metformin, it can reverse liver disease and IR

[merryBe]

I'm having a real dilemna here, and I would really like to see more discussion of this topic.

here is a great synopsis I just found:


http://www.nature.com/nm/journal/v6/n9/full/nm0900_998.html

WOW, that was a mouthful!!

in light of the findings from all those studies listed I would think this needs much closer examination.

In light of the fact that I am currently UND and have no virus, the reversal of fatty liver and less necrosis and less HCC all sounds very appealing, not to mention any reduction in IR would mean ones own Interferon response would be better post tx. and this alone may increase ones chances of an SVR even if begun at the end of an SOC regime.
Perhaps now, more than any other time it could help insure one will recognize any lingering HCV and seek and destroy as designed.
As long as one kept the dose low, monitored the liver, and watched for lactic acidosis, what would be the harm in trying?

arguments in favor or opposed please weigh in, if obese women went from 20% to 60% SVR that should tell us something??

mb

[merryBe]

yes, if one becomes both type 1 and 2, then a pump might be option if like I said you had issues with shots, or remembering.

remember the longer one has IR and leaves it untreated or not controlled by some means, be that meds diet or some combo of both (it should be both because not changing diet means IR dosages have to be higher and that leads to more dangerous side effects).  but the longer IR goes untreated, the more risk the pancreas will give up  finally, leading to type 1...and this is where blindness and the loss of limbs, being found comatose etc become very real and present dangers.

the pumps have issues also, they are not problem free and require some adjestment. One should read up on them and have realistic expectaions.

One can also use pumps now for Byetta...if  one has not progressed to a true type 1 then this is also a good option.

Of course, for those who are used to shots after tx...it may be easy for them, but there is definitely more work in testing...and less micro control than with a pump.

Example: children with type 1 have wild fluctuations and are often fitted with pumps allowing for a much more even BS throughout the day, and for microinjections to kick in when needed. A pump cannot stop all fluctuations but it gives an opportunity to control mini amounts, and bring up the levels a few ml at a time without repeated injections. It is safer for the patient than to overshoot..or overcorrect...and for the aged and children it is easier for another adult to help you monitor what the pump is doing.

I'd suggest folks check out the diebetic forum, you'll find some folks on 2,3 even 4 meds for their diebetes.  Many try to stay on orals too long when their disease has really progressed to where more is needed.

Ps. just because we haven't heard of things, doesn't mean they aren't real. There are millions of things none of us have heard of...that are true none the less.

mb

[merryBe]

sorry if I didn't explain the whole thing well....CoW could undoubtedly do it better.

again sometime a person can have both insulin resistance AND lack of insulin being produced.  This is known as having type 1 and type 2 diebetes simultaneously.

At the time this occurs treating for the IR may mean adding 2 oral meds rather than one, to make cells more receptive, but if the pancreas is giving out, or under auto-immune attack it can stop producing enough insulin, couple that with the fact that the cells are now resisting, and a low level, and you have a real connundrum.

The solve for this is a combo therapy,
Abstract
Purpose
To compare the efficacy of adding pioglitazone or bedtime isophane (NPH) insulin to maximal doses of metformin and an insulin secretagogue in patients with poor glucose control.

Methods
We conducted a nonblinded, open-label, randomized controlled trial involving 62 patients with type 2 diabetes and glycosylated hemoglobin (HbA1C) levels >8.0%. Patients received either pioglitazone or bedtime NPH insulin in addition to their usual diabetes medication for 16 weeks. Outcome measurements of glycemic control, hypoglycemia, blood pressure, lipid levels, microalbuminuria, and quality of life were assessed at baseline and at 16 weeks.

Results
HbA1C levels were lowered to a similar degree in each treatment arm (pioglitazone: –1.9% ± 1.5%; insulin: –2.3% ± 1.5%; P = 0.32), but hypoglycemia was less common among patients who received pioglitazone than those who received insulin (37% [11/30] vs. 68% [19/28], P = 0.02). Pioglitazone, but not insulin, resulted in an increase in high-density lipoprotein (HDL) cholesterol levels. Both treatments had similar effects on weight, other lipid values, blood pressure, and urine microalbumin levels.

Conclusion
Adding pioglitazone or bedtime insulin for 16 weeks improved glycemic control in type 2 diabetic patients with secondary oral agent failure. Pioglitazone was associated with less hypoglycemia and improved HDL cholesterol levels.

This is what happens after years of IR....the dynamic changes as the pancreas can't keep up...Co writer did talk about this also I recall.
Eventually any type 2 diebetic can become a type 1 as well.
Type 1 is usually seen in young people and type 2 in older folks. Type 2 is related to diet and excercise whereas type 1 has to do with the pancreatic cells that make insulin dying and not being replaced, usually due to genetics or auto-immune things.
In the older and obese, it is believed the the long time of untreated IR which forces the pancreas to overproduce for years trying to cope with the insulin resistance is what finally just wear the poor thing out. Then you have 2 problems at once to treat.

mb

[merryBe]

I am SO sorry if you misunderstood and took personally my remark to be determined.

I'm in no way suggesting you are not. This was a general statement intended to encourage everyone to be pro-active, and I did not assume you weren't.

Just giving general advice to a general question.

Perhaps it might help you to understand why I made a statement concerning determination. Like you I have tried mightily, not only in tx but in weight loss.
It is frustrating when all our efforts do not always pay off. (for instance before I knew my pituitary wasn't working I tried weight loss for a year at 800-1200 calories a day...counting every drop of oil and calorie...yet only lost 4 lbs due to my metabolic issues.  Such things are very frustrating to say the least....and plenty in here have been real warriors.
However, that said, do you recall that lately there have been several TV commercials about people with diebetes saying "I shouldn't have waited so long".
Well there's a reason for those commercials. One person said, I was afraid of the word, afraid to even try the medicine because I didn't want it to be true.
There are folks like this too Penny. Sometime they lose sight and more before they get treated for their diebetes
.
When I was doing physical therapy the saddest cases were the amputations.
Trying to get people to walk again, missing toes or even a calf is not easy.

Unfortunately 2 factors played into such losses one was docotor driven, docs didn't used to tell folks they were prediebetic, or even call it that. They didn't get treatment for IR because they didn't know, and the docs didn't recognoze the signs either...

But now that has changed, yet still there is a subgroup that is terrified of the diagnosis, and does not realize that their life will be happier and healthier if they do make the diet and/or medications adjustments.

sometimes I am saying things for everyones benefit, and I forget that someone may think such statements are aimed at them when they are not.
Again sorry for that.

mb

[bandman54]

Insulin pump won't help for IR.
If you are IR you are producing plenty of insulin (my fasting insulin is high) but it can not "unlock" your cells very well to let the glucose in.  Your cells are "insulin resistant".

At least that is my understanding.

bandman

[apache1]

Insulin pump for IR...good question BM, I must have missed that.
Guess they think if your not sensitive enough to insulin, just pump in more, and more, till it gets it done...lmao

dang...where's CO when ya need her

[bandman54]

I am aware of all that concerning cp450.

What I was wondering is how will an insulin pump help someone with IR.  Doesn't make sense.

Now, if you progress to the point where your pancreas is not producing insulin, you are a diabetic and an insulin pump might be in order.  

Also, A1C is of little importance in trying to figure out your IR.  I am extremely IR, and have a great A1C.    So I am not diabetic, but I am IR.  (homa 3.4 and it was higher!) but I could progress to diabetes (as my father did).

bandman