Question:
I just found out today that I am insulin resistant. Are all overweight people?
Does this anything regarding the approval process by the insurance company. — alecsnana (posted on September 22, 2003)
September 22, 2003
Insulin resistance is also a term used for type 2 diabeties (I teach people
on diabeties). Ask your MD outright if you are diabetic, if you don't
already know that.
The more overweight you are the more you tend to resist your own insulin,
your making plenty but your body doesn't recognize it.
There are a lot more things I'd like to share w/you. Email me back and
we'll arrange a time to chat or call.
Carol
— Carol H.
September 22, 2003
Not all overweight people are insulin resistant. Being insulin resistant is
usualy because of the beginnings of Diabetes, poly cystic ovaries or other
diseases that can cause it. It is usualy found in overweight poeple because
of health problems caused either by obesity, or health problems that are
cause by obesity (it can be a nasty cycle). I do also have to say that not
all pcod suffers are insulin resistant either. Diabetes doen't run in my
family, but because I have pcod I am insulin resistant and have probs w/ my
blood sugar. It should affect your surgery in a positive way though.
Insulin resistance can either cause obesity or be caused by it. With pcod
your body releases a horemone that causes the fat cells to become larger
than they should, and that in turn releases another horemone that causes
you to secrete more insulin causing your muscles to be insulin resistant
causing you to release more of the horemone that causes the fat cells to
become larger. Your doc should determine which. aslo if it is caused by
pcod, you may have other symptoms like irregular cycles, heavy or non stop
bleeding (sometimes the opposite occours. no cycles at all birth controll
will help w/ this) excessive harryness (My eyebrows grow together and I
could grow a full beard and moustache if I didn't wax), infertility,
ovarian cyctits, pain durring sex, bleeding durring/after sex, excessive
tiredness, easily becomming irritated. That's just a few of the symptoms,
and your Gyno should be the one to diagnose you. Also, symptoms can varriy.
You may have all or very few of the symptoms and have it. Either way
because it can cause weight gain it increases your chances of having
bypass, as a lot of times it can be controlled or eliminated once you start
loosing the weight. Sorry about the long winded letter.... I had to do tons
of reaserch on insulin resistance and pcod for my shrink. He wanted to know
how it would effect me if he didn't approve me for surgery. Good luck and
God bless!! out 19 weeks, down 70 lbs
— mellyhudel
September 22, 2003
I don't have an answer, but a few questions. My PCP said that my sugar
test came out normal, but 2 years ago, she thought I had hypeinsulinemia. I
have dark rings around my neck and underarms. I have extremely heavy
periods, so heavy that she had to presribe iron back in August. How do they
test for PCOS?
— D. K.
September 22, 2003
I too am insulin resistant and treated with Glucaphage to help with that
and my PCOS. However, my blood sugar is perfectly normal. I understand
that it CAN lead to type 2 diabetes, and often does but it is not the same
as being diabetic. Do NOT let any doctor or nurse put that on your medical
records unless you are actually diabetic or it could hurt your insurability
with any insurance company in the future. I went a few rounds with an
idiotic nurse at the hospital that insisted that if I was on Glucophage
that I MUST be diabetic and she kept writing it until I got nasty with her
trying to explain. I have MILD PCOS but it has never affected my periods,
or fertility. It HAS caused me tremendous weight gain over the years.
Insulin is a fat storing hormone in itself, and it really has to be treated
with a low carb (not no carb) diet and sometimes medication. Personally,
the glucaphage has helped my weight loss a lot.
— Happy I.
September 22, 2003
The best place for info on insulin resistance and PCOS is
www.pcosupport.org.
— Maria N.
September 22, 2003
Insulin resistance is NOT the same as type 2 diabetes. One of the hallmarks
of Type 2 diabetes is abnormal blood sugar-- if you are insulin resistant
your fasting blood sugar is usually normal but your fasting insulin level
is usually sky-high. If you have been told that you are insulin resistant,
please be sure that you have had a glucose tolerance test (a 2-hour test is
what my doc did, as opposed to a 3 or 5 hour test) that includes an insulin
level drawn with each blood glucose level. A glucose level taken without an
insulin level is completely useless, as it does not tell the whole story.
And I had the same problem when I was in the hospital for my surgery:
everyone saw the word "glucophage" and assumed I was diabetic and
needed blood glucose monitoring. It took my paging my surgeon in the middle
of the night to get the nurses to leave me alone.
