Insulin Resistance: Key Questions for Your Gynecologist

Q: Insulin Resistance: Key Questions for Your Gynecologist

Hello： Regarding your question, the response is as follows： (1) The etiology of polycystic ovary syndrome (PCOS) is unknown. <br>It is characterized by an abnormal frequency of gonadotropin-releasing hormone (GnRH) secretion from the hypothalamus, leading to increased secretion o

May I ask the doctor?

Since I got my first period (in the fourth or fifth grade), it has been very irregular, often with long gaps in between.
During this time, I intermittently visited a traditional Chinese medicine practitioner and took herbal decoctions and powders.
This summer, I visited a gynecologist for the first time; the doctor performed an ultrasound and found no abnormalities, then prescribed ovulation medication and instructed me to have blood drawn on the third day after my period.
During my second visit, the doctor said the blood test results were normal, but my insulin levels were too high, and prescribed "Metformin" for me.
I was instructed to take it before meals: for the first week, one meal a day; for the second week, two meals a day; and from the third week onward, with every meal, continuing for six months.
I have already received a three-month continuous prescription and was told to return for a follow-up in three months.
I have been on the medication for less than a week and have not experienced any side effects.
I would like to ask the doctor: 1.
Will I still need to take "Metformin" after my insulin levels are controlled, or will I be able to stop? 2.
Does the absence of abnormalities on the ultrasound rule out the possibility of "polycystic ovary syndrome"? 3.
Is my high insulin level due to genetic factors related to diabetes in my family, or are there other contributing factors? 4.
If my insulin levels can be controlled and I can stop taking medication, can I switch to traditional Chinese medicine? 5.
Does "Metformin" have weight loss effects, and could it have any long-term side effects on my body? 6.
My father's diabetes medication is the same as mine, but he takes it after meals while I take it before meals.
Is this normal? 7.
Are there other methods to control high insulin levels besides medication? 8.
Is my continuous weight gain since sixth grade related to high insulin levels, even though my diet has remained normal? 9.
The dosage of the medication prescribed to me is gradually increasing; will it eventually decrease, or will it continue to increase?

iuo, 10~19 year old female. Ask Date: 2010/08/04

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: Regarding your question, the response is as follows: (1) The etiology of polycystic ovary syndrome (PCOS) is unknown.
It is characterized by an abnormal frequency of gonadotropin-releasing hormone (GnRH) secretion from the hypothalamus, leading to increased secretion of luteinizing hormone (LH) from the pituitary gland.
When LH is secreted excessively, it can 1.
Stimulate theca cells in the ovaries to synthesize excessive androgens, resulting in symptoms such as hirsutism, acne, rough skin, deepening voice, and even apple-shaped obesity (fat accumulation in the upper body and abdomen).
2.
Inhibit the action of aromatase in ovarian granulosa cells, leading to decreased estrogen secretion, which in turn causes follicular atresia, resulting in chronic anovulation and amenorrhea-related infertility.
3.
Induce premature luteinization, causing unruptured follicles to form polycystic ovaries.
(2) Glucose in the bloodstream requires insulin to enter peripheral cells for utilization.
When peripheral cells show decreased or no response to insulin stimulation, this is referred to as increased insulin resistance.
At this time, the pancreatic beta cells compensate by increasing insulin secretion, leading to compensatory hyperinsulinemia.
Hyperinsulinemia can easily cause increased ovarian androgen production and also reduce sex hormone-binding globulin levels in the serum, resulting in elevated free testosterone concentrations in the serum.
High levels of androgens can interfere with the frequency of GnRH secretion from the hypothalamus, triggering increased LH secretion from the pituitary gland, thus forming polycystic ovary syndrome.
(3) Currently, it is known that there is a close relationship between polycystic ovary syndrome and increased insulin resistance, but it is unclear whether increased insulin resistance is the cause of PCOS or merely a symptom.
However, when PCOS is associated with increased insulin resistance, treatment with Metformin or Troglitazone typically shows effects within two to three months, including weight loss, reduced hair loss, slowed hair growth, normalized menstruation, and restored ovulatory fertility.
(4) Metformin has multiple actions: it reduces glucose absorption in the intestines; decreases glucose production in the liver; increases tissue sensitivity to insulin (i.e., reduces insulin resistance), helping insulin clear excess blood glucose, thereby lowering insulin secretion; additionally, it has the effect of lowering triglycerides and cholesterol.
In the ovaries, it can reduce androgen secretion.
If the cause of increased insulin resistance is not addressed, the condition may relapse after discontinuation of Metformin.
(5) The diagnosis of polycystic ovary syndrome indicates that the presence of polycystic ovaries is just one marker and not a necessary one.
Therefore, patients with PCOS may not necessarily show polycystic ovaries on ultrasound examination.
(6) It is currently believed that the cause of excessive insulin resistance may be genetic.
(7) Side effects of Metformin include upper abdominal burning sensation, diarrhea, and loss of appetite; very few individuals may experience lactic acidosis.
(8) Metformin is generally taken with meals, so it can be taken 30 minutes before or after meals.
(9) It is generally believed that obesity is a high-risk factor for increased insulin resistance, and a weight loss of 5-10% can significantly improve insulin resistance.
(10) The cause of obesity is unknown, and obesity and increased insulin resistance can be mutually causal.
(11) The initial lower dosage of Metformin is to allow the body to adapt and avoid side effects, and then the dosage will gradually be increased to a certain level for continued treatment.
Thank you for your letter!

