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What you Need to Know About Insulin Resistance to Increase SVR

Mar 04, 2009 - 21 comments
Tags:

insulin resistance

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HOMA

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insulin

,

hyperinsulinemia

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pre-diabetes

,

Diabetes

,

non-responders

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metformin

,

SVR



WHY EVERYBODY SHOULD READ THIS.......

In cellular metabolism, glucose (sugar) can be converted into fatty acids. Many viruses use these fatty acids to build their viral envelopes, or outer coatings, which help the viruses penetrate and infect human cells.

When the Hepatitis C virus gets into your body, it tries to increase your metabolism so that it can reproduce more quickly by using fatty acids to build protective outer coatings which will help it penetrate and infect your liver cells.

And one of the ways to create more glucose that can be converted into fatty acids, is by making you INSULIN RESISTANT and eventually turning you into a DIABETIC.

And being INSULIN RESISTANT or DIABETIC, lowers your chances of treatment success. And if you know nothing about insulin resistance or diabetes, then you're already at a disadvantage. So keep reading even if you think this thread is not for you because you're not diabetic. Because what you learn here, may help you beat the virus.


A fasting blood sugar higher than 100 means you're insulin resistant and gives you a diagnosis of "PRE-DIABETES".

The first time I heard about "Pre-diabetes" was at a diabetes conference. An endocrinologist giving the lecture started by saying she'd just gotten married and showed us a picture of her wedding. She and her new husband were standing in profile....and his big belly was sticking out of his belt. It looked terrible. I remember thinking that she should have chosen a better picture.

Then she pointed to her husband's belly on the picture and loudly said, "PRE-DIABETES".

What a way of making an impression.  Years later I still remember what the picture looked like (I also remember that when the audience stood to leave, we were all sucking our belly in...LOL).  You see....a fat belly (waist larger than hips) is a sign of pre-diabetes. And having pre-diabetes means that you're insulin resistant and it gives you a higher risk of becoming a diabetic later on in life.

I was so excited about what I had learned that on my way home I stopped by my office and picked up a glucometer.  
The next morning I tested every member of my family. Everybody's blood sugar was less than 100 except for my son's. His was 103.  It made sense, all four of his grandparents were diabetic. So my son was already pre-diabetic (insulin-resistant) and he was just a kid....and he was thin.

What was the one thing I could do to hopefully...maybe... keep him from becoming diabetic in the future????

Teach him how to keep his weight down. Obesity is like an invitation for diabetes. However, thin people can be insulin resistant too. And the Hepatitis C virus causes insulin resistance!!!

And a Glucose >100 mg/dl Reduces Interferon/RBV SVR

http://www.natap.org/2008/HCV/031008_01.htm



We know that the Hepatitis C virus CAUSES INSULIN RESISTANCE....but....

WHAT IS INSULIN RESISTANCE?????

Insulin Resistance means that the body becomes less sensitive to insulin. Even though the insulin may be there, the body does not recognize it or use it. It's as if some of the insulin keys got RUSTY and your body can't use them to open the cells. The keys are there but your body can't use them.

When you first start getting insulin resistance, the pancreas notices that some of the insulin keys are rusty and you don't have enough insulin to keep your blood sugar under control. So the pancreas starts working faster to produce more insulin. But gradually, the insulin resistance gets worse and worse. Let's say that from 10 rusty keys you went to having 50 rusty keys.....and the pancreas works faster to make more insulin. But since your body is insensitive to some of the insulin, you end up with a bunch of insulin you can't use.....WAY TOO MUCH INSULIN......that's called HYPERINSULINEMIA.

And THAT is what lowers SVR. The high amounts of INSULIN caused by the insulin resistance. You see....too much INSULIN, MAKES INTERFERON INEFFECTIVE!!!!!

This is a quote from a study that showed that during Hep C treatment, HYPERINSULINEMIA (high levels of insulin).....MAKES INTERFERON INEFFECTIVE!!!


