Insulin is necessary for managing type 1 diabetes — but what happens if you’re insulin resistant? Insulin resistance is a common part of living with type 2 diabetes, but it can also happen in people with type 1 diabetes. Insulin resistance means your body doesn’t respond to insulin as much as it should.

Learn more about insulin resistance in type 1 diabetes mellitus, including what increases your risk for insulin resistance, how it affects your health, and how to manage or prevent it to help you in your type 1 diabetes care plan.

What Is Insulin Resistance?

Insulin is a very important hormone made by the pancreas. It helps muscle and fat cells take in blood sugar (blood glucose) to use for energy. It also tells the liver to store blood sugar for later.

Insulin resistance happens when your body needs more insulin than usual to absorb sugar from the blood and store it in the liver. This happens because your body builds up a tolerance to insulin. As a result, you don’t respond to the insulin as well as you should.

Doctors don’t know why a person becomes insulin resistant, but there are ways to manage and even prevent it.

How To Know if You’re Insulin Resistant

You might have insulin resistance if you need to use more insulin than normal to manage your blood sugar. For example, if your insulin dose is higher than expected for your body weight, it might mean you’re insulin resistant. This is something your doctor could help you figure out. If you notice that you need to use more insulin than usual to keep your blood sugar levels in a safe range, you might have insulin resistance.

Talk to your doctor if you think you’re using more insulin than normal so they can figure out what might be causing it. They may need to adjust your treatment plan.

Insulin Resistance and Type 1 Diabetes

Insulin resistance is normally an issue for people with type 2 diabetes and prediabetes, but it can affect people with type 1 diabetes, too. If you have type 1 diabetes and insulin resistance, you need to take more insulin to help your cells absorb sugar from the blood and keep your blood sugar levels from getting too high.

What Causes Insulin Resistance in Type 1 Diabetes?

Experts are still learning why the body stops responding to insulin in people with type 1 diabetes. Findings from one study showed that insulin resistance in type 1 diabetes is mostly caused by long-term high insulin levels in the bloodstream from multiple subcutaneous insulin injections (when you inject insulin with a needle under the skin).

The results suggest that this is the main cause of insulin resistance in type 1 diabetes, not hyperglycemia (high blood sugar), as previous studies suggested. However, both long-term high blood sugar and insulin therapy can reduce the body’s response to insulin and increase insulin resistance.

Risk Factors for Insulin Resistance in Type 1 Diabetes

There are several reasons why your body might become insulin resistant. Some risk factors can be changed, while others are outside your control. According to the American Diabetes Association, risk factors of insulin resistance in people with type 1 diabetes include:

• Being overweight
• Smoking
• Taking certain medications, like steroids
• Going through puberty
• Having a family history of type 2 diabetes
• Being pregnant, specifically in the second and third trimesters

Studies have also shown other characteristics, like age, sex, ethnicity, and how long you’ve had type 1 diabetes, can affect your risk of insulin resistance in type 1 diabetes. For example, women with type 1 diabetes may be less sensitive to insulin than men, according to the International Journal of Environmental Research and Public Health. Hispanics and non-Hispanic Black individuals may have greater insulin resistance than non-Hispanic white people. Ask your doctor about your risk factors for insulin resistance based on your traits and health history.

How Does Insulin Resistance Affect Your Health?

Insulin resistance can make it more difficult to manage type 1 diabetes because it can be harder to keep your blood sugar in the target range. You may need to take more insulin to maintain healthy blood sugar levels.

Insulin resistance might also increase the risk of cardiovascular disease and other type 1 diabetes complications. For example, reduced insulin sensitivity in adolescents has been linked to cardiovascular risk factors, including higher:

• Blood pressure
• Waist circumference
• C-reactive protein (a protein that indicates inflammation)
• Cholesterol

Insulin resistance in people with type 1 diabetes has also been linked to reduced cardiopulmonary fitness and coronary artery calcification. This is when calcium builds up in the two main arteries of the heart. Coronary artery calcification makes your arteries stiffer, which increases the risk of cardiovascular problems.

How To Manage Insulin Resistance

The U.S. Food and Drug Administration (FDA) hasn’t approved any treatments for insulin resistance in type 1 diabetes. However, studies continue to look at ways to manage it.

For example, research from the journal Diabetes Therapy has shown that metformin (a medication used to treat type 2 diabetes) can increase insulin sensitivity when it’s used with insulin therapy in people with type 1 diabetes. This reduces the amount of insulin needed to keep good blood sugar levels. However, metformin is currently not approved by the FDA to treat type 1 diabetes. Some health care providers may prescribe metformin off-label for insulin resistance, meaning it’s used in a way not officially approved by the FDA.

In addition, some researchers have stated that improving the movement of insulin between the liver and bloodstream, such as by injecting insulin directly into the abdomen, may help manage insulin resistance. It might also improve long-term outcomes of living with type 1 diabetes.

Ways You Can Prevent Insulin Resistance

There are several ways you can help prevent insulin resistance while living with type 1 diabetes. Some prevention strategies are about risk factors you can change.

The following steps may help prevent your body from becoming insulin resistant:

• Get more physical activity, which can make your cells more sensitive to insulin.
• Quit smoking if you do smoke.
• Consider weight loss if you are carrying extra weight, such as by being mindful of your diet and choosing healthy snacks.
• Follow up with your doctor about switching medications if drugs (like steroids) are the cause of your insulin resistance.

Some factors that put you at increased risk for insulin resistance are outside your control, like your racial/ethnic background and family history. Talk to your doctor about more ways you can manage or prevent insulin resistance based on your needs and health history.

Talk With Others Who Understand

On myT1Dteam, the social network for people with diabetes and their loved ones, more than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Do you have insulin resistance with type 1 diabetes? What do you do to manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.