Insulin Resistance and Double Diabetes

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Insulin Resistance and Double Diabetes

Dear CDE: My doctor just told me that I have insulin resistance? I thought that only happened in people with type 2 diabetes? Can people with type 1 diabetes also be insulin resistant?

Thanks for asking this important question. Insulin resistance is a decreased ability of the cells of the body to respond to insulin. Diabetes is such a complex disease process and not much was known about the ways to treat it before the advent of the discovery of insulin by Banting and Best in the 1920s. Most people with T1 diabetes died from insulin starvation and muscle wasting within months of being afflicted due to deficient beta cell production of insulin, the essential endocrine hormone needed to metabolize carbohydrates and nourish the cells and organ tissues of the body. For a long time T2 diabetes was known as “adult diabetes” because it was observed to happen in overweight middle-aged people who were still making some insulin, but often died in their 40s, 50, or 60s of heart attacks and strokes. Not much was known until more recent times about how the two types of diabetes can overlap and people can be both insulin deficient and insulin resistant. Referred to as  “Double Diabetes” (DD) the insulin resistance seen in T2 diabetes can lead to eventual insulin depletion (insulin deficiency or T1D). The opposite is true for some T1 PWDs with insulin deficient diabetes who can, in some cases, become insulin resistant and develop attributes of T2D.

Today, the science behind the causes of diabetes has advanced and the ways to treat it is much more sophisticated than in previous generations. However, a basic intrinsic truth that has been proven by all the research done about diabetes is this: Everybody needs insulin to function and be alive. To not have adequate levels of insulin available, circulating and entering the cells of the body is incompatible with life. So in that sense everyone is insulin dependent whether they have diabetes or not. Once a person is diagnosed with diabetes, whatever type, the chronic nature of diabetes as a disease process unfolds and progresses across the entire lifespan. Our bodies change as we age and how our bodies maintain health is influenced by our lifestyle, nutritional habits, level of physical activity, and the interaction of insulin with other essential hormones and metabolic processes in the body. We are no different from all other women, but we are unique in that we live in bodies that on a cellular level, are challenged to produce and maintain utilization of insulin sufficiently.

What Causes Insulin Resistance?

It is not uncommon for women with T1 (insulin deficient) diabetes to experience some insulin resistance during times of intense physical, psychological or emotional stress. Insulin resistance can result from hormonal changes that occur during pregnancy and a woman’s menopausal years. Some women may experience insulin resistance when taking certain medications for chronic physical or mental health conditions over a long period of time. For example corticosteroids, used to decrease inflammation in joint disorders or asthma, and medications used to suppress the immune response in organ transplants can increase hyperglycemia and cause insulin resistance in T1s. Atypical psychotropic medications used to treat thought and mood disorders, and certain anti-seizure medications cause chronic hyperglycemia. Long-term use of these types of medication may be necessary as treatment strategies for other health problems besides diabetes, and unintentionally cause insulin resistance in T1s and increased insulin resistance in T2s. Thus for some people, DD is medication induced.

Other factors that contribute to insulin resistance in both T1 and T2 women is having an overweight BMI greater than recommendations for your age, height and bone structure; and lack of sufficient muscle mass and poor muscle tone from not getting enough aerobic and resistance type of exercise. We all need to keep moving our bodies and be physically active for insulin to move efficiently in and out of the cells. Insulin resistance can be triggered by chronic and excessive consumption of carb dense and fat laden foods that are stored as visceral fat when not sufficiently metabolized and burned as calories to fuel the body in physical activity. Metabolic syndrome (more commonly seen in T2D) can occur in some women with T1D who are overweight, leading to DD.

Obstructive sleep apnea can exacerbate insulin resistance and contribute to DD. For women who smoke, build-up of tar and nicotine from long-term cigarette smoking causes extensive tissue and nerve damage to the cardiovascular system, which impedes the flow of oxygen, nutrients, and insulin transport across cellular membranes to enter the cells of the body which can cause insulin resistance.

What can Be Done?

If you have advanced duration T1 or T2 diabetes and it has been awhile since your A1c has been at target level, you may wish to have a conversation with your endocrinologist to discuss various factors that could possibly be causing insulin resistance and strategies to employ to overcome it. A T2 PWD may need to start taking insulin. Some progressive endocrinologists are using metformin to treat overweight T1s with insulin resistance by adding a daily dose of the drug to help pump-infused or injected insulin get into the cells. This is considered off-label, but there is some research data to back effective benefits. It is important to speak to the clinical providers who are on your diabetes treatment team to verify what is going on before initiating any medication changes. Double diabetes may develop as a co-morbid condition of living a long life with T1 or T2 diabetes and needs clinical oversight for proper treatment.  

Things you can do to resist insulin resistance in T1, T2, and DD:   

·If you smoke, stop.

·Think about what you eat before you eat it, especially before overeating indulgently and indiscriminately. Ask yourself, “How will my body metabolize this? Do I need to eat this as fuel now?”

·Follow and stick to a plan to consume portion controlled meals and snacks at regular intervals.

·Keep your weight within the recommended BMI target range for your age, height, and shape.

·Do something everyday to keep moving! Dance, walk, swim, power walk, stretch, do yoga, tai chi, chi qong, climb stairs, work out on fitness equipment, chair march while watching TV, play hoola hoop with your kids or grandkids, walk your dog, run, jog, shovel snow, rake leaves, weed a garden, plant a tree or some flowers, ice skate, snow ski, or shovel snow if you can tolerate it. The point is to do something physically active to burn calories for energy and keep your insulin activated and circulating throughout your body.

So you can see that insulin resistance is a complex health issue that affects many women with diabetes, both T1 and T2 sisters. Some women may develop DD during the course of their lives living with diabetes. It is not always as clear and obvious as one would expect. Generally in is not expected for T1 PWDs to develop insulin resistance and DD, but it may happen. If you suspect or have concerns that you may be insulin resistant because of any of the items mentioned here, please speak to your health care providers for further guidance and advice. It doesn’t matter what kind of diabetes one has, we all need insulin to live and be healthy.

Resources

Dolson, Laura. (2011). What is Insulin Resistance? Insulin Resistance and Why It Is Important. Retrieved from About.com.http://lowcarbdiets.about.com/od/prediabetesanddiabetes/a/insulinresistan.htm

Katz, David. (2008) What Is Double Diabetes, and How Do I Treat It? Retrieved from:http://www.oprah.com/health/Treatment-for-Double-Diabetes#ixzz2taS8JJma

Thompson, Dennis. (2006). ‘Double Diabetes’ a New Threat. HealthDay. Retrieved fromhttp://www.medicinenet.com/script/main/art.asp?articlekey=77891