Reply Date: 2010/08/04

More Info

Understanding insulin resistance and its implications for gynecological health is crucial, especially for women experiencing irregular menstrual cycles and elevated insulin levels. Your situation, characterized by irregular menstruation since puberty and recent findings of high insulin levels, indicates a potential underlying issue that needs to be addressed holistically.

1. Regarding "泌樂寬" (Metformin): This medication is primarily used to improve insulin sensitivity and lower blood sugar levels. Once insulin levels are controlled, some patients may be able to taper off the medication, but this should be done under the guidance of your healthcare provider. It is essential to monitor your insulin levels regularly to determine if you can discontinue the medication safely. Stopping the medication without proper monitoring may lead to a resurgence of insulin resistance.

2. Ultrasound Findings: The absence of abnormalities on ultrasound does not definitively rule out polycystic ovary syndrome (PCOS). PCOS can sometimes be diagnosed based on clinical symptoms and blood tests rather than imaging alone. If you have symptoms like irregular periods, weight gain, or excessive hair growth, further evaluation may be warranted.

3. Family History of Diabetes: Genetics can play a significant role in insulin resistance and diabetes. If there is a family history of diabetes, it may increase your risk of developing insulin resistance. However, lifestyle factors such as diet, exercise, and weight management also significantly influence insulin sensitivity.

4. Transitioning to Traditional Chinese Medicine (TCM): If your insulin levels normalize and you wish to explore TCM, it is advisable to discuss this with your healthcare provider. They can help you transition safely and ensure that any herbal treatments do not interfere with your current medications.

5. Weight Loss Effects of Metformin: Metformin can aid in weight loss for some individuals, particularly those with insulin resistance. However, it is essential to maintain a balanced diet and exercise regimen to achieve sustainable weight loss. Long-term use of Metformin is generally considered safe, but potential side effects include gastrointestinal issues and, in rare cases, lactic acidosis.

6. Medication Timing: The difference in timing for taking Metformin (before meals for you and after meals for your father) is based on individual treatment plans. The timing can be adjusted based on how your body responds to the medication and your doctor's recommendations.

7. Alternative Methods to Control High Insulin: Besides medication, lifestyle changes are crucial in managing insulin resistance. Regular physical activity, a balanced diet low in refined carbohydrates and sugars, weight management, and stress reduction techniques can significantly improve insulin sensitivity.

8. Weight Gain and Insulin Resistance: Your observation of weight gain despite normal eating habits could indeed be linked to high insulin levels. Insulin resistance can lead to increased fat storage and difficulty losing weight, even with a healthy diet.

9. Medication Dosage: The gradual increase in your Metformin dosage is standard practice to minimize side effects and allow your body to adjust. Future adjustments will depend on your response to the medication and your insulin levels. Your doctor will monitor your progress and may adjust the dosage as needed.

In conclusion, managing insulin resistance often requires a multifaceted approach, including medication, lifestyle changes, and regular monitoring. It is essential to maintain open communication with your healthcare provider to tailor a treatment plan that works best for you. Regular follow-ups will help assess your progress and make necessary adjustments to your treatment plan.

Similar Q&A

Understanding Endocrine Issues and PCOS in Young Women: A Case Study

Hello, Doctor: I am currently 19 years old, with a height of 151 cm, weight of 45.4 kg, body fat percentage of 20.3%, and a waist circumference of 58 cm. Description of my condition: In March of this year, my weight suddenly increased from a stable 48 kg to 52 kg, and I missed my...

Dr. Xiao Yongxun reply Internal Medicine
Dear Miss Nini: 1. The formula for Basal Metabolic Rate (BMR) is often estimated using various regression equations; it represents the energy required to maintain basic physiological functions daily. It can be used as a reference, but there is no need to be overly concerned, as ...

Understanding Polycystic Ovary Syndrome: Insulin Resistance and Weight Management

I have been overweight since I was a child! Now, my mom took me to the weight loss clinic at XXX Hospital, and the doctor there is also an obstetrician-gynecologist! After a blood test, the doctor said I might have polycystic ovary syndrome (PCOS). The blood test revealed that I ...

Dr. Zhang Yongxuan reply Obstetrics and Gynecology
1. You can eat anything, but you need to control your carbohydrate intake and avoid excessive consumption of artificial sweeteners. 2. Elevated insulin levels can lower blood sugar; if the level drops below 50 mg/dL, it can cause confusion, dizziness, hunger, seizures, and even...

Understanding Insulin Resistance: Impact of Diet and Monitoring Tips

Hello, doctor. Recently, my health check revealed an issue with insulin resistance (index 2.2) (BMI 19 / body fat 25 / visceral fat 3). I would like to ask if the diet from the previous night could cause a discrepancy in the index (I had sweets around 11 PM and had blood drawn ar...

Dr. Wu Zongying reply Family Medicine
Insulin resistance is associated with being overweight or metabolic syndrome. Your BMI is only 19, so you may want to consider a follow-up examination.

How to Diagnose My Health Issues: Weight Gain and Urinary Concerns

Hello Doctor, I have had a question for a long time. My weight suddenly increased by over 20 kilograms in the past few years. During my health check last year, the report showed that my blood sugar was normal, but my urine glucose was ++. At that time, I didn't think much of...

Dr. Xiao Yongxun reply Internal Medicine
Dear Ms. Gigi: According to medical principles, polycystic ovary syndrome (PCOS) is an endocrine disorder that can lead to irregular menstruation, obesity, masculinization, and even infertility. It is often associated with diabetes or insulin resistance-related glucose intoleranc...