Insulin Clearance

I recently came across this paper on insulin clearance. It's a little technical but discusses the insulin-degrading enzye (IDE) and how it affects type 2 diabetes.

As we all know, insulin makes blood glucose (BG) go down, and glucagon makes it go up. In most cases, the absolute amount of these hormones is not as important as their ratio. But other hormones can affect BG levels as well. For example, the hormone somatostatin inhibits the secretion of both insulin and glucagon as well as other hormones.

And IDE can also affect BG levels by degrading insulin in the liver.

So if, for some reason, you were producing too much insulin and not enough glucagon, IDE could help to control the excessive insulin levels. This is called insulin clearance, and it seems to decline with the progression of type 2 diabetes. Lower levels of IDE are found in obesity and type 2 diabetes. Less insulin clearance would result in higher insulin levels, and these could cause insulin resistance.

However, there's no agreement on whether lower levels of IDE are because insulin levels are declining or insulin resitance is increasing (essentially reducing the levels of effective insulin) or whether they are the result of dysfunction in the liver.

From a practical point of view, it doesn't matter that much what causes the decline in IDE levels. What matters to us is how this decline affects our BG levels. The authors found that exercise can increase IDE levels.

One interesting thing about all this is as an illustration of how complex the control of BG levels is. Many hormones and enzymes are involved, and we may have differences in the effectiveness of the various hormones and enzymes. Is it any wonder that we don't always see the same results from some drug or diet? Results of big clinical studies are reported as averages. But there are usually outliers.


We have to constantly experiment, keep records, and work out what is best for us. It's a lot of work, but it's worth that effort. Good control now will mean fewer problems in the future.