"interferon alpha blocks HCV replication. However, when insulin (at doses of 128 microU/mL,similar to that seen in the hyperinsulinemic state) was added to interferon, the ability to block HCV replication disappeared"

http://www.ncbi.nlm.nih.gov/pubmed/17131467?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


And decreasing insulin resistance increases SVR!!!

http://www.hivandhepatitis.com/2008icr/aasld/docs/112108_a.html


HOW DO YOU GET TESTED TO SEE IF YOU'RE INSULIN RESITANT???

HOMA is a formula that uses the results of 2 blood tests ....a FASTING INSULIN and FASTING GLUCOSE (sugar) to figure out if you're insulin resistant.

A HOMA result of < 2 is considered NORMAL.

In genotype 1, studies have shown that the more insulin resistant you are, the lower the SVR (and Genotype 2 and 3 can also be insulin resistant!!!)...

HOMA less than  2 ....SVR 60.5%

HOMA between 2-4 ....SVR 40%

HOMA higher than 4 ....SVR 20%


http://www.ncbi.nlm.nih.gov/pubmed/17131467?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum



What DECREASES INSULIN RESISTANCE??????

1. EXERCISE
2. Gradual weight loss if you're obese. (quick weight loss can cause insulin resistance)
3. Getting rid of the Hepatitis C virus.
4. Medications like Metformin, Avandia and Actos

(Sometimes exercise and weight loss are not enough to get rid of the insulin resistance because the Hepatitis C virus keeps causing it)

Medications like Metformin and Actos decrease insulin resistance. In other words, they help make the cells in your body more sensitive to insulin. BUT they DO NOT make the pancreas produce more insulin, so they won't make your blood sugar come down 20 points of whatever. They don't do that.

Let me explain to you what Metformin does....

When you eat a meal, the food goes from the mouth to the stomach where it turns into liquid sugar. From the stomach and intestines, the sugar is quickly absorbed into the blood.

  ****Metformin helps by making the sugar slow down a little so it's not absorbed into the blood so fast.


When the sugar goes inside the muscle cells....the muscles use the sugar as energy.

   ****Metformin helps the muscles use the sugar a little faster.


During the night when you go many hours without eating, the blood sugar starts going down...and the liver gives you a bunch of sugar (this is a big problem for people who have Hep C because the virus causes the liver to disgorge large amounts of sugar).

    ****Metformin tells the liver not to give you so much.


So Metformin helps improve insulin resistance....but it doesn't make the pancreas produce more insulin. So it's not going to make your blood sugar come down 50 or 60 points.

Think of it this way......

If insulin is like keys....and some of those keys get rusty and don't work.....then Metformin is like oil you put on the key holes so the keys work better.



WHAT IS "BORDERLINE" DIABETES?????

The American Diabetes Association retired the term "borderline diabetic" years ago.  WHY???  Because a fasting blood sugar of 80-120 was considered "normal"....and some doctors called a fasting blood sugar of 130 "borderline", while others considered 200 "borderline".  So many patients were not being diagnosed as diabetic when they should have been.

So there's no such thing as "borderline diabetic". You're either a diabetic or you're not. It's sort of like being a thief. You're either a thief or you're not. You're not a "little bit" thief.


INSULIN RESISTANCE CAN ADVANCE TO DIABETES.....

For a long time, maybe YEARS, the pancreas is able to keep up the fast pace and is able to make enough insulin to keep your blood sugar under control. But eventually the pancreas gets tired. It can't keep up the fast pace and slows down.....and your blood sugar gets higher and higher.....until you become a DIABETIC. (On the other hand, some people can be insulin resistant and never advance to diabetes).

A fasting blood sugar higher than 126 on two separate ocassions gives you a diagnosis of DIABETES.

So before you become a diabetic, you first become insulin resistant. That means that ALL Type 2 diabetics are insulin resistant.

I'm sure you've heard diabetics say that their diabetes used to be under control with just one diabetes pill a day.....but later they had to take two.....and eventually they had to take insulin even though they were eating the same things. Why did that happen if they were eating the same and exercising the same? Because their Insulin Resistance increased. Their body became less sensitive to the insulin.


