Why Insulin is Not Working in Type 2 Diabetes

Insulin resistance in Type 2 Diabetes

It is not uncommon to hear people with type 2 diabetes mellitus saying that their insulin is not effective or not working at all. This is especially true in patients who are overweight or obese and have marked insulin resistance.

Type 2 diabetes patients are not insulin deficient. Their insulin levels may in fact be higher than in normal people without diabetes.

People with diabetes type 1 are insulin deficient and have no or minimal insulin resistance. They require very small doses of insulin.

However, unlike people with diabetes type 1, type 2 diabetic patients have resistance to insulin and may require very high doses of insulin.

The units of insulin required can also be estimated by the patient’s body weight and the number of body fats a person has. So, morbidly obese individuals may require more than 100 units per day.

The following steps describe how insulin works normally [ref]:

  • Your body turns food into glucose (sugar), which is then used as the body’s main source of energy.
  • The body’s cells can utilize blood sugar as energy with the aid of insulin.
  • To store blood sugar for later use, the liver receives a signal from insulin.
  • Low blood sugar levels signal insulin to do the same when blood sugar enters cells.
  • Lower insulin levels signal the liver to release stored blood sugar, ensuring that energy is always available, even if you haven’t eaten in a while.
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How do people develop Diabetes?

Blood sugars are extremely well controlled by the human pancreas. However, this finely tuned system can quickly become out of whack when:

  • A large amount of blood sugar enters the bloodstream.
  • To get blood sugar into cells, the pancreas produces more insulin.
  • Cells eventually stop responding to all that insulin and become insulin resistant.
  • The pancreas continues to produce insulin in an attempt to stimulate cell response.
  • The pancreas eventually can’t keep up, and blood sugar levels rise.

The two major issues diabetics face are:

Insulin resistance is the hallmark of diabetes type 2. Insulin deficiency occurs later as the disease progresses and more than 50% of the islet cells are lost.

A large amount of blood sugar in the bloodstream is extremely harmful to the body and must be moved into cells as soon as possible.

There is also a lot of insulin, which tells the liver and muscles to store blood sugar. When they’re full, the liver sends any remaining blood sugar to fat cells, where it is stored as body fat.

The resultant weight gain, visceral fats, and inactivity lead to further insulin resistance. The person develops prediabetes and diabetes.

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Why Insulin may not work in Type 2 Diabetes?

The exact cause of insulin resistance is unknown, but a family history of type 2 diabetes, being overweight (especially around the waist), and being inactive can all increase the risk.

Insulin resistance does not require being overweight. It is impossible to tell if someone has insulin resistance simply by looking at them [Ref].

  • Obesity:

Obesity, particularly excess fat in your belly and around your organs (visceral fat), is thought to be a primary cause of insulin resistance.

Insulin resistance has been linked to a waist circumference of 40 inches in men and 35 inches in women.

According to research, belly fat produces hormones and other substances that can contribute to long-term inflammation in the body. This inflammation may contribute to insulin resistance.

If you are obese, you are more likely to have insulin resistance. You may require more than the normal dose of insulin.

In addition, you need to lose weight, and add medications to your insulin regimen to make insulin work efficiently.

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  • Physical inactivity:

Physical activity increases insulin sensitivity and builds muscle that can absorb blood glucose. Inactivity can have the opposite effect and cause insulin resistance.

Furthermore, sedentary lifestyles and a lack of physical activity are linked to weight gain, which can contribute to insulin resistance.

  • Diet:

A high-carbohydrate diet and a diet high in saturated fats have been linked to insulin resistance.

Your body digests highly processed, high-carbohydrate foods quickly, resulting in a spike in blood sugar.

This puts additional strain on your pancreas to produce a large amount of insulin, which can lead to insulin resistance over time.

  • Certain medications:

Certain medications, such as corticosteroids, some blood pressure medications, HIV treatments, and some psychiatric medications, can cause insulin resistance.

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Additional Causes of High Blood Sugar Despite Insulin Use:

Your high blood sugar may also be brought on by other factors, such as insulin resistance, which may run in your family.

When that occurs, your body’s response to the insulin it produces isn’t as effective as it should be. You can also be taking medication for another medical condition that prevents your body from properly utilizing it.

Your body may not be absorbing insulin. This can occur if you repeatedly give yourself insulin shots in the same spot.

Injecting into indurated or scarred area may also impair insulin absorption. Changing locations or using an insulin pump is helpful.

