What causes Insulin resistance? Is it Insulin injections, Diabetes tablets or Diabetes itself?

Recently a patient who is on Insulin injections for long time got his Serum Insulin tested on my instruction. He as well as me were surprised (rather shocked) to see that the result was more than 200 when the reference range is only (2.6 - 24.9).

I was diabetic from 2006 to 2009 & no more diabetic afterwards. During Jan 2010 I made a poster presentation (Day 1: picasaweb.google.com/115840... , Day 2: picasaweb.google.com/115840... , Day 3: picasaweb.google.com/115840... ) on my diabetes experience at the backyards of Indian Science Congress at the University Campus & one of the visitors who had Doctorate in bio-chemistry remarked that only with a Serum Insulin test one can confirm that the Pancreas is back to normal working condition & that HbA1c/OGTT tests do not suffice. Hence I got my Serum Insulin tested on 25.03.2011 along with my quarterly Cardiology check-up. The result was "Ser. Ins: 10.03 micro U/ml" with "Ref. range(2.6 - 24.9)".

I have heard many experts talking about Insulin resistance; have read in web articles as well. I had & have never used Diabetes tablets or Insulin injections. Hence arose the above question in my mind "IS IT THE INJECTED INSULIN OR THE SWALLOWED TABLETS OR THE ILLNESS (or syndrome according to the modern medicine) DIABETES ITSELF THAT CAUSES THE INSULIN RESISTANCE IN DIABETES PATIENTS?".

More over if the high value of Serum Insulin in my friend/patient is not due to Insulin resistance, what else could be the cause?

I very earnestly solicit the opinion of every one, especially the numerous experts on this forum.

Last edited by

50 Replies

  • dear george,

    that surprisingly high amount 200!!

    could it be due to the unit change?

    international unit and

    standard international units?

    the si units are in pico moles.

    or is it that a confusion between fasting insulin and post glucose load.?

    please clarify.

    good luck

  • insulin resistance is simply the need for more insulin for an individual to dismiss glucose out of blood [into tissues-liver ,adipose ,muscle etc]

    to give an example

    an average person requires 1 international unit of insulin to handle 50 units of blood glucose.

    a person with IR requires much more than

    one IU of insulin.

    insulin resistance is caused by obesity [ 'fat around waist' type particularly] is the main opinion among scientists.

    my rough understanding[memory aid] is:

    it is the same risk factors of type 2 diabetes itself.

    the presence of excess insulin

    also can be due to some

    rare things like inslinomas or some special growths that contributes to excess of beta-cells.

    i have not herd anywhere that diabetes or diabetes medicines cause IR.

    it is the other way round IR is a risk factor for diabetes.

    when age advances DM advance and we require more medicines.

    after all ,

    all of us have to die;

    otherwise Thomas Malthus will grumble in his grave,

    children will not have enough space to run around--Charls Darvin and Lamark will be unhappy.

    excuse poor indiacratus sarcasm.

    good luck

  • I was trying to find out the reason for an abnormality. What the science or scientists have accepted/recognised till this day is not what matters to me, but what appears logical & convincing to me is what matters to me. Human society, science & scientists have passed through centuries or millenniums accepting that Earth is STATIONARY & Earth is A FLAT DISK.

    But we know now that their acceptance or firm belief did not make earth neither stationary nor flat; earth was spherical, rotating on its imaginary axis & revolving around the Sun. Please correct me if I am wrong or ignorant.

  • dear george,

    these confusions about science and scientific knowledge can be easily solved if we sit down to resolve the issues.

    one thing

    scientific knowledge is different from scientific approach.

    a scientific approach is nothing but a policy to verify by experiments.

    scientific knowledge:

    there is no such thing as scientific knowledge.

    that is it.

    i will avoid a prolonged explanation--

    and try to cut short through some examples.

    class A

    look through a telescope , you see things clearer and near,

    or look through a convex lense ,you see things bigger.

    put sugar in a glass of water and stir it , you see the sugar dis appears.

    after some time if you go on adding sugar,

    sugar will not disappear further.

    this class A type knowledge is universal. and is just knowledge and not scientific knowledge.

    though science has brought it for us.


    there are mangoes in the tree near the river.

    andromeda galaxy is visible with the naked eye.

    sun rises in the east

    class C

    earth is moving around the sun.

    the sun is moving around the earth.

    both these class C instances i gave are correct according to relativity theory.

    class C type of knowledge are the products of an interpretation.

    interpretations will be constantly changing.

    which of them, A,B,C, is scientific knowledge?

    none of them.

    there is no such thing as scientific knowledge.only scientific attitude can be successfully defined.

