Ask Dr. E: Does Insulin Resistance in Type 2 Diabetes Increase with Age?

What Is Insulin Resistance?

Insulin resistance is a complex condition that happens when cells in your muscles, fat, and liver don’t respond to insulin like they should due to certain genetic, metabolic, and lifestyle factors. It’s a key underlying cause of type 2 diabetes.

Type 2 Diabetes Is Naturally Progressive

Type 2 diabetes is a progressive condition, which means the initial strategies you used to manage it in the beginning may become less effective over time.

Two things can happen as type 2 diabetes progresses:

1. You might see increased Insulin resistance, especially if weight increases or physical activity declines
2. The pancreas gradually loses its ability to produce enough insulin to overcome the insulin resistance (declining beta cell function)

That’s why someone who initially managed their diabetes with lifestyle changes and metformin may eventually need a higher dose of metformin, or additional medications such as a GLP-1 receptor agonist, an SGLT2 inhibitor, insulin, or a combination of therapies.

The progression of type 2 diabetes varies from person to person, and researchers are still trying to figure out why some people need to do more to manage their diabetes than others. 

Age can also play a role in how your diabetes changes. The older you get, the more other factors can contribute to increased insulin resistance:

Reduced physical activity:

Activity often declines as we get older. Since exercise improves insulin sensitivity, less activity can worsen insulin resistance. If you’re not exercising, your muscle mass goes down, and muscle is the most important organ for glucose uptake. 

Hormonal shifts:

Aging is associated with changes in growth hormones, sex hormones (estrogen and testosterone), and cortisol, all of which influence insulin sensitivity.

Changes in weight and body composition:

With age, muscle mass tends to decrease, while body fat (particularly visceral fat) often increases. Less muscle and more central fat make the body less responsive to insulin. 

However, insulin resistance doesn’t automatically worsen simply because you’re getting older and you’ve had diabetes for a long time. Stay active as long as you can… light weights and walking are great ways to do that.

Is there a Way to Measure Insulin Resistance? 

There really are no obvious symptoms of insulin resistance, but there are sophisticated ways to measure insulin resistance that are done in clinical research centers. The most commonly used method is called the glucose clamp technique (are you sorry you asked?).

There’s another measurement sometimes used in research studies called the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), which is a blood test calculating fasting glucose and insulin to measure insulin resistance and beta cell function.  If you’re an inquisitive nerd, you can ask your doctor about it!

In clinical practice, we look at the ratio of insulin and body weight or BMI. The more insulin you use per body weight, the more likely you are to be insulin resistant.

How to Improve Insulin Sensitivity

Chronic low-grade inflammation is linked to insulin resistance. Here are a few ways to reduce chronic inflammation and improve insulin sensitivity:

• Get regular physical activity (walking counts)
• Lose excess weight
• Eat nutritious, balanced meals
• Improve sleep quality

You don’t have to overhaul your entire life overnight. A 10-minute walk after meals, practicing 5 minutes of mindfulness per day, or following a few simple tips for better sleep can all improve insulin sensitivity over time.

Key Takeaways: Insulin Resistance and Type 2 Diabetes

It’s completely normal to have increased insulin resistance over time with type 2 diabetes, but it’s not inevitable. If your medication doses need to be adjusted at some point, please know you are not failing at your diabetes management!

And remember, the goal isn’t to be on the lowest dose of medication or the fewest number of drugs. Diabetes isn’t a competition! The real goal is stable and consistent blood sugar levels that protect your health and help you live a long, full life. Needing a higher dose of metformin (or any medication) is very common, and it doesn’t mean you’re failing…it means you’re taking care of yourself!

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