Additionally, some people take less insulin than is recommended. They can be terrified of having low blood sugar or they might be afraid of needles.

Your comfort may improve if you gradually increase your insulin dosage. If you dislike needles, think about using an insulin pump or pen. Many pumps will sound an alarm if your blood sugar level drops.

Work closely with your doctor to discover a cure for whatever is causing your blood sugar levels to spike. Additionally, always consult them before adjusting your insulin dosage.

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How to make your insulin work for you (Increase Insulin Sensitivity)?

To control your blood glucose and improve insulin sensitivity, you may need to do the following:

  • Physical activity:

Physical activity makes you more sensitive to insulin, which is why it’s such an important part of diabetes management (and overall health!).

Even if you are not suffering from diabetes, you should perform regular exercise. Don’t wait to become diabetic. The sooner you act (literally), the better off you will be.

  • Eating a nutritious diet:

Your doctor or dietitian may advise against consuming large amounts of carbs since they cause the body to produce too much insulin.

They may also advise against consuming too much unhealthy fat, sugar, red meat, and processed carbohydrates.

Instead, they’ll probably advise consuming a diet rich in whole foods, which includes more fruits, vegetables, whole grains, fish, and lean meat.

  • Losing weight:

In order to try addressing insulin resistance, your doctor may advise you to try to reduce weight. According to one study, 7% weight loss can delay the onset of Type 2 diabetes by 58%.

  • Stress:

Stress prevents your body from producing insulin, which causes glucose levels in your blood to rise. Long-term stress causes your blood sugar levels to keep rising.

Yoga, meditation, tai chi, and breathing exercises are examples of regular exercise and relaxation methods that can be beneficial.

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Why Insulin has stopped working?

Lastly, it is also very common that a person is well-controlled with a specific insulin regimen, and all of a sudden there is a spike in blood glucose.

This can occur in the following situations:

  • Insulin has gone bad:

Insulin may become ineffective if:

    • insulin is not stored properly. It can be kept between 59 F and 86 F for 28 days out of the fridge. However, extremes of temperature and prolonged storage beyond 28 days may result in a loss of insulin effectiveness.
  • You have stopped exercising and took lots of high-calorie food:

Exercise and a low-calorie diet are essential for diabetes control. If you are non-compliant with diet and exercise, your blood sugars may spike.

  • You are in stress:

Anxiety and stress cause the release of hormones that have anti-insulin effects. Adrenaline and corticosteroids make your blood glucose go out of control.

Blood glucose spikes in stress may not respond simply to increasing your insulin dose. You may need anxiety medications to keep you calm and control your blood glucose.

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  • You have an infection:

Sometimes your blood glucose is very well controlled and once you have an infection, your blood glucose may spike.

Common infections associated with high blood glucose when insulin is not working include urinary tract infections and respiratory tract infections.

  • You have stopped insulin sensitizers:

Common insulin sensitizer drugs include metformin, pioglitazone, and GLP-1 analogs like Ozempic, Wegovy, Rybelsus, Liraglutide, Dulaglutide, and others.

These drugs can be used with insulin:

  • to limit the weight gain associated with insulin
  • enhance the effectiveness of insulin by lowering insulin resistance, and
  • by directly lowering blood glucose.

However, these drugs are associated with gastrointestinal side effects and may not be tolerated by type 2 diabetic patients.

When you skip the dose of these drugs, your blood glucose may go out of control. Before stopping any medicine, you need to consult.

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In Conclusion:

If you have diabetes type 2 and you think your insulin is not working, check for the following factors and managed them accordingly:

Causes and Treatment of why Insulin is not working Type 2 Diabetes




Insulin Resistance
  • Obesity
  • Lack of exercise
  • Genetics
  • Start exercising
  • Improve diet (low calorie, low fat)
  • Take insulin sensitizers
  • May need to switch to insulin analogs
Insufficient dose
  • Insufficient dose
  • Wrong injecting technique
  • Injecting into scars
  • Need to increase insulin dose gradually
  • Inject into the skin around the navel
  • Avoid injecting into scars as it may impair absorption
Insulin went bad
  • Insulin stored inappropriately
  • Insulin batch ineffective
  • Store insulin at 2 C to 8C. Do not freeze it or store it at high temperature
  • May need to change your insulin vial
Personal issues
  • Stress and anxiety
  • Infections
  • Stopping insulin sensitizers
  • May need stress-relieving exercises like yoga or medications to relieve stress
  • Identify and treat infections
  • Do not discontinue insulin sensitizers
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Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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