Re: Insulin Resistance, Polycystic Ovarian Syndrome and Its Effects on Women (LONG)
From: Christina (anonymous@obgyn.net)
Tue, 27 Feb 2001 16:48:29 -0600 (CST)
Great article Paula!! It is very informative! :)
--
Christina :)
>Insulin Resistance, Polycystic Ovarian Syndrome and Its Effects on Women
>
>What is insulin resistance (IR)? What causes it? What are the symptoms
>and how can I treat it? These are common questions that need to be
>addressed. Unfortunately, while insulin resistance may affect anywhere
>from 7-15% of women, many doctors seem to be clueless as to its
>existence. Therefore, those of us who suffer from it must essentially
>become medical professionals able to diagnose and recommend treatment
>for ourselves. We are often faced with the choice of eternally
>switching doctors in the hopes we find one with the knowledge we need,
>or simply educating the doctor we have. Neither option is ideal, but
>educating yourself about your body is never a bad thing.
>
>The first thing one should learn what insulin is and why it is
>important. Insulin is a hormone produced in an area of the pancreas
>called the islets of Langerhans. This hormone is essential to the
>function of the human body. It promotes glucose utilization, protein
>synthesis, and the formation and storage of neutral lipids by regulating
>the sugar metabolism of the body. Ok, what does that mean? Everything
>we eat is taken into the body and converted from its original form into
>something we can utilize. When you eat protein, it has to be broken
>down by the digestive system into its base amino acids so that our
>bodies can use it. The same goes for carbohydrates. Carbohydrates are
>broken down into a simple sugar, glucose. This glucose is the fuel of
>the body. Much as a car needs gas to run, our bodies need glucose.
>Insulin is a carbohydrate promoter. When you have broken the carbs you
>eat into glucose, they are released into the blood stream where they
>travel to where they are needed. The glucose arrives at a cell, but
>cannot gain entry without insulin. Insulin promotes the entry of
>glucose into body cells. It tells the cells . . . ”hey, you need
>this glucose stuff,” and the cells allow the glucose to enter where it
>is used for energy. If the cells are “resistant” to the insulin, then
>the glucose cannot get in and is instead stored as fat.
>
>So then what causes cells to be resistant? It is believed that the cause
>of insulin resistance is due to a defective gene located on chromosome
>19. There appears to be a damaged gene located next to a gene for
>insulin reuptake. This defect damages insulin receptor sites located
>throughout the body. So the base effect is that the cells are resistant
>because they do not know the insulin is “knocking” to let the glucose
>in. It is as if your doorbell is broken. Someone could stand outside
>the house for hours ringing and ringing, and it the doorbell is not
>working, you might never know. They would get tired of waiting and
>leave. This is essentially what happens in the body.
>
>With insulin resistance, the body tries to compensate for the genetic
>defect by producing more insulin. This does not really help at all. In
>fact, it causes a vicious cycle. Essentially the cycle works like this:
>the affected individual eats a carbohydrate rich food (such as potatoes,
>breads, and pastas). Once the carbohydrates have been broken down into
>sugars, the pancreas sends out a copious amount of insulin to help the
>glucose enter the cells. When the cells do not work correctly, the
>glucose is then stored as fat, and since there is now much too much
>insulin in the blood stream, the blood sugar falls dramatically below a
>normal level causing hypoglycemia and hunger, even if it has only been
>an hour since the last meal. Since the blood sugar is low, the body
>craves instant energy, usually in the form of a carbohydrate craving.
>Once the person eats another carb-rich meal or snack, the whole series
>begins again. The disease progresses to the point where any small
>amount of carbohydrates taken into the body will cause the pancreas to
>pour forth with insulin, causing the rapid onset of weight gain and
>other symptoms.
>
>Insulin resistance in women is especially troublesome, and occurs in
>three stages. Stage one is characterized by increased fasting insulin
>levels and normal glucose levels. In general, a female in her early
>20s, who is otherwise healthy, should have a fasting insulin level of
><10. In stage one insulin resistance the fasting level of insulin is
>generally between 15-25. At this point the disease can usually be
>controlled by a low-carbohydrate diet.
>Stage two insulin resistance is characterized by medium to high fasting
>insulin levels (26-40) and impaired glucose tolerance. This stage of
>the
>illness is usually treated by a low-carbohydrate diet and medications
>that promote proper insulin function, such as Glucophage. Finally,
>Stage three insulin resistance patients may not experience any symptoms
>that can be directly attributed to insulin resistance due to the fact
>they are usually full blown diabetic and glucose levels are controlled
>by diabetic medications.
>
>There are several effects of insulin resistance on the female body, some
>symptoms are serious, others merely annoying. The main factor in the
>kind of symptoms a patient experiences is whether or not their insulin
>production has been askew long enough to cause other hormonal
>imbalances. In most patients, unfortunately this is the case.
>Over-production of insulin causes other hormone producing organs, such
>as the pituitary gland and the ovaries, to also either overproduce or
>underproduce their respective hormones. Many of the serious effects of
>insulin resistance come from “side illnesses” or conditions which have
>the root cause of insulin resistance.
