Can people with type 1 diabetes have insulin resistance?
Sarit Polsky, MD, MPH responds
Insulin resistance, requiring high doses of insulin to manage blood glucose, is common in prediabetes and type 2 diabetes. But it can also occur in people with type 1. In those instances, insulin resistance may be present when type
1 diabetes is diagnosed or may develop over time.
What to Know
Insulin acts like a key, unlocking cells so they can take in glucose from the blood. Someone with insulin-resistant diabetes requires more insulin than average to usher glucose into the cells.
There are a number of reasons why someone with type 1 diabetes might have insulin resistance. Risk factors include excess body weight, medication use (including steroids), smoking, puberty, pregnancy in the second and third trimesters, and a family history of type 2 diabetes.
If you suspect you have insulin resistance, talk to your health care provider. He or she can calculate the total amount of insulin you’re using per day relative to your body weight. If this is significantly higher than average, it’s a sign of insulin resistance.
Insulin resistance can raise blood glucose levels. Left untreated, high blood glucose can increase your risk for heart disease and other long-term complications of diabetes, so it’s important to use as much insulin as you need to keep your blood glucose levels in your target range. Your health care provider can work with you to adjust your insulin plan and may suggest additional medications that can help reduce insulin resistance.
What to Do
Working with your health care provider is key. The following steps may help you reduce insulin resistance:
- If you are overweight or obese, lose weight. Dropping about 7 to 10 percent of your body weight makes a big difference.
- Change your diet by reducing the amount of fat and/or calories you consume.
- Exercise makes your cells more sensitive to insulin, so get active for 45 minutes to an hour at least three days per week.
- For insulin resistance that’s caused by medications such as steroids, ask your doctor if there is a good alternative. (But don’t stop taking a medication without first talking to your doctor.)
- If you smoke, quit.
- If you eat excess carbohydrates, reduce your intake. A registered dietitian can help guide you.
If you seem to require larger amounts of insulin than usual, reach out to your health care provider to identify potential causes, come up with a plan of care, and monitor the condition closely.
Sarit Polsky, MD, MPH, is an assistant professor of medicine and pediatrics at the University of Colorado School of Medicine and the Barbara Davis Center for Diabetes.