Insulin Dose and Types and question about resistance

Hi all
I wasn’t sure where to post this as there isn’t a general forum for all types. I am in the process of trying to learn if I am Type 2 or 1.5. Everything is pointing to 1.5. I had my first endo appointment today and she didn’t trust the lab that did my c-peptide (.38) so is having me re-test. Antibody tests are not available here in Guatemala. But my question right now is because I am wondering if this endo knows what she is talking about. She said something that totally contradicts what I thought I understood. So I need to decide if I can trust her. Here is my question:

Isn’t it true that Type 2’s need generally to take higher doses of insulin than type 1’s or 1.5’s due to the fact of insulin resistance? (She said the opposite). I think I’ll cross-post this question under Type 2 as well.

Kind of yes and no. Some type 2’s are insulin resistant so if they take insulin they will need to take a fair amount of it. Some are very insulin sensitive, they just don’t produce enough so they don’t need very much. However, to say that type 1’s and type 1.5’s are generally more insulin resistant than type 2’s is kind of dumb.

Dear Zoe good question. All diabetics has two issues: how insulin resistant you are and how much insulin your pancreas produces. In some type 1 the pancreas still produces some insulin and if they have little resistance they will need a small amount of insulin. Some so called type 2 have no more insulin production of the own and can be very insulin resistant so they will need a lot of insulin.

If you use less than about 0.5 units per Kg of body weight per day. You are not very insulin resistant or your pancreas is still producing it.

Zoe, I think I can understand what your doctor is saying.

On the one hand, you are right - generally, by the time T2s need insulin, they will often need more than someone than Type 1, but not always. The problem with some T2s is not the insulin production but the insulin resistance. They can be producing huge amounts of insulin and still need more.

Someone with a zero functioning pancreas needs their own full dose of insulin, whatever that may be. Someone who is not hugely overweight, but still has T2 and is put on insulin may well not need as much as someone with T1 with no functioning pancreas.

Insulin needs depend on what they’re eating, how much exercise, their weight, their age and so on, for all types of D… the list is pretty long.

Essentially, you are both right. It really depends on the situation and this is one time that making generalisations isn’t helpful.

Why don’t you ask her what she meant? Sometimes the explanation will go a long way.


Thanks, Sue. I realize now that this is just one of many questions about diabetes which is YMMV…just too many variables to make generalizations. Mainly I was hung up on the question of whether or not I could trust this Guatemalan endo. I think the answer is probably not that different from many of our diabetes docs: Yes and No. I think for various reasons (lack of knowledge, (especially PCPs, and especially when it comes to Type 1.5) insurance constraints, Managed care, ADA recommendations lagging behind) you only get part of the picture from your doc and then the rest is learning yourself, and trial and error, as well as like the Beatle song says, "a little help from your friends."

Dear Zoe.

Usually by the time type 2 are put on insulin their pancreas is toast so with insulin resistance they will need a lot more than other insulin dependent diabetics. now if you can stop the death of the pancreas with some external insulin right in the beggining and handle the insulin resistance some people respond well to metformin, they may use less.

Absolutely Zoe! Maybe you need to proceed with caution with this doc and see how it goes?

While I start on an insulin pump in 2 weeks, what I’ve learned on my own in preparation can’t begin to match a few appointments with a DE, 1 with a dietitian and 1 days’ training on the pump. I’ve spent countless hours learning on my own.

Learning for ourselves is just one part of being responsible for our health. It’s absolutely essential if we want to understand how D affects us and how to manage it effectively.

Good luck with the new endo, Zoe! Let us know how it goes.