Insulin Resistance: Treatment, Cost and Side Effects

Insulin is a hormone secreted by a set of cells called beta cells in the pancreas. Insulin helps in absorption of sugar by other cells of the body to get energy. Insulin resistance is a condition wherein the cells are not able to absorb blood sugar, thereby increasing blood sugar level. High blood sugar level triggers the beta cells in the pancreas to produce more insulin which in turn contributes to a high insulin level in the blood stream. This eventually leads to latent autoimmune diabetes in adults and type 2 diabetes. If the blood glucose level in your body is not as high as in type 2 diabetes but is higher than normal, then the condition is considered to be prediabetes. Risk factors for insulin resistance are obesity and overweight, physical inactivity or a sedentary life, old age or more than 45 years, giving weight to an obese baby, having gestational diabetes during pregnancy, having cardiovascular disease and having polycystic ovary syndrome in girls. The medical conditions associated with insulin resistance are fatty liver, acanthosis nigerians, arteriosclerosis, issue in reproductive health and skin tags. Treatment for insulin resistance mainly involves changes in lifestyle and can sometimes require medication. The first and foremost treatment to fight insulin resistance is physical exercise to lose weight and maintain a proper metabolism. Some medications that help control the condition are thiazolidinediones and metformin. Another medication used in the treatment of insulin resistance is acarbose (Precose).

The medications used for the treatment or reversing insulin resistance are metformin (Glucophage), acarbose (Precose) and thiazolidinediones like rosiglitazone (Avandia) and pioglitazone (Actos). Medication with metformin has been found quite effective as it works in two mechanisms. Metformin resists the liver cells to release glucose into the bloodstream and it also increases the sensitivity of the muscle and fat cells to glucose in the blood. The fat and muscle cells absorb more glucose from the blood, thereby decreasing the blood glucose level. Metformin has been proved to decrease the chance of diabetes by 31 percent. The drug is mainly used for patients who are overweight and have been proved to promote reduction of weight. Acarbose has been found to act in the intestines wherein it slows down glucose uptake by the intestinal cells. This reduces the requirement of insulin thereby reducing the release of insulin by the beta cells of the liver. Acarbose has been found to reduce the change of development of diabetes by about 25 %. The use of thiazolidinediones drugs have also been found to act by increasing insulin sensitivity. A few other medications that have proved beneficial for treating severe insulin resistance are cyclophosphamide, prednisone and rituximab. Insulin resistance can also be treated by bariatric surgery like gastric bypass, gastric banding and sleeve gastrectomy. This has been the most effective treatment for obese patients who have not been able to reduce weight with other options like medication and exercise.

Person diagnosed with excess level of glucose in the blood that are also overweight, have family history of diabetes, sleep problems, regular smoking, and old age and due to some other drugs like use of steroids, are eligible for treatment.

People who are not diagnosed with increased insulin level in the blood are not eligible for the treatment.

Yes, the medications do cause side effects like nausea, vomiting, diarrhoea, bloating, gas and loss of appetite, sometimes infections in respiratory tract, weakness, very low blood glucose level, chills, heartburn and low vitamin B 12. Metformin also has a rare but very serious side effect called lactic acidosis. Lactic acidosis in turn causes abnormal heartbeats, breathing problems, discomfort in stomach, muscle ache and light-headedness. Acarbose medication can have side effects like unusual, bleeding, severe stomach ache, severe itching due to allergic reaction, watery and bloody diarrhoea etc. Thiazolidinediones (TZDs) cause side effcts like edema, macular edema, heart failure, weight gain and hypoglycaemia.

Along with the treatment for insulin resistance it is recommended to work out so that you lose weight, quit smoking, cut on carbohydrate and sugar intake and get sufficient sleep. After getting the bariatric surgery done, it is recommended to take diet low on carbohydrate and sugar and that rich in proteins to preserve the muscles in the body. Also it is important to have small meals, eat and drink slowly, chew the foods thoroughly before swallowing and take mineral and vitamin supplements as recommended.

It takes about 6 to 12 weeks to normalise insulin levels in blood.

It costs around Rs. 200 to Rs. 7 lakh including consultation, medication and bariatric surgery if required.

Yes the treatments are often quite effective and permanent. So, once treated for reversing insulin resistance and proper steps are taken to keep body weight under check and have appropriate food intake, the glucose and insulin level in the blood is maintained for whole life.

The alternatives for the treatment is changes in lifestyle like doing regular exercise and following a proper diet to lose weight and get rid of obesity.