WHAT IS DIABETES?????

First we're going to talk about somebody who DOES NOT have diabetes....

Whenever we eat, the food goes from the mouth to the stomach......where it turns into SUGAR.....EVERYTHING we eat turns into a liquid type of sugar. EVERYTHING, doesn't matter what it is. (Some things, like bread and pasta turn into sugar quickly while other foods like meat, take 6-8 hours to turn into sugar, but eventually, everything we eat turns into liquid sugar).

From the stomach and intestines, the liquid sugar is absorbed into the blood. So now you have lots of sugar in your blood....(and some of the sugar is saved by the liver).

As soon as you have lots of sugar in your blood, that automatically sends a message to the pancreas. "Mr Pancreas, Mr Pancreas! Please give me some insulin because I have lots of sugar in my blood!".....and Mr Pancreas says...."Sure....no problem" and it gives you a bunch of insulin.

Imagine that the INSULIN looks like YELLOW KEYS......and let's say the pancreas gives you 100 insulin keys.

The yellow insulin keys go and open all the doors on the MUSCLE CELLS......and once the doors are open, the sugar in the blood can go inside the cells and feed them. And if you over-eat, the yellow insulin keys also open the FAT CELLS......and sugar goes inside them too and you get fat.

And THAT, is how food turns into energy. That's the way it's supposed to work.


NOW LET'S LOOK AT A DIABETIC.....

Mr Diabetic eats the same food as the other person. Food goes in the mouth and down to the stomach where it turns into SUGAR....liquid sugar.....and from the stomach and intestines, the sugar is absorbed into the bloodstream and some of it is saved in the liver.

As soon as Mr Diabetic has lots of sugar in his blood, it automatically sends a message to the Pancreas.....
"Mr Pancreas, Mr Pancreas! Please give me some insulin because Mr Diabetic has lots of sugar in his blood".

But Mr Pancreas, says, "I'm sorry....I don't have enough"....so let's say that instead of giving him 100 insulin keys like it gave the other person, it only gives Mr Diabetic 50 insulin keys. ( ***People can also be producing enough insulin, but because they are insulin resistant...insensitive to insulin... the body doesn't recognize it and can't use it )

Those 50 insulin keys go and open SOME of the muscle cells .....but since Mr Diabetic didn't get enough insulin keys, some of the muscle cells remain CLOSED. The sugar in the blood goes inside the cells that are open but it can't go inside the cells that are closed. And the sugar has no place to go and STAYS IN THE BLOOD. So when his doctor orders a blood test, it will show that he has high blood sugar....that's DIABETES.

AND HAVING DIABETES.....LOWERS TREATMENT SUCCESS.....and increases fibrosis progression and the risk of liver cancer.

Bottom line....being insulin resistant/diabetic, decreases your chances of SVR greatly. Many of you who have failed treatment, probably failed because of INSULIN RESISTANCE...the most important host factor in the prediction of treatment response....the common denominator to the majority of features associated with difficult-to-treat patients (patients with cirrhosis, obesity, HIV coinfection, Afro-American and non-responders) ...and the one thing you can change.  

Co

Comments
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Avatar universal
by Tippyclubb, Mar 05, 2009
Well, I really blew that one seeing as this is a public journal and not a pm.  Don't know what I was thinking.  Blame it on the meds.  Lol !

568322 tn?1370169040
by CoWriter, Mar 05, 2009


No problem, I took care of it.  

A HOMA will tell you whether you're insulin resistant.  It's a formula that uses the results of two blood tests....a fasting blood sugar and a fasting insulin.

Fasting blood sugar X  Fasting insulin.....divided by 22.5 =  HOMA


The higher the HOMA, the more insulin resistant you are and the more SVR drops.

HOMA less than  2 ....SVR 60.5%

HOMA between 2-4 ....SVR 40%

HOMA higher than 4 ....SVR 20%



The reason you need both blood sugar and insulin tests done is because the blood sugar can be okay....but the insulin very high and that will give you a high HOMA.