    descrbing further will be involving many conflicts of centuries old discussions.

    but i think i have clearly elucidated my point

    and the same is valid in medicine too.

    interpretation will change

    but the presence of bacteria or insulin are just knowledge or perception, experience only.

    good luck

  • in a nut shell:

    what i wanted to emphasize


    the facts of a scientific discovery never changes.

    in other words the microscope and all that discoveries in the microbial world will remain

    invariable,for ever.,

    irrespective of the theories of light and its behaviour.

    in the ultimate sense,

    all of that have the same status

    as my

    disappearing sugar[in the example of class a knowledge.].

    dear george,

    no doubt, many concepts of philosophy and science are very complex and far beyond our understanding or imagination:

    but once explained in simple language

    they are very simple, though for that many centuries may have to pass.

    good luck

  • Hope the statements will remain invariable,for ever.

    Good luck to you too.

  • Hi indiacratus,

    You are very much (or completely) right in telling that all of us have to die; but the problem is that we have to live till that & as far as possible comfortably, peacefully etc.

  • the lab can clear it.

    some mistake somewhere.

    it may be 20 and not 200.

    one thing some labs give:

    μIU/mL and mIU/L . but they are the same thing.

    multiplying by ten to the power three on both sides -numerator and denominator.....

    and if it is

    in international units ,

    200 justifies that you are both shocked.

    good luck...

  • Hi indiacratus sir,

    I have checked with the patient again. Blood sample is drawn in Fasting condition.

    The lab is the same where I get my blood tested for Cardiology reviews every quarterly for nearly a decade now.

    The lab has NABL & ACHSI accreditation & the attaching hospital has NABH accreditation.

    The lab as well as the hospital are fully computerised.

    Hence I do not see any possibility for a human error.

    Any how I have requested him to verify with the lab, keeping a copy of the printout with him.

    The report says:

    Serum Insulin (ECLIA) 262.7 micro U/ml

    Ref: 2.60 - 24.90

  • i had messaged you an article.

    did you get that article?

    it is also given as a reply to patliputra

    . the magazine article somewhere at bottom . this place is crowded now.

    good luck

  • Analtycal errors are different. Insulin measurements is non linear,i.e. It is not like 1,2,3,4,5,6,7,8,9,10. Estimationof insulin by immunoassay (ELISA)is always on log scales, like1,10,100,1000 10,000 . Hence the analyist must be carefull to actually note extact colour and plot in logathimic scale. There are graph sheets which are semi logarthimic and also log log scale. Any error would lead to, not double of values but differ by magnitude of logarthimic exponents. Thus 20 can easily read as200.

    This is the reason that I emphsising qualified bochemical analyist should supervise the lab before releasing results.


    Molecular Endocrinologist

  • dear sarmaji,

    thanks for response.most people in this forum are people from outside medical profession.so if you explain a bit clearer ,will be more welcome.people like you are most wanted in this forum.

    is patliputra right?

    one need not be shocked by a reading of 200,it is usual. can you agree to this.

    you are from the lab and may be,

    you may have come across many measurements.

    good luck

  • True I am medical scicentist.

    There are very many details which is beyond the scope of this blog. Like I pointed out about measurement technique of insulin. We teach lots of students on analytical errors.

    Regarding insulin resistance there is basic agreement on the definition of insulin resistance.It is simply stated that" inability of insulin to push glucose into targeted tissue."

    But what casuses is question that is being addressed by many.

    For better understanding of the molecular basis of glucose clearance.you should know the kinetics of glucose absorption,insulin release,mechanism of action of insulin action,insulin receptors, signal transduction, types of glucose transpoters. Insulin sensitization,insulinogogues, ketosis dangers etc

    I am ot computer expert to document all details.But if you find good endocrinolgy book or website please go through and educate others.

    I wish to educate , but too tired after extensive teaching for the five decades.


    Molecular Endocrinologist.

  • Kindly go through glucose wikipedia on the isomers indetails it is very exhaustive

  • You both are forgetting the fact that the patient who tested 200, was on insulin medication. So I think one should stop speculating about the number. Molecular endocrinologist should know better .

  • share your mobile number that will be helpful for me. i am from kollam.

  • @ShooterGeorge,

    Interesting reading at below in the attachment.


    Unfortunately, Healthunlocked does not allow attachments in post. Otherwise would have posted the PDF along with the above link as well.


  • Hi Recyan,

    Unfortunately it could not be accessed because logging-in is a precondition there (like here); I am fed up of log-ins. :-)

  • @ShooterGeorge,

    Sorry. I had clicked on the link & found it to open without any log-in. Had not checked clicking on the pdf attachment link at that time. Now on trying, found that the article attachment needs log-in.

