478. INSULIN - INSULIN RESISTANCE - Medications

INSULIN RESISTANCE - Medications

There are several different types of medications that can be used to treat patients with abnormal blood sugar or insulin levels:

·Biguanides. Biguanides are drugs that improve the body's sensitivity to insulin by lowering the absorption of glucose in the small intestine, decreasing the liver's production of glucose, and increasing the uptake of glucose in muscle and fatty tissues.

Metformin (Glucophage), a drug used in the treatment of type 2 diabetes, is the most commonly used biguanide in treating insulin resistance.

It has also been studied as a possible treatment in preventing or delaying the onset of type 2 diabetes.

·Thiazolidinediones. These drugs stimulate glucose uptake in the muscles and fatty tissues by activating specific receptors in the cell nucleus.

They also lower blood insulin levels in patients with hyperinsulinemia.

The thiazolidinediones include pioglitazone (Actos) and rosiglitazone (Avandia).

·Glucocorticoids. These drugs may be given to patients with insulin resistance caused by anti-insulin antibodies produced by their immune system.

Prednisone (Deltasone) is the most commonly used glucocorticoid.

·Insulin itself. Some patients with insulin resistance benefit from injectable insulin to reduce their blood sugar levels.

As of early 2005, however, the Food and Drug Administration (FDA) has not approved any drugs for the treatment of insulin resistance by itself.

For this reason, the American Diabetes Association does not recommend treating insulin resistance with medications unless the patient has already been diagnosed with diabetes.

The patient's doctor may also prescribe medications to treat specific health problems associated with insulin resistance. These drugs may include diuretics and other medications to lower blood pressure; aspirin to reduce the risk of heart attack; medications to lower the levels of triglycerides and LDL cholesterol in the blood; and weight-control drugs.

The drugs most frequently prescribed in the early 2000s to help patients lose weight are orlistat (Xenical) and sibutramine (Meridia).

Acanthosis nigricans may be treated with topical preparations containing Retin-A, 20% urea, or salicylic acid; however, many patients find that the skin disorder improves by itself following weight loss.

Surgery

Insulin resistance by itself does not require surgical treatment; however, patients who have already developed heart disease may require coronary artery bypass surgery.

In addition, very obese patients—those with a BMI of 40 or higher—may benefit from bariatric surgery.

Bariatric surgery includes such procedures as vertical banded gastroplasty and gastric bypass, which limit the amount of food that the stomach can contain.

Alternative  treatment

Some alternative treatments for insulin resistance and type 2 diabetes have been studied by the Agency for Healthcare Research and Quality (AHRQ).

        One study reported in 2004 that omega-3 fatty acids, a dietary supplement commonly derived from fish, canola, or soybean oil, did not appear to have any significant effect on blood sugar levels or blood insulin levels in patients diagnosed with type 2 diabetes or the metabolic syndrome.

        An earlier study of Ayurvedic medicine, the traditional medical system of India, reported in 2001 that certain herbs used to make Ayurvedic medicines, such as

1.    fenugreek,

2.    holy basil,

3.    Coccinia indica, and

4.    Gymnema sylvestre

appear to be effective in lowering blood sugar levels and merit further study.

        The AHRQ report also noted that the Ayurvedic practice of combining herbal medicines with yoga and other forms of physical activity should be investigated further.

Other alternative treatments for insulin resistance and type 2 diabetes include

1.    chromium supplements,

2.    ginseng,

3.    biofeedback, and

4.    acupuncture.

        The connection between chromium supplementation and insulin resistance is that the body needs chromium to produce a substance called glucose tolerance factor, which increases the effectiveness of insulin.

        Further studies need to be done, however, before recommendations about dietary chromium as a treatment for insulin resistance can be made.

 

Prognosis

Since insulin resistance is a condition that precedes the appearance of symptoms of a number of different disorders, its prognosis depends in part on the patient's

1.    age,

2.    ethnicity,

3.    family history, and

4.    severity of any current health problems.

`      Some patients diagnosed with insulin resistance eventually develop type 2 diabetes, but it is not yet known why the others do not; for example, some patients do not develop diabetes in spite of a high degree of insulin resistance. What is known at present is that weight reduction and exercise can control or even reverse insulin resistance in many people.

Prevention

Genetic factors contributing to insulin resistance cannot be changed as of the early 2000s.