Like it happened to bandman54.  His fasting blood sugar was 97 and his insulin was 18......which gave him a HOMA of 4.48

Here's his post.....

http://www.medhelp.org/posts/show/774204


I would show the doctor the studies I posted on uric acid and ask him to check your fasting blood sugar and insulin.  And tell him about the back pain you're having.  

Co

Avatar universal
by geterdone, Mar 05, 2009
I guess all the Ben & Jerry’s and other sugary comfort food we eat during treatment is actually reducing our chances of obtaining SVR even though we reach UND early and because of the excess sugar turning into fatty acids, it builds an even more protective outer coating on the virus cells which helps it penetrate and infect your liver cell. So, this added outer coat of fatty acids helps it encapsulate the virus but once inside the liver cell the outer coat is broken down and the virus is then able to replicate?

I wonder if this is why there is more research being done on the cholesterol and lipid front relating to hepc and the use of cholesterol fighting drugs.

Could it also be the liver pain that some experience during the course of treatment and post treatment is that the pancreas is constantly working harder at times to make the keys needed to keep the glucose balanced?

jasper


568322 tn?1370169040
by CoWriter, Mar 06, 2009

Hi Geter:

The Hep C virus turns the liver cell into a virus reproduction factory. It teaches the liver cell how to make more copies of the virus.  

HCV is associated with lipid in the serum and uses lipid receptors to enter hepatocytes.  

Several studies have shown that some statins (cholesterol meds), have an inhibiting effect against the virus.

http://www.tulsaworld.com/lifestyle/article.aspx?articleID=20080411_1_A5_hAnOk02858

Re the pain......

In some people, HCV causes the liver to disgorge huge amounts of glucagon.  This kind of sugar infusion would overwhelm most people's ability to produce enough insulin to control it.  The pancreas has to work harder and gets overworked, trying to keep up with the huge amounts of sugar....and eventually the beta cells in the pancreas get damaged.  

Pancreatitis (inflammation of the pancreas) causes pain and it can become chronic.  Sometimes the pain can be relieved by anti-oxidants....

http://www.diabeteshealth.com/read/2009/01/22/6059/antioxidants-relieve-pain-of-chronic-pancreatitis/?section=16


But the most common cause of liver pain is steatosis (fatty liver).


Sometimes I feel like people are not understanding how important IR is...so I must not be explaining it right.    But it looks like this time I did.  You got it : )

Thanks for stopping by.

Co

568322 tn?1370169040
by CoWriter, Mar 06, 2009
Geter:

Toxicity from very high triglycerides can also cause abdominal pain.  And interferon can cause high triglycerides.  

Co


Avatar universal
by geterdone, Mar 06, 2009
The Triglycerides are coming down slowly but are coming down. I have been watching and cutting as much sugar out of the post tx as possible. One sugar on the first cup of coffee and black after that also cutting the donuts, man it is harder than tx at times. The sugar fix in the am is like the cigarettes next to them and sad but true they are coming to an end not because of the enjoyment but that of the cost.,lol. I knew going into this that there were going to be some ramifications at the end but if it was in the process, so be it.

Thank You for the many gray areas.
and as in the twelve steps, my apologies as to when you first arrived.

jasper


568322 tn?1370169040
by CoWriter, Mar 07, 2009
"One sugar on the first cup of coffee and black after that "

And there's your problem....the coffe....it increases blood sugar.  Whether it has sugar or not.


"also cutting the donuts, man it is harder than tx at times."

I have this little story I tell the people who attend my nutrition class.....

If I was to tell you that I know a place that sells the best chocolate donuts in the whole wide world....and tomorrow, I will pick you up and take you....and you can have as many as you want...my treat.  What would you think?  That I'm really nice, right?

But if instead I put a bunch of flour on the table....and some sugar and LARD.....and I tell you to eat it.  What would you think?  That I'm nuts, right?  or that I want to torture you.

That's what donuts are....flour, sugar and lard.  From now on, think about it that way.


"and as in the twelve steps, my apologies as to when you first arrived."

