Insulin Resistance

Throw  another  dilemma   I  have  encountered  in  my life of dealing with Polycystic   Ovarian  Syndrome  (PCOS)  being  Insulin  Resistant.   I  was diagnosed by a Reproductive Endocrinologist back in March of 2001.

Insulin resistance occurs when the normal amount of insulin secreted by the pancreas  is  not  able to remove glucose from the blood into the cells for use  as  energy  or  storage  for  future  use.  To maintain a normal blood glucose,  the  pancreas secretes additional insulin.  In about one-third of the  people  with  insulin resistance, when the body cells resist or do not respond  to  even high  levels  of insulin, glucose builds up in the blood resulting  in  high  blood  glucose  or  type 2 diabetes.  Even people with diabetes  who take oral medication or require insulin injections to control their blood glucose levels can have higher than normal blood insulin levels due to insulin resistance.  More than 60 million Americans may have insulin resistance.  One in four of them will develop type 2 diabetes.

Many  women  with  PCOS  become  resistant to the hormone insulin, which is normally responsible for carrying the sugar glucose into the cells.  As the cells  become  more  insulin resistant, sugar levels increase in the blood, eventually  causing  glucose  intolerance,  along with many of the problems associated  with  adult  onset  diabetes.  It is the excess insulin that is apparently  responsible  for directly stimulating the ovaries to produce an excess  of  male  hormones,  throwing the entire system out of balance.  In fact,  high  levels  of  insulin  stimulate the production of testosterone, which  aggravates  the  PCOS.  By age 40, up to forty percent of women with PCOS  have  some level of abnormal glucose tolerance, in the form of either diabetes or impaired glucose tolerance.

Some Symptoms of Insulin Resistance

Chronic Fatigue
High Cholesterol and/or Triglycerides and/or low HDL
Hypertension
Inability to lose weight, even with a low fat diet
Craving Carbohydrates
Binge eating after carb intake
Sluggishness or fatigue after carb intake
GI Digestive Tract Problems

Irregular or absent menstrual cycles
Endometrial   Hyperplasia  (excessive  uterine  lining  due  to  infrequent
menstruation)
Endometrial Cancer

Mental confusion
Frustration from lack of concentration
Irritability
Intermittent depression
Chronic Cystic Acne (into 20's, 30's and over)
Thinning hair/Early male pattern baldness
Skin Tags

*Information taken from Nutrition Resource - a division of Health Quest

Dietary Recommendations for PCOS/IR

This is my hardest part of dealing with IR... its not a matter of eating a lot of food... its that I am a very fussy eater.  I am not a big eater of meat, veggies or fruit... so you say what do you eat... everything that I shouldn't... BREAD & PASTA... I love them and could eat them 24/7!  Not a good thing when dealing with IR!!  Here are some recommendations:

1.   Follow the diabetes food guide pyramid for guidelines on what and how much to eat.
2.  Eat a variety of food.
3.  Food Pyramid - the amounts needed from each of the food groups

• Grains, Beans & Starchy Veggies - 6 or more servings per day

• Vegetables - 3 to 5 servings a day

• Fruits - 3 to 4 servings a day

• Meat - 2 to 3 servings a day

• Milk - 2 to 3 servings a day

• Fats and Oils - only in small amounts

• Sweets - only once in awhile

4.  Keep a food journal - keep track of your food, amount of food, activity and your moods/feelings.
5.  Control carbohydrates - includes both starches and sugars.  Your total amount of carbs is more important than the source of carbs.  Carbs can be either refined or processed such as in soft drinks and candy, and can be found in pasta, bread, rice, dried beans, peas, and starchy veggies such as potatoes, corn or green peas. 
6.  Do NOT eat carbohydrates by themselves... combine them with a protein and/or fat.

