Systemic insulin resistance is distinct from the normal physiological glucose sparing observed in muscle on low-carb diets.

“now this is important it's all starting with the muscle cell right in in times of fizzy of non physiologic or pathogenic insulin resistance again I would say that muscle centric paradigm in which people are eating a low carbohydrate diet starts with the muscle as it doesn't need glucose because it has free fatty acids when someone has insulin resistance and is hyperinsulinemic hyperglycemic as we would imagine a type-2 diabetic to be it starts with the adipocyte and the adipocyte is becoming insulin resistant and they are sitting it is not doing the proper formation of palmitoleic acid relative to palmitate and the adipocyte is what is signaling to the rest of the body the adipocyte is not seeing the insulin signal so its insulin resistance in the adipocyte in types of diabetes and its glucose pairing that starts in the muscle in a low carbohydrate diet but these are not the same they look similarly but only if we're not careful to distinguish which tissue is reacting”

“this is physiologic insulin resistance quote which should be glucose sparing this is a very different state because in this glucose sparing state as you said insulin is low Glu is low yeah right and it's really only the muscle that is refusing glucose it's not you know in and and it's really only the muscle that is becoming resistant to the actions of insulin or saying hey I'm not gonna listen to you insulin I'm gonna do my free fatty acids right and it doesn't have to really listen insulin as much because insulin levels are very low yeah in terms of glucose partitioning”

“so the muscle tissue says do you know what i can run on fat so i'm just going to turn off this insulin signal and you don't need to give me any glucose because i'm sparing the glucose for the rest of the body”

“and this is why um the states are so different in physiological insulin resistance where blood glucose is low because you're not getting in any in through the diet and then you have tissues particularly the muscle tissue which uh can adapt to using free fatty acids released either from the diet or released from the output uh released from the adipose tissue if you're if you're in a deficit and then there are some tissues in the body that do have um a requirement for glucose they can't fat adapt particularly certain cells in the brain and the red blood cells so you need whatever glucose you have to be spared for those for those cells”

“and it's very different than systemic insulin resistance”

“pathologic insulin resistance happens when you have high levels of insulin the body is trying to signal to the fat cells to the muscle cells to the liver to take up glucose and to take up free fatty acids to take up energy currency but those tissues are refusing that because the fat cells are broken and they are sending out all sorts of signals to the body to refuse the actions of insulin”