What makes someone

[gail2]

Insulin resistant? i have been told that im very insulin resistant. this is one of the reasons that they will not up my insulin any more im currently on 120 units of insulatard
gail

 

[AlisonM]

I just did a quick Wiki and there's a bit of a list but the first item on it is diet, closely followed by a sedentary lifestyle.

 

[Robster65]

http://en.wikipedia.org/wiki/Insulin_resistance

It's a fascinating article and dispels a few myths while explaining (too deeply for me in places 🙄) how all the factors interplay.

It seems that once you are prone to resistance, it's very difficult to snatch yourself back from the brink of the weight gain without going on a crash diet and hard exercise. So, gently easing into the normal T2 remedies could actually send you sliding further down the slope.

Maybe why early insulin use gives better results because it crashes the BGs back into range before the metabolism can coat the organs in fat, reinforced by the insulin reistance itself. A self-reinforcing spiral that is harder to get out of, the further down the line you are.

If I've understood it correctly (ish).

Rob

 

[hotchop]

My dsn told me last week that i was insulin resistant and the only course of action was to include novorapid into my routine as levemir on its own wasnt working. ( im not overweight and i regularly excercise... i mention this as weight is usually a factor in resistance)

i was on 70 units of levemir... add novorapid into the mix and im now down to 20 units of levemir and maybe 22 ish units of novo

 

[Northerner]

i was on 70 units of levemir... add novorapid into the mix and im now down to 20 units of levemir and maybe 22 ish units of novo

That's a very interesting change of therapy and puts you on quite a low total dose from what I have read of other Type 2s requiring. I wonder if all HCPs are as clued up on the potential for such a regime?

 

[Robster65]

As the 600 cal diet test showed, and it seems to say in the wiki article is that it's the internal fats around the organs, particularly pancreas and liver, that raises resistance, which as far as I know, is what makes someone type 2. The reduced pancreatic function which usually develops presumably comes from an exhaustion of the beta cells from having to output so much insulin to overcome the resistance.

The article also says that saturated fats are the main culprits for depositing fat around organs and that the polyunsaturated fats with omega 3 fatty acids seem to undo the harm the saturated fats do.

So presumably, a diet rich in omega 3, such as oily fish, would actually help to lower resistance in the same way as exercising to burn off excess fat.

But I suspect I'm seeing it a bit too simplistically.

Rob

 

[Northerner]

...
So presumably, a diet rich in omega 3, such as oily fish, would actually help to lower resistance in the same way as exercising to burn off excess fat.
Rob

Cue for a poem about oily fish!

Oh oily fish! Dear oily fish!
By far and away my favourite dish!
Infuse me with your Omega 3,
Please oily fish, come dine with me!

Oh, take away my chicken bhuna!
Replace it with a slab of tuna!
And though I love the taste of gammon,
I'd much prefer some Scottish salmon!

Imagine eating with every course
Some pilchards in tomato sauce!
If every herring could be mine,
Then life on Earth would be divine!

So, fill me up with oily fish!
Believe me, it’s my dearest wish!
My heart’s desire, where have you been?
Embrace me now, oh plump sardine!

 

[hotchop]

I questioned it when I saw her and she explained that the Novo "carries" me through the daytime and I now take my Levemir at night.

My waking is around 5 mmol and random tests during the day are very similar.

Before the Novo, my waking was around 10 mmol even with 70 ish levemir.

I was amazed!!

 

[mcdonagh47]

As the 600 cal diet test showed, and it seems to say in the wiki article is that it's the internal fats around the organs, particularly pancreas and liver, that raises resistance, which as far as I know, is what makes someone type 2.
So presumably, a diet rich in omega 3, such as oily fish, would actually help to lower resistance in the same way as exercising to burn off excess fat.

But I suspect I'm seeing it a bit too simplistically.

