My 25 year old daughter is often insulin resistant. During these periods she is high all the time and feels sick. She just started on Symlin and, although it works for after meal highs, when she’s insulin resistant, nothing helps except not eating. She’s on a pump, and has a good doctor and diabetes care team, but everyone is baffled and can’t seem to figure out what’s wrong.

Insulin resistance is a continuum from very little to a lot. It sounds like she has a lot of resistance. The resistance can be genetic or acquired. Obvious things that increase resistance include excess weight, medications, other diseases involving muscle, and excessive eating patterns. Given you have probably already looked at and addressed these, there are other forms of genetic insulin resistance that are associated with physical exam findings such as increased pigmentation, referred to as acanthosis nigricans. There are some research laboratories that are interested in forms of genetic insulin resistance, such as the group at the National Institutes of Health. You may want to ask your physician for a referral there. It might be possible they can see if she has genetic abnormalities associated with the insulin receptor and be able to perform studies under a research protocol that might be able to be done, otherwise. This is such a complicated field that you need a physician who will walk you through this.

JTL