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

Unlocking the Metabolic Wall of Severe Insulin Resistance

14 Jul 2026 · 1 min

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In this segment, the speaker introduces the "metabolic wall" subtype of severe insulin‑resistant diabetes, a condition where the pancreas secretes abundant insulin but peripheral tissues are markedly unresponsive. The presenter contrasts this with other insulin‑resistant forms that feature insufficient insulin production. To illustrate, a detailed case is described: a 45‑year‑old South Asian businessman with a 40‑inch waist, a body‑mass index of 26 (adjusted for Asian criteria), fatty liver disease, triglyceride levels ≥250 mg/dL, and persistent abdominal adiposity despite regular exercise. The example underscores the clinical challenge of losing visceral fat when a metabolic wall blocks insulin signaling.

Chapters

The next one is severe insulin-resistant diabetes. Now, this is opposite to the other one. You have plenty of insulin produced by your body, but you have insulin resistance. This is a metabolic wall subtype. Body makes plenty of insulin, but your cells refuse to respond. So example here is a 45-year-old South Asian businessman, 40 inches of waist, body mass index is 26. Because they're Asian. Fatty liver, high triglycerides of 250 or more. Despite exercising, he cannot lose belly fat.