Juicebox Podcast: Type 1 Diabetes
Episode #1447 Pro Tip: Insulin Resistance
Host: Scott Benner
Guest Expert: Jenny Smith, CDCES & RD
Date: February 28, 2025
Episode Overview
This episode adds to the Juicebox Pro Tip series, focusing on understanding and addressing insulin resistance in people with Type 1 diabetes. Scott Benner and Jenny Smith provide a comprehensive discussion on what insulin resistance is, why it happens, how to recognize it, and effective strategies—including lifestyle, dietary, and medical approaches—to manage and improve insulin sensitivity. The dialogue balances practical advice, listener questions, and the latest clinical perspectives, aiming to empower people to be “Bold With Insulin” without fear.
Key Discussion Points and Insights
1. Defining Insulin Resistance in Type 1 Diabetes
[02:21–06:43]
- Definition: Insulin resistance means body tissues (liver, skeletal muscle, fat cells) do not respond effectively to insulin, impeding glucose uptake into cells.
- High insulin use alone doesn’t always mean chronic insulin resistance—it can also result from temporary factors (puberty, medication, stress).
- "You might feel like 'it doesn’t matter how much insulin I give myself, it’s not moving,' but not all high insulin needs are true insulin resistance." – Jenny [06:19]
Notable Quote
“Insulin resistance is a very specific thing, but you could be at times resistant to insulin... Those two things get blended together.”
— Scott [06:19]
Temporary Vs. Chronic Causes ([05:07–07:04])
- Puberty, steroids, pregnancy, and certain medications can cause temporary insulin resistance.
- Weight gain outside normal developmental parameters and sedentary lifestyle are more likely to indicate true insulin resistance.
- Family history of Type 2 diabetes raises risk for developing insulin resistance in Type 1.
2. The Overlap: Type 1, Type 2, and “Double Diabetes”
[08:07–14:28]
- The concept of “double diabetes” (features of both Type 1 and Type 2) is gaining recognition in clinical care and insurance coding.
- The 2025 ADA Standards acknowledge that some Type 1s present with obesity, metabolic syndrome, or PCOS, justifying use of non-insulin treatments.
- GLP-1 medications (like Ozempic, Mounjaro) may benefit Type 1s with marked insulin resistance—insurance increasingly covers cases with documented dual diagnoses.
Notable Quote
“There is now...an ADA standard change...that notes that although type 1 is the diagnosis, some people with type 1 may have features that are associated with type 2—things like insulin resistance, obesity, metabolic abnormalities...”
— Jenny [11:41]
3. Factors Increasing Insulin Need—Not All Are “Resistance”
[16:03–19:15, 25:34–26:54]
- Genetics, age, physical activity, pregnancy, stress, illness, poor sleep, and certain hormones can all increase insulin requirements.
- Lifestyle factors like activity level can make “auto-mode” systems (AID pumps) or settings difficult to fine-tune.
Example
"Why do people struggle with AID systems sometimes? Because I'm super active on the weekend, but not during the week, or vice versa… your lifestyle is greatly impacting your insulin needs.”
— Scott [16:04]
4. The Liver’s Role & Inflammation in Insulin Resistance
[19:15–21:00]
- The liver governs endogenous glucose release; insulin resistance means it doesn’t respond to insulin’s “stop” signal adequately.
- Chronic hyperglycemia increases insulin resistance due to ongoing inflammation.
Notable Analogy
“High blood sugars...it’s like a sand blaster to the outside of a painted building—the more sugar you have circulating, the more damage it creates inside your vessels.”
— Jenny [11:41]
5. Long-Term Consequences & Maintenance
[21:00–25:11]
- Poorly managed insulin resistance leads to higher risk for cardiovascular complications, eye/nerve damage, and worsened glucose management.
- Emphasizes proactive maintenance—“polishing the chrome”—analogous to caring for a classic car for long-term health.
Notable Quote
“If you want to still be valuable many decades from now, you gotta polish the chrome a little bit...there’s maintenance to your body you have to do.”
— Jenny [25:00]
6. Troubleshooting Persistent High Blood Sugars
[25:11–26:54]
- Not all post-meal highs are due to insulin resistance—consider changing insulin-to-carb ratios, basal rates, and reviewing changes in activity or lifestyle.
- "If you need to pre-bolus an hour before eating, it's probably not a pre-bolus issue. Go back and check basal, insulin-to-carb ratios, and life changes."
— Scott [26:13]
7. Dietary Strategies for Insulin Sensitivity
[27:01–34:19]
- Two main dietary camps:
- Low-fat, high-carb, plant-based (e.g., Mastering Diabetes)
- Low-carb, higher-fat/protein (ketogenic)
- Scientific support exists for both—the key is long-term adherence.
- Diets eliminating processed foods, regardless of macronutrient distribution, tend to improve insulin sensitivity.
Notable Quote
“If you’re going to do plant-based low-fat, then do it and stick with it. Same with low-carb. The metabolic benefits emerge when you truly commit.”
— Jenny [29:00]
- Micronutrients & Individualization: Work with a professional for optimal macro/micronutrient intake, factoring in exercise and lifestyle.
8. Intermittent Fasting & Insulin Resistance
[34:19–37:33]
- Intermittent fasting can improve insulin sensitivity for some, but needs careful monitoring to avoid hypoglycemia—especially in Type 1s.
- Success is more likely with advanced technology (CGM, AID pumps) and appropriate insulin adjustments.
Notable Quote
“Arden can fast almost forever…but she’s on an algorithm that takes away her insulin at times. With great settings, you can avoid lows during fasting.”
— Scott [34:19]
9. Processed Foods & Why They Worsen Insulin Resistance
[37:33–40:41]
- Refined carbs, added sugars, processed fats, and additives (anti-caking agents, etc.) disrupt metabolism and increase inflammation.
