Insulin resistance in Type 1

Type 1 and LADA
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My endocrinologist had never heard of it, but it’s common on this forum. A person with IDDM can develop insulin resistance, same as NIDDM. While she’d never heard of it, my endocrinologist suggested metformin (Glucophage), and it worked.

It’s a problem: using Google to find papers on an IDDM developing insulin resistance turns up almost nothing except this forum, no papers, no research, so endocrinologists have never heard about it. But (of course) if elderly Type 1 diabetics with a family history of Type 2 get older (and I do not approve of the only alternative) there is no theoretical reason why they cannot develop insulin resistance. Why there isn’t more of this in the literature might come down to the fact that there weren’t very many elderly diabetics until recently: when I was a boy, I read that Type 1 diabetics rarely lived to be 60. There were no meters, and the medical advice was to keep the urine test barely green, just a tiny amount of sugar in the urine, meaning a blood sugar of about 180. If no sugar in the urine, one might be hypo (no way to tell), and a hypo can kill much quicker than a sugar of 180, so that’s what the medical books recommended until the '80s. Of course, 180 kills, but more slowly than a severe hypo.

In any case if one is younger than 60, Type 2 is rare. There are, of course, 3 things that are contributing factors to Type 2: heredity, weight, and age. Only one of these (weight) can be controlled by a Type 2. And one of them (age) seldom happened to Type 1 diabetics, so I have been unable to find a single medical research paper about Type 1 diabetics with insulin resistance, even though (if one follows this forum) it’s now quite common.

So the only solution is to find an endocrinologist who will prescribe metformin. (Since developing insulin resistance, I’ve done a LOT of reading, and the textbooks all say metformin; the drug companies that make newer, more expensive medications for Type 2 all say their newer treatments are better, and some gullible doctors prescribe them, but the independent research papers all strongly recommend starting with metformin for insulin resistance. Of course, metformin eventually fails, and Type 2 diabetics must then supplement it with another medication, but the textbooks all say to start with metformin for Type 2, which strongly implies that Type 1 diabetics who have gotten older and developed insulin resistance should start with metformin.)

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When you say “another med” for T2, do you mean insulin? For controlling bg, insulin is highly effective.

Is the real question for the T1 with developing resistance whether to use more insulin, or insulin plus another med, in which case, that should depend on how much more insulin and/or what tradeoffs from more insulin v side effects of the other med(s)?

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Do you workout? One way of increasing insulin sensitivity is exercise.

From what I’ve read, most type 2’s are diagnosed at 50, give or take a few years, and the time of diagnosis is not the same as the start of the occurrence. Added to that, although the type 2 etiology is partially dependent on genetics, there are some lifestyle modifications that can help, exercise and diet, in addition to drugs.

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I an across a study with this conclusion, that points to improved aerobic fitness as the main driver in this intervention for insulin sensitivity. The second was an odd thing I ran across in the same search.

CONCLUSIONS —Current clinical dietary and exercise recommendations, even when vigorously implemented, did not significantly improve insulin sensitivity; however, a more intensive program did. Improved aerobic fitness appeared to be the major difference between the two intervention groups, although weight loss and diet composition may have also played an important role in determining insulin sensitivity.

https://care.diabetesjournals.org/content/25/3/445

https://care.diabetesjournals.org/content/27/1/281

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I know a type 1 in town here who takes metformin. He is in his sixties. Dx age 20.

If nothing else, Metformin should keep your liver from outputting as much glucose.

Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.

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A couple of T1 diabetic hacks to improve insulin sensitivity:

Berberine - can provide the same blood glucose lowering benefits that Metformin does, only without the gastrointestinal side effects

Alpha Lipoic Acid - improves glucose control, and also protects against retinopathy and diabetic neuropathy

https://www.goodhormonehealth.com/2020/02/03/3ss-2/

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Physicians have understood Type 1 since 1921: give insulin! No one really understands Type 2. The textbook says to start with metformin until that fails, then different authors recommend different things. And drug reps go to GPs (all of whom have many Type 2 diabetic patients) and say metformin is out of date, not really very good, their new (and very expensive) oral treatment is much better (at least for their employer’s bottom line). When a Type 2 who was controlled by metformin starts having a high HbA1c (as always happens if they live long enough), some say add insulin, some add sulfonylurea, and the drug reps all say to use the latest (and most expensive) medication that their employer sells.
I see some say exercise to lower blood sugar. Again, the sugar in the blood is used to supply energy to the brain and to the various muscles in the body. Medications cause that sugar to go into the liver cells or into the fat cells. Exercise causes that sugar to go to calories consumed by the exercise. Both exercise and medications lower blood sugar, and there is much to be said for lowering sugar as much as possible by using exercise instead of meds, and exercise always reduces the amount of meds one needs to take (whether insulin for Type 1 or something else for Type 2).

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There are a lot of things that effect insulin resistance.
Caffeine exercise cinnamon to name a few.
Luckily I have pretty much the same insulin needs that I had 30 years ago. If I see it changing I will see about supplements and if that doesn’t work I’ll go got a d

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Type 2 diabetic for 28 years now on Metformin and MDI here. The old adage about type 2 DM was the four Fs, Forty, Family, Fat and Female. Having 2 of the Fs increases ones odds of developing T2DM 3 or more makes it nearly a given. I imagine the increased risk for women is from polycystic ovary syndrome and gestational diabetes.

