Insulin resistance

I have been trying to understand what appears to be at the heart of Type 2 diabetes and that is insulin resistance. Put simply this is an inefficiency in the mechanisms controlled by insulin that remove glucose from the blood.

You aren't necessarily diabetic if you have insulin resistance (IR) but IR forces the pancreas to produce more insulin and it becomes a vicious circle until not enough excessive insulin is produced to efficiently to remove glucose from the blood effectively and it's the resulting high residual glucose that is personified in Type 2 diabetes.

But what exactly is insulin resistance? This was a mystery to me for quite some time but if I am right the answer is that it is several things. There is tissue IR, which is the reluctance by fat cells and muscle cells to respond to insulin and absorb and store glucose from the blood. But it seems that by far the most powerful factor is liver insensitivity to insulin. When the liver becomes insensitive to insulin it adds too much glucose when there is demand and doesn't shut off the supply as quickly as it should when the demand subsides.

So how do you improve insulin sensitivity? It seems that for muscle and fat tissue exercise to maintain or increase muscle mass and losing weight, perhaps to add sugar storage capacity to fat cells, are the obvious strategies? I'm not sure that's exactly correct and where that's the case I'd love someone to clarify this. For liver insensitivity to insulin it appears that exercise and muscle building are again important because of a link to human growth hormone (which acts on Insulin-like Growth Factor (IGF)). I don't fully understand the mechanism but IGF receptors in the liver trigger the liver's glucose production but the receptors don't work properly when the liver is insulin resistant.

So I'm now speculating completely - but this problem with the IGF receptors in the livers of insulin resistant people seems to be linked to fatty livers (which have become fatty because of eating more carbs than the body cab deal with and some people have lower carb thresholds than others.

I do, therefore, wonder if the benefit of getting rid of fat in and around the liver to reverse diabetes factors (like the Newcastle diet) to a degree involves the de-fatting of these IGF receptors?

If anyone would like to jump in here - you're most welcome!

phil169 said:

if what you are saying is right then why do I have inherited type 2 which is uncontrolled at this time ???????????

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Well I have a combination of genetic predisposition and historical overweight thanks to a lack of physical activity and large portion sizes which I apportion some blame on following traditional advice of following a low-fat diet.

I don't really know much about your situation as there isn't much detail in your profile but you do indicate that you are on lots of medications. I think it's fair to say that for most of us T2s diet is a major - maybe THE major - factor in control. Traditional and, sad to say, current advice in the UK is to reduce carbs but not by, I feel, anywhere near low enough. It's quite common even here where we are well-informed to find people wondering they have sky high BGs after eating things I'd avoid like the plague. I'm not saying that's you (I have no idea at all what you eat) but I think it's fair to say that many T2s are not reducing their carb intake enough and not consistently enough.

Again I'm not giving you a guarantee, but people how do low carb successfully and who started out on medication do sometimes improve to the point that they can come off their medication. But everyone is different and variables include the physical state of your body and the liver and pancreas in particular and your weight, fitness, activity, etc.

AndBreathe said:

@vit90 - At a high level, I agree with you that IR is utterly fundamental to the mechanism of T2, and Professor Taylor (or if my memory is worse than I thought, it might be Professor Zikaris) demonstrates this with a bicycle, with pedals rotating, but unable to liberate energy to the rear wheel, which made all manner of sense to me.

It is my personal belief, that for me, IR was my major, if not only problem. I started with pretty big numbers, and over time, aligned to improved (carb controlled) diet, resultant weight loss and further resultant reduction of day-to-day blood scores, I have achieved a few back to back non-diabetic HbA1c test results. I am otherwise healthy, and believe my crucial organs (liver, pancreas, and their management mechanisms) just got so out of synch they lost the plot, and lost the battle against glucose control, for me.

I have often said that diabetes is a portfolio disease; a bit like arthritis, asthma or hypertension, where one label actually gives a readily understood (and often misinterpreted) description of a wide range of conditions, albeit each with some common signs and symptoms.

I don't like labels, and with diabetes; and T2 in particular, it seems like a really very wide range of conditions are lumped under one banner. I'm sure as research progresses, more categorisations will emerge; a bit like they have done for LADA, T1.5, MODY, and probably others I have never heard of.

@phil169 - how do you mean your diabetes is currently uncontrolled? How long have you been diagnosed, and what steps/medications have been tried to get your condition into a better place? Vit90, apologies if this last bit is OT, but if it develops, it could become a thread of its own.

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No problem at all -

This guy seems to make a lot of sense and it's reassuring to note that I am doing most of what he advocates: