I am trying to understand how insulin resistance affects me. I was diagnosed with Type 2 diabetes five years ago. At that time my a1c was 10.5. I was immediately placed on insulin. Within six months of using both long acting and short acting insulin, my a1c dropped to below 7.0. This was without any oral medication (I am currently using an insulin pump and take 1500 mg. of metformin per day).
I am trying to understand is how much insulin resistance is affecting me. I used the formula:
weight(in pounds)/4
to determine my daily insulin requirement of 57.5 units per day. For the past year I have required an average of 45 to 55 units of insulin per day (basal and bolus combined) to keep my a1c <6.5… I have been on a pump for the past two weeks and my daily insulin usage has been below 60 units.
If my actual insulin requirement is within range of my calculated body’s requirement, does that suggest that my body is now less resistant to insulin? Is insulin resistance always part of Type 2 Diabetes?
Lastly, is insulin sensitivity the opposite of insulin resistance?
Yes, pretty much by definition. But insulin requirements vary significantly between everyone-healthy normal people and diabetics both T1 and T2. The calculation is just a rough estimate doctors use to figure out the initial starting point for someone newly diagnosed. It quickly loses any clinical significance.
Not really. Insulin sensitivity is a measure of how much insulin will cause a specific drop in Bg. For instance, if your Bg is 200, and you take 10 units to bring it down to 100, then your insulin sensitivity is 1:10.
Insulin resistance will have more to do with calculating your C:I ratio, i.e. how much insulin you need to take to cover a gram of carbs. So if you need 10 units for a 40 g carb meal to keep your Bg in the normal range, your C:I will be 4. The higher the C:I, presumably, the greater your insulin resistance.
But if these calculations were this simple in reality, then diabetes would be really easy to control. There are so many things that can effect your IR and IS that it’s like a game of 8 dimensional chess.
The metformin may be reducing your total insulin requirements, as it limits glucose dumped from your liver. Was metformin started immediately, and then insulin added when numbers did not come down?