Jaiwant Rangi, MD, FACEEndocrinologist | Founder, Lower The Dose® | Speaker

Managing Severe Insulin-Resistant Diabetes: Beyond Traditional Insulin Therapy

16 Jul 2026 · 1 min

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Dr. Jaiwant Rangi treats severe insulin-resistant diabetes by shifting away from high-dose insulin toward agents that address the root problem: resistance itself. An A1C can drop 2-4% in three months using GLP-1 agonists like semaglutide, pioglitazone, metformin, and high-dose omega-3s, with symptoms improving within weeks.

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How we monitor is, is very specific. The timeline is usually the blood sugar control needs to be done within days because the A1C at the presentation is very high. A1C drops by 2 to 4% in the next 3 months, and the symptoms improve within a couple of weeks. Now, if you go to the next one, which is severe insulin-resistant diabetes, then in that case, the treatment is geared towards how to improve the resistance. And that is when we choose medications, not insulin, but we use GLP-1 agonists like semaglutide or liraglutide or tirzepatide. Appetite. Sometimes I even use pioglitazone for insulin sensitivity, which is called Actos in United States. We also use metformin in this case, and they also benefit from high-dose omega-3s, about up to 2 to 4 grams daily.