Insulin resistance is often associated with type 2 diabetes (T2D), but people with type 1 diabetes (T1D) can also struggle with the condition. Here, we take a closer look at what insulin resistance is and how JDRF is addressing the issue. 

What is insulin resistance?

Insulin resistance (IR) occurs when the body becomes less responsive to insulin. In people with T1D, this can lead to an increase in the amount of insulin needed to keep blood sugar in a safe range. 

What causes insulin resistance in people living with T1D?

Over time, chronically elevated blood glucose and the use of insulin therapy (such as multiple daily injections or an insulin pump) can reduce the body’s response to insulin and increase IR. Studies have also shown that genetic predisposition and obesity play a role in the development of insulin resistance in people with T1D. Medications, such as steroids, can temporarily trigger IR as well.

What are the risks associated with insulin resistance?

IR can increase the burden of T1D management. People with reduced insulin sensitivity may have trouble meeting blood glucose targets and experience weight gain. IR also increases the risk for cardiovascular and renal complications and mortality.

Is there a treatment for insulin resistance in T1D?

Currently, there are no medications approved by the FDA to treat IR in people living with T1D. In recent years, several clinical trials have shown the benefits of using metformin in people with T1D. Some healthcare providers prescribe metformin to their patients with T1D off-label.

In other populations, studies have shown that lifestyle changes, including diet and exercise, can improve insulin sensitivity and reduce the risk of long-term complications. However, a direct connection between improved nutrition and physical activity and their impact on IR in people with T1D is still under investigation.

Improving lives: JDRF-funded research in insulin resistance

Interventions to improve insulin sensitivity have the potential to improve long-term outcomes, particularly for cardiovascular health. JDRF is supporting research that focuses on IR and its impact on the lives of people with T1D.

“For people with type 1 diabetes, glucose control alone is not enough to improve long-term health outcomes,” said Courtney Ackeifi, Ph.D., JDRF Senior Scientist, Research. “We also need to address issues that impact glucometabolic control, such as insulin resistance.”

Determining the mechanisms of insulin resistance in T1D

The development of insulin resistance in T1D is poorly understood. A JDRF-funded study by Janet Snell-Bergeon, MPH, Ph.D., assistant professor of epidemiology at the University of Colorado Barbara Davis Center for Diabetes, aims to better understand these processes through in-depth analysis of fat and muscle tissues. This work has the potential to identify new treatments to help people with T1D use insulin more efficiently and prevent complications like heart and kidney disease.

Blocking glucagon activity to improve insulin sensitivity

In people with T1D, high glucagon levels stimulate glucose production in the liver and the production of ketones. This contributes to high blood glucose, insulin resistance, and an increased risk of diabetic ketoacidosis (DKA). Jeremy Pettus, M.D., associate professor of endocrinology at the University of California San Diego, is leading a JDRF-funded investigation of a novel drug that blocks glucagon action. Ongoing studies will assess if using this drug alongside insulin therapy can improve blood glucose, reduce IR, and prevent ketone formation.

Assessing the link between high insulin levels, insulin resistance, and cardiovascular disease in T1D

Cardiovascular disease (CVD) is the leading cause of death for people with T1D. People with T1D are at risk of CVD even when they achieve their blood sugar targets. This is why exploring CVD in T1D is a research priority for JDRF. JDRF-funded researcher Justin Gregory, M.D., MSCI, assistant professor of pediatrics at Vanderbilt University School of Medicine, is exploring a hypothesis that IR, caused by high levels of insulin in the blood, may weaken the body’s blood vessels and lead to CVD. Findings from this study will provide insight into the metabolic processes that lead to heart disease in people with T1D.

Learn more about how JDRF-funded research improves the lives of people living with T1D.