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Overview

Insulin is a hormone produced by the pancreas to help our body utilize sugar and other starches. In some individuals, the insulin is not able to work properly or to put it more accurately, the cells in the body are unable to respond to it which is why one over time develops Insulin Resistance. The body compensates for this by increasing the amount of insulin to keep blood sugars from rising. The main factors that lead to Insulin Resistance are obesity, physical inactivity, and a family history of diabetes. High insulin levels in turn may promote fat accumulation. Insulin Resistance diet plans and medications can help prevent Insulin Resistance from developing.

Prediabetes & Insulin Resistance

A condition such as Insulin Resistance is commonly a precursor of diabetes and is associate with a high risk of heart diseases and strokes. Before the onset of diabetes, blood sugar levels may be mildly high and may only be caught on by a glucose tolerance test or after-meal glucose testing (Prediabetes). We often associate Insulin Resistance with high blood pressure (hypertension) and abnormal blood fat levels (high triglyceride fat and low good HDL cholesterol level). Women often develop abnormal menses, increased hair growth on the face, and polycystic ovarian syndrome (PCOS). This is one of the reasons why an Insulin Resistance diet comes in as a recommendation by doctors and dietitians.

Treatment for Insulin Resistance

Treatment depends on several factors including the severity of the condition, the age of the patient, and the nature of initial symptoms (if present). The physician will first order certain tests. They may probably suggest a referral to a registered dietitian for the individualized diet plan. Sometimes testing basal metabolic rate (e.g. Medgem) may be helpful. Unfortunately, insurance companies may not pay for dietitians and related services. Nevertheless, lifestyle changes such as reduction in meal size and snacks, an Insulin Resistance diet, and regular exercise are the most effective treatment for Insulin Resistance in most cases. 

Observing the treatment effects may however take a while. As little as 5-10% loss of weight may have substantial beneficial effects on your health (such as preventing diabetes, heart disease, etc.) With successful treatment (lifestyle measures or medications), women with PCOS may experience normal menses and may ovulate (contraception may be a requirement if there is no need for pregnancy).

Medications for Insulin Resistance

Medications are given as a prescription adjunct to lifestyle changes when the above interventions including Insulin Resistance diet do not work or the condition is severe (such as rising blood sugar levels or severe PCOS).

Insulin Resistance Diet And Prediabetes Medications And TreatmentsThese include:

Metformin:

This medicine may help lower blood sugar, blood insulin level, and body weight. It is used to treat diabetes but is sometimes useful in Insulin Resistance, prediabetes, or PCOS. Possible side effects include upset stomach or diarrhea. Rarely a serious complication called metabolic acidosis can occur (usually in frail & elderly patients or if kidney function is abnormal). If you are taking metformin, you will need a blood test to check your kidney function after surgeries or a CT scan. Consult with your doctor and/or dietitians. They may be able to draw up an Insulin Resistance diet that might help you along with the medication.

GLP-1 Agents:

It is a natural hormone that helps in weight management. GLP-1 agents are medicines that work like the “natural” hormone. They work on metabolism in a more natural way to help you lose weight in a slow & sustained manner. It is not a quick fix and therefore is less likely to lead to a rebound weight gain. They include Wegovy®, Ozempic®, and Saxenda®. These medications coupled with an Insulin Resistance diet plan can help you manage your weight and your blood sugar levels.

Pioglitazone:

This medicine may help lower blood sugar and blood insulin levels but does not cause weight loss. Side effects may include weight gain, swelling & fluid retention. This medication comes in as a recommendation when treating diabetes but is sometimes useful in Insulin Resistance, prediabetes, or even PCOS.

Orlistat:

This medicine blocks the absorption of fat in the diet and therefore helps with weight loss. Side effects may include diarrhea and oily stool, particularly if food has too much fat. We highly recommend consuming multivitamins to prevent deficiency of fat-soluble vitamins. Insurance companies often do not pay for Orlistat, but it is now available over the counter in a half-dose

Weight loss medications:

These medications are sometimes a requirement when lifestyle changes including Insulin Resistance diet plans do not help. Examples include Phentermine (Adipex), Qsymia® (Phentermine + Topiramate) & Contrave® (Bupropion + Naltrexone) – which are available as pills (sometimes Bupropion or Topamax are used instead, because of the cost).

Spironolactone:

This medicine is often use to treat excess facial hair growth in PCOS and insulin-resistant women. It is a diuretic and may cause potassium retention, so blood levels of potassium undergo periodic monitoring. In younger women, Spironolactone is given in combination with oral contraceptives because it may affect menses and if taken while pregnant, it may cause fetal damage. It takes several months to improve hair growth but is generally quite effective in doing so.

Others:

Various other agents are useful in treating different aspects of Insulin Resistance syndrome. Through the use of ACE inhibitors or ARB agents, one can easily control their high blood pressure (hypertension). Cholesterol or triglyceride-lowering medicines are often need to reduce the risk of heart disease and stroke. Wellbutrin® (Bupropion) may be use if there is an element of depression (symptoms may be really mild such as fatigue, lack of motivation, stress eating).

The Takeaway

You should plan treatment with the help of your physician and then keep regular follow-ups.  Remember, lifestyle changes are the best way to combat this condition and long-term changes are superior to short-term fads such as extreme carbohydrate restriction or liquid diets.

 

Dr. Wasim Haque M.D., F.A.C.E.

Dr. Wasim A. Haque graduated from the Aga Khan University Medical College with a medical degree. In Flower Mound, Texas, he works as an Endocrinology, Internal Medicine, Diabetes, and Metabolism Specialist. He has been in practice for more than 30 years.

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