Role of Insulin In PCOS

Exactly why and how PCOS develops is not quite clear, however most experts now agree that insulin plays a major role. Insulin is a powerful hormone that is released by the body’s pancreas in response to eating food - especially carbohydrates. It transports sugar out of the blood and into muscle, fat and liver cells, where it is converted to energy or stored as fat. Many women with PCOS have insulin resistance. This means that the process of getting the sugar out of the blood and into the cells is defective – the cells are “resistant” to insulin. The pancreas must secrete more and more insulin to get sugar out of the blood and into the cells. High levels of insulin or hyperinsulinemia, can wreak havoc in the body, causing any or all of the following conditions: polycystic ovaries, weight gain and/or difficulty losing weight, increased risk of heart disease by increasing LDL and triglycerides, decreasing HDL and increasing clotting factors. In addition, it can increase risk of diabetes by up to 40% by age 40.

The discovery of insulin’s role in PCOS has brought hopes for better treatment. Treatment is no longer just aimed at treating the individual concerns (ie. erratic menses, hirsutism, acne, etc.), but instead is now aimed at treating one of the underlying causes – insulin resistance. If insulin resistance is present, it is best treated with diet, exercise and weight loss if needed.  Insulin sensitizing medications may be used as well. Most physicians prefer to start with diet and exercise and turn to drugs if needed. Keep in mind that not all women with PCOS have hyperinsulinemia, but the majority do. 

* Info taken from OBGYN.net - by Martha McKittrick, RD

TREATMENT OF INSULIN RESISTANCE

Having IR does not necessarily mean that someone has diabetes It does however, if a person is overweight, increase the chance that they will develop diabetes, particularly if there is a family history. Over time, the resistance to insulin tends to increase and when the pancreas can no longer keep up by making more insulin, glucose levels go up in the blood and diabetes develops.

This is not inevitable however. Some simply luck out and do not develop diabetes at all. Losing weight, even as little as 20 pounds is the best way to reduce the risk. Not everyone is able to accomplish this however. The unfair thing about IR is that is not only made worse by weight gain, it makes losing the weight harder. Fortunately we now have medications which sensitize the body to insulin. They can reduce IR considerably and may even lessen the chances of going on the actual diabetes.

The new medications for IR and early diabetes

Older diabetes medications simply pushed the pancreas to release more insulin to overcome the IR. Rather than flog the pancreas, it is better to restore the body’s response to insulin. Several new medications can do this. The one most often used for IR in PCOS is metformin (Glucophage® and Glucophage XR®). One of the appeals of this medication is that it often helps somewhat in losing weight. It can be unsafe in people with kidney disease and interacts with certain things such as x-ray dye and general anesthesia, so if you are on metformin, be sure to tell any doctor or any other health care provider you see that you are on it.

Two newer drugs which directly improve the body’s response to insulin are rosiglitazone (Avandia®) and pioglitazone (Actos®). A similar medication, troglitazone (Rezulin®) was withdrawn because it could cause serious liver problems. The two new ones are much safer for the liver but you should discuss the need for monitoring with your doctor. Research on troglitazone in PCOS showed that it could improve IR and it is likely that the two newer and safer ones have the same effect though so far as I know, they have not yet been studied with PCOS.

One of the best things about insulin sensitizes is that they often restore ovulation and may improve the odds of getting pregnant. Some feel they are the first thing to try, before more difficult and expensive treatments such as hormone injections or IVF. While they have been used to help fertility, they are not FDA approved for this indication, or specifically for PCOS.

WEIGHT LOSS AND PCOS

Weight is an important factor and in an unfair way because PCOS seems to make the pounds go on all too quickly and off too slowly, if at all. And as weight is gained, the various symptoms may increase. Some women have few signs of PCOS but develop them when they gain weight. IR seems to induce weight gain because the higher insulin levels promote storage of fat.

Two things can help with this frustrating situation. First, metformin helps somewhat with weight loss in people with IR It is not a “diet pill” – all diet pills have harmful effects and are to be avoided. Second, a change in nutrition to high protein, low carbohydrate has made a major difference for many women with PCOS. There are several books about these diets but in my experience people do much better if they see a professional registered dietitian. The dietary establishment is still skeptical about low carb diets – the American Dietetic Association issued a position statement questioning them – but they clearly work for some women for whom nothing else works. Low carb diets require eating meat or fish. If you are vegetarian, a different approach is needed –- and it is even harder to find a sympathetic nutritionist -- but veg diets can be good for PCOS too.

* Information taken from The Hormone Help Center