PCOS Messages for April, 2003: Re: A couple questions about IR and symptoms

Re: A couple questions about IR and symptoms

From: cruffyinaz (anonymous@obgyn.net)
Thu, 24 Apr 2003 10:50:28 -0700

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In reply to: Michelle: "A couple questions about IR and symptoms"

Here is some info that I found since I am also IR -- hoe it helps! ~~~~~~~~~~~~~~~~~~~~~~~~

Polycystic ovary syndrome is a diagnosis made in 5%-10% of women between late adolescence and the menopause. Patients may present with oligomenorrhoea or amenorrhoea, anovulation or infertility, hirsutism or acne.

Women with the syndrome have at least seven times the risk of myocardial infarction and ischaemic heart disease of other women, and by the age of 40 years up to 40% will have type 2 diabetes or impaired glucose tolerance.

Polycystic ovary syndrome is associated with insulin resistance, with consequent hyperinsulinaemia and (frequently) hyperlipidaemia and obesity.

Recent research has shown that the application of diabetes management techniques aimed at reducing insulin resistance and hyperinsulinaemia (such as weight reduction and the administration of oral hypoglycaemic agents) can not only reverse testosterone and luteinising hormone abnormalities and infertility, but can also improve glucose, insulin and lipid profiles.

The management of polycystic ovary syndrome should now include patient education and attention to diabetes and cardiovascular risk factors such as hyperlipidaemia, obesity, physical exercise, glucose intolerance, hypertension and cigarette smoking. ---------------------------------------------------------------------------- ---- ----------------------------------------------------------------------------

---------------------------------------------------------------------------- Insulin resistance in the polycystic ovary syndrome

In a study of women with polycystic ovary syndrome performed 18 years ago, most were found to be hyperinsulinaemic and to have a glucose metabolism that was resistant to the stimulatory effects of insulin.15

The insulin resistance in type 2 diabetes and polycystic ovary syndrome occurs mainly in muscles,16 but also in the liver in obese women with polycystic ovary syndrome.11 Insulin resistance is aggravated by physical inactivity, upper abdominal obesity, hyperandrogenism, pregnancy, the ageing process and by medications such as thiazide diuretics, corticosteroids and certain hormonal steroid preparations. Insulin resistance in polycystic ovary syndrome is not due primarily to obesity (as lean women with polycystic ovary syndrome are insulin resistant) or to hyperandrogenism17 (as androgen blockade reduces insulin resistance by only 10%-15%).18

Insulin resistance leads to hyperinsulinaemia as pancreatic insulin secretion rises to maintain normoglycaemia. Hyperinsulinaemia can then stimulate lipid storage, altered lipoprotein and cholesterol metabolism and (possibly) altered steroid hormone metabolism. Hyperinsulinaemia increases ovarian androgen production19 by stimulating an ovarian enzyme complex cytochrome P450c17, either directly and/or by stimulating pituitary luteinising hormone secretion.

The accurate measurement of insulin resistance is an expensive, labour-intensive research technique. The easiest, but least sensitive, measure of insulin resistance is fasting serum insulin, with values between 10 and 14 mU/L (72-100 pmol/L) indicating mild insulin resistance and values above 14 mU/L indicating moderate or severe insulin resistance. As fasting serum insulin values lie in the least sensitive range of the immunoassay curve, fasting serum insulin is more accurate if a mean of three specimens taken over 10 minutes is used. The insulin assay should have no cross-reactivity with proinsulin.

Insulin resistance can also be assessed by the serum insulin response to an oral glucose load during an oral glucose tolerance test, peak serum insulin levels above 100 mU/L (718 pmol/L) being highly suggestive of insulin resistance. As most women with polycystic ovary syndrome should have a glucose tolerance test, serum insulin can be measured on three fasting specimens, as well as at one and two hours, so that both parameters of insulin resistance can be assessed.

Various measures of insulin resistance in polycystic ovary syndrome have recently been studied, and the ratio of fasting insulin (mU/L) to fasting glucose (mmol/L) has been found to be a simple and accurate indicator of insulin resistance (sensitivity 95%, specificity 84%, positive predictive value 87% and negative predictive value 94%) at values above 4mU/mmol.20

Catherine

-----Original Message----- From: anonymous@obgyn.net [mailto:anonymous@obgyn.net Behalf Of Michelle Sent: Thursday, April 24, 2003 8:52 AM To: Multiple recipients of list PCOS Subject: A couple questions about IR and symptoms

Hi everyone,

I have had PCOS for a number of years and just a few months ago found out that I am IR. I am going in on Monday to have blood drawn to make sure my liver and kidneys can handle metformin.

I was just wondering if anyone knew what the symptoms of IR are? I have been feeling kinda like my equalibruim is off, and sometimes I feel funny, almost weak, kind of like when you let yourself get really hungry and you almost feel nausus (sp). I was wondering if this was because of the IR.

Any info would be greatly appreciated.

Thanks in advance

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