insulin resistance

[Susan615]

Several months ago during some routine testing the doctor said my insulin level was too high.  On the report it did not show outside the normal but she said the usually accepted cut off for insulin resistance was lower than my level.  I was placed on 500mg metformin, told to cut out process/refined sugar, carbs, and be re-tested.  This process has continued and now I am on 2000 mg of metformin and my levels are actually higher.  I have not been perfect with the diet but certainly much better than before.  I actually had recently lost 50 lbs on a high protien diet before I had the initial tests run.  My weight loss physician had told me I was losing the weight kind of fast and I needed to gradually bring back in good carbs.  So I started that, maintained the weight loss for 3 years and now am told I am insulin resistant.
  So now I am trying to increase my exercise and back off any carbs as much as possible.  I guess my questions are
1.  what are the "numbers" I am looking at?  My glucose was not high on the tests but she said my insulin was.  She kept mentioning number sin the teens, like she said 14 was a cut off and I am at like 15, then 21, then 19...
2.  what am I supposed to be eating?  I am afraid to eat anything.
3.  Why would the metformin not be working?

Any help would be great!!

[Zoelula]

Sounds like you had a good visit and got a lot of information and guidance. I'm sorry but the pituitary issues are totally out of my knowledge base.

As for the side effects from metformin, they are generally at their strongest when you first start taking them and are of a gastrointestinal nature. The only concern would be if the diet combined with the metformin brings your numbers down too well and you have hypoglycemia. I would just monitor this by testing at home and seeing how your numbers are. If you test two hours after a meal now and then this will also give you more information about your blood sugar until the endo is able to do the A1C. I'm glad the doctor is recommending low carb diet, as so many doctors are still stuck on low fat. Let us know how it goes and what happens when you see the endo.

[Susan615]

OK, here is what I found out.  The doctor said she tested my insulin serum level.  The range is 0.0-24 and my levels have been 21, 15, 19, 17 with the last 2 being on 2000mg of metformin.  I have only seen 2 glucose levels and they were 89 and 91 fasting.  The doctor said most endos like the serum insulin level to be below 13.  She says she feels I am insulin resistant.  She said I should get the Insulin Restistant Diet book and follow it exactly for one month and see what happens.  If I am able to lose weight and the numbers drop then that confirms the IR.  She said I was able to lose weight rapidly on the low carb diet because that is the best way for IR people to lose.  She says I am having trouble losing now due to not following the diet exactly and some of my thyroid issues.  She is reffering me to an endo for both problems but she said it will take a while to get in to this endo because she is really good.
Some now my questions are if I follow this diet and my numbers do drop then will I feel side effects from too much meds?  Also she told me that the pituitary is getting a message from the insulin or fat telling it to crave carbs and the process cycles.  She had also told me one of my thyroid numbers is pituitary realted.  Could all this be from a malfunctioning pituitary?
Thanks for all the help!

[Susan615]

Wow.  Thanks for the info.  I am really ready to go to my appontment tomorrow and ask some better questions.  I won't be able to see the endo until next month but I can certainly ask more questions of my doctor in the meantime.
Thanks again!!!

[Zoelula]

Yes, there is a test for diabetes called the A1C which checks the average blood sugar for a period of 2-3 months. This is the criteria for diagnosis of diabetes, not a random blood sugar.

As if you aren't confused enough, I have something else to throw into the mix. If you are diagnosed with diabetes you will need to ascertain your type. Your doctor seems very fixed on insulin resistance which means he thinks you are at risk (if you don't already have) type 2. I wouldn't be that sure. Up to 20% of Type 2's are misdiagnosed just based on their age, when they are in fact Type 1s or LADAs which is a form of type 1 with a more gradual onset.You mentioned two things that make me think of that which are that you have thyroid disease and that you lost a lot of weight easily. I'm glad you are being referred to an endo; they will be able to sort all this out.

[Susan615]

Thanks for the response.  This is kind of what I thought too but I was afraid I was missing something.  I go back on Monday and I will ask more questions.  The doctor said since I had high BP (not very hogh though) and had extra weight in my mid section, plus the insulin level I was insulin resistant and if I didn't fix it I would have diabetes.  She is also referring me to an endo.  I have some chronic thyroid problems as well.  I have hashimotos thyroiditis and have been hypo for many, many years.  Lately my thyroid levels have been off as well.  I will see if I can get clarification on exactly what this test keeps showing.  I have searched for insulin test results ion the ranges she gave me but these ranges do not seem to appear anywhere.  I wonder if there are different types of tests.
Thanks!

[Zoelula]

I'm very puzzled by what you write. To my understanding insulin resistance can exist as a precursor to type 2 diabetes, and I would guess your doctor is trying to head off the diabetes. But you are on the maximum dosage of metformin for somebody WITH diabetes. You are saying your blood sugar is not at all high? Did he do an A1C test and if so what is the results? I'm sorry but I don't know too much about insulin resistance except how it works in type 2 diabetes, but I have never heard of someone taking that much metformin who is not diabetic. If I were you I would read up on insulin resistance, and I would make an appointment to see an endocrinologist. There is something wrong with this picture imho: 1. Why he is treating insulin resistance without diabetes so aggressively and 2. If you were that insulin resistant you wouldn't have been able to lose weight so easily that the doctor commented it was too fast.

I would make sure the doctor explains to you what he is treating and why. I would absolutely want clarification (by A1C test) as to whether you have diabetes.