    Will try & find the web path for the article & post.it asap.


  • @ShooterGeorge,

    The link below :



  • Okay, thank you.

  • very interesting, thanks for the information

  • For me it is not surprising. Hyperinsulinemia precedes by many years before development of diabetes. As a matter of fact hyperinsulinemia is supposed to cause many chronic diseases.

  • hi patliputra,

    agreed .hyper-insulinemia precedes many people of the t2dm.

    and that is something many diabetics are unaware.


    they were surprised over the high value of 200

    when it has to be around 25 at the most.

    " were surprised (rather shocked) to see that the result was more than 200 when the reference range is only (2.6 - 24.9)."

    it can go upto 200 or above

    if that is after a glucose load and taken within 30 minutes to two hours.in mIU/L

    in picomoles as i said the si units ,

    these may be even beyond a thousand or near2000.

    from milli international units to SI units one has to multiply by 7 roughly.

    hope you might have come across such things in case of glucose where the conversion coefficient is 18.

    in usa a person has a bs equal to 90 and in London it is 5

    90=18 into 5

    good luck

  • dear george ,

    kindly note,

    ' in many'

    "hyper-insulinemia precedes many people of the t2dm.

    and that is something many diabetics are unaware"

    what i meant is hyperinsulinemia is not necessary in all .

    good luck


  • ok.dear george.

  • Sorry for delayed reply. My net was down.

    Before coming to main topic, I must confess that I am unaware of your diabetes history. So I will try to Clear your dilemma based on the information contained in the mail.

    Diabetes is a very complicated and human body is much more complicated than the most advance and sophisticated computer. Having said that let us review the available facts .(1) no record of serum insulin estimation prior to 25/3/11. (2) Duration of diabetes unknown (3) diabetes cured,as per your own version since August/September 2009.

    It is well known that Diabetes manifests clinically long after certain changes have occurred in the body relating to glucose homeostasis. One of the earliest change is development of insulin resistance,which over a variable period of time leads to hyperinsulinemia. If bs is brought back to within normal or non diabetic range,without any medication,and maintained for a variable period of time,it can easily be inferred that there is no more insulin resistance and hence no hyperinsulinemia.

    Your case perfectly fits.


  • too much of insulin in blood

    can coexist with normal bs levels

    with practically no other symptoms in some people.

    in fact that is what insulin resistance leads upto prior to becoming diabetic.

    good luck

  • You are absolutely right.

  • a large testing of fasting insulin levels

    A startling 66% showed fasting insulin over 5 µIU/mL, with some in DANGEROUSLY high ranges of 10-30 µIU/mL.

    -----------------------------------------------------------------------------------it is logical to assume that many of the 66% whose fasting insulin was over 5 µIU/mL also were overweight or obese. Thinner people tend to have lower fasting insulin levels.


    good luck

  • why basal insulin levels remain high ? A very complicated issue.Different explanations are given by different researchers and involves a lot of very technical details,not fit to be discussed here.But crux of the matter is that there is no unanimity on the issue,so can be safely said that it is still very poorly understood.

    Obesity is cause or effect of this phenomenon , it is still being debated.

  • dear patliji,

    that is simple .

    mechanism error.

    just see my answer to

    sharmaji above.

    the 1234 is the homeostasis.

    1]when bs goes up

    2]more insulin is released into blood,[ prompting a bs fall]

    3]then bs falls.

    4] then insulin also falls.[due to reduced release, because the prompt has fallen. ]

    but in the person who is insulin resistant

    the released insulin as in [2]is unable to cause a needed amount of bs fall.

    thus the amount of fall ,,as in [3] also will be less.

    then more and more insulin has to be released instead of as in [4].

    resulting in hyperinsulinemia.

    the same applies in case of fasting as well as always .

    we chose fasting state only as a matter of

    steady state condition.


    then the question is why the bs fall is less?in some people.?

    mechanism errror.

    which in biological terminology is homeostasis error.

    that is insulin resistance itself.

    that is ,in some persons more insulin is needed for the same amount of fall which happens in a healthy man.

    homeostasis is a closed loop.

    when such a system stabilizes

    the result will depend on all the factors in the loop.

    for instance

    in this case

    the response of the insulin receptor[the bridge],the number of receptors,

    the activity beyond called insulin signalling,

    then the glut4 vesicles, translocation --glucose entry.

    all these act in circular chain which is called a closed loop.

    such a system can oscillate or stabilise in any levell [of glucose or insulin]

    i can give a simple example.

