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Patient Resources

Type B Insulin Resistance

February 08, 2022

Type B insulin resistance is a very rare form of diabetes and is usually a component of an autoimmune disorder. It is so rare that the exact prevalence is unknown. 

Endocrine Connection 

The immune system works to fight infections and protects your body from harmful environmental factors. Autoimmune diseases arise when the immune system mistakes parts of the body as being foreign or ‘non-self’ and mounts an immune response against the body’s healthy cells, tissues, and organs.  

One way that the immune system protects you is by antibodies. When the immune system is functioning correctly, antibodies attach to invaders in your body, like bacteria or viruses. This allows your immune system to identify the invaders and get rid of them. In people who have autoimmune disorders, the immune system can make antibodies against parts of your own body. The immune system may try to attack the part of your body that the abnormal antibody is attached to. 

Most people who get type B insulin resistance have an underlying autoimmune disorder. The most common autoimmune disorder associated with type B insulin resistance is lupus or a closely related disorder. Sometimes, people may already have a diagnosis of lupus or a similar condition when they develop type B insulin resistance. However, sometimes type B insulin resistance is the first sign of an autoimmune disease in people who do not have a known autoimmune disorder. Rarely, type B insulin resistance occurs in people who have certain types of cancer. In these types of cancer (usually lymphoma or multiple myeloma), the cancer cells make the abnormal antibodies that bind to the insulin receptor. 

The symptoms people experience when they have autoimmune diseases depend mostly on the organs and cells attacked by the malfunctioning immune system. In the case of type B insulin resistance, your body makes abnormal antibodies that attach to normal insulin receptors on your cells and blocks the good effects of insulin. Binding of insulin-to-insulin receptors is needed for the body to use glucose (sugar). If insulin receptors malfunction, glucose can’t get into cells normally and it builds up in blood, causing high blood sugars. This form of impaired insulin action resembles severe diabetes, but it is not the same as the more common types of diabetes. It also requires a different approach to treatment. 

While there is no specific diagnostic test, type B insulin resistance is suspected if someone has very high fasting insulin levels, high levels of adiponectin and low or normal triglyceride levels with darkening of the skin in someone with a known autoimmune disorder. This diagnosis is typically made with blood tests and physical exam by an experienced physician. 

Common symptoms of type B insulin resistance are: 

  • Sudden onset of diabetes (high blood sugars) that are hard to control, even with very high doses of insulin. 
  • Darkening of the skin, especially on the face, under the arms, and around the groin.  
  • Weight loss despite increased appetite. 

Women may experience high testosterone, irregular or absent periods, or increased hair growth. Low blood sugars may occur in people with type B insulin resistance in the early stages of illness, but this is rare. Usually, low blood sugars occur after type B insulin resistance starts to get better. 

In many people, type B insulin resistance can be a life-threatening condition. The diabetes caused by type B insulin resistance is very difficult to treat. It can lead to diabetic ketoacidosis (DKA), a complication of diabetes when the body produces excess acids known as ketones. Mismanaged diabetes can increase the risk of infections, eye, nerve, and kidney damage. For people, type B insulin resistance gets better without treatment. However, this may take many years.  In some cases, as type B insulin resistance improves, the antibody against the insulin receptor may cause low blood sugars. These low blood sugars may lead to seizures, coma, or even death. 

The goal of treatment for type B insulin resistance is to get rid of the antibody that stops insulin from working properly. To do this, it is necessary to treat the underlying lupus or lupus-like autoimmune disease. 

Many medications are used that make the immune system less active (also called immunosuppressive drugs). None of them are specifically approved to treat type B insulin resistance. Using these drugs have helped patients with type B insulin resistance It’s considered part of standard medical care. The choice of medications used will depend on your health and may change if side effects develop.  

All of the immunosuppressive drugs used to treat type B insulin resistance have risks and potential harmful side-effects. Most of the side effects can be lowered by careful monitoring of symptoms and lab tests. Your healthcare provider will closely monitor you during treatment. 

Type B insulin resistance requires treatment for diabetes, which usually involves insulin shots. Most people with this condition do not respond well to insulin, therefore, treatment calls for large doses of insulin. Patients may need to inject 10 to 20 times more than the usual amount for most people with diabetes. Other diabetes medications may be prescribed, such as metformin, a pill used to improve the body’s response to insulin. 

A typical treatment regimen used to treat the underlying autoimmune disease in patients with type B insulin resistance are:  

Rituximab – 2 intravenous infusions two weeks apart 

Dexamethasone – Pills taken for four days out of every four weeks, until you are in remission 

Cyclophosphamide – Pills taken every day until you are in remission 

Azathioprine – Pills taken every day for about 6 months starting after you are in remission 

With proper treatment, type B insulin resistance can go into remission (no longer having diabetes) in about 4 or 5 months. Remission may occur quickly in some patients, and more slowly in others. In most patients, type B insulin resistance never comes back, but it can return again. If type B insulin resistance returns, it is diagnosed quickly and can be treated with less medications. 

  • Can insulin resistance be caused by stress? 
  • Is type B insulin resistance hereditary? 
  • Should I consider genetic testing? 
  • What treatment options are available for me? 
  • What are the potential side effects of treatment? 
  • Are there any dietary restrictions/considerations? 
  • Should I see an endocrinologist? 

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