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June 24, 2007

Hyperglycemia and DKA, Type 2

Question from India:

Can persistent hyperglycemia and insulin resistance in type 2 diabetics be due to decreased transcapillary movements of insulin (resulted from cell swellings in blood and in vascular walls) by hypotonicity of blood due to elevated glucose or otherwise? Since the insulin molecule is bigger, does it result in decreased insulin exposure to target cells instead of commonly thought decreased sensitiveness of insulin? This looks quite relevant and simple reasoning to insulin resistance or persisting hyperglycemia.


The major effect of insulin resistance is a post-receptor event. Your hypothesis has not been shown to be a major cause of insulin resistance. The movement of insulin to its receptor on the surface of target cells is not a rate-limiting step in insulin’s effects.