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Re: Insulin Resistance, Polycystic Ovarian Syndrome and Its Effects on Women (LONG)From: donna (anonymous@obgyn.net)Wed, 28 Feb 2001 16:50:27 -0600 (CST)
At Tue, 27 Feb 2001, paula wrote: > >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 It is hard to read through the tears.........Thank you, Paula. I have been sufering for the past 3 years, not knowing from what or the cause, but only the feeling that something had taken over my body. I have been to several doctors (those allowed by my hmo) and have only found confusion and frustration. Concerns such as - How can I gain 50lbs in a year while practically starving myself (and suffering hypoglycemic episodes)? Why am I losing the hair on my head yet gaining a moustache? What is wrong with my skin and what are these areas that just look "dirty" (sometimes I scrubbed myself raw trying to get rid of them). Why do I now get migranes when I never did before? Why are my periods all screwed up and what is causing this pain? (could it have anything to do with the diagnosis of ovarian cysts a few years back?) Why do I feel like I must be losing my mind? - were dismissed or not taken seriously. By accident today, I came across this site. Other women actually experience the things I believed were exclusive to me. I am not crazy. In response to your request for feedback on your paper, what can I say? It feels like you wrote it for me. No changes needed. Empathetic, informative but not clinical, right on target. Excellent work.
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