Insulin Resistance

My understanding is
- Type 1 is the pancreas not producing any (or, during the honeymoon period, enough) insulin
- Type 2 is the body unable to effectively use the insulin the pancreas is producing. This inefficiency may reach the point that the pancreas cannot keep up with the insulin demands and, hence, not produce enough insulin for the body's needs.

In other words, producing not enough insulin is as a result of bad insulin resistance.

On the other hand, I have type 1 so I may have this wrong.

Although there are tests for IR, these are cumbersome, and 'markers' for IR are used instead.
Those with too much excess weight are likely to have developed IR.
Those with Metabolic Syndrome are likely to have developed IR.
Those with a bad TG/HDL are likely to have developed IR.
https://www.escardio.org/Journals/E...io-as-surrogate-marker-for-insulin-resistance
This is why metformin is a 'favourite' of GPs and DSNs on diagnosis, as it helps with IR.
Geoff

This is actually a really good question. The best explanation I've ever heard is that:
Type 1 is an autoimmune disease that causes your body to kill off your insulin-producing pancreas' beta cells. The ultimate result is people have no endogenous (natural) insulin production.

Type 2 is actually an unclassified group of diabetes types rather than caused by something specific.

To the OP's point: In theory, someone could have 0 natural insulin production but not be type 1. Furthermore, someone can have type 1 and insulin resistance.

It's for similar reasons why some people can control their type 2 diabetes with diet and exercise while others run marathons, yet are insulin-dependent.

Mr_Pot said:

Type 2 diabetes is either the pancreas not producing enough insulin, or the insulin that is produced is not used effectively (insulin resistance), or possibly both.
I see a lot of posts on here where people say they have very bad insulin resistance or they want to reduce their insulin resistance or similar comments, but how do they know that is the problem rather than lack of insulin production? Is there some way to tell?

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There are tests available, but NHS is unlikely to provide them
IR test https://www.medichecks.com/diabetes-tests/insulin-resistance-test

I think the GAD and C-Pep tests determine insulin production

Many people find they are more IR at the start of the day, and the easy test is to have a measured amount of carbs in the morning, and same in the evening, measure the increase BS over 2 hours for both meals.
I will wager the evening meal results in a smaller increase

Mr_Pot said:

but how do they know that is the problem rather than lack of insulin production? Is there some way to tell?

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Actually there is a simple fasting insulin test for T2D that can tell us if we have low, normal or elevated/high insulin levels.
https://www.facebook.com/thenoakesf...695104938116/1030397243734567/?type=3&theater


It is very unfortunate, but the term insulin resistance is often framed in the context of ineffective insulin. This somehow downplays/ignore/overlooks the fact that T2D is often a condition of high circulating insulin/IGF1 level for many years, until the point of betacells exhaustion.

Joslin Center describes it rather well...
http://www.joslin.org/info/what_is_insulin_resistance.html

The person's body may not be producing enough insulin to meet their needs, so some glucose can't get into the cells. Glucose remains in the bloodstream, causing high blood glucose levels. In many cases, the person may actually be producing more insulin than one might reasonably expect that person to need to convert the amount of food they've eaten at a meal into energy. Their pancreas is actually working overtime to produce more insulin because the body's cells are resistant to the effects of insulin.

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And of course Dr Jason Fung put's it in a clear laymen context
https://intensivedietarymanagement.com/my-journey/

Then came the inescapable, horrifying conclusion. We, as doctors, had been treating T2D exactly wrong. And that is why I have started this journey. Because with the proper treatment, T2D is a curable disease. T2D is a disease of too much insulin, just as obesity results from too much insulin. The treatment is to lower insulin, not raise it. We weren’t just not treating T2D, we were making it worse.

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This explains why the low carb high fats and intermittent fasting approach works particularly well for so many...

But this is typical for obesity related T2D, not those that are triggered by steriod use or other conditions.

Mr_Pot said:

Type 2 diabetes is either the pancreas not producing enough insulin, or the insulin that is produced is not used effectively (insulin resistance), or possibly both.
I see a lot of posts on here where people say they have very bad insulin resistance or they want to reduce their insulin resistance or similar comments, but how do they know that is the problem rather than lack of insulin production? Is there some way to tell?

Click to expand...