— lizinPA
September 22, 2003
I still insist that insulin resistance is part of type two diabeties, it is
not the only part though.Too many times patients tell us their doctor told
them they are "insulin resistant", or have "a little
sugar" and they spend ten years wondering why they are haveing a butt
load of problems and come to find out, the doctor didn't tell them they
were diabetic. Believe me, sometimes doctors mince words and just don't
spit the truth out so a person can deal with it. It is best to go back to
the doctor and ask them outright, if you are diabetic. Granted their are
other conditions that can contribute to insulin restance, but many times
when a doctor tells a person this, they are having trouble with their
sugars. How else would they know that they were "resistant" to
their own insulin?
Yes diabeties halmark is abnormal blood sugar levels. Insulin resistance
can cause this. Glucophage, is a biguanide, the only biguanide sold alone
on the market, ...in a nutshell it keeps you liver (a storage unit for
sugar) from dumping out sugar (prevents gluconeogenis). Many people are
able to manage diabeties, with diet and exercise. Just because your blood
sugar levels are normal the day you test (spot checks) may not tell you if
you are beginning to develop diabeties, it tells you your blood sugar
levels are ok at that moment. Many diabetics have their disease under
control and their bsl (blood sugar levels) are normal. The best overall
indicator of how well you are doing is your hemoglobin A1c, it should be
less than 7%, but this is not for diagnosing diabeties but in the
management.
At any rate, without mincing anymore words, ask your doctor outright if
this is diabeties....or something else....
There is more to this than can be typed. That is why in my original post,
I asked to speak or chat with the poster to get more information.
— Carol H.
September 22, 2003
Here is some literature from the American Diabeties Association. It can be
found at www.diabeties.org.
Look at what it is saying closely.
The Metabolic Syndrome
What is the Metabolic Syndrome?
People have the metabolic syndrome when they have several disorders of the
body's metabolism at the same time -- such as obesity, high blood pressure,
and high cholesterol. This syndrome affects at least one out of every five
overweight people ... but by making some positive lifestyle changes, you
can reduce or eliminate some of the components of the syndrome.
The metabolic syndrome (also referred to as "insulin resistance
syndrome" and "syndrome X") is serious, because its
components can lead to complications including hardening of the arteries
and an increased risk for cardiovascular and kidney disease. If you have
one component of the syndrome, you are at increased risk for having one or
more of the others. And the more components you have, the greater the
risks to your health.
Obesity/Abdominal Fat
Obesity is often confirmed by a determination of body mass index (BMI).
You can find your BMI by using the chart below. An increase in abdominal
fat in particular (having an "apple shaped" rather than
"pear shaped" body) has been associated with an increased risk
for heart disease.
Hypertension (High Blood Pressure)
Hypertension has long been associated with heart disease, stroke, and
kidney disease.
Dyslipidemia
Lipids are fatty substances that are essential for the proper functioning
of the body. Dyslipidemia occurs when the amounts of lipids in the blood
are higher or lower than normal.
For years we heard of the dangers of "high cholesterol." This
refers to an increase in low density lipoprotein, or LDL, cholesterol, the
so-called "bad cholesterol." There is also the "good
cholesterol", high-density lipoprotein, or HDL, cholesterol. In
general, the lower a person's LDL, and the higher their HDL, the better.
Other blood lipids called triglycerides can also be high in dyslipidemia.
Dyslipidemia is present when LDL is high, HDL is low, triglycerides are
high, or a combination of those factors. Dyslipidemia is associated with
an increased risk for heart disease.
Insulin Resistance ****************************
Many scientists believe that insulin resistance is one of the major factors
that either allows or causes the components of the metabolic syndrome to
develop. The body manufactures insulin to transport sugar (glucose) into
cells so they can use it for energy. Obesity worsens insulin resistance,
making it increasingly difficult for cells to respond to insulin. The body
reacts by releasing more insulin to "override" the insulin
resistance. When the body can't produce enough insulin to overcome insulin
resistance, blood sugar levels rise, ultimately leading to diabetes.
****************************************
Although there is no complete agreement yet on the components of the
metabolic syndrome or the individual risk levels for each component, we
know the syndrome poses a significant health risk to individuals and is a
growing health crisis for our country. But there are some steps you can
take to reduce the risk posed by each element of the metabolic syndrome.