>
>The most common illness caused by insulin resistance in women is
>Polycystic Ovarian Syndrome (PCOS). PCOS is a serious disease with many
>effects including: chronic fatigue, balance and spatial orientation
>problems, confusion, hypoglycemic episodes, trouble concentrating,
>abnormal cholesterol levels, hypertension that is not responsive to
>conventional medications, hirsutism, obesity, diabetes, lack of
>menstrual cycles, and anovulation, causing infertility. Other illnesses
>caused by insulin resistance include: irritable bowel syndrome,
>vulvodynia, and chronic migraine headaches. The merely “annoying”
>symptoms of insulin resistance are generally cosmetic, but can result in
>severe social consequences. These effects include: hirsutism (facial
>and body hair in overabundance), obesity, severe acne, acanthosis
>nigracans (darkening of skin giving the appearance of dirt), and male
>pattern hair loss. Picture a 20 year old female who weighs 300 pounds,
>has very little hair on her head, an overabundance of hair elsewhere on
>her body, and dark patches of skin on her neck, knees, knuckles, and
>elbows. This is what woman with insulin resistance must deal with.
>While insulin resistance is a syndrome, and not all women with it are
>suffering from all of the symptoms, many are affected by all of them.
>
>Diagnosing insulin resistance early is the key component to effective
>treatment. The disease can be deceptive in diagnosis, and frankly many
>doctors are unwilling to search for the cause of a fat woman’s problem
>with weight when it is much easier to claim the problem is self-induced.
>However, there are many tests that can be preformed to give a diagnosis,
>if the doctor is willing to order them and is then able to interpret
>them.
>
>Diagnosis of insulin resistance and PCOS is a complicated procedure and
>is made by performing several tests including a physical exam, hormone
>levels, and ultrasound. Testing should begin with a comprehensive exam
>of hormone levels including: Luteinizing hormone (LH),
>Follicle-stimulating hormone (FSH), total and free testosterone,
>Dehydroepiandrosterone sulfate (DHEAs), prolactin, Androstenedione,
>Progesterone. Additionally women with irregular periods and very high
>androgen levels should be screened for adult onset adrenal hyperplasia
>which can sometimes, but rarely mask as PCOS. To test for this you
>should have a hormone 17-hydroxyprogesterone. One should also have an
>IGTT. This is a 2-5 hour test that measures insulin and glucose spikes
>and dips. It involves several blood draws, and sometimes the same thing
>can be accomplished by a fasting insulin and a fasting glucose, but I do
>not recommend that route because often this test comes back as a false
>normal, and doctors sometimes do not want to perform the IGTT. So it is
>better to go for the more accurate one first. Finally, your doctor
>should run a lipid panel. often women with PCOS have elevated
>cholesterol and an unhealthy balance of LDL and HDL. So the doctor
>should run: cholesterol, HDL and LDL.
>
>The doctor should also perform an ultrasound of the ovaries and uterus
>to be sure they are healthy. Ovaries do not have to be cystic for a
>diagnosis for a diagnosis of PCOS. The Uterine lining should be checked
>for unusual thickness or any cysts there. If it has been an extremely
>long time since the last period, one should also have a biopsy of the
>uterine lining to rule out any abnormalities. If the patient is
>overweight, it is much more accurate to have a vaginal ultrasound as
>this gives a better view of the uterus and ovaries.
>
>Once a diagnosis is made and the stage of the illness is determined, it
>is time to pursue treatment. Depending on whether a patient is
>afflicted with PCOS or not, the treatment may or not include fertility
>treatments. If the patient does not desire a pregnancy at the time,
>treatment should include some sort of low-carbohydrate diet, medications
>to control insulin resistance, and an exercise regimen. Many doctors
>are now prescribing medications such as Glucophage (formerly used
>exclusively for diabetes, this drug has shown to lower insulin levels),
>spironolactone (used to suppress body hair and stimulate scalp hair),
>and provera (a hormone used to promote menstruation).
>
>There are many treatments available, and much research being conducted.
>There is no longer the need for this disease to progress beyond help.
>Doctors and patients working together can easily control and in some
>cases even reverse the effects of this illness. Insulin sensitizers
>have been godsends to patients suffering from both IR and PCOS. They
>have proven to not only reduce insulin levels, but in some cases their
>use results in the regulation of monthly periods and ovulation. Also,
>great success in weight loss and over health has been reported with the
>use of these drugs. This is no longer something to fear. Those of us
>with this disease can now take back control of our bodies and can live
>completely normal lives.
>
>There are several resources on the internet about PCOS and Insulin
>resistance. If you or someone you know has the symptoms of these
>diseases, please do some research and see your doctor. If left
>untreated this can be devastating.
>
>****please let me know what you think (im not looking for praise lol) i
>want this to be as accurate as possible, and please let me know if i
>have been too redundant or need to add something or some detail****
>
>love, paula
>
>--
>feel free to email me anytime at paulam74@hotmail.com
>
--
Christina :)
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