14: Overcoming Insulin Resistance in Type 1 Diabetes

Suggest guests or get in contactIn this deep-dive episode, John Pemberton explores the misunderstood world of insulin resistance in people with type 1 diabetes. Drawing on years of personal experience, clinical expertise, and the latest research, he breaks down why insulin resistance matters—even in a condition defined by insulin deficiency.Click here for the detailed 3-part write upThe episode walks through the 'Ominous Octet', eight mechanisms that drive insulin resistance, and explains how they impact blood glucose control, weight management, and long-term health. More importantly, it offers practical strategies to reduce total daily insulin dose through lifestyle changes, activity, nutrition, and pharmacological options.Whether you're living with T1D, supporting someone who is, or simply want to better understand the complex interplay between insulin and the body, this episode provides clarity and direction.Takeaways:People with T1D often require more insulin due to lack of portal delivery and higher peripheral levelsInsulin resistance occurs in the liver, muscle, brain, kidneys, gut, and fat tissueMeasuring units per kilogram is a useful proxy for insulin sensitivityActivity is the most powerful modifiable factor for improving insulin sensitivityWeight loss, high-protein diets, and reduced saturated fat intake all help reduce resistanceGLP-1 and dual agonists (e.g., tirzepatide) show promise for T1D, but are not yet widely approvedSGLT2 inhibitors and pioglitazone offer targeted benefits but must be used with careA multifaceted approach is often needed to lower insulin needs and support healthChapters:00:00 - 02:10 | IntroductionJohn Pemberton welcomes listeners to Episode 14.Shares his background: living with T1D, creating the Glucose Never Lies Education Programme, and motivation from personal and family experiences.Introduces co-host Louise (not present in this episode).Outlines the episode focus: insulin resistance in type 1 diabetes.02:10 - 04:35 | Why Insulin Resistance Matters in T1DT1D often leads to higher insulin doses.High insulin doses are linked to increased risk of cardiovascular disease and mortality.Importance of understanding and managing insulin resistance to reduce long-term health risks.04:35 - 06:50 | The Metabolic Disadvantage in T1DDescribes differences in insulin delivery: endogenous (via portal vein in non-diabetics) vs. exogenous (subcutaneous in T1D).Explains how peripheral insulin levels are 4–8x higher in T1D, contributing to insulin resistance.06:50 - 09:15 | The Ominous OctetIntroduces eight mechanisms of insulin resistance (based on Dr. Ralph DeFronzo’s work): Liver insulin resistanceMuscle insulin resistanceBeta-cell dysfunctionHyperglucagonemiaBrain insulin resistanceGut hormone dysfunctionFat cell dysfunctionKidney (renal) insulin resistance09:15 - 11:30 | Measuring Insulin ResistanceEuglycemic clamp = gold standard (not used in T1D).Use total daily insulin (TDI) per kilogram as a practical metric.Defines ranges:<0.4 units/kg = insulin sensitive0.5–0.7 = mild insulin resistance0.7–1.0 = moderate1.0 = high insuliDisclaimerThis podcast is for education and informational purposes only. It does not constitute medical advice and is not a substitute for individualised care.The Glucose Never Lies® is independent by designWe do not accept sponsorships and advertising. We operate via education grants and donations from listeners who value independence. So, consider:Buying the GNL a Coffee:https://www.buymeacoffee.com/jspfree2EnquiriesCollaboration: John Pemberton — [email protected]: Anjanee Kohli — [email protected] The Glucose Never Lies®Website: https://theglucoseneverlies.com/Instagram: https://www.instagram.com/theglucoseneverliesLinkedIn: https://www.linkedin.com/company/theglucoseneverliesLinkedIn: John Pemberton: https://www.linkedin.com/in/john-pemberton-587104361/X: https://twitter.com/GlucoseNLiesDisclaimer This content is for informational purposes only and does not constitute medical advice.© The Glucose Never Lies Ltd. All rights reserved.