TREATMENT OF INSULIN RESISTANCE

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TREATMENT OF INSULIN RESISTANCE

Gabe Mirkin, M.D.

Most people who develop diabetes in later life can be controlled so that they

are not at increased risk for the many complications of diabetes such as heart

attacks, strokes, blindness, deafness, amputations, kidney failure, burning foot

syndrome, venous insufficiency with ulceration and stasis dermatitis. Late onset

diabetes usually means that a person has too much insulin because his cells

cannot respond to insulin. Too much insulin constricts arteries to cause heart

attacks, and stimulates your brain and liver to make you hungry and manufacture

fat. The insulin resistance syndrome (IRS) puts you at very high risk for a

heart attack and is associated with storing fat in the belly, rather than the

hips; having high blood triglyceride levels and low level of the good HDL

cholesterol; high blood pressure and an increased tendency to form clots.

If you have any of these signs, check with your doctor who will order a blood

test called HBA1C. If it is high, you have diabetes and can usually be

controlled with diet and/or medication. You should learn how to avoid foods that

give the highest rise in blood sugar. When you eat, blood sugar level rises. The

higher it rises, the more sugar sticks on cells. Once stuck on a cell membrane,

sugar can never detach itself. It is converted to a poison called sorbitol that

damages the cell to cause all the side effects of diabetes mentioned above.

Avoid the foods that cause your blood sugar to rise quickly. These include all

types of flour products: bread, spaghetti, macaroni, bagels, rolls, crackers,

cookies and pretzels; refined corn products and white rice; and all sugar added

products. Eat lots of vegetables, un-ground whole grains, beans, seeds and nuts.

Eat fruits and root vegetables (potatoes, carrots and beets) only with other

foods.

There are two type of drugs that are used to treat diabetes: those that lower

blood sugar and raise insulin, and those that lower blood sugar and lower

insulin also. As I mentioned earlier, insulin is a bad hormone, so the safest

drugs are those that lower both insulin and sugar. Virtually all diabetics

should be on Glucophage before meals. It prevents blood sugar levels from rising

too high and sticking to cells and has an excellent safety record. However,

eating a few bagels will produce such a high rise in blood sugar that Glucophage

will not be effective. So Glucophage is used in addition to avoiding foods that

cause a high rise in blood sugar. If HBA1C cannot be controlled with diet and

Glucophage, your doctor will usually add Avandia 4 mg or Actos 30mg. They are

essentially the same and can cause liver damage, so liver tests must be done

monthly, at least for the first few months.

You should be seen monthly and get either a HBA1C (that measures blood sugar

control over 2 months) or fructosamine (that measures control over 2 weeks).

Each time that your HBA1C is above normal, you should yell at your doctor to

change your drugs and he should yell at you to change your diet.

If your HBA1C is still not under control, you need to take a bad drug that

raises insulin levels. I usually start with Prandin because its effects last

only a couple of hours and when taken before meals, it rarely causes low blood

sugar levels. If that doesn't control your HBA1C, you need to take raise the

dose of Prandin or take a long-acting insulin-raiser such a Glucotrol XL. If

that doesn't work, you will need to inject yourself with insulin.

1) K Rett. The relation between insulin resistance and cardiovascular

complications of the insulin resistance syndrome. Diabetes Obesity & Metabolism,

1999, Vol 1, Suppl. 1, pp S8-S16.

2) J Tooke. The association between insulin resistance and endotheliopathy

Diabetes Obesity & Metabolism, 1999, Vol 1, Suppl. 1, pp S17-S22.

3) B Balkau, E Eschwege. Insulin resistance: an independent risk factor for

cardiovascular disease? Diabetes Obesity & Metabolism, 1999, Vol 1, Suppl. 1, pp

S23-S31.

4) M Kobayashi. Effects of current therapeutic interventions on insulin

resistance. Diabetes Obesity & Metabolism, 1999, Vol 1, Suppl. 1, pp S32-S40. 5)

CA Reasner. Promising new approaches. Diabetes Obesity & Metabolism, 1999, Vol

1, Suppl. 1, pp S41-S48.

5) CA Reasner. Promising new approaches. Diabetes Obesity & Metabolism, 1999,

Vol 1, Suppl. 1, pp S41-S48.

-- 7/25/03

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