A chief issue in insulin resistance is an over abundance of insulin receptors with not enough insulin to work with them to metabolize glucose in the body. That is why you see it in more overweight persons than normal weight folks. The dietary issues you mention are helpful but for someone in Hyperglycemia and in keto- acidosis, high dose insulin bolus and then a titratable insulin gtt with fluids and sometimes a bicarb gtt are the only thing that works to get the sugar down. Insulin resistance is mananged in the long term, not so much by higher regular Humulin “scales” but by determining what level of endogenous insulin a person can make on his own and augmenting with oral agents if the person will respond to them or if not, the use of Lantus or long acting insulins that act to produce a “steady state” level of insulin which works better with insulin resistant persons. The steady state works better because if you have a constant level of insulin, there is more insulin available over a longer period of time for a larger number of insulin receptor sites to utilize to bring the total glucose numbers down. Some persons may need lower doses and some persons need higher doses of insulin at a constant rate. Diet and weight loss certainly have their place but the notion that “higher insulin doses” cause more resistance is not accurate.
A subpar phosphorus level(especially during a hyperglycemic crisis) may mimic resistance because phosphorus is needed to make ATP’s which is the body’s chief energy molecule. Correct the phosphorus and the insulin starts working and the sugar levels drop.