Facts About Insulin Resistance in Type 1 Diabetes

I was diagnosed with Type 1 diabetes in 1967. Since then, I have dedicated my life to researching Type 1 diabetes and to helping people with any form of diabetes maintain better control. I suffered from insulin resistance in Type 1 diabetes (after diagnosis) until I committed myself to improving my insulin sensitivity.

Many people have fallen prey to the myth that people with Type 1 diabetes cannot have insulin resistance. This is absolutely not Insulin Resistance in Type 1 Diabetestrue. It is very common for people with Type 1 diabetes to also have insulin resistance. Carla Greenbaum, MD, who is a Member of the Benaroya Research Institute and serves as Director of the Diabetes Research Program and the BRI Clinical Research Center(1), has conducted multiple studies related to insulin resistance in people with Type 1 diabetes. An abstract from one of those studies states:  “Insulin resistance plays a larger role in the type 1 diabetes disease process than is commonly recognized.”(2) It is estimated that one in three people with Type 1 diabetes also has insulin resistance.(3) One study estimated that 25.8 million people in the US have Type 1 diabetes and insulin resistance; and that insulin resistance plays a large contributing role in the complications associated with Type 1 diabetes.(4) The phenomenon of people having both Type 1 diabetes and insulin resistance is sometimes referred to as “double diabetes” or “Type 1.5 diabetes.”

Sadly, many people with Type 1 diabetes do not believe it’s possible for them to have insulin resistance. This lack of knowledge and refusal to accept the truth can greatly inhibit their ability to control their blood sugars. Their lack of knowledge stems from the insistence that Type 1 diabetes and Type 2 diabetes have nothing in common. Although the causes of each type of diabetes are different, Type 1 and Type 2 have more in common than many people realize.

Before I go further, let’s review the three basic types of diabetes. There are others, but these are the most common:

Type 1 Diabetes:  An autoimmune condition characterized by insufficient insulin production due to the body attacking the beta cells in the pancreas which produce insulin. Type 1 diabetes used to be known as “juvenile onset diabetes” or “insulin dependent diabetes.” Neither of those terms is accurate in today’s world where adults are often diagnosed with Type 1 diabetes and where people with Type 2 diabetes often require insulin to maintain normal glucose levels.

Type 2 Diabetes:  A chronic condition characterized by the body’s inability to properly use insulin. The body’s inability to correctly absorb and use insulin results in high blood sugars and many of the same side effects as Type 1 diabetes. Type 2 diabetes has many other names, most of which are outdated and inaccurate.

Latent Autoimmune Diabetes in Adults (LADA):  A slowly progressing form of diabetes in which the beta cells in the pancreas are slowly destroyed due to an autoimmune attack. Destruction of the pancreatic cells usually occurs much more slowly than it does in Type 1 diabetes, with the patient often not needing insulin for months or even years. Type 1 diabetes and LADA are very similar and have very similar control protocols once someone with LADA progresses to the point of needing insulin.

It is very true that insulin resistance is a characteristic of Type 2 diabetes, but it is also a characteristic of Type 1 diabetes. People with Type 2 diabetes develop insulin resistance before they are diagnosed with Type 2 diabetes; people with Type 1 diabetes usually develop insulin resistance after they develop Type 1 diabetes. Insulin resistance in Type 1 diabetes is very common, but there are ways to reduce its effects.

Symptoms of Insulin Resistance in Type 1 Diabetes

The following symptoms may indicate insulin resistance in someone with Type 1 diabetes:

  • Elevated cholesterol and triglyceride levels
  • High blood pressure
  • Weight gain not associated with an increase in food or decrease in exercise
  • Needing increasing amounts of insulin to maintain normal glucose levels
  • Elevated liver enzymes:  High insulin levels are known to impair the liver’s ability to metabolize glucose, which may result in elevated liver enzymes in blood work.(4)
  • Coronary artery disease

It is somewhat interesting that many of the complications we associate with Type 1 diabetes may actually be caused by excessive use of insulin. Maintaining blood sugars as close to normal as possible is imperative, but there are things we can do to help reduce our need for insulin. My goal in my own control and when I work with clients who have Type 1 diabetes is to improve health by living a lifestyle that improves glucose control, lowers A1C levels, and requires less insulin to maintain normal glucose levels.

