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

“when we eat a low carbohydrate meal the muscle this is and I want to explore this physiology with you the the fat cells when the fat cells see insulin drop right then they will release then hormone sensitive lipase is activated there is increased free fatty acids in the blood and the increased free fatty acids in the blood signal to the muscle tissue so we have a dipa sites responding to lowered levels of insulin which is generally a good thing which is what will happen when we eat low carbohydrate diets and that will signal to the muscle cells that hey you don't need to take up glucose because you have free fatty acids so that the muscle cells see the free fatty acids and then they pause they do glucose sparing and they will not take up glucose”

“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”