Insulin resistance can be managed in two ways. First, the need for insulin can be reduced, and second, the sensitivity of cells to the action of insulin can be increased.
The need for insulin can be reduced by altering the diet, particularly the carbohydrates in the diet. Carbohydrates are absorbed into the body after they are broken up into their component sugars. Some carbohydrates are broken up and absorbed faster than others and are referred to as having a high glycemic index. These carbohydrates increase the blood glucose level more rapidly and require the secretion of more insulin to control the level of glucose in the blood.
Examples of carbohydrates with a high glycemic index that rapidly raise blood glucose levels include:
- unrefined sugars
- white breads
- unrefined corn and potato products (for example, bagels, mashed potatoes, doughnuts, corn chips, and french fries)
Examples of foods with a low glycemic index include:
- foods with higher fiber content such as whole grain breads and brown rice
- non-starchy vegetables (for example, broccoli, green beans, asparagus, carrots, and greens)
Since foods are rarely eaten in isolation, it can be argued that the glycemic index of each food isn't as important as the overall profile of the whole meal itself.
Several studies have shown that weight loss and aerobic exercise (without weight loss) increase the rate at which glucose in the blood is taken up by muscle cells as a result of improved sensitivity of the cells to insulin.
There are two important studies that have looked at the prevention of type 2 diabetes. Both studies took patients who could not control their blood glucose levels, which, for the purposes of this discussion, can be considered the same as patients with insulin resistance. One study done in Finland, showed that changes in diet and exercise reduced the development of diabetes by 58%. Another study, done in the United States and referred to as the DPP study, showed a similar reduction in diabetes with diet and exercise.
Metformin (Glucophage) is a medication that is used for treating diabetes. It has two mechanisms of action that help to control blood glucose levels. It prevents the liver from releasing glucose into the blood, and it increases the sensitivity of muscle and fat cells to insulin so that they remove more glucose from the blood. Because of these actions, metformin reduces blood insulin levels.
The DPP studied the effects of metformin in addition to diet and exercise on the prevention of diabetes in insulin resistance. Metformin reduced the development of diabetes by 31%. (Note, however, that the benefit was not as great as with diet and exercise!) Metformin is a reasonably safe medication when used in the right population. Although there are gastrointestinal side effects with metformin, it usually is well-tolerated.
Another study, the STOP NIDDM (Study to Prevent Non-insulin Dependent Diabetes Mellitus) trial, studied individuals with insulin resistance by treating them with a medication called acarbose (Precose). Acarbose works in the intestines to slow the absorption of sugars, and this effect would reduce the need for insulin after meals. The study found that acarbose reduced the development of diabetes by 25%.
Other medications in a class of drugs called thiazolidinediones, for example, pioglitazone (Actos), rosiglitazone (Avandia), also increase sensitivity to insulin. At this time, however, these medications are not routinely used, in part because of liver toxicity that requires monitoring of blood liver tests. Avandia, however, has been associated with an increased risk of heart attack and stroke, and experts have debated the severity of these concerns since the risk was first reported. On September 23, 2010, the U.S. Food and Drug Administration (FDA) announced that it will significantly restrict the use of the diabetes drug rosiglitazone (Avandia) to patients with type 2 diabetes who cannot control their diabetes on other medications such as pioglitazone (Actos). These new restrictions are in response to data that suggest an elevated risk of cardiovascular events, such as heart attack and stroke, in patients treated with Avandia.
One study, the TRIPOD (Troglitazone in Prevention of Diabetes) study, treated patients with gestational diabetes, a precursor of insulin resistance and diabetes, with troglitazone (Rezulin), however, because of severe toxic liver effects; troglitazone has been taken off the market and is no longer available. Among the women treated with troglitazone, diabetes was prevented in 25%.
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