I've developed a new way of looking at it when it happens.  I think how great it will be when they change their mind about me. : )







233616 tn?1312790796
by merryBe, Mar 13, 2009
this is a cool journal entry but you should post it to the main board where all will see it. It's always scary when folks first hear that their diet may be whats killing them, but there are millions of heart and pancreatic patients walking around who will say amen to any attempts to enlighten.  Diet realy does effect outcome.

Also, as we are on the subject, would you share anything you know regarding the influence of vitamin A&D on pancratic function. years ago it was considered essential but I've yet to see discussion on this.

Also, what about the Zone diet, and slowing down IR by including 30% of calories from fat to slow sugar/carb absorption.

Also, I'm baking now with honey as my gut can't tolerate the synthetics like splenda. I use half what the recipe calls for, and the honey takes 3 times longer to absorb than white sugar, so less spikes in BS. Do you think this is OK for those able to keep their BS in the normal range?  I'm thinking it is because just switching to fake sugars does not slow down the calorie consumtion..in fact it doesn't even get people to thinking of food as calories or points, they tend to think of the splenda stuff as calorie free even when it's icecream containing more calories than most on the shelf!!
I think the key in all of this is learning portion control and balance.

Also, food cravings go down as balance is restored in the diet.I know the less sugar I eat, the less I crave.

What to you know about protein as it relates to sugar cravings. Is it still thought that a craving for sugar is really a need for protein to get high octane glucose..or has that changed?

mb

338734 tn?1377163768
by IAmTheWalrus, Mar 13, 2009
Well put. It makes sense to me.

Avatar universal
by Deb_c430, Mar 13, 2009
Exactly, this is easy to understand and informative.   I am the same port, i feel bad sometimes people write these wonderful posts. But Rarely can I focus on them. or post these studies.

I am like huh?  

This one I could!  Thank you CO.  

568322 tn?1370169040
by CoWriter, Mar 19, 2009
To: merryBe

"Also, what about the Zone diet, and slowing down IR by including 30% of calories from fat to slow sugar/carb absorption. "

Here's what hepatologists recommend...page 17

http://www.hcvadvocate.org/hepatitis/About_Hepatitis_pdf/1.1.1_Living_With_HepatitisC/SIDE_EFFECTS.pdf


"I'm baking now with honey "

Honey is sugar, try Stevia.  It improves insulin sensitivity and glycemic control.  And a study showed that stevioside decreased viral load.  So maybe it could prevent relapse?  Just a guess.

Co

568322 tn?1370169040
by CoWriter, Mar 19, 2009
To: IAmTheWalrus

Thank you for your input.  I'll take this opportunity to congratulate you on having completed your Tx successfully.

Co

568322 tn?1370169040
by CoWriter, Mar 19, 2009
To: Deb_c430

You're very welcome.

Co

233616 tn?1312790796
by merryBe, Mar 26, 2009
well, of course honey is sugar, I used to be a bee keeper, about 10 hives.

sugar metabolizes more quickly...honey takes 2-3 times as long....even fructose is better than sugar in that it takes longer.

It's not all about amounts, it's about the glycemic index and slowing down absorption rates.

An oatmeal cookie, heavy on egg nuts and raisin, with 1/2 to 1/3 the amount called for, is a healthier choice for me because

A. the oils in the recipe and protein slow down the sugar absorption further,
B. the balance of protein/fat/complex carbs and low sweet make 2 of these 2 inch cookies a better solution than to eat high amounts of fruits or carrots only say...which have a higher glycemic index.
C. this choice I can live with...as a treat once or twice a month....melon for desert every night I can't.

the stevia has me concerned because the clearance rates in humans of the metabolites was low...and FDA approval issues.

