How do you know if you have insulin resistance?

[Microbe99]

Hi All,

Just trying to understand my new status as LADA and was wondering how you know if you have insulin resistance?
Is it by the doses of insuin you have per day?
Or is it something else?
Tia

 

[boggle]

We all have some degree of insulin resistance. Time of day can affect insulin resistance. You might teed a higher bolus for a morning meal Temperature too. Extra weight causes more insulin resistance.

Not a doc, but I'll hazard a guess that you would measure insulin and bg circulating in the body (probably in a fasting scenario)and be able to make some rough guess on the level of resistance (after ruling out T1 etc).

 

[Marie 2]

LADA is type 1, Type 1's don't usually have insulin resistance per see. You are slowly losing the ability to make insulin until you stop completely, so over time you will require more and more insulin. That's what we call the honeymoon period and it can take up to 8 years plus to completely happen. And it can make your dosing a little irregular as sometimes you make more insulin and sometimes you don't. You can have insulin resistance as a type 1, but it is more likely to happen over time, if it happens. At the beginning starting to take insulin can cause weight gain because before you were taking insulin, you weren't actually utilizing all the food you ate, so you are now actually eating more than you need? Which then leads to weight gain and hence more insulin is then needed.

There are issues that can be a temporary cause to needing more insulin. There is no wrong amount for a type 1, it's whatever you need to keep your BG levels in control. But there is something called DP (dawn phenomenon) and FOTF (foot on the floor) which are hormone releases in the morning that can cause you to need more insulin when you first get up and a few hours after, Some people notice with higher temperatures, stress that your needs can go higher or lower. Infections/illness can raise your needs. Exercise helps you utilize insulin better, so it helps lowers your need and your BG level can drop and make you go too low if you haven't allowed properly for it.

I suppose to judge insulin resistance, it might be able to be determined on how long it takes insulin to work .................but so many things affect us, what you eat, our activity level, and being in the honeymoon stage which is an erratic production, would sort of make that harder to figure. And I know the higher the level my BG is at, the more insulin I need to get it to come down. Not an uncommon complaint.

Best words of advice.........when on insulin always carry a hypo treatment at all times with you and also keep it by the bedside too. Even long term type 1's need it sometimes.

The other thing is to take the amount of insulin for what you actually eat. Don't develop a habit to have to eat for what amount you took. Learn to carb count if you haven't already so you can dose accurately. And then it becomes a matter of timing. I take some as a prebolus and then the rest when I eat so I can adjust that second dose to what I actually ate.

 

[Microbe99]

Thanks for the comprehensive response its much appreciated.
The reason I ask is my dn is saying I'm more likely to be LADA than type 1 as I was diagnosed more than 10 years ago and LADA is somewhere between type 1 and type 2 requiring insulin but also having insulin resistance.
I currently take 17 units of Tresiba a day plus about 16 -18 units of Fiasp which I understand is not a high requirement so I was thinking this does not indicate insulin resistance but am not sure.
I am seeing a consultant on 15th to discuss so may have more info then.

 

[EllieM]

Not a doc, but I'll hazard a guess that you would measure insulin and bg circulating in the body (probably in a fasting scenario)and be able to make some rough guess on the level of resistance (after ruling out T1 etc).

As @Microbe99 is LADA, they are presumably taking some insulin already?

It's an interesting question. I googled but didn't find out anything conclusive.

As a long term T1 I find it hard to believe I'm producing more than miniscule quantitities of insulin after 50 years, so I reckon I'm a bit insulin resistant because my insulin ratio is 1unit to 3g carbs rather than the 1 to 10g that new diabetics seem to start at. But my consultant denies that I have double diabetes. Maybe because I'm still on less than 50 units a day?? (By virtue of eating 100g or less a day, though). And some T2s end up on literally 100s of units a day, which definitely makes my dose seem not desperately high.

I currently take 17 units of Tresiba a day plus about 16 -18 units of Fiasp which I understand is not a high requirement so I was thinking this does not indicate insulin resistance but am not sure.
I am seeing a consultant on 15th to discuss so may have more info then.

It doesn't sound like a lot but of course we don't know how much of your own insulin you are still producing. I would be interested to hear your consultant's take on it.

 

[Marie 2]

Those are not high doses at all. I take Humalog in a pump so it's my basal and bolus and I average about 45 units a day. My basal is 21 of that and my bolus makes up the rest. I have never been told I have insulin resistance and I have had 3 endos. I am considered very well controlled. An A1c of 30 and a TIR of 96%, I eat what I want and for me I am a vegan so it's always vegan. I have been a Type 1/LADA for 19 years.

