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.

477. INSULIN - Gene Ontology

Gene Ontology Molecular function • protease binding • insulin receptor binding • insulin-like growth factor receptor binding • hormone activity • protein binding Cellular component • extracellular region • extracellular space • endoplasmic reticulum lumen • Golgi lumen • endosome lumen • secretory granule lumen Biological process • MAPK cascade • negative regulation of acute inflammatory response • glucose metabolic process • energy reserve metabolic process • regulation of transcription, DNA-dependent • regulation of cellular amino acid metabolic process • acute-phase response • G-protein coupled receptor signaling pathway • cell-cell signaling • positive regulation of cell proliferation • insulin receptor signaling pathway • positive regulation of phosphatidylinositol 3-kinase cascade • glucose transport • regulation of transmembrane transporter activity • positive regulation of cell growth • positive regulation of cell migration • endocrine pancreas development • positive regulation of protein autophosphorylation • activation of protein kinase B activity • positive regulation of cellular protein metabolic process • negative regulation of protein oligomerization • regulation of protein localization • negative regulation of NAD(P)H oxidase activity • wound healing • negative regulation of protein catabolic process • glucose homeostasis • negative regulation of apoptotic process • positive regulation of MAPK cascade • cellular protein metabolic process • small molecule metabolic process • positive regulation of nitric oxide biosynthetic process • positive regulation of cell differentiation • negative regulation of gluconeogenesis • positive regulation of glycogen biosynthetic process • positive regulation of DNA replication • negative regulation of glycogen catabolic process • positive regulation of glycolysis • positive regulation of mitosis • negative regulation of proteolysis • negative regulation of vasodilation • positive regulation of vasodilation • negative regulation of fatty acid metabolic process • positive regulation of glucose import • positive regulation of insulin receptor signaling pathway • alpha-beta T cell activation • positive regulation of lipid biosynthetic process • regulation of protein secretion • negative regulation of protein secretion • positive regulation of cytokine secretion • positive regulation of peptidyl-tyrosine phosphorylation • regulation of insulin secretion • negative regulation of lipid catabolic process • positive regulation of nitric-oxide synthase activity • positive regulation of NF-kappaB transcription factor activity • positive regulation of protein kinase B signaling cascade • fatty acid homeostasis • negative regulation of respiratory burst involved in inflammatory response • positive regulation of respiratory burst • positive regulation of peptide hormone secretion • positive regulation of brown fat cell differentiation • negative regulation of feeding behavior Sources: Amigo / QuickGO

476. INSULIN - Blood Sugar & Insulin The Essentials

Blood Sugar & Insulin

The Essentials

 

Blood Sugar
        You have approximately 5 liters of blood traveling around in your blood vessels and heart at any given moment.
In these 5 liters of blood, you need only about one teaspoon of sugar for all of your regular activities.
        If you regularly have more than a teaspoon of sugar floating through your blood vessels, the excess sugar can slow down your circulation, which, over time, can cause all of the problems you would expect to have if you had thick maple syrup clogging up your blood vessels. This is essentially what happens when a person becomes diabetic.
        In order to keep the amount of sugar floating through your blood vessels at around a teaspoon, your body releases insulin whenever you eat foods that result in sugar entering your bloodstream.
        Eating sugary foods, most sweeteners, grains, cookies, pastries, cakes, pasta, and starchy vegetables like potatoes all lead to a release of sugar into your bloodstream.
        Insulin works by stimulating your cells to sponge up this excess sugar out of your bloodstream.
        Once inside your cells, sugar is used for energy, with any excess amount being converted to fat tissue.
        If you regularly eat sugary foods and too many processed carbohydrates, your body will have released so much insulin that it will begin to lose its sensitivity to insulin, which means that your cells won’t receive as strong a signal to sponge up excess sugar out of your blood.
        This will lead to excess sugar floating around your blood vessels and all the health problems that come with this scenario.
        Although many doctors consider 110 - 120 mg/dL (6.1 - 6.7 mmol/L) as the upper range for a normal fasting blood sugar level, I am convinced that a healthy fasting blood sugar level should be in the range of 70 - 90 mg/dL (3.9 - 5 mmol/L).
        You can get your fasting blood sugar/glucose test done at your doctor’s office, or with a home monitor, performed after at least six hours of fasting. The difference is that laboratories measure the sugar in a component of your blood called plasma, while home monitors measure the sugar in whole blood. It is believed that home monitors that measure sugar in whole blood give readings that can be around 15 percent less than plasma readings from laboratories. Some home monitors are calibrated to give plasma-equivalent readings. Regardless of what kind of home monitor you might use, it's handy to have an objective way to ensure that your food choices are keeping your fasting blood sugar level close to or in a healthy range.
Insulin
        If you have too much sugar floating around in your blood vessels, it is likely that you also have too much insulin traveling through your system as well.
        Even if your fasting blood sugar level is in a healthy range, it is possible that you have too much insulin floating through your vessels, particularly if you have high triglycerides and/or are overweight.
        Normal blood sugar and high blood insulin can be the result of your cells losing some sensitivity to insulin, which necessitates that your body releases extra insulin into your blood circulation in an attempt to stimulate your desensitized cells into sponging up excess sugar out of your blood circulation.

What's the problem with having too much insulin in your circulation?

Excess insulin is known to cause:

·Weight gain, since insulin promotes the storage of fat

·Lower cellular levels of magnesium, a mineral that is essential for keeping your blood vessels relaxed and your blood circulation efficient

·An increase in sodium retention, which leads to holding excess water in your system, which causes high blood pressure

·Increased amounts of inflammatory compounds in your blood, which can cause direct physical damage to your blood vessel walls and encourage the development of blood clots which can lead to heart attacks and respiratory failure

·A reduction in HDL, an increase in undesirable small molecules of LDL, and an increase in triglycerides, all of which increase your risk for heart disease

·Possibly a higher risk for cancer due to insulin's ability to contribute to cell proliferation

        You can test your insulin level by asking your doctor or laboratory for a fasting insulin test. Less than 10 IU/mL is ideal. Anything over 10 IU/mL indicates that you are eating too many foods that are stimulating excess insulin release from your pancreas, paving the way to all of the negative health effects listed above.

What can you do with your food and lifestyle choices to support healthy blood sugar and insulin levels?

1.    Make non-starchy vegetables the foundation of your diet. Dark green leafy lettuce, tomatoes, celery, cucumber, cabbage, kale, Swiss chard, bok choy, zucchini, broccoli, cauliflower, and all unmentioned green vegetables are excellent choices.

2.    Reduce or eliminate your intake of sugar and all foods that contain sugar. Some of the most concentrated sources of sugar are soda, cookies, chocolate bars, donuts, pastries, ice cream, and ketchup.

3.    Reduce or eliminate your use of sweeteners like molasses, corn syrup, high fructose corn syrup, pasteurized/heated honey, and maple syrup.

4.    Limit intake of fruit juices. Even freshly squeezed fruit juice taken over the long term can lead to high blood sugar and insulin levels. If you want to taste fruit, eat whole fruit, not the juice. The fiber, vitamins, and minerals that come with whole fruit help to slow down the pace at which the natural sugars from fruit enter your bloodstream.

5.    Do activities and exercises that build or maintain your muscles. Muscle tissue acts as a storage site for extra sugar. The more muscle tissue you have, the better you can regulate your blood sugar and insulin levels.