Dear fellow researchers,
Recently, I conducted some research and noticed that some authors have already demonstrated that long-term insulin therapy—although crucial for the treatment of type 1 diabetes—may induce insulin resistance in mice with type 1 diabetes. However, I have not found any studies addressing this potential relationship in humans. Could you help me with this?
Hello Professor Raquel da Franca,
Thank you for your inquiry regarding the potential relationship between long-term insulin therapy and insulin resistance in type 1 diabetes (T1D). Recent studies have provided some insights into this complex relationship, although the evidence in humans remains limited.
Insulin resistance (IR) is increasingly recognized as a significant factor in the progression of T1D. Elevated insulin resistance has been observed in relatives of T1D patients, suggesting a potential genetic predisposition. IR may predate the onset of T1D and contribute to disease progression, consistent with Wilkin's "accelerator hypothesis," which posits that IR leads to β-cell metabolic overload, hyperglycemia, and subsequent autoimmunity.
While there is no direct evidence that long-term insulin therapy induces IR in humans with T1D, studies have shown that exogenous insulin replacement can lead to iatrogenic hyperinsulinemia, which may exacerbate peripheral IR. This hyperinsulinemia is a result of the non-physiological insulin infusion methods used in T1D treatment, which can contribute to the development of IR. The presence of insulin resistance in T1D patients is associated with an increased risk of disease progression and cardiovascular complications. Understanding the interplay between insulin therapy, metabolic factors, and immune mechanisms in T1D is crucial for optimizing treatment strategies and improving patient outcomes.
Best regards,
Zhenglin He
Dear Zhenglin He
Thank you very much for your detailed contribution and valuable insights into the relationship between insulin therapy and insulin resistance in type 1 diabetes. Your comments provide important perspectives on the complexity of this topic, particularly regarding iatrogenic hyperinsulinemia and its potential effects on peripheral insulin resistance.
I will continue investigating this interaction, considering both metabolic and immunological mechanisms, to contribute to a better understanding of this phenomenon and its clinical implications. I truly appreciate you sharing your knowledge!
Best regards,
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