Rob

Insulin Resistance in Type 2s can also have a physical basis. Insulin grabs a molecule of glucose and takes it to a cell. The insulin pops the glucose into a receptor base. The insulin then has to tether itself to the insulin receptor port and when it does that, signals go down to the nucleus of the cell and Glucose Transporters (GLUTs) swarm up to punch a hole in the cell wall and take the glucose into the cell. The insulin tethered to the receptor port is either released to float off again or is taken apart and assimilated into the cell wall.
Powerful scanning microscopes have shown that in some T2s the insulin is malformed, lacking the tethers or just having stubby tethers, that it needs to tie itself to the cell and signal the cell that a delivery of glucose is waiting. With no signal being given, both the insulin and glucose just drift off.
So some IR in T2s is created by physically defective insulin - that's one reason injected insulin works well for most T2s - its always perfectly formed.

Other research into IR has looked at the GLUT transporters inside the cell and the signalling to them. One of them, GLUT4, has been suggested as a culprit that's not doing its job in some instances of IR.

The current research on the 600 calorie diet just looked at production of insulin in the Beta cells and didn't address IR at the level of the cells (presumably). That might help explain why the drastic diet didn't work for 40% of the participants.

The other issue with it is that T2s have no problem making insulin but it isnt being used. So why reduce the fat in the pancreas if IR will still cause major problems at the cell level ?

__________________

 

[Robster65]

That seems to make sense. Thanks for the additional info McDonagh. So, as with most illnesses, a range of possible factors in various combinations.

So, presumably, the low fat/low carb and vigorous exercise won't necessarily do didly squat for those with genetically deformed insulin, etc.

Which would make them more like a T1.5 in treatment options. Some functional insulin but in one case, a lack of consistent production and in the other case, a lack of functional insulin.

I think. I wonder how many GPs, DSNs or even consultants have a good grasp on how the different types overlap or differ and why.🙄

Rob

 

[mcdonagh47]

That seems to make sense. Thanks for the additional info McDonagh. So, as with most illnesses, a range of possible factors in various combinations.

Rob

That's what we were always told in the 1990s - Type 2 Diabetes is probably half a dozen different illnesses with a common symptom.

The article below concentrates on the signalling failures inside the cell as a cause of IR, so that the GLUT4 (Glucose Transporter) isn't told there is glucose waiting on the cell wall to be brought into the cell....

http://www.nejm.org/doi/full/10.1056/nejm199907223410406

 

[Andy HB]

I suspect that my diagnosis came about primarily because I was insulin resistant.

However, it did seem to 'reverse' (I use that term carefully!) quite quickly for me when I exercised regularly and lost weight at a rate of a little less than 1lb/week.

I cut out a lot of saturated fat (am no longer the cheddar cheese junky that I used to be!).

My scales seem to indicate that the levels of fat around my internal organs has reduced considerably (something born out by my last liver scan showing a clean result after initially having some fatty deposits in it).

Andy 🙂

 

[Robster65]

The dietician told me I needed to reduce my saturated fat but didn't really explain why. The assumption was for heart health, as it is for everyone. Had she said it's because it makes you insulin resistant, I may have taken it more seriously.

As it turns out, my doses are not too high, mainly due to being quite a busy little bee most of the time, but come winter I may be in bother

Rob

 

[Lula]

Brilliant poem northerner!! In my case its fairly true 🙂

(sorry I don't have any wisdom to add on the matter of insulin resistance, just liked the poem!)

 

[hyper-Suze]

The dietician told me I needed to reduce my saturated fat but didn't really explain why. The assumption was for heart health, as it is for everyone. Had she said it's because it makes you insulin resistant, I may have taken it more seriously.

As it turns out, my doses are not too high, mainly due to being quite a busy little bee most of the time, but come winter I may be in bother

Rob

Oh no!!! 😡

I've just stocked up my fridge with Seriously Cheddar while it was on Tescos buy 1 get 2FREE!!!!

And I'll be damned if the dog gets all this lovely cheese...my TR/heart health will have to suffer for another few weeks!

 

[RachelT]

I had heard of genetically deformed insulin before, that's interesting (thinks maybe this is why i'm diabetic and my more overweight relatives arn't). Everything i've read says insulin resistance is all about body fat, but i guess new research is going on all the time.