My glucose level are on the high side (6.5, 5.2, 6.1 mmol/l at -1, 1, and 4 weeks of TX respectively). Hence, I suspect I'm insulin resistent. I'm genotype 1 and have also HIV. At 4 weeks I only had a 0.23 log drop in VL. I may well be a non-responder, and perhaps it is related to a possible IR.
In November 2008 the results of a double blind test was published, where IR geno 1 HCV where treated with additional Metformin to suppress the IR. It worked, but mainly for women and fat people. However, I'm neither.
Nevertheless, I'm wondering, would taking something like Metformin perhaps slow down my liver fibrosis? I want to wait for the new meds to arrive in two years time, but perhaps the increasing fibrosis will catch up with me. I hope that if I turn out to be IR, suppressing it will give some relief in this respect.
IR is a predictor of SVR. HCV slowly damages the mitochondria through a process of oxidative stress. Aerobic exercise helps produce more mitochondria and a high-protein diet boosts the benefit of exercise, which decreases insulin resistance.
Being insulin resistant impairs your ability to achieve a sustained response to Chemotherapy drugs peginterferon and ribavirin... Adding Metformin before and during Hep C treatment increases your odds of clearing...
IR can be the cause of steatosis & fibrosis in genotype 1 patients. So, yes taking Metformin could slow down fibrosis.
How do you reduce Insulin Resistance & manage blood sugar?
1. Take Vitamin K- It is found in brussel sprouts, brocolli, & dark leafy greens.
2. High intensity exercise- Lift weights & ride your bike.
3. Eat high fiber foods- fortified cereals
4. Consume Citrus Peel Extract
5. Take Alpha Lipoic Acid supplements- Also Flaxseed is a good food source as well
6. Low glycemic index diet
7. Eat Chromium
8. Resistance Training
10. Use Turemic when you cook
11. Deep restorative sleep
12. Low grain, NO SUGAR diet
13. Supplements- Gymnema sylvestre, bitter melon, fenugreek, banaba, & cinnamon
15. Omega 3-fatty acids, fish oils
agreed that the '08 metformin study did not make a strong case for adding metformin in all patients, however you might also want to look at a recent Khattab'10 study that looked at adding pioglitazone in geno 4s with HOMA1 gt 2.
They measured across-the-board improvement in SVR rates 60% vs 39% significant at 0.04. Geno 4s seem to be particularly susceptible to IR-related effects so this may not generalize. Your glucose levels seem pretty high - did your Dr. confirm a diagnosis of diabetes? The combination of IR HIV and HCV is not a good one as both IR and HIV have been associated with rapid progression. Anything you can do to control/improve the glucose levels seems worth pursuing. Cory's list is an excellent start and talking to your Dr. about adding metformin/pioglitazone seems prudent.
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