Reducing Risk Factors
Lose Weight. Obesity is a major contributor to many of the components of
the metabolic syndrome. By losing weight and keeping it off -- even 10
pounds can make a difference -- you can greatly improve your health. Work
with your health care team to plan a diet that will help you lose weight
and maintain a healthy weight, and still include the foods you enjoy.
Increase Physical Activity. Physical activity burns excess fat and
increases muscle mass, helping your body burn calories much more
efficiently. Talk to your health care team about a physical activity plan
that will be safe and effective for you. You don't have to join a gym or
buy any special equipment to get more active. So, walk your dog. Take the
stairs instead of the elevator. Take walking breaks at work. Activities
you enjoy are the ones you will stick with for the long term.
Lower Blood Pressure. Losing weight and increasing physical activity can
lower your blood pressure. When more intervention is needed, medication
can be prescribed to help lower blood pressure.
Lower Cholesterol. Regular physical activity and a diet low in saturated
fats and high in fiber, and medications, can help normalize blood lipid
levels.
Stop Smoking. Smoking is known to greatly worsen the health consequences
of the metabolic syndrome. Many cessation plans are available to smokers,
so talk to your health care team about ways to quit and prevent weight
gain.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes,
either the body does not produce enough insulin or the cells ignore the
insulin. Insulin is necessary for the body to be able to use sugar. Sugar
is the basic fuel for the cells in the body, and insulin takes the sugar
from the blood into the cells. When glucose builds up in the blood instead
of going into cells, it can cause two problems:
Right away, your cells may be starved for energy.
Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or
heart.
Finding out you have diabetes is scary. But don't panic! Diabetes is
serious, but people with diabetes can live long, healthy, happy lives. You
can too by taking good care of yourself.
What is Type 2 Diabetes?
Diabetes is a disease that impairs the body's ability to use food. The
hormone insulin, which is made in the pancreas, helps the body to use food
for energy. In people with diabetes, either the pancreas doesn't make
insulin or the body cannot use insulin properly. Without insulin, glucose -
the body's main energy source - builds up in the blood.
Approximately 90-95% of Americans with diabetes have type 2 diabetes --
about 16 million people.
Some of the symptoms of type 2 diabetes are the same as those for type 1
diabetes: frequent urination, excessive thirst and hunger, dramatic weight
loss, irritability, weakness and fatigue, and nausea and vomiting. Some
other symptoms of type 2 diabetes may include: recurring or hard-to-heal
skin, gum, or bladder infections, blurred vision, tingling or numbness in
hands or feet, and itchy skin. Unlike type 1 diabetes, symptoms for type 2
diabetes usually occur gradually over months or even years, and some people
with type 2 diabetes have symptoms that are so mild they go unnoticed.
The causes of diabetes are still a mystery, but researchers have discovered
that being overweight can trigger the onset of diabetes because excess fat
prevents insulin from working properly. Type 2 diabetes is treated with
exercise and an individual meal plan designed by you and your health care
provider to help you maintain a healthy weight and keep your blood glucose
levels in check and avoid complications. If diet and exercise alone do not
lower your blood glucose levels, diabetes pills, insulin, or both may be
needed in addition to diet and exercise.
Although diabetes cannot be cured, it can be treated. With family support,
daily care, and proper treatment, you can lead a healthy, active life.
Insulin
Inside the pancreas, beta cells make the hormone insulin. With each meal,
beta cells release insulin to help the body use or store the blood glucose
it gets from food. In people with type 1 diabetes, the pancreas no longer
makes insulin. The beta cells have been destroyed and they need insulin
shots to use glucose from meals. People with type 2 diabetes, make insulin,
but their bodies don't respond well to it.
About PCOS, per the ADA
Polycystic ovary syndrome (PCOS) is the most common cause of infertility
among women in the United States, affecting 6 to 10 percent of women of
child-bearing age.
The hallmark of PCOS is a lack of ovulation. Eggs mature in the ovaries,
but they aren't released, resulting in fewer than eight periods a year.
Other symptoms are acne, excess hair growth, and abnormally high levels of
testosterone in the woman's body.
But there's another side to PCOS: It often co-exists with insulin
resistance, a condition in which the body's cells do not use insulin
efficiently and a major cause of Type 2 diabetes. Women who have PCOS are
two to four times more likely to develop Type 2 diabetes than women who
don't have PCOS.