Koyama E, Sakai N, Ohori Y, Kitazawa K, Izawa O, Kakegawa K, Fujino A, Ui M.
Kashima Laboratory, Mitsubishi Chemical Safety Institute Ltd., 14 Sunayama, Hasaki-machi, Ibaraki, 314-0255, Kashima-gun, Japan. e-***@****

Stevia mixture, sweeteners extracted from the leaves of Stevia rebaudiana Bertoni, consists mainly of the glycosides of the diterpene derivative steviol. The aims of this study were to investigate the absorption (in rats) and the hepatic metabolism (in rats and humans) of both stevia mixture and steviol. Absorption was investigated both in vivo and ex vivo. In ex vivo experiments using the rat everted sac method, no absorption of stevia mixture was observed, but significant absorption of steviol was noted (equivalent to approximately 70% of the absorption reference- salicylic acid- value). In the in vivo experiment, rats received a single oral administration of either steviol or stevia mixture; a peak steviol concentration in plasma was observed 15 min after its oral administration, demonstrating rapid absorption. However, after oral administration of stevia mixture, the steviol concentration in plasma increased steadily over 8 h, suggesting that stevia mixture components are first degraded and then absorbed as steviol in the rat intestine. Steviol metabolism in humans and rats was examined by incubating steviol with liver microsomes from the two species. Oxidative (monohydroxy and dihydroxy) metabolites of steviol were observed by LC-ESI/MS after incubation with both human and rat liver microsomes. The intrinsic clearance of steviol in human liver microsomes was 4-times lower than that found in rat liver microsomes. In conclusion, this study suggests that there are no major species differences in steviol hepatic metabolism between rats and humans. Absorption from the human intestine can be predicted to occur in an analogous manner to that from the rat intestine.

I guess a couple of the metabolites were liver toxic.....anyway, when I checked out all the sugar subs a couple years back something threw me off of them all...but then I stopped MSG and dozens of other things 40 years ago.
I don't know if more research has proven this study untrue.....but any time humans clear something 4 times slower than rats it can mean trouble longer term.
just me...doesn't mean I'm right.

mb
.


Avatar universal
by geterdone, Mar 26, 2009
I happened on a Saturday night as the place was rocking and the place got out of hand and three were jailed but one was paroled. I the incarceration of the other two was short lived and the soggy bottom boys were determined to take this IR message to SVR’s golden shore. So post it here... CO

http://www.youtube.com/watch?v=08e9k-c91E8


568322 tn?1370169040
by CoWriter, Apr 10, 2009
To geterdone

IR gets us in trouble all our days
no pressure there
still got three friends...LOL
Down in the river to pray
oh brothers let's go down
come on down
don't you wanna go down
we'll show you the way
down in the river
to sing the IR songs and pray.
we are singing
oh yes, singing
cause we're winning
winning....winning.....hey geter
week 4 UND says we won!
The soggy bottom boys
are on their way
to SVR's golden shore.

568322 tn?1370169040
by CoWriter, Mar 16, 2012
Yes, we won, but two years later we're still having to deal with post treatment side effects.

Co

317787 tn?1473362051
by Dee1956, Jun 10, 2012
Thank you so much for this journal post.  It was very helpful to me and helped me get to SVR

568322 tn?1370169040
by CoWriter, Mar 14, 2013
If it helped just one person then I did well.  Congratulations Dee.

Co

317787 tn?1473362051
by Dee1956, Jan 22, 2014

Hi Co, I wanted to come back and say that the first time I treated in 2008 I did not know anything about Insulin resistance.  After getting to UND by 7th or 8th week I finished tx and I relapsed within 4 weeks.

Then I came on here and started reading everything I could find.  I started tx in Sept 2011 and I watched everything, took my Metformin religiously, got to UND quickly and am now cured.  Thank you for all of your research.  It really helped me.  

Thank you

317787 tn?1473362051
by Dee1956, Jan 07, 2015
Hey there I wanted to come back to say that for every one person who posts there are hundreds who just read and the information helps them to get to UND. Who knows, if they tell a friend or two and so on and so on.....
So...I would say you have helped hundreds if not thousands of people.

Other forums have a counter that shows how many people replied how many people viewed, it is amazing all of the people who view but not post.

Thank you so much for everything you are doing.  Also please tell Mr NOD that his web site is so helpful to everyone, especially our Vietnam Veterans.

My best to you Co, Dee

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