3rd December 2006
Yes. I am saying that "insulin resistance" is a contributor to diabetes - insulin resistance alone may not be sufficient to cause a person to have diabetes in the absence of other factors.
This is a speculation - not a cite of a known case -
Let's say there is a person who is of below normal weight, having a low BMI, which means he has lots of muscle and very little fat. He has insulin resistance, but no family history of diabetes for 3 generations. He exercises vigorously 4 days a week. His HbA1c measures 7.1. He has a tendency to eat starchy foods and not too much lean meat or green, leafy vegetables.
This person could conceivably get labeled "prediabetic". His HbA1c is not sufficiently high to cause his doctor to prescribe medication. In reality, this
person is probably non-diabetic, even though he is insulin resistant, because the other factors are not present. His HbA1c might go down to 6.5 or lower if he would simply change his diet to include less starches and more veggies.
His doctor sends him home with encouragement to eat better.
Now, let's let our fictional person stop exercising, gain 45 pounds, and not change his diet.
His HbA1c is now 8.6 - his doctor diagnoses him with diabetes, prescribes Amaryl, and tells him to come back in 3 months. His insulin resistance is now
sufficient to cause him problems.
Now, I am going to describe a person I know well. She is a close relative, so I know all these things. I have watched this for years in absolute unbelief.... If I had a lifestyle like this, I would be dead.
She has a family history of diabetes, her mother was insulin-dependent before she died. She weighs nearly 300 pounds on a 5' 6" frame, she is largely confined to bed with fibromyalgia and migraine, as sedentary as sedentary can get. Her diet is awful, it is comprised largely of junk food.
Her fasting blood sugar is low 90s. She doesn't even make "prediabetes" -
this is a clear case of having no insulin resistance, she can ingest huge quantities of carbs with no lasting rise in blood sugar. Even though every other factor is present, she is nondiabetic because she is not insulin-resistant. Her doctor doesn't even bother to send her for HbA1c test - he knows it will be 5...
Fictional person #2 has normal weight, good exercise, no family history. However, she has a congenital pancreatic deficiency which causes her to manufacture insufficient insulin. She has diabetes, and is insulin-dependent. Her low dose, compared to others of similar size and age, shows clearly that she is not insulin-resistant, it is simply that she doesn't have enough insulin to keep her sugar levels down.
This is a speculation - not a cite of a known case -
Let's say there is a person who is of below normal weight, having a low BMI, which means he has lots of muscle and very little fat. He has insulin resistance, but no family history of diabetes for 3 generations. He exercises vigorously 4 days a week. His HbA1c measures 7.1. He has a tendency to eat starchy foods and not too much lean meat or green, leafy vegetables.
This person could conceivably get labeled "prediabetic". His HbA1c is not sufficiently high to cause his doctor to prescribe medication. In reality, this
person is probably non-diabetic, even though he is insulin resistant, because the other factors are not present. His HbA1c might go down to 6.5 or lower if he would simply change his diet to include less starches and more veggies.
His doctor sends him home with encouragement to eat better.
Now, let's let our fictional person stop exercising, gain 45 pounds, and not change his diet.
His HbA1c is now 8.6 - his doctor diagnoses him with diabetes, prescribes Amaryl, and tells him to come back in 3 months. His insulin resistance is now
sufficient to cause him problems.
Now, I am going to describe a person I know well. She is a close relative, so I know all these things. I have watched this for years in absolute unbelief.... If I had a lifestyle like this, I would be dead.
She has a family history of diabetes, her mother was insulin-dependent before she died. She weighs nearly 300 pounds on a 5' 6" frame, she is largely confined to bed with fibromyalgia and migraine, as sedentary as sedentary can get. Her diet is awful, it is comprised largely of junk food.
Her fasting blood sugar is low 90s. She doesn't even make "prediabetes" -
this is a clear case of having no insulin resistance, she can ingest huge quantities of carbs with no lasting rise in blood sugar. Even though every other factor is present, she is nondiabetic because she is not insulin-resistant. Her doctor doesn't even bother to send her for HbA1c test - he knows it will be 5...
Fictional person #2 has normal weight, good exercise, no family history. However, she has a congenital pancreatic deficiency which causes her to manufacture insufficient insulin. She has diabetes, and is insulin-dependent. Her low dose, compared to others of similar size and age, shows clearly that she is not insulin-resistant, it is simply that she doesn't have enough insulin to keep her sugar levels down.