The Peripheral Peril: Injected Insulin Induces Insulin Insensitivity in Type 1 Diabetes.

Abstract:

:Insulin resistance is an underappreciated facet of type 1 diabetes that occurs with remarkable consistency and considerable magnitude. Although therapeutic innovations are continuing to normalize dysglycemia, a sizable body of data suggests a second metabolic abnormality-iatrogenic hyperinsulinemia-principally drives insulin resistance and its consequences in this population and has not been addressed. We review this evidence to show that injecting insulin into the peripheral circulation bypasses first-pass hepatic insulin clearance, which leads to the unintended metabolic consequence of whole-body insulin resistance. We propose restructuring insulin therapy to restore the physiological insulin balance between the hepatic portal and peripheral circulations and thereby avoid the complications of life-long insulin resistance. As technology rapidly advances and our ability to ensure euglycemia improves, iatrogenic insulin resistance will become the final barrier to overcome to restore normal physiology, health, and life in type 1 diabetes.

journal_name

Diabetes

journal_title

Diabetes

authors

Gregory JM,Cherrington AD,Moore DJ

doi

10.2337/dbi19-0026

subject

Has Abstract

pub_date

2020-05-01 00:00:00

pages

837-847

issue

5

eissn

0012-1797

issn

1939-327X

pii

69/5/837

journal_volume

69

pub_type

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