Insulin Resistance (cont.)
How is insulin resistance managed?
Insulin resistance can be managed in two ways. First,
the need for insulin can be reduced, and second, the sensitivity of cells to the action of insulin
can be increased.
Life-style changes: The need for insulin can be reduced by
altering the diet, particularly the carbohydrates in the diet. Carbohydrates are
absorbed into the body after they are broken up into their component sugars.
Some carbohydrates are broken up and absorbed faster than others and are
referred to as having a high glycemic index. These carbohydrates
increase the blood glucose level more rapidly and require the secretion of more
insulin to control the level of glucose in the blood. Examples of carbohydrates
with a high glycemic index that rapidly raise blood glucose levels include
unrefined sugars, white breads and unrefined corn products (for example, bagels,
mashed potatoes, doughnuts, corn chips, and french fries). Examples of foods
with a low glycemic index include those with higher fiber content such as whole
grain breads and brown rice. Non-starchy vegetables are another example of foods
with a low glycemic index (for example, broccoli, green beans, asparagus,
carrots, and greens). Since foods are rarely eaten in isolation, it can be
argued that the glycemic index of each food isn't as important as the overall profile of the
whole meal itself.
Several studies have shown that weight loss and aerobic
exercise (without weight loss) increase the rate at which glucose in the blood
is taken up by muscle cells as a result of improved sensitivity of the cells to
insulin.
There are two important studies that have looked at the
prevention of
type 2 diabetes. Both studies took patients who could not control their blood
glucose levels, which, for the purposes of this discussion, can be considered
the same as patients with insulin resistance. One study done in Finland, showed that changes in
diet and exercise reduced the development of diabetes by 58%. Another study,
done in the United States and referred to as the DPP study, showed a similar
reduction in diabetes with diet and exercise.
Medications: Metformin
(Glucophage) is a medication that is used for treating diabetes. It has two
mechanisms of action that help to control blood glucose levels. It prevents the
liver from releasing glucose into the blood, and it increases the sensitivity of
muscle and fat cells to insulin so that they remove more glucose from the blood.
Because of these actions, metformin reduces blood insulin levels. The DPP
studied the effects of metformin in addition to diet and exercise on the
prevention of diabetes in insulin resistance. Metformin reduced the development
of diabetes by 31%. (Note, however, that the benefit was not as great as with
diet and exercise!) Metformin is a reasonably safe medication when used in the
right population. Although there are gastrointestinal side effects with metformin, it
usually is well-tolerated.
Another study, the STOP NIDDM (Study to Prevent
Non-insulin Dependent Diabetes Mellitus) trial, studied individuals with insulin
resistance by treating them with a medication called acarbose (Precose).
Acarbose works in the intestines to slow the absorption of sugars, and this effect would reduce the
need for insulin after meals. The study found that acarbose reduced the
development of diabetes by 25%.
Other medications in a class of drugs called
thiazolidinediones, e.g., pioglitazone (Actos), rosiglitazone (Avandia), also
increase sensitivity to insulin. At this time, however, these medications are
not routinely used, in part because of liver toxicity that requires monitoring
of blood liver tests.
One study, the TRIPOD (Troglitazone in Prevention of
Diabetes) study, treated patients with gestational diabetes, a precursor of
insulin resistance
and diabetes, with troglitazone (Rezulin), however, because of severe toxic
liver effects; troglitazone has been taken off the market and is no longer
available. Among the women treated with troglitazone, diabetes was prevented in
25%.
Next: What's new in insulin resistance? »
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