I'm highly insulin sensitive, but my blood sugar can go abnormally high and stay high- why?

i thought type 2’s were supposed to be insulin resistant. i’m not type 2 yet, but i can get blood sugars that go to 200. i was A1c 5.9 years ago eating lots of whole grains and exercising. losing 15 pounds low carb got me to 5.7. cutting out fruit and increasing fat made me gain some weight back, but my A1c is 5.3 now.
i had my fasting insulin done: 3.5 and my fasting glucose: 85. my homa-ir is 0.7, which is supposed to be great. why then do i have a lot of abdominal fat in comparison with the rest of my body? in a glucose tolerance test i took, my blood sugar was 128 two hours later. my hypothesis is that i don’t produce a lot of insulin, but of what i do produce, i use it well- hence sensitivity. these results match research on people who have the risk allele for the TCF7L2 gene, which is the risk allele most highly predictive of type 2 diabetes using current research. the problem is insulin insufficiency, not overproduction.
"The single nucleotide polymorphism (SNP) within the TCF7L2 gene, rs7903146, is, to date, the most significant genetic marker[6] associated with Type 2 diabetes mellitus (T2DM) risk. SNPs in this gene are linked to higher risk to develop type 2 diabetes,[7] as well as gestational diabetes.[8]“wikipedia
"The TT genotype was associated with decreased insulin secretion but not increased insulin resistance at baseline.” from ‘TCF7L2 polymorphisms and progression to diabetes in the Diabetes Prevention Program’. I am CT.

May I welcome you to the group. But your post Is way above my head. Sorry, I am not much help.Nancy

I’m pretty sure you’ve answered your own question! For what it’s worth, I have a similar profile (although I’m “officially” LADA): insulin sensitive, low A1c (last was 5.1), very, very low fasting insulin, but will go high after exercise or eating. I’m on Metformin, eat a moderate carb diet (about 70-100 net carbs per day, with high fiber intake), and exercise pretty intensely. I had to increase my carbs because I couldn’t maintain weight eating low-carb, even on a 3,000+ kcal per day diet.


Why not increase good fats like avocado and nuts to gain weight

Actually most people find that while on a very low carb diet calories don’t matter. And you can eat literally crazy amounts of fat without gaining weight. Check out this story.

I did, you can’t eat less than 30g of carbs without eating an enormous amount of fats. I was eating 3,500 calories per day and losing five lbs per week. Sometimes, it’s just a matter of insulin deficiency (which in my case was exacerbated by not eating carbs).

There are a handful of us who can’t eat very low carb without exogenous insulin, because we get in this nasty spiral of unintended (and dangerous) weight loss. As my doctor put it, “your pancreas works just well enough to cause you some problems, and not well enough to cause you more problems.”

Although I’m still waiting on the endo to get back to me (my last A1c put me literally on the bottom of the list for getting in to see her), I suspect the long-term solution will be starting on very small doses of insulin, which should let me eat and exercise the way I want to.

Age 68, type2 for 15 years. 5’11" and 260 pounds on a very large frame. A1C 6.0, metformin and 79 units Lantus daily, 15 g carbs + fiber daily, eat less than anyone I have ever met, but cannot lose weight. Eating lots of fats resulted in “high LDL cholesterol” and doctors are panicking, prescribed statin. Yet a camera looking through my arteries and heart revealed no deposits (“good for the next 20 years”) and ultrasound over head and neck arteries also looked good. Previously my doc told me I had no increase in likelihood of heart disease since A1C is good. I read that diabetics who use statins have increased morbidity, also cholesterol amounts not linked with heart disease after all, but large LDL size is (never checked).Also, blood sugar levels go very high even after a small meal without carbs and stay high for hours-- was told I have vagus nerve degradation typical of diabetics, so stomach empties very late and slowly, They weren’t concerned about high readings since A1C is good. I have an extremely healthy diet, but am crippled and cannot do much for exercise.

Do I just shut the docs down and ignore all this, take the statin and die, or is there something I can do to help? Very confusing.