The relationship between insulin resistance and PCOS has been keeping
Theodore Ciaraldi, PhD, busy in the laboratory at the VA San Diego
Healthcare System and University of California, San Diego. Under a grant
from the American Diabetes Association, Ciaraldi and his team of
researchers are studying the interplay between insulin resistance and PCOS
and trying to sort out why the conditions often - but not always - occur
simultaneously. Is it a genetic defect? Does one cause the other or is
their common occurrence together a coincidence? Why do some women with
insulin resistance have PCOS while others don't?
The team will culture the cells in petri dishes for about two months to
grow cells that have not been exposed to the body's environment. Then the
team will expose the cells to various combinations of sugar, insulin, and
androgens (male hormones) that might occur naturally in the women's bodies
and see how the cells behave. One aim would be to mimic, in the petri dish,
the environment seen in either the normal, diabetic, or PCOS state.
Tying It Together
Here's where it all comes together, says Ciaraldi. First the team will
expose the cultured cells from all three groups of women, grown under
normal conditions, to insulin and sugar and see whether the cells are
insulin resistant. At that point, any cells that are insulin resistant were
probably genetically programmed to be, because they have never been exposed
to sugar, insulin, or androgens in the environment of the women's bodies.
"If cultured cells are insulin resistant, then we know the insulin
resistance is intrinsic to the cell. It might be genetic, and not because
of an effect of their environment [the body]," he says.
In earlier studies with muscle cells from subjects with Type 2 diabetes,
Ciaraldi and Robert Henry, MD, estimated that about 50 percent of the
insulin resistance seen in skeletal muscle tissue in Type 2 may be acquired
from the body's environment (high blood sugar and insulin) and that 50
percent could be an intrinsic property of the muscle. One question under
investigation in the current study is whether the same properties exist in
PCOS. Another question is: What are the effects of high androgens? And
another: Might women with PCOS be more sensitive to high insulin or
androgen levels than their counterparts who don't have PCOS?
For instance, if cultured cells from the women with PCOS are not insulin
resistant at first, but become insulin resistant after being exposed to
high levels of androgens or insulin in the petri dishes, that might
indicate that excess androgens or insulin in a woman's body - which both
occur in PCOS - might be causes of insulin resistance.
"Basically, for each insulin resistant group [the first two groups] we
are comparing what happens in the test tube to what happens in the body to
tease out where the problem is occurring," says Ciaraldi.
From there the team can narrow down exactly what is happening in the cells
from the first two groups compared to the cells from the third group, and
better define which comes first - PCOS or insulin resistance - and whether
one condition causes or worsens the other.
The possibility exists that insulin resistance in women with PCOS has a
different cause than insulin resistance in women without PCOS. In women
with PCOS, it may be a result of their bodies' environment. In women with
Type 2 and no PCOS, insulin resistance may be determined by genetics.
All the better for developing treatment specific to each kind of insulin
resistance, says Ciaraldi. "By finding out exactly what's going wrong
in cells, that tells you what you need to target," he says.
He points to a special protein, called an AKT protein, as an example.
"There is a 75 percent reduction of this protein in the skeletal
muscle tissue of women with PCOS when we look at muscle right after it is
taken from the women. But after culturing the cells for two months outside
the body, there is no reduction in this protein. So that indicates that
this specific muscle cell defect in women with PCOS is probably acquired in
the body, and not caused by genetics," he says.
But is that reduction in protein tied to the PCOS or the insulin
resistance? And if there was some way to stop the reduction of that
protein, would it stop the insulin resistance, the PCOS, or both?
Ciaraldi notes that even current treatments for PCOS are not
well-understood. Some doctors prescribe the diabetes drugs metformin
(Glucophage), pioglitazone (Actos), or rosiglitazone (Avandia) to treat
PCOS. (This is considered "off-label" usage, as these drugs are
not approved by the Food and Drug Administration specifically for treating
PCOS.) All are Type 2 drugs, and all have been used successfully to treat
some women with PCOS, but they work differently. The "glitazones"
sensitize cells to insulin; metformin slows the production of sugar in the
liver.
Ciaraldi adds that researchers don't know why two different kinds of drugs
would have the same effect on PCOS. Is it because they keep blood sugars in
check, or because, by keeping blood sugars in check, they keep the amount
of insulin in the blood in check as well?