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@JamesIgoe It is only anecdotal evidence, my own. When I was first diagnosed type 2 back in 1992 I was overweight, tired all the time and stressed. I began exercising, first walking and later bought a used road bicycle to once again take up my lifelong love of bicycling. This improved things so much that I was weaned off of Micronase and was drug free for 10-12 years.

Type 2 has a way of progressing and it did. Next step was Metformin, then Lantus and now Humalog. I still exercise regularly which seems to increase insulin sensitivity.

I am convinced that the chronic fatigue I was feeling before diagnosis was from insulin resistance. My thinking is that even though cells are swimming in glucose they re not accepting insulin and therefore starving for fuel.

There is too much research on drug therapies and not enough on finding the genes, triggers and more.

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My perception is that academics and researchers are too often distracted by hyperglycemia when instead they should focus on hyperinsulinemia. In T2D, too much insulin appears years before the symptoms of too much glucose. It is a leading indicator of T2D that doctors maintain rigid ignorance about. I don’t get it.

Too much insulin causes insulin resistance. It’s just as true in T1D as it is in T2D.

When I finally concluded that I was an insulin resistant T1D after 28 years of living with diabetes, I implemented a low carb diet, cut my total daily dose of insulin by more than half (from 80+ units/day to < 40 units/day), lost weight and overall felt much better. My A1c dropped, average BG decreased, and glucose variability diminished as well.

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It’s funny you posted this. I was just reading about insulin resistance and what the actual cause is. I had read I. The past it was a certain type of lipid(fat) that blocked the receptors.

However the new thinking is more like what you are saying.
Higher levels of glucose and insulin cause the cells themselves to reject insulin and become resistant. They have just had enough.

It’s a really tough thing for type 2 specifically because when you have high sugars they treatment is more insulin, but more insulin causes more insulin resistance.

So really the way to combat it is to use less insulin by eating few carbs and exercise and metformin makes sense I guess. I’m type 1 and I’ve been taking about the same insulin since I started 45-55 per day.

Right now I’m trying to lose 10 lbs so I’m only needing 35 or so. But if I start seeing my needs increase, I’ll probably need to address it.

I’ve never had a doctor tell me how much insulin is too much. I mean if sugars are good but you are taking 100 units a day, is that too much? Where is the cut off. I know a young kid in my daughters school who is type 2 and obese taking 300 units every day. But what is that insulin doing to his arteries and heart.

I sent an email to my doctor, he said take as much as your body needs, however never really answered the question.

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Well the very well educated type 1’s at Mastering Diabetes believe fat makes a person insulin resistant. When I ate 30 carbs daily I took around 21 units of insulin, but once I dropped most fat and added more exercise I started eating about 275 plant based carbs daily
and take about the same amount of insulin. The fat was making me insulin resistant.
By the way, I also recovered from 5 yrs of CFS. I was in a wheelchair before I turned my life around.

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Take this with a grain of salt but I personally think just about everyone is insulin resistant to some degree, otherwise there would be a standard insulin sensitivity number based on weight. The more active you are the more insulin sensitive you are, so obviously in a normal state there is some resistance going on.

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Although I usually calculate my injection by the carb amount, I have read studies that shows both fats and protein increase insulin needs. Fat as a body component likely creates it own problems, but so does eating fat and protein.

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I went on a low fat diet. It didn’t change my control or my insulin requirements. I did that when I was having digestive issues. It turned out to be the statin my doctor insisted i take.
I stopped my statin and my issues went away. So I gave up the low fat diet. I try to be balanced as much as I can

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Timothy, it isn’t as simple as just eating lower fat. See the Mastering Diabetes website or read the book if you really have an interest in learning how to lower insulin resistance. I had to follow the program to see a difference and make the change from a very low carb diet. It is not as simple as just saying you tried going on a low fat diet.

Glad that going off the statin helped your digestive issues. I can’t take statins, but wish I could.

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My LIPIDs are normal, but my doctor said research shows taking statins adds 10 years to your life. Your post makes it sound like it just seems 10 years longer.

I fear pharmaceutical companies specialise in promoting their products, not in being truthful. My doctor said the recommended dose is 10 mg/ day, so I agreed to take 5 mg/week, and no side effects.

My aunt’s doctor (she’s 96) told her she must take statins, and she felt so bad, she stopped both the statins and that doctor.

I strongly suspect anything that works for everyone. Except vitamins. And insulin if you’re Type 1. (And a rather long list of other stuff, like exercise and lay off whole rashers of bacon and don’t eat a whole chocolate cake in one sitting and …)

But I still strongly suspect statins, and figure the recommendation is more to improve the health of the pharmaceuticals’ bottom line than their patients’/customers’ health.

If they told me those with very high LDL lived longer with statins, I’d believe them. But when they say everyone needs a high dose of statins every day and not taking lots of statins will shorten your life by at least 10 years, I get very suspicious.

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I think your doctor is wrong!

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I think your doctor is speaking from the idea that everyone eats a similar diet high fat cholesterol and limited exercise.

If your lipids are in normal range then I don’t see the point.
I had an ultrasound done a few years ago. I was probably 52.
I had chest pain which turned out to be a torn pectoral.
But the ultrasound showed no blockages or narrowing.

That was pretty good news. I don’t know how good that procedure is or if I can depend on it.
Historically my cholesterol has been naturally low and hld has been high. Because I exercise a lot.
However it has been creeping up a little bit lately.
Statins make me sick,I’ve tried 3 of them.
So unless the come up with something new
I’m on an insulin only cocktail.
I also don’t drink except on the rare occasion.
I don’t know how that effects esterol production in the liver.
There are both good and bad from drinking moderately.