- Processed foods’ negative effects: metabolic overload, oxidative stress, hormone disruption, weight gain, and micronutrient deficiencies.
Notable Quote
"If you just ate food that you lift up and go, 'this is broccoli, I see chicken,' and eat it, you’d eliminate a lot of those factors."
— Scott [40:19]
10. Medical and Supplement Options
[40:41–45:16]
- Medication options for Type 1s with true insulin resistance (often requiring a dual diagnosis for insurance approval):
- GLP-1 agonists (Ozempic, Mounjaro, etc.)
- Metformin (less effective but sometimes helpful)
- Supplements such as berberine may provide mild, short-term benefits, but data is limited—prefer working closely with a healthcare provider.
Notable Quote
"I once got listeners to send me all the supplements they take…It’s hard to be certain about any of it..."
— Scott [45:16]
11. Hydration, Electrolytes, and Insulin Sensitivity
[41:52–44:24]
- Dehydration impairs glucose and insulin delivery—think “mud versus water.”
- Hydrate primarily with water (not soda, juice, or flavored drinks), and consider basic electrolytes if drinking large amounts.
12. Body Composition: Weight, Muscle, and Physical Activity
[48:55–58:55]
- Weight loss improves insulin resistance, even in some non-overweight individuals if abnormal fat distribution or other metabolic issues exist.
- Building muscle increases insulin sensitivity by improving glucose utilization.
- Exercise—especially regular activity—dramatically enhances insulin function, sometimes serving as “free insulin.”
Notable Quote
"Your muscles...are more free to open at will and they don’t need as much insulin to unlock the doors and let the glucose flow in."
— Jenny [56:40]
13. Other Variables: Hormones, Stress, Illness, Sleep, and Thyroid
[58:55–61:18]
- Short-term spikes in insulin needs may stem from hormonal changes (puberty, cycles), stress, illness, steroids, or poor sleep.
- Thyroid disorders (hyper or hypo) also impact insulin sensitivity and should be carefully screened and treated.
- “Quality sleep is as important as getting enough hours. Insufficient or poor sleep is a form of stress that raises insulin resistance.”
— Jenny [61:14]
14. Testing and Early ID of Insulin Resistance
[63:32–66:13]
- Lab tests:
- A1C
- Fasting insulin/C-peptide
- HOMA-IR
- Triglyceride/HDL ratio
- Liver enzymes
- Uric acid
- Physical markers: fatigue, cravings, dark skin patches, PCOS, high waist circumference, etc.
15. Myths, Misconceptions, and Vetting Information
[66:13–69:26]
- There is confusion between fluctuations in insulin needs and true chronic resistance—many community discussions wrongly conflate temporary and structural causes.
- "Not all high insulin needs are 'insulin resistance'; sometimes it’s settings, growth, or life variables."
— Jenny [68:13] - Validate information with lab markers, trends, and expert advice—not just peer anecdotes.
16. Getting Started & Avoiding Frustration
[70:25–74:22]
- First step if overwhelmed:
- Assess current insulin settings
- Optimize for exercise and weight loss
- Seek help from professionals for persistent resistance
- Realize that management steps can feel conflicting—address one problem at a time and advocate for yourself with your clinician.
Notable Moment
“Don’t give up. Finding a doctor who understands what you figured out is a big deal.”
— Scott [75:30]
Notable Quotes and Moments
- “Insulin resistance is a very specific thing, but you could be at times resistant to insulin... Those two things get blended together.”
— Scott Benner [06:19] - "There is now...an ADA standard change...that notes that although type 1 is the diagnosis, some people with type 1 may have features that are associated with type 2."
— Jenny Smith [11:41] - “If you want to still be valuable many decades from now, you gotta polish the chrome a little bit…there’s maintenance to your body you have to do.”
— Jenny Smith [25:00] - "If you just ate food that you...go, 'this is broccoli, I see chicken,' and eat it, you’d eliminate a lot of those factors."
— Scott Benner [40:19] - "Your muscles...don't need as much insulin to unlock the doors and let the glucose flow in."
— Jenny Smith [56:40] - "Don’t give up. Finding a doctor who understands what you figured out is a big deal."
— Scott Benner [75:30]
Timestamps of Key Segments
- Definition & drivers of insulin resistance: [02:21–06:43]
- Double diabetes and dual diagnosis: [08:07–14:28]
- Temporary vs. chronic rises in insulin needs: [16:03–19:15, 25:34–26:54]
- Diet and processed foods discussion: [27:01–34:19, 37:33–40:41]
- Medications & supplements: [40:41–45:16]
- Exercise, muscle & body composition: [48:55–58:55]
- Impact of hormones, sleep, stress, thyroid: [58:55–61:18]
- Testing and early detection: [63:32–66:13]
- Vetting information, busting myths: [66:13–69:26]
- Getting started and avoiding frustration: [70:25–74:22]
Tone & Takeaways
The episode is conversational, supportive, and highly practical—with a focus on actionable insights and debunking confusion. Both Scott and Jenny use relatable analogies and real-world examples to make clinical concepts accessible. Jenny’s expertise and empathy shine, giving listeners both reassurance and clear next steps.
Main Messages:
- Insulin resistance in Type 1 is real but nuanced; don’t confuse high insulin needs with actual resistance without deeper investigation.
- Diet, movement, sleep, hydration, stress, and gut health all play roles—start by optimizing what you can control.
- Medications beyond insulin may help—but require proper diagnosis and provider advocacy.
- Don’t be discouraged by setbacks or misinformation; be persistent, informed, and collaborative with your care team.
If you haven’t listened, the episode delivers an engaging, state-of-the-art guide for anyone with Type 1 (or their caregivers), demystifying insulin resistance with clarity and hope.