Dr. Ben Bikman

So...

The fat tissue becomes insulin resistant first.

That facilitates the insulin resistance of the glucose controlling tissues, muscle, liver, and the alpha cells.

And when those start to become insulin resistant in any particular order, that's when you start to see the glucose start to climb.

But we know decades potentially before the person ever starts to have hyperglycemia, they have hyperinsulinemia.

That's why I think the fat cell is subtle enough in its metabolic demands that it doesn't really need a lot of glucose.

Its metabolic rate is so modest.

So it can become insulin resistant without really affecting fasting glucose levels.

So the person's fasting glucose levels can stay normal.

But once the glucose handling tissues, like the three I've already articulated, become insulin resistant, now glucose is uncontrolled.

Yeah, they do.

Yeah, but they shrink.

So I actually say, when I talk about this in my class, I say the patient's on a fat cell shrinking journey.

That's exactly how I describe it.

Because that is weight loss.

All weight loss is shrinking of the fat cells.

Now, however, a fat cell has a lifespan of about 10 years.

And so depending on the utility of that fat cell, it may not be replaced or it may be replaced.

And so you can, over time, lose fat cell number.

And indeed you do.