"We know that the drugs do work, but that's all," he says.
"It would be helpful to know exactly why."
The Metabolic Syndrome
What is the Metabolic Syndrome?
People have the metabolic syndrome when they have several disorders of the
body's metabolism at the same time -- such as obesity, high blood pressure,
and high cholesterol. This syndrome affects at least one out of every five
overweight people ... but by making some positive lifestyle changes, you
can reduce or eliminate some of the components of the syndrome.
The metabolic syndrome (also referred to as "insulin resistance
syndrome" and "syndrome X") is serious, because its
components can lead to complications including hardening of the arteries
and an increased risk for cardiovascular and kidney disease. If you have
one component of the syndrome, you are at increased risk for having one or
more of the others. And the more components you have, the greater the
risks to your health.
Obesity/Abdominal Fat
Obesity is often confirmed by a determination of body mass index (BMI).
You can find your BMI by using the chart below. An increase in abdominal
fat in particular (having an "apple shaped" rather than
"pear shaped" body) has been associated with an increased risk
for heart disease.
Hypertension (High Blood Pressure)
Hypertension has long been associated with heart disease, stroke, and
kidney disease.
Dyslipidemia
Lipids are fatty substances that are essential for the proper functioning
of the body. Dyslipidemia occurs when the amounts of lipids in the blood
are higher or lower than normal.
For years we heard of the dangers of "high cholesterol." This
refers to an increase in low density lipoprotein, or LDL, cholesterol, the
so-called "bad cholesterol." There is also the "good
cholesterol", high-density lipoprotein, or HDL, cholesterol. In
general, the lower a person's LDL, and the higher their HDL, the better.
Other blood lipids called triglycerides can also be high in dyslipidemia.
Dyslipidemia is present when LDL is high, HDL is low, triglycerides are
high, or a combination of those factors. Dyslipidemia is associated with
an increased risk for heart disease.
Insulin Resistance
Many scientists believe that insulin resistance is one of the major factors
that either allows or causes the components of the metabolic syndrome to
develop. The body manufactures insulin to transport sugar (glucose) into
cells so they can use it for energy. Obesity worsens insulin resistance,
making it increasingly difficult for cells to respond to insulin. The body
reacts by releasing more insulin to "override" the insulin
resistance. When the body can't produce enough insulin to overcome insulin
resistance, blood sugar levels rise, ultimately leading to diabetes.
Although there is no complete agreement yet on the components of the
metabolic syndrome or the individual risk levels for each component, we
know the syndrome poses a significant health risk to individuals and is a
growing health crisis for our country. But there are some steps you can
take to reduce the risk posed by each element of the metabolic syndrome.
Reducing Risk Factors
Lose Weight. Obesity is a major contributor to many of the components of
the metabolic syndrome. By losing weight and keeping it off -- even 10
pounds can make a difference -- you can greatly improve your health. Work
with your health care team to plan a diet that will help you lose weight
and maintain a healthy weight, and still include the foods you enjoy.
Increase Physical Activity. Physical activity burns excess fat and
increases muscle mass, helping your body burn calories much more
efficiently. Talk to your health care team about a physical activity plan
that will be safe and effective for you. You don't have to join a gym or
buy any special equipment to get more active. So, walk your dog. Take the
stairs instead of the elevator. Take walking breaks at work. Activities
you enjoy are the ones you will stick with for the long term.
Lower Blood Pressure. Losing weight and increasing physical activity can
lower your blood pressure. When more intervention is needed, medication
can be prescribed to help lower blood pressure.
Lower Cholesterol. Regular physical activity and a diet low in saturated
fats and high in fiber, and medications, can help normalize blood lipid
levels.
Stop Smoking. Smoking is known to greatly worsen the health consequences
of the metabolic syndrome. Many cessation plans are available to smokers,
so talk to your health care team about ways to quit and prevent weight
gain.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes,
either the body does not produce enough insulin or the cells ignore the
insulin. Insulin is necessary for the body to be able to use sugar. Sugar
is the basic fuel for the cells in the body, and insulin takes the sugar
from the blood into the cells. When glucose builds up in the blood instead
of going into cells, it can cause two problems:
Right away, your cells may be starved for energy.
Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or
heart.
Finding out you have diabetes is scary. But don't panic! Diabetes is
serious, but people with diabetes can live long, healthy, happy lives. You
can too by taking good care of yourself.