General rule of thumb;
Total Insulin Daily Requirement per San Fransisco University (It's about half way down the page)
Weight in pounds divide by 4, weight in kilograms times .55
That's just a starting guideline, it can vary depending what you eat, health, stress levels, activity and your weight etc.

https://dtc.ucsf.edu/types-of-diabe...e-1-insulin-therapy/calculating-insulin-dose/

 

[Deleted member 527103]

I wonder what difference it makes whether you have insulin resistance or not when you have Type 1/LADA.
You take as much insulin as you need ... and your doses do not appear to be very high.

 

[Fenn]

I also have been wondering about this, I think it would be very difficult to gage IR from insulin amounts per day as it would depend what we eat that day. Carb ratio would be better I think, we can’t use being overweight either as everyone carrying weight would be prediabetic or worse.

 

[Oldvatr]

I am not an insulin user, but this study may be elevant to this question.
https://eje.bioscientifica.com/view/journals/eje/173/1/101.xml

 

[Microbe99]

I wonder what difference it makes whether you have insulin resistance or not when you have Type 1/LADA.
You take as much insulin as you need ... and your doses do not appear to be very high.

Agreed, it's just that my dn seems to be making a big difference between LADA and type 1 which I don't see on here or understand. As far as I was aware it's a matter of timing of diagnosis rather than anything else much.

Do I consider myself as type 1 or not?

 

[Deleted member 527103]

LADA seems to be loosely defined.
When I was diagnosed nearly 20 years ago, no one had heard of it.
Then I became aware of it as a description of Type 1 diagnosed as an adult. The main difference being that it comes on slowly (adult beta cells seem to be a bit more resilient than child ones). For this reason (and the falsehood that Type 1 is a childhood disease), Type 1 for adults is often confused with type 2.
More recently, I have seen LADA being described as a cross between Type 1 and type 2. I assumed this was because it came on slowly. However, there now seems to be an association with insulin resistance. I am not a doctor and am not interested in reading research papers that require a medical degree to understand. So I don't know what is the official definition for LADA. But I do notice that neither do health care professionals. Or at least, different hcps use different definitions.

 

[Daibell]

Thanks for the comprehensive response its much appreciated.
The reason I ask is my dn is saying I'm more likely to be LADA than type 1 as I was diagnosed more than 10 years ago and LADA is somewhere between type 1 and type 2 requiring insulin but also having insulin resistance.
I currently take 17 units of Tresiba a day plus about 16 -18 units of Fiasp which I understand is not a high requirement so I was thinking this does not indicate insulin resistance but am not sure.
I am seeing a consultant on 15th to discuss so may have more info then.

I don't agree with that. Although LADA can come on gradually in middle age it will end up the same as T1. Being LADA does not imply insulin resistance any more than it does with T1. LADA can have other causes such as viruses than T1 auto-immunity but it's T2 that's likely to have an insulin resistance cause. I have my body fat checked in the gym.

 

[Marie 2]

LADA is just a description of slow onset "Latent Autoimmune Diabetes in Adults" in type 1's. You have the auto immune response of your beta cells being destroyed. While LADA is used as a description, once you test positive for the antibodies (which I believe you did) it automatically puts you into the category for treatment in the medical field and insurance purposes in the US as a type 1. The end result is the same whether you get it as a kid or adult.

 

[Microbe99]

Thanks again all for the feedback, I'll see what the consultant says next Friday and will feedback.

Until I get told otherwise I will consider myself as type 1!

Are there any insurance or driving issues of being type1 vs type 2 on insulin?

 

[Deleted member 527103]

Are there any insurance or driving issues of being type1 vs type 2 on insulin?

You must tell you insurer and DVLA if you have any type of diabetes treated with insulin.
Your insurer should not change anything (but failure to tell them may make you uninsured).
The DVLA will change your license to a 3 year one which requires approval from a doctor.
You will also need to test every 2 hours when driving to prove you do not have a hypo.

 

[Antje77]

LADA can have other causes such as viruses than T1 auto-immunity

The first A in LADA stands for autoimmune.
It is believed that T1/LADA can be triggered by viruses but it's still the immune system killing the beta cells.

If the reason for not producing (enough) insulin is damage to the pancreas from any other cause than an autoimmune attack, it's type 3C, not LADA.

 

[Microbe99]

Went to hospital for appointment with diabetes consultant on Friday and he said I'm type 1.
My c-peptide is so low that its irrelevant, I'm now entirely dependant on injected insulin.
He did not think I was showing signs of insulin resistance but thought I was quite sensitive to insulin which may be due to my taking metformin.
He also recommended that I continue with metformin as it seems to provide some protection from heart and renal disease.
I've been set a target for A1c of low 50s which I last achieved in 2016, I'm 62 now so I've got some work to do.
All good, thanks all for your helpful feedback

 

[Marie 2]

It'll be easier now, honest. I was misdiagnosed for years as a type 2. Once you know you need insulin for everything, even a bowl of broccoli, control becomes a process of learning how much you need for what. There is no set amount to use, it's what you need to keep your blood sugars in normal ranges. Good Luck! I'm glad you finally got a doctor that knew what he was doing!