Dr. Ben Bikman

That is then when the muscle becomes insulin resistant.

You have lost access of the main glucose consumer.

So you're clearing the glucose out far of the blood, far worse, less readily than you were before, resulting in a hyperglycemia.

When the liver becomes insulin resistant, insulin can no longer inhibit glycogenolysis.

So normally one of the mechanisms whereby the liver works with insulin is by storing glucose as glycogen.

Insulin inhibits the breakdown of that glycogen.

Unless the liver's become insulin resistant.

Now the liver is breaking down glycogen and releasing it as glucose, even when insulin is attempting to tell it not to, thereby further compounding the hyperglycemia.

Then the last one is the most overlooked, but absolutely relevant, which is the alpha cell.

The alpha cell is the yin to the beta cells yang, where the beta cell releases insulin, and insulin's most famous job is to lower blood glucose.

The alpha cell releases glucagon, and its most famous job is to increase blood glucose.

So it's very important for fasting and exercise, the opposite of when insulin would be up, basically.

But the alpha cell knows when to not release glucagon,

when the beta cell is releasing a lot of insulin.

Because insulin, and their next door neighbors within the islets of the pancreas, insulin will flood the beta cell with, rather, the beta cell will flood the alpha cell with insulin, and insulin will inhibit the production of glucagon.

Which is good because then it helps insulin overall affect blood glucose to bring it down.

But the alpha cell can become insulin resistant.

Dr. Roger Unger at UT Southwestern over years published a series of mind-blowingly cool papers finding that in type 1 diabetes, if you just control the glucagon excess, you don't even need to give the patient insulin.

That you could correct all hyperglycemia by just inhibiting the glucagon.

So that's just a weird little feature of the fact that when the alpha cell becomes insulin resistant, and it does, it starts releasing uncontrolled glucagon, which comes to the liver and once again is telling the liver to make glucose and release it into the bloodstream.