What Is Severe Insulin-Resistant Diabetes (SIRD)

Severe insulin-resistant diabetes (SIRD) is a subgroup of type 2 diabetes. While symptoms of SIRD are the same as other forms of type 2 diabetes, complications leading to severe kidney disease set it apart.

Keep reading to learn what makes SIRD different than other types of diabetes and how you can cope if you are diagnosed with this form of type 2 diabetes.

A man sitting at a table testing his blood sugar.

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What Does Insulin Do?

Insulin is a substance that allows glucose (sugar) to enter your cells to supply them with energy. Without insulin—or a healthy response to the insulin your body makes—glucose can build up in your bloodstream causing high blood sugar (hyperglycemia) and a range of complications.

Types of Diabetes

  • Type 1 diabetes is an autoimmune health condition in which your body attacks itself, preventing insulin production. This form of diabetes often develops in childhood and is sometimes referred to as juvenile diabetes.
  • Type 2 diabetes often develops later in life due to diet and lifestyle changes. With this type of diabetes, your body either doesn't make enough insulin for the amount of glucose you take in, or your body doesn't have a strong enough response to the insulin you produce (insulin resistance). Most people—90% to 95%—with diabetes have type 2 diabetes.
  • Gestational diabetes is a form of diabetes that only develops during pregnancy. It can develop in pregnant people who didn't have diabetes before their pregnancy and often goes away once the baby is born. If left untreated, gestational diabetes can cause problems with your baby or your pregnancy and increase your chances of developing type 2 diabetes later in life.

Beyond these main types of diabetes, there are several subtypes of type 2 diabetes, including:

There is also a subtype called severe autoimmune diabetes (SAID), specific to type 1 diabetes.

Each subtype has specific criteria and may be associated strongly with particular complications.

What's In a Name?

Dividing diabetes into subgroups is a newer classification tool aimed at moving toward more precise medicine. Below is an estimation of how common each type 2 diabetes subtype is:

  • Severe insulin-resistant diabetes (SIRD): 15%
  • Severe insulin-deficient diabetes (SIDD): 18%
  • Mild obesity-related diabetes (MOD): 22%
  • Mild age-related diabetes (MARD): 39%

SIRD Symptoms

Symptoms of SIRD are similar to other forms of type 2 diabetes, but people who fall into this category are usually older—between the ages of 52 and 66—and have more diabetes-related kidney problems.

Other clinical signs and symptoms of SIRD can include:

  • High homeostatic model assessment indexes (HOMA2-IR and HOMA2-B) (an estimation of insulin resistance)
  • High body-mass index (BMI)
  • Low HbA1c (a blood test used to diagnose and monitor diabetes)
  • Lower kidney function/glomerular filtration rates (GFR)
  • Higher levels of urine acid
  • Good metabolic control

Other common symptoms of type 2 diabetes may also be present and may include:

SIRD Causes

Like other forms of type 2 diabetes, SIRD is primarily caused by diet, lifestyle choices, and genetics. This type of diabetes usually develops later in life as a result of things like:

SIRD Complications

People with SIRD are more likely to experience severe diabetic kidney disease that can progress to end-stage renal disease.

Other complications known to occur more frequently in people who fall into the SIRD subgroup include the development of nonalcoholic fatty liver disease (NAFLD).

Some other complications noted in different subgroups of type 2 diabetes, like high blood pressure and cholesterol levels, are not as common in people with SIRD.

All the subtypes also share general complications associated with type 2 diabetes, including:

·      Foot problems

·      Heart attack

·      Stroke

·      Gum and mouth disease

Treatment of SIRD

SIRD and other type 2 diabetes subtypes are treated similarly. Diet and lifestyle changes, like carbohydrate control and regulated exercise, are vital to diabetes management. Treatment may also include oral antihyperglycemics, such as metformin or injected insulin.

Your healthcare provider may also recommend additional treatments, including:

  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as Byetta (exenatide), Adlyxin (lixisenatide), Rybelsus (semaglutide), Trulicity (dulaglutide), Bydureon (exenatide extended-release), Victoza (liraglutide), and Ozempic (semaglutide)
  • Sodium-glucose cotransporter 2 inhibitors (SGLT2i), such as Invocana (canagliflozin), Jardiance (empagliflozin), Farxiga (dapagliflozin), and Steglatro (ertugliflozin)
  • Insulin sensitizers, like peroxisome proliferator activator receptor agonists
  • Anti-inflammatory medications


Diabetes is a chronic condition for which there is no cure. You will have to manage diabetes for the rest of your life once diagnosed, but the disease is manageable with the proper lifestyle and diet changes and medications.

Sticking to a treatment plan you create with your healthcare provider can help you keep your diabetes in check and prevent the development of dangerous complications.

Coping With SIRD

Living with diabetes can be challenging, and being in the SIRD subgroup means you have significantly higher chances of developing severe kidney disease.

The key to living with diabetes successfully is making a realistic plan with your healthcare provider, sticking to it, and asking for help when needed. Here are some tips to help you cope with and manage diabetes:

  • Let yourself get upsetLiving with diabetes can be difficult. Acknowledge these feelings and talk to someone about them. Get help if you need it, or reach out to a support group to share your experience with others.
  • Get financial help: The cost of diabetes supplies and medications can add up quickly. Talk to your healthcare provider or insurance company about financial assistance programs if you need them.
  • Accept help: Whether it's financial help or assistance cooking, don't be afraid to ask for help and take it when it's offered.
  • Try not to get overwhelmed: Do one thing at a time, and don't try to make too many changes at once.
  • Find things you enjoy: Whether it's an activity you love or a healthy snack, don't forget to find something you enjoy.


Diabetes is a serious condition no matter what subtype you have. It's important to find a way to be successful in managing your diabetes, especially if you have a subtype like SIRD that can increase your risk of serious complications like kidney failure.

Symptoms of SIRD are similar to type 2 diabetes symptoms, including increased thirst, frequent urination, blurry vision, and slow wound healing, among others. Causes are typically due to lifestyle and diet factors and genetics, including obesity, inactivity, and insulin resistance.

SIRD is treated similarly to type 2 diabetes—through lifestyle and diet changes and, sometimes, medication. Speak to your healthcare provider about a treatment plan that works for you.

A Word From Verywell

Diabetes is a disease for which there is no cure and requires lifestyle and diet changes. SIRD is one subgroup of the disease that, if not managed well, could lead to serious complications with kidney function and overall health. Talk to your healthcare provider about the best way to manage your diabetes and—if you have SIRD—how to protect the health and function of your kidneys.

Frequently Asked Questions

  • Do artificial sweeteners increase the risk of insulin resistance?

    Some evidence suggests that artificial sweeteners can trick your body into releasing insulin and contribute to insulin resistance. Talk to your healthcare provider or a nutritionist about the best sweeteners to use if you have diabetes or are at risk of developing the condition.

  • Can you reverse insulin resistance?

    Increasing exercise and improving your diet can help improve—and possibly even reverse—insulin resistance in the early stages (prediabetes). However, if you've already been diagnosed with diabetes, lifestyle and diet changes can help but are unlikely to reverse your insulin resistance completely.

  • Does severe insulin resistance put you at risk for other conditions?

    Kidney and vascular problems are the issues most often linked to insulin resistance. High glucose levels in your bloodstream don't just keep energy from your cells; they can clog or slow other systems in your body.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Rachael Zimlich, BSN, RN
Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.