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September 15, 2007

Type 2

Question from India:

Can we consider insulin resistance as a tolerance or resistance to previous excessive or increased exposure of sugar or/and insulin in type 2 diabetics? Is such previous excessive or more exposure common up to some stages after getting type 2 diabetes? As such, can decreasing excessive intake of foods, exercising, withdrawal of oral diabetic medicines and injected insulin for some time can help in reversing insulin resistance? I mean reversing insulin resistance, but not just normalizing of glucose level temporarily.


Resistance can happen both ways. For instance, patients with type 1 diabetes are insulin resistant. They are exposed to high insulin levels with exogenous insulin therapy. This results in down-regulation of insulin receptors. We routinely clamp patients with good control with type 1 diabetes and they have insulin resistance, compared to age-matched healthy subjects. People with type 2 diabetes have insulin resistance as a result of a post-receptor defect in insulin signal transduction. It is clear that short-term food restriction or weight loss will decrease insulin resistance. However, there is no eliminating insulin resistance as a pathophysiologic process. The property is genetic and can be seen in first degree relatives of people with type 2 diabetes who are otherwise healthy. It can be decreased with healthy lifestyle.