Potential Causes of Insulin Resistance in Type 1 Diabetes

The following reasons explain why people with Type 1 may develop insulin resistance:   

  • Stress and illness:  Stress and illness can cause temporary insulin resistance in anyone, but the effects may be much more noticeable in a person who has Type 1 diabetes and is checking blood sugars frequently. This is one of several reasons people with Type 1 diabetes typically need significantly more insulin during times of illness or stress.
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  • Large insulin requirements:  A healthy pancreas produces 20-25 units of insulin each day. Many people who are clients of mine were taking 100-300 units of insulin daily when they first came to see me. I was taking more than 100 units of insulin daily when I began making lifestyle changes to control my blood sugars better. I now take 20-25 units of insulin daily and maintain A1Cs below 6.0. The high amounts of insulin my clients took were required to maintain blood glucose levels as close to normal as possible. The problem is that high insulin usage can have many negative side effects and can cause the body to become “overwhelmed” with insulin and stop absorbing it properly. This results in insulin resistance. Sadly, insulin resistance is very common in people with Type 1 diabetes. For more information in insulin, please read:  Surprising Facts About Insulin. The challenge is that maintaining normal blood glucose levels is essential, even if it requires large amounts of insulin. I’ll share more about effectively addressing that challenge later in this post.
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  • Ethnicity:  People with Type 1 diabetes who are African American, Eskimo, Asian or Hispanic typically have higher rates of insulin resistance than Caucasians with Type 1 diabetes. This is why people of the above ethnicities often require much higher amounts of insulin.
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  • High levels of insulin-binding antibodies:  It is common for people with Type 1 diabetes to have higher levels of insulin-binding antibodies than people who do not have any form of diabetes. (Insulin-binding antibodies are not the same antibodies that attack the beta cells in the pancreas.) Insulin-binding antibodies prevent the body from absorbing insulin and/or neutralize the insulin. This causes people with extremely high levels to require more insulin to maintain normal blood glucose levels. Amounts of insulin-bining antibodies vary greatly from person to person. More research is being done about how to control these antibodies.(3)
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  • Obesity:  It is a well-known fact that obesity reduces insulin sensitivity. Unfortunately, insulin is a hormone that stimulates the body to store fat, so people with diabetes who are on large amounts of insulin often find it very difficult to lose weight.

Potential Ways to Reduce Insulin Resistance in Type 1 Diabetes

Although insulin resistance can make it very difficult to control Type 1 diabetes, there are certain lifestyle habits that can greatly improve insulin sensitivity in people with Type 1 diabetes. Those habits include:

  • Reducing carbohydrate consumption and eating mostly low-glycemic carbohydrates:  Reducing the amount of insulin the body needs is a first step to helping cells “reset” and restore insulin sensitivity.
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  • Exercise:  As little as ten minutes of exercise improves insulin sensitivity for up to six hours. One study found that people who engaged in exercise and who followed a low-glycemic eating style had improved insulin sensitivity within just a week. Heavy weight lifting can improve insulin sensitivity for up to 48 hours. I engage in aerobic exercise and heavy weight lifting at least three times a week. If you are not currently exercising, start out slowly and increase your activity very gradually.
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  • Limited use of supplements:  There are some supplements known to improve insulin sensitivity. I am not mentioning then here because they should be used with caution and because each person’s personal physiology needs to be considered when selecting an appropriate supplement. There’s nothing healthy about taking handfuls of pills every day, so I am very cautious when recommending supplements and rarely recommend more then two. I’ve seen A1C levels drop in some clients by as much as 30% after the addition of a single supplement, even if the client refused to make dietary and lifestyle changes.
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  • Working closely with your physician or endocrinologist:  As lifestyle and dietary changes are made, it is imperative to work very closely with one’s physician and to monitor blood sugars very closely so insulin dosages can be adjusted as needed.
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  • Medication:  Although it’s not my first choice, some people with Type 1 diabetes and insulin resistance find that using medication such as Metformin helps them maintain normal glucose levels. Some also find a short trial of Metformin helps them lose enough weight that their physician can then very slowly wean them off of their Metformin dose.

There are no “easy fixes” for insulin resistance in Type 1 diabetes, but a combination of dietary and llfestyle changes can help. I know, because I’ve been able to reduce my insulin resistance and improve my health dramatically using a variety of small changes. After almost 50 years with Type 1 diabetes, I have no complications and live abundantly with ample energy. It is possible!

References:

(1) https://www.benaroyaresearch.org/what-is-bri/scientists-and-laboratories/scientific-staff/carla-greenbaum

(2) Diabetes Metabolic Research Review. 2002 May-Jun;18(3):192-200.

