Mar 04, 2009
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
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"
And decreasing insulin resistance increases SVR!!!
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%
What DECREASES INSULIN RESISTANCE??????
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.