Narrative reviewindependent cross-checkabstract checked I-INTB-03 standard review

Does too much insulin cause insulin resistance?

Insulin resistance and hyperinsulinemia: is hyperinsulinemia the cart or the horse?

Overview

Shanik MH et al.. Diabetes Care 2008 · PMID 18227495 · DOI 10.2337/dc08-s264

Evidence suggests high insulin can be both a result and a driver of insulin resistance.

Does the study support the specific claim? Partly · Methodological quality: low

Study explained simply

What did the researchers want to find out?: Examine whether insulin itself causes insulin resistance
How was the study done?: Narrative review
How many people, animals or samples were studied?: Animal and human studies
What was actually found?: Hyperinsulinaemia often both result and driver
How large was the observed effect?: not applicable
What do the results mean in everyday life?: Excess insulin may worsen the body's response to insulin, but the response problem is real.
What are the study's limitations?: Selective review; abstract only
What does it say about Elawady's specific claim?: Partly supports his focus on insulin; contradicts 'no such thing'.
Do the results apply to Germany and Europe?: Universal
What can explicitly not be concluded from this study?: Cannot show that insulin resistance is a wrong term.

Authors: Shanik MH et al.
Journal: Diabetes Care
Year: 2008
Identifier: PMID 18227495 DOI 10.2337/dc08-s264
Verification: verified – PubMed efetch 2026-10-25
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Research Support, Non-U.S. Gov't (publication type); no COI statement in record

Can elevated insulin itself contribute to insulin resistance?

Study design: Narrative review – Narrative review of evidence that hyperinsulinaemia itself causes or sustains insulin resistance
Population: Animal and human studies
Country: not applicable
Period: literature up to 2008
Sample size: not applicable
Inclusion and exclusion criteria: not stated

Exposure / intervention: Hyperinsulinaemia (transgenic mice, high insulin doses, insulinoma, pulsatile vs continuous insulin)
Comparator: not applicable
Endpoints: Insulin resistance
Statistical methods: none

Results: Defines insulin resistance as present when insulin levels are higher than expected relative to glucose. Lists evidence: mice with extra insulin gene copies (2-4-fold insulin) develop insulin resistance, hyperglycaemia and hypertriglyceridaemia at normal weight; rats and humans treated with escalating insulin doses show hyperinsulinaemia and insulin resistance; pulsatile insulin reduces insulin requirements; many insulinoma patients have reduced (but not absent) responsiveness to insulin.
Absolute risks: not applicable
Authors' conclusion: Hyperinsulinaemia is often both a result and a driver of insulin resistance.

Hypothesis-oriented review; supports a bidirectional relationship, not the absence of insulin resistance.

Partly matches Elawady's emphasis on excess insulin; at the same time it treats insulin resistance as real.

Most clinical evidence places insulin resistance and beta-cell dysfunction together in type 2 diabetes pathogenesis.

Universal physiology.

Fair counterpoint: the causal order between hyperinsulinaemia and insulin resistance is debated, but the phenomenon itself is not.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	low
Risk of bias	not assessable
Precision of results	not applicable
Directness	indirect
Reproducibility	partly replicated
Consistency with the overall evidence	mixed
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable

How much hyperinsulinaemia drives human insulin resistance in daily life.