My consultant has checked and reconfirmed I'm severely insulin resistant. I inject huge amounts of insulin which would normally kill someone outright. I think this is how they know I'm severely insulin resistant and not just suffering with some small degree of IR.
Being of a heavy weight this makes any medication susceptible to difficult absorption. That is why clinic weigh you. So the heavier the person the more resistance. Only with overweight diabetics. Not none diabetics. Some large/overweight people do not suffer with IR. (None diabetics).
Now people who don't inject can still have severe insulin resistance but with weight loss, exercise and good diet it can be managed and supported by tablets. Everyone is different. Some people have only a little insulin resistance but poor quality insulin made by their body or none causes severe high bgs, hence insulin injections and tablets.
You can find out how insulin resistant you are by following weight loss plan, exercise and have a well balanced diet to manage your diabetes but if more is needed the more the severity of the IR.
Some sufferers can even reverse their IR with enough weight loss and low carb eating. With occasional fasting to keep the calories down to less than 600. 800 as a compromise.
We are finding out more and more about IR and clever drugs like metformin working in the gut to suppess appetite I hope is just the start.
Hormones found in the gut of bariatric surgery patients are opening new light onto the subject too.
Leptin resistance can mar insulin resistance reversal. They are closely connected.

mr_Pot said:

I am sure that test would work because I eat a lot more carbs in the evening than at breakfast with a similar raise in BS. However I still don't know if it is my IR that is changing or the amount of insulin I am producing.

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Insulin is released as long as its produced, as of stored glucose in liver, other organs and muscles. They balance each other out but in IR the insulin is blocked and glucose can be over released due to confused messages from the cells in the pancreas. High bgs due to lack of insulin and oversensitive liver (liver dump) even when blood sugar levels are perfect. Metformin also works in the liver to limit the over secretion of glucose.

If your bgs are higher or lower than it would normally be for you then IR is the cause. Glucose and insulin release are intermittent not working constantly. IR takes days to change, months or years.

I'm slim and I am insulin resistant but I was a bit over weight when I was diagnosed and I have had a few tests to double check that I am a t2 diabetic and that I need insulin to keep me going and I am taking just under a 100 units of insulin a day over 4 injections but before I was placed on this regime I was on 2 injections a day a taking 120 units a day and that was to overcome the resistance of the insulin and I know others that take way more than that a day because of it and my pancreas is preducing some insulin as well and I am unable to use the insulin from my pancreas so that is how I am ir to insulin as well

Mr_Pot said:

I don't think that is correct. Insulin is produced by the pancreas in response to the increase in glucose in the blood, it's certainly not constant.

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You are right. Ive editted to explain. Of course your right.

@Mr_Pot if you were not producing insulin you would waiver on suffering with ketoacidosis with very high bgs indeed. Coma or death if untreated.

This is a very interesting question you asked and I for one will admit that I haven't a flaming clue what I've got in respect to your question on insulin resistance. These two words have never been mentioned by my GP or diabetic nurse, so It would be nice of them to explain exactly where I am in relation to this cos I've always assumed i'm not producing enough insulin and that's it

I found out that I was via the amount of insulin I am using and the dsn and the doctor at the diabetes centre and I had the tests done when I was diagnosed about 23 yrs ago and the test last year when they checked so the answer is you get told and you can guess by the amount of insulin you take but not the second one always and I only guessed before I got told off the nurse of it a few years ago and I have tried to make the most of it by using less carbs in my diet but I still am resistant to the insulin and use more when I have to boost up the doses about every 2 weeks or so as I do that myself but I usually give my body a couple of weeks to settle down before the next dose goes up

I wish there was more drugs that helped with IR like metformin around. Some poor people cannot tolerate it.
I normally can but even I couldnt 2yrs ago but re-introduced it back after a whole yrs break. Ironically I lost weight but my bgs were 22s etc.
We need a drug like what statins do to the arteries. A drug which blocks the damaging effects of high bgs but with the benefit of weight loss which comes with high bgs. Like a protection for organs and vessels from high bgs. Then no testing nor injecting for type1s and 2s. It wouldnt matter if we had high bgs or not if protected by something/a wonder drug.
Although that would solve complications from fiabetes but not insulin resistance. IR adds weight on people, it complicates the hormonal factory in our body. It causes pcos and other hormonal problems. We are just finding most of its damage now.
Metformin is the best drug for helping to reduce insulin resistance.
Some may argue 'and any weight loss medication'.

I've been on metformin before with the maximum dose of 3mgs a day or 6×500 mgs a day and not even that stopped the insulin resistance nor did it with the glimapride 6 mgs a day as well as they would have helped with the ir but it only added weight on me and in the long term the doctors took me off everything except the insulin and changed that over from 2 injections to 4 injections a day and I am waiting to see if the insulin needs to go up again in a couple of days time as I am getting a mixed bag of results to play with and I need to work it out if I should change it again but I know that I haven't put anymore weight on so that is good for a change due to the insulin amount but later on in my years they may sort out the insulin resistance part out eventually we all hope

I mentioned weight loss medication because in the 80s my mum's gp orescribed appetite suppressants. Only safe one I know is xenical which is orilstat.
Others were taken off the market due to heart damaging side affects and not close enough medical supervision.
Maybe more weight loss meds are needed afterall?