What is Type 2 Diabetes?
Diabetes is a disease that impairs the body's ability to use food. The
hormone insulin, which is made in the pancreas, helps the body to use food
for energy. In people with diabetes, either the pancreas doesn't make
insulin or the body cannot use insulin properly. Without insulin, glucose -
the body's main energy source - builds up in the blood.
Approximately 90-95% of Americans with diabetes have type 2 diabetes --
about 16 million people.
Some of the symptoms of type 2 diabetes are the same as those for type 1
diabetes: frequent urination, excessive thirst and hunger, dramatic weight
loss, irritability, weakness and fatigue, and nausea and vomiting. Some
other symptoms of type 2 diabetes may include: recurring or hard-to-heal
skin, gum, or bladder infections, blurred vision, tingling or numbness in
hands or feet, and itchy skin. Unlike type 1 diabetes, symptoms for type 2
diabetes usually occur gradually over months or even years, and some people
with type 2 diabetes have symptoms that are so mild they go unnoticed.
The causes of diabetes are still a mystery, but researchers have discovered
that being overweight can trigger the onset of diabetes because excess fat
prevents insulin from working properly. Type 2 diabetes is treated with
exercise and an individual meal plan designed by you and your health care
provider to help you maintain a healthy weight and keep your blood glucose
levels in check and avoid complications. If diet and exercise alone do not
lower your blood glucose levels, diabetes pills, insulin, or both may be
needed in addition to diet and exercise.
Although diabetes cannot be cured, it can be treated. With family support,
daily care, and proper treatment, you can lead a healthy, active life.
Insulin
Inside the pancreas, beta cells make the hormone insulin. With each meal,
beta cells release insulin to help the body use or store the blood glucose
it gets from food. In people with type 1 diabetes, the pancreas no longer
makes insulin. The beta cells have been destroyed and they need insulin
shots to use glucose from meals. People with type 2 diabetes, make insulin,
but their bodies don't respond well to it.
About PCOS, per the ADA
Polycystic ovary syndrome (PCOS) is the most common cause of infertility
among women in the United States, affecting 6 to 10 percent of women of
child-bearing age.
The hallmark of PCOS is a lack of ovulation. Eggs mature in the ovaries,
but they aren't released, resulting in fewer than eight periods a year.
Other symptoms are acne, excess hair growth, and abnormally high levels of
testosterone in the woman's body.
But there's another side to PCOS: It often co-exists with insulin
resistance, a condition in which the body's cells do not use insulin
efficiently and a major cause of Type 2 diabetes. Women who have PCOS are
two to four times more likely to develop Type 2 diabetes than women who
don't have PCOS.
The relationship between insulin resistance and PCOS has been keeping
Theodore Ciaraldi, PhD, busy in the laboratory at the VA San Diego
Healthcare System and University of California, San Diego. Under a grant
from the American Diabetes Association, Ciaraldi and his team of
researchers are studying the interplay between insulin resistance and PCOS
and trying to sort out why the conditions often - but not always - occur
simultaneously. Is it a genetic defect? Does one cause the other or is
their common occurrence together a coincidence? Why do some women with
insulin resistance have PCOS while others don't?
The team will culture the cells in petri dishes for about two months to
grow cells that have not been exposed to the body's environment. Then the
team will expose the cells to various combinations of sugar, insulin, and
androgens (male hormones) that might occur naturally in the women's bodies
and see how the cells behave. One aim would be to mimic, in the petri dish,
the environment seen in either the normal, diabetic, or PCOS state.
Tying It Together
Here's where it all comes together, says Ciaraldi. First the team will
expose the cultured cells from all three groups of women, grown under
normal conditions, to insulin and sugar and see whether the cells are
insulin resistant. At that point, any cells that are insulin resistant were
probably genetically programmed to be, because they have never been exposed
to sugar, insulin, or androgens in the environment of the women's bodies.
"If cultured cells are insulin resistant, then we know the insulin
resistance is intrinsic to the cell. It might be genetic, and not because
of an effect of their environment [the body]," he says.
