited information available.

Your body composition and metabolism are unique to you and therefore the best course of action will also be unique for you. That's something you'll need to figure out.

Best to You...

Thanks I really need to increase my weight

 

[HICHAM_T2]

During this 9 year period did your BG remain at high levels AND were you attempting to lose weight or did it just "fall off"?

Just fall off

 

[HICHAM_T2]

"A snake, a tree or a wall?"

So, to answer a simple but complex question with the simplest possible answer: "liver fat".

I was never fat because I had fat in my liver