    in an over head tank with water falling into it

    let the rising water operates a float which can counter act the tap that admits water in.as we see every where.

    let water continuously falls into the tank

    as well as moves out of the tank for household use.

    also let the lever and the float is arranged to work at the bottom of the tan kitself at a very early stage by connecting a rod to the float..

    what determines the water level finally in the tank?

    the length of the float lever,

    the rate of water entry,

    the rate of water going out,

    the diameter of the hole on which the float valve works ?

    and at a time how much of this hole is closed,and so on.

    such homeo stasis is studied very extensively.

    the cell biology behind it is

    too much.

    heredity as well as a conditionally arrived body weight are the major reasons that controls the level of insulinemia in an individual.

    good luck

  • Thank you @patliputra for the explanation :-) .

  • My fasting insulin level is 4.04uU/ml, what does it mean to me? (reference rang 2.6-24.90).

  • sharmaji,

    it simply means you are not insulin resistant. you are well within the range;[presuming of course, your fasting bs is well within range as well.]you are enough sensitive to insulin.

    otherwise with such a small amount of fasting insulin in blood

    you would have had high fasting bs.

    1]when bs goes up

    2]more insulin is released into blood,[ prompting a bs fall]

    3]then bs falls

    4] then insulin also falls.[reduced release]

    but in the insulin resistant

    the released insulin as in [2]is unable to cause a needed amount of bs fall

    the amount of fall ,thus,as in [3] also will be less

    then more and more insulin has to be released instead of as in [4].

    resulting in hyperinsulinemia.

    the same applies in case of fasting as well as always .

    we chose fasting state only as a matter of

    steady state condition.

    during fasting ,work done is least[we were sleeping,] and dietary glucose arrival is nil

    [we dont eat in night].

    the so called steady state in homeostasis arrived..

    you are healthy as far as insulin sensitivity is concerned..[in mind also you are healthy, please come often]

    good luck

  • 4.04 micro units/Milli liter.( Reference range 2.6-24.9). Thanks.

  • Before putting forward any explanation, it is pertinent to know whether you are on Insulin therapy?

  • If your FBS is normal then you are not insulin resistant.

  • Method USED IS C.L.I.A.

  • It is neither external insulin or hypoglycemics tabs which causes Diabetes. Diabetes is not the cause of insulin resistance rather insulin resistance leads to diabetes.

  • No i am not on Insulin Therapy.

  • Rksk, body always needs some insulin circulating in the blood,otherwise the liver will go on dumping glucose in the circulation,whether you eat or not. Circulating insulin should never be zero. But some times it does happen in untreated type 1 diabetes.

  • yes you are absolutely right.

    over and above that,

    insulin has many other functions in addition to glucose transportation.for instance, aminoacid transportation into cells, ,lipid homeostasis etc.

    we understand it mainly in the glucose context.

    "The metabolic functions of insulin are primarily reflective of its role in glucose and lipid homeostasis in skeletal muscle, adipose tissue, and liver. However, insulin also exerts important functions in other non-classical insulin target tissues such as the brain, pancreas, and the vascular endothelium. The ability of insulin to exert vasodilator action in the vascular endothelium as a result of increased nitric oxide (NO) production is an important component of the ability of this hormone to enhance glucose uptake by skeletal muscle. The insulin-mediated signaling pathway that triggers production of NO in vascular endothelium involves the same signaling proteins (PI3K, PKD, and PKB/Akt) that are components of metabolic regulatory pathways induced by insulin. Therefore, it is understandable why the same disruptions to insulin signaling that lead to IR (see above) caused by excess FFAs and hyperglycemia......."


    good luck

  • Yes insulin has multi dimensional role as far as metabolic functions are concerned. Each aspect of insulin can be discussed,but I don't think we should do it because it gets too technical and will not serve any purpose. We should confine ourself to basics and try to educate people to understand diabetes and related issues in simple non technical language. In the past we have done this and let us start afresh again.

  • agreed

  • Investigating people say that there will be the signature of God on something remaining at the crime site that will lead the way to the culprit.

  • Dear SG, I am following LW roti made it grinded powder and made roti since 5 months i am having but skipped sometimes for week and continued again . Will this hinder the cure. I am looking for cure not control bs

  • Hi Niranjan_Kanna,

    Occasional skipping of LWM may not hinder the cure, but the items that you take instead of it (LW based) MAY - if those are fruits, root vegetables, sweets, liquor, bakery products etc.

    Be systematic; you will hit cure for sure - if the dry-heating/static-charge accumulation do not spoil the curative ability of LW.

  • @cscon, yes.

You may also like...