In earlier studies with muscle cells from subjects with Type 2 diabetes,
Ciaraldi and Robert Henry, MD, estimated that about 50 percent of the
insulin resistance seen in skeletal muscle tissue in Type 2 may be acquired
from the body's environment (high blood sugar and insulin) and that 50
percent could be an intrinsic property of the muscle. One question under
investigation in the current study is whether the same properties exist in
PCOS. Another question is: What are the effects of high androgens? And
another: Might women with PCOS be more sensitive to high insulin or
androgen levels than their counterparts who don't have PCOS?
For instance, if cultured cells from the women with PCOS are not insulin
resistant at first, but become insulin resistant after being exposed to
high levels of androgens or insulin in the petri dishes, that might
indicate that excess androgens or insulin in a woman's body - which both
occur in PCOS - might be causes of insulin resistance.
"Basically, for each insulin resistant group [the first two groups] we
are comparing what happens in the test tube to what happens in the body to
tease out where the problem is occurring," says Ciaraldi.
From there the team can narrow down exactly what is happening in the cells
from the first two groups compared to the cells from the third group, and
better define which comes first - PCOS or insulin resistance - and whether
one condition causes or worsens the other.
The possibility exists that insulin resistance in women with PCOS has a
different cause than insulin resistance in women without PCOS. In women
with PCOS, it may be a result of their bodies' environment. In women with
Type 2 and no PCOS, insulin resistance may be determined by genetics.
All the better for developing treatment specific to each kind of insulin
resistance, says Ciaraldi. "By finding out exactly what's going wrong
in cells, that tells you what you need to target," he says.
He points to a special protein, called an AKT protein, as an example.
"There is a 75 percent reduction of this protein in the skeletal
muscle tissue of women with PCOS when we look at muscle right after it is
taken from the women. But after culturing the cells for two months outside
the body, there is no reduction in this protein. So that indicates that
this specific muscle cell defect in women with PCOS is probably acquired in
the body, and not caused by genetics," he says.
But is that reduction in protein tied to the PCOS or the insulin
resistance? And if there was some way to stop the reduction of that
protein, would it stop the insulin resistance, the PCOS, or both?
Ciaraldi notes that even current treatments for PCOS are not
well-understood. Some doctors prescribe the diabetes drugs metformin
(Glucophage), pioglitazone (Actos), or rosiglitazone (Avandia) to treat
PCOS. (This is considered "off-label" usage, as these drugs are
not approved by the Food and Drug Administration specifically for treating
PCOS.) All are Type 2 drugs, and all have been used successfully to treat
some women with PCOS, but they work differently. The "glitazones"
sensitize cells to insulin; metformin slows the production of sugar in the
liver.
Ciaraldi adds that researchers don't know why two different kinds of drugs
would have the same effect on PCOS. Is it because they keep blood sugars in
check, or because, by keeping blood sugars in check, they keep the amount
of insulin in the blood in check as well?
"We know that the drugs do work, but that's all," he says.
"It would be helpful to know exactly why."
— Carol H.
September 23, 2003
Just another viewpoint. I don't at all agree that insulin resistance is
part of type 2 diabetes. 3 years ago (before my WLS), my only co-morbidity
(other than morbid obesity) was sleep apnea, irregular periods and insulin
resistance. Never had problems with blood pressure, cholesterol, high or
low blood sugar or anything else. The way my doctor found out about my
insulin resistance was that my periods were irregular (no other signs of
PCOS or anything else) and I couldn't get pregnant. She decided to run
some tests and found I was insulin resistant. I still to this day have not
had any signs/symptoms of diabetes and now that I'm at goal weight, I no
longer have sleep apnea, insulin resistance, or irregular periods. Just my
2 cents worth. Hope this helps. Just remember - EVERYONE is different.
— Lynette B.
September 23, 2003
I found out I was insulin resistant because I did a little research on
Metabolic Syndrome (or Syndrome X, etc.) and I fit the picture with
hypertension, being apple shaped with abdominal fat, elevated LDL, low HDL,
etc. So I asked my doctor to check a fasting insulin level. (It was in
the high normal range). My HbA1cs and fasting sugars have always been
normal. It was when I saw an outstanding endocrinologist about my thyroid
problem, that I was treated for the insulin resistance. She put me on
Glucophage XL 2000 mg per day and had me checking my blood sugars in the am
(fasting) and then 1 hour and 3 hours after a meal. Although I didn't lose
weight on this, I certainly felt better overall (along with treatment of my
hypothyroidism.) As for your question about how insulin resistance will
affect your approval - well, it can only
help!
— koogy
Click Here to Return