While it is widely known that insulin resistance is a central feature of type 2 diabetes and pre-diabetes, it is less well known that it can also affect people living with type 1.

The term ‘double diabetes’ was coined in 2001, and describes people with type 1 diabetes autoantibodies who also develop insulin resistance.

The normal action of the hormone insulin helps manage blood glucose levels by moving glucose from the blood into muscles, fat cells, and the liver to be used for energy.

When you are insulin resistant, the body has built up a tolerance to the actions of insulin, and insulin is less effective in doing its job.  As a result, more insulin may be required to coax the cells and liver to take up the glucose from the blood.

Insulin resistance

Insulin resistance is what contributes to the increased insulin requirements usually seen in people with type 1 diabetes during puberty, pregnancy and periods of illness.

Insulin resistance is also linked with:

• Carrying extra weight (especially around the waist)
• Not enough physical activity (sedentary lifestyle)
• Family history of type 2 diabetes
• Certain ethnic groups (eg South East Asian, Indian, North African, Aboriginal & Torres Strait Islanders, Maori, and Polynesian)
• Getting older
• Polycystic ovarian syndrome (PCOS)
• Certain medications (e.g. steroids)

Intensive insulin therapy, increasing insulin dose requirements, recurrent hypoglycaemia and excessive snacking may contribute to weight gain and insulin resistance in people with type 1 diabetes.

Exercise

Now for the good news!  Being more active can make the body more sensitive to insulin in the short and long term.  Regular exercise and resistance training helps build muscle and can open up an alternative pathway for glucose to enter muscle cells without insulin as a mediator.  This reduces the cells’ dependence on insulin for energy, and can improve blood glucose levels.

Weight loss

If you are overweight, losing weight can improve insulin resistance. Weight loss can be achieved by maintaining a healthy diet and regular exercise. Eating five serves of veggies and two pieces of fruit per day and limiting your intake of processed foods, cakes, biscuits, and fried takeaway foods can help.

If your insulin requirements are increasing despite maintaining a fairly consistent diet you should speak to your doctor or diabetes educator. Insulin resistance may be playing a role. Insulin resistance makes managing your diabetes more difficult and increases your risk of developing cardiovascular disease.

Support

If you need support to get more active or with healthy eating, an exercise physiologist and dietitian can help.

By Nicole McClure

Credentialled Diabetes Educator, RN