Question for you experts!

[Kathy1960]

This doesn't apply to me, but something I have been wondering about. I know that type 2s sometimes use insulin. Just wondering how this works if you have insulin resistance? It's bound to be more complicated than I understand, but how does extra insulin help with the absorption of glucose when your cells are resistant to it? I understand that type 1s don't produce their own insulin and therefore need to inject it - but they don't have insulin resistance do they?

 

[Ljc]

Hi. Us T2s on insulin may need more units of insulin to overcome any insulin resistance. ATM I need around 1.50 units per 10 carbs, other T2s may need a higher ratio the me. Some people who are T1 may only need a 1 in 10 ratio.
Just to make our lives er interesting 😉 🙂 with all flavours of D who use insulin , our ratio's can change quite often, sometimes it just depends on which way the wind is blowing 😱.

 

[Robin]

I think what happens when you need insulin as a Type 2, is that your pancreas has become worn out and is producing less insulin, or just can't produce enough insulin because it needs to produce a lot extra to try and overcome the insulin resistance. So it needs a helping hand from an external source of insulin. People with Type 2 who are on insulin normally also continue with Metformin if they can tolerate it, to help overcome the insulin resistance.

 

[DaveB]

Hi. Taking insulin when having high insulin resistance may not be the best way to manage it due to the high doses needed. Surely having the right diet to get that insulin resistance lower may reduce or even eliminate the level of insulin needing to be injected. I'm sure some won't agree with this view. Some so-called T2s with low insulin production may well be LADA and not T2 anyway.

 

[mikeyB]

Yes, Dave, diet, weight loss ( especially round the middle) will reduce insulin resistance. (My consultant told me that, so it must be true). I agree with your last point as well.

 

[KookyCat]

Hi Kathy

The simplest way to describe it would be if you imagine that someone is water resistant, if one glass of water an hour is needed by the body then a person who can only absorb fifty percent of it would need two glasses to get the same effect as everyone else, if the resistance is higher and they only absorb 25% they'd need four glasses to do the same job. The same is essentially true with insulin resistance, if resistance is at 50% you'd need twice the normal amount of insulin to use the glucose, if it was at 25% you'd need four times the amount and so on. The pancreas can't cope with continuous overproduction of insulin, it isn't made for that kind of intensity. Insulin therapy in that instance is topping up the job done by the pancreas. Undoubtedly decreasing the resistance to insulin is the key to treating the condition, the insulin is just managing the impact of the resistance because the body is unable to manage naturally.

Sensitivity to insulin is not static or standard either. I have the opposite problem, I'm super sensitive to insulin, so the amount of insulin I inject for a sandwich wouldn't be nearly enough for most other people. Sensitivity is increased (and resistance decreased) by oxygen, if you get oxygen into muscles for example they are much more receptive to insulin, you increase oxygen by increasing blood flow, you increase blood flow by making your cardio vascular system work for its keep, namely exercise. Fat cells are aggressively anti insulin, they put up a barrier that makes it difficult for the insulin to get through, so the less fat there is the more sensitive to insulin you are. There's also a fair bit of evidence to suggest that excess levels of circulating insulin also increase insulin resistance which is why some medical folk describe type 2 as a progressive condition. Part of what they mean is that resistance is progressive, the more resistant you become the more insulin is floating around, the more insulin there is floating around the more resistance your body builds. I'm massively over simplifying some very complex biochemical interactions so apologies to the scientists on the forum!

It also needs to be said that some folk can carry a lot of additional padding and indulge in little to no exercise and not develop resistance to a level that is dangerous or compromises blood sugar control, and some folk with little to no extra padding and a joyously vigorous exercise regime still encounter resistance issues. It's also been shown that some people have high resistance levels, and overproduce insulin but maintain blood sugar control for much longer than others. This is currently occupying the minds of some brilliant research scientists so nobody really knows the definitive answer. Body fat and exercise are pivotal, but they are most certainly not the only factor and the jury is still very much out about about whether they are a causative agent or merely a symptom, but I won't start that debate off at this time in the morning, least not before I've had my porridge 🙂

Quick side bar, people with type 1 can be insulin resistant, as can people who are not diabetic but in general it wouldn't be as extreme. That why diet, exercise and body weight are important to everyone with or without diabetes. Hope I haven't confused you even more, if I have feel free to ignore my ramblings 🙄

 

[BigMalc]

Thanks for the KookyCat, that possibly helps explain why I've had a few night time hypo's recently.

I'm T2 and on insulin and for 2017 have started being much more active and controlled and even having reduced insulin levels have had a couple of late night 3's, (which due to the hour or so of lost sleep has meant I have missed a gym session in the am!). So it could easily be that I am carrying a lot more oxygen round as am exercising 5/6 times a week rather than 2/3.

Back to a libre to do a better study.
Cheers
Malc