(3) Wien Klin Wochenschr. 1985 Apr 12;97(8):359-63

(4) The Interplay of Autoimmunity and Insulin Resistance in Type 1 Diabetes, Nokoff, Rewers, Cee Green; University of Colorado School of Medicine, 2/14/2012

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Dr. Pamela Reilly is a Naturopathic Physician dedicated to helping people improve their health and eliminate symptoms using natural, integrative methods. She has over 25 years of experience and has helped men, women and children improve their health using a holistic, client-centered focus. She sees clients in Indianapolis, does house calls, and also conducts consultations via Skype or telephone. Please feel free to contact her or visit her Consultations page for more information. Dr. Pamela speaks nationwide on a wide variety of health topics and welcomes speaking invitations.

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5 Responses to Facts About Insulin Resistance in Type 1 Diabetes

  1. Bill Serjeantson says:

    Our 25 yr old daughter has been a type 1 diabetic since she was 4 yrs old. 2 yrs ago she became Insulin Resistant and before the problem was properly diagnosed she had severe gastroparesis. They changed her insulin which seemed to work for the last two years but she seems to becoming insulin resistant again. She is not overweight. Her diet is very limited now because of the gastroparesis.

  2. Kimberly says:

    Thanks so much for the information. When I was first diagnosed in 1991, I had an AMAZING endocrinologist at St. Thomas hospital in Nashville, TN. He saw me personally every 3 months all the way thru college, and until I married and moved out of state. I have had similar experiences to Scott since. I feel like they don’t have time for me, don’t care how I actually do, just get me in, tell me all the medications I “should” be taking, and then send me out. I don’t want to take cholesterol meds, especially when I wasn’t 30 yet and they hadn’t done much testing on it, but they were all determined I HAD to take it even though my triglycerides were EXCELLENT (my bad cholesterol wasn’t bad, but was too high for a diabetic, they said.) I still only take insulin. My new endocrinologist, I was referred to in June 2014, and I’ve seen him 3x. I had taken myself off the pump because of insurance reasons and wanted to go back on it. He first sent me home with 70/30 and Lantus when I asked for Novolog and Lantus. Then he told me that he doesn’t want me to have ANY lows (which I understand that bad lows aren’t good, but I’m okay with a 64. So, my A1Cs have gone up each time I’ve been there. He’s got my insulin to carb ratio off (It should be at least 10:1); he has it at 14:1. He has my insulin sensitivity factor at 50. I’m not sure what exactly it should be, but I’m pretty sure it should be lower. I’m taking around 32 units of insulin a day, but I think I need around 38-40 for what I’m eating. I haven’t been on a regular exercise routine since 6/14 because I wanted to get everything straightened out, but I’m really frustrated that I feel I’m working with someone who really doesn’t care about my outcome; possibly because he’s overwhelmed with patients? I don’t know. I would LOVE to be a part of a support group and know others who use pumps who can make suggestions or help me. I sent a text to someone about my issues with my Dexcom (continuous glucose monitor), and they told me they would call me right back. Still waiting to hear from them and that was May 19. If anyone has any suggestions for me, I would LOVE to hear!!!

    • Hi, Kimberly. I’m so sorry to hear that, but I can certainly relate! Kudos to you for being your own advocate and standing up for your rights! If you look on Facebook, there are multiple groups that share their personal experiences. It can be somewhat dangerous to take advice from a Facebook group, so I don’t recommend that, but having an online support group available 24/7 can be very helpful. One i enjoy is called “You Know You’re a Type 1 When …” There are many other groups available. Maybe finding one of those would be a good place to get support and see how others handle frustrations and pump issues. I wish you the very best!

  3. Scott Gibson says:

    Hi. reading your blog today was so enlightening.
    How do you find a Good Endo.
    The one I have now, I haven’t seen him directly in over 2 yrs, He did a blood test and determined I went from Type 2 to Type 1, Put me on the pump and I’ve been seeing his nurse/educator since.
    I got this referral from my primary care physician.
    Thanks for your time.
    Scott

    • Hi, Scott. So sorry to hear of your challenges. Great question! I actually don’t have an endocrinologist anymore. I found a holistic DO who works with me instead of against me and is willing to be the only doctor helping me control diabetes. This works very well for me. I encourage you to research doctors with a holistic mindset in your area and interview a few to find one which would be a good fit for your needs and with whom you are comfortable. I wish you the very best!

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