Insulin resistant and insulin deficient

I’ve heard the terms insulin resistance and insulin deficient used in many different posts/discussions and my doctor use them as well at my first appointment. I am wondering a few things:
Can western (or Eastern for that matter) medicine figure out which we are from any kind of test?
What can a type 2 diabetic do to improve either issue?

I apologize if this is posted elsewhere. I am new here and learning my way around. I did see these conditions mentioned in other posts but they were usually referring to something besides my question. So I thought I’d ask it directly. Hope that is ok.

I have another question but will ask it in a different discussion to keep the topics seperate and more clear, at least for me, as I take in this new aspect of my life.

Thanks to all here for their wisdom and patience.

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>>Can western (or Eastern for that matter) medicine figure out which we are from any kind of test?

Not directly.

Insulin Resistance can’t be directly measured at all. However, doctors can get an idea of how resistant you are based on how you respond to drugs/Insulin and other clinical markers (how you respond to diet/exercise, your general symptoms, the pattern of your blood sugar highs & lows, etc)

Insulin Deficiency can be indirectly measured by measuring C-Peptides. C-Peptide is produced by the pancreas at the same time it produces Insulin (in fact, the c-peptide itself is the last 31 molecules of the pre-insulin structure. As the last step of producing insulin, those 31 molecules are chopped off and dumped into your bloodstream). So the C-Peptide is a somewhat useful test - only somewhat, because it’s highly variable based on what lab is doing it, and a good doctor should be able to figure out what level of insulin deficiency you are by other clinical markers.

>>What can a type 2 diabetic do to improve either issue?

Everything we talk about here!

To improve insulin resistance: Drugs, diet, & exercise. Indeed, exercise can stimulate your muscles to take up blood sugar without using Insulin, which I think is the coolest thing ever. Eating a balanced diet reduces fat - and there’s a lot of evidence that too much fat in and of itself increased insulin resistance. That’s why it’s so important for diabetics to try to lose weight if they’re overweight - and it doesn’t have to be drastic, even 5 or 10% of your body weight can make a difference when it comes to Insulin resistance. Many drugs work directly on insulin resistance as well.

To improve insulin deficiency: So far, there hasn’t been any wonder-treatment that can bring a dead pancreas back to life. However, there’s a lot of evidence that early, intensive Insulin therapy to Type 2s who are not producing as much Insulin as they should will protect the pancreas and prevent or slow down further damage to the pancreas.

And, of course, even if your pancreas is totally dead, you can take Insulin to overcome any insulin deficiency.

Dear Barbra.

Which drugs help with insulin resistance? Metformin is supposed to but in my case it did nothing to improve the average nor the standard deviation of the BG readings. I was trying some 1 year ago and it did not reduce insulin consumption measurably. Avandia similarily was a bust. Any others?

This lead me to question if insulin resistance really exist. It must because some diabetics need prodigious amounts. In my case it is about 0.55 IU/ Kg-day which is significantly above 0.35 to 0.40 that long standing type 1 can manage with.

Loosing weight helps even a reduced calorie diet for a few days makes things better. Permanent weight lost I have not been able to achieve since going on the high insulin dosage. I tried and sucessfully lost 10 lb on a balanced diet(40% carbs, 30% protein and 30% fats with minimal saturated) slowly over 68 days but then all hell broke loose the body did not take kindly to the slow rate of starvation and not only did I regain the 10 but and extra 10. also I was very careful to avoid lows since they reinforce the body into believing it is starving…

Tried to join a study of a fibre for weight loss at the University of Calgary. The research assistant refused saying that diabetics on a high dosage of insulin had little or no chance of success.

It is interesting that you mention that intensive insulin therapy right at the beggining is now cool. 10 years ago the Canadian medical ■■■ treatment protocol only allowed insulin after your pancreas was severely damaged. I even specifically asked an Endo to be put on insulin because loosing 85 lb, 2 hours a day of exercise and metformin did not bring my BG into the normal range. The Endo Dr. Adamiak answered you dont want to touch that s==t witha ten foot pole.

Well now not only I am touching it, I am injecting it in very large amounts. And I suspect strongly that this makes non-sense of any attempts at weight loss. So far the best I can achieve permanently is weight stalemate and this with at least 1 hour of exercise per day.

Well, I’m hardly an expert in drug therapy, but the Joslin Diabetes Deskbook says that Metformin, Avandia, and Actos all improve insulin sensitivity.

Metformin “decreases hepatic glucose production through a reduction in hepatic resistance”: in other words, it makes your liver less insulin resistance and therefore gets the damn thing to stop spitting out glucose all the time.

Actos & Avandia “Improves glucose control by improving insulin sensitivity. Works primarily to reduce peripheral insulin resistance (primarily muscle, adipose) but also can have hepatic effects.” In other words, reduces insulin resistance in your fat & muscles, and maybe your liver too.

So that’s what it says. I, like you, have had no luck with Metformin, but unlike you, a little bit of Insulin does wonders for me, so I wonder if I’m Insulin Resistant as well.

And yes, things have definitely been changing as far as when Doctors are willing to put people on Insulin. Most of what I read says that early & intensive Insulin therapy is very much an option for Type 2s for whom diet/exercise/Metformin doesn’t work.

Anthony, have you ever considered going to a Diabetes research clinic to see what they can do for you? I don’t know how things work in Canada, or what your financial situation is, but you seem to both be incredibly knowledgeable about diabetes yet still struggling with your own. I’m going to Joslin for a 4-day clinic in March… it’s pricey (close to $4K, not including travel expenses), and I can’t get a straight answer from my insurance about whether or not they will cover it, so I’m prepared to pay for it myself if they don’t. I’m going to make sure to quiz them about some of the stuff you’ve brought up, if only to settle my own curiosity.

Dear Barbra.

Great ask them about all we have discussed and if you are on a high dose of insulin what to do for weight loss. Without insulin I was able to loose enormous amount of weight. Now it is a struggle to maintain a BMI of 30.

Never tried actos but like metformin, avandia was a total bust same average BG and same standard deviation the only thing that was a lot lighter was the pocket book.

Ask them if Levemir is a good substitute for Lantus for some weight loss. My Endo said great success in one of his patients. I have some will need several months to see if any effect.

I can see if there still is a diabetic clinic in town. Was not a winner 10 years ago the dietitian was talking cereal and muffins and I was talking sauerkraut. I told here I never ate cereal or muffin before diabetes and did not intend to start now.

In Canada health care coverage varies enormously in each province. We live in a province where the health minister is very right win and stupid. He doesnt believe at all in prevention. But in paying a fortune for amputations, heart by-pass surgery and EMS personnel and 2 day stays in emergengy which are all paid for by the tax payer.

Dear Barbra.

Just an after though ask them about medications to help weight loss in diabetics. The Canadian treatment protocol states that orlistat ( trade name at least in Canada is xenical) and sibytramine (meridia) can be considered. It would be interesting to hear what Joslin has to say?

xenical if I remember correctly gives you … to put it lightly … “anal leakage” - same thing as Alli. I remember a co-worked was taking it and didn’t have a good time with it at all. I may be mistaken as to what it’s name was.

I’ll make a note of this and make sure to ask. I expect to come back with my head full!

No Cynthia. This is why I never filled the prescription that the DR. gave me for the xenical I could not find diapers and pants big enough to fit. but in desperation might be good.

Thanks Barbra.

Good luck and try an absorb as much as possible. That is another problem with a university type 8 hours of lectures per day. My brain would turn off after the first session.

Banding of the stomac?