What are symptoms of insulin resistance?

[griffinannie]

Does TRT affect it? Can you have normal blood glucose and insulin resistance?

[marianco]

Originally Posted by griffinannie

Does TRT affect it? Can you have normal blood glucose and insulin resistance?

Symptoms of Insulin Resistance depends on the cause. There are many causes.

Hypogonadism and hypothyroidism may result in insulin resistance, for example. The symptoms would then be related to those conditions.

Common signs include darkening of the skin, skin tags, obesity and increased abdominal fat, hypertension, high triglycerides, and high fasting blood glucose levels (though not to the point of being officially diabetes).

Testosterone replacement may help reduce insulin resistance. In some people, however, high levels of testosterone may instead increase insulin resistance.

A person can have normal blood glucose and insulin resistance if they have both insulin resistance and adrenal fatigue (which lowers blood sugar).

[griffinannie]

Thanks Marianco. Could erectile dysfunction come into play also? How is insulin resistance tested in the face of normal glucose?

[marianco]

Originally Posted by griffinannie

Thanks Marianco. Could erectile dysfunction come into play also? How is insulin resistance tested in the face of normal glucose?

Insulin resistance itself may cause testosterone deficiency.
Nerve signal conduction is impaired with Insulin resistance.

Erectile dysfunction may occur with insulin resistance.

Erectile dysfunction is very common in diabetics - with one reason being nerve damage/neuropathy for diabetes.

Possibly useful tests include:
A postprandial (after meal) glucose and insulin level.
Finger-stick glucose 1 hour after meals, which is over 150 is suspicious for insulin resistance.
A 3-hour glucose tolerance test measuring both glucose and insulin levels - is a standard test for insulin resistance.
A triglyceride to HDL cholesterol ratio over 3.5 is one clue.

[griffinannie]

Marianco Thank you. One more question in the face of ed from nerve damage/ neuropathy what can be done to try to reverse?

[marianco]

Originally Posted by griffinannie

Marianco Thank you. One more question in the face of ed from nerve damage/ neuropathy what can be done to try to reverse?

That is a difficult condition to reverse.

Current thoughts on the matter:

It is of primary important to address insulin resistance by what means necessary (oral, insulin, diet, exercise, etc.) to prevent further damage.

It is important to optimize thyroid hormone, testosterone, and adrenal hormone function (cortisol, DHEA, progesterone) to help reduce inflammation and improve nerve cell function.

Sometimes Alpha Lipoic Acid, Acetyl-L-Carnitine, B6, and Vitamin E may help - but again it would be clinical trial with no promise of improvement given the difficulty faced.

[infoseeker]

Marianco: This thread is very intersting - may I chime in with a question or two?

My husband is not fitting the profile listed above exactly:

Excellent low triglycerides (81)
PLA result quite low (45?)
Normal blood pressure (112/75)
total cholesterol low enough (145)
HDL barely off (38)
LDL in ideal range (91) BUT fractionated LDL slowing slightly elevated particle number (1150), therefore his aggressive lipidologist has just put him on Tricor.

Metformin XR (1500 mg) is barely budging his weight (230, 6'1") and barely nudging the blood glucose (typically 110-115 fasting AM and 170 at highest postprandial, many times lower) down despite the best a person can do in the way of diet, exercise, as acknowledged by the doctor and as testified by me, the observer. (A1C 6.1)

Because of total testosterone at an even 200 (he's 45), Androgel 10mg. per day has been prescribed but not obtained yet due to funding problems; he's scrambling to obtain it, though.

1. Is this (Androgel)safe enough re: cancer risk? (by the way, digital prostate exam revealed no hypertrophy whatsoever.) I just literally watched my mother die from cancer so understandably I have no stomach for risk

2. Another doctor friend we unofficially consulted said Androgel won't hurt but he recommends letting the Metformin do its job (normalizing testosterone amongst other thigns) and re-check T in December and supplement at that point if necessary - any thoughts?

3. Could it be that the Androgel might be the potentiator to make this metformin do its job (lower glucose closer to normal levels) and get the weight off? I testify that he's doing everything right and the weight just sits there

4. Is ED and lack of libido in this case most likely due only to very low T and hopefully not to nerve damage or blood vessel damage? I'm under the impression that the pretty-good bloodwork shows no evidence of vessel blockage.

5. Cialis doens't do a whole lot (works some, but in my view doesn't improve the inconsistent and definitely not "lost" but definitely not "normal" erectile function) which leads me to believe the problem is not local (blood vessel) but rather all based in the low T, which Cialis obviously doesn't do a danged thing for. The dr. we consulted unofficially has said: "But please for now he needs to avoid any Viagra and related product, they do not work on increasing the testosterone level but just
bringing more blood to the area, and with vascular issues it can be dangerous."

I've aked for clarification on that but none yet - I believe it has something to do with the diabetes/pre-diabetes (there's already been very limited nerve damage to a toe, but it seems to be reversible or at least not perceptible - feeling returning to feet was first thing noted upon bringing A1C down.) We were under the impression that PDE-5 inhibitors are safe and in fact benefiicial in the "use it or lose it" sense. Any comments, Marianco, since this is obviously clear as mud to me? THANKS.

[marianco]

Originally Posted by infoseeker

Marianco: This thread is very intersting - may I chime in with a question or two?

My husband is not fitting the profile listed above exactly:

Excellent low triglycerides (81)
PLA result quite low (45?)
Normal blood pressure (112/75)
total cholesterol low enough (145)
HDL barely off (38)
LDL in ideal range (91) BUT fractionated LDL slowing slightly elevated particle number (1150), therefore his aggressive lipidologist has just put him on Tricor.

Metformin XR (1500 mg) is barely budging his weight (230, 6'1") and barely nudging the blood glucose (typically 110-115 fasting AM and 170 at highest postprandial, many times lower) down despite the best a person can do in the way of diet, exercise, as acknowledged by the doctor and as testified by me, the observer. (A1C 6.1)

Because of total testosterone at an even 200 (he's 45), Androgel 10mg. per day has been prescribed but not obtained yet due to funding problems; he's scrambling to obtain it, though.

1. Is this (Androgel)safe enough re: cancer risk? (by the way, digital prostate exam revealed no hypertrophy whatsoever.) I just literally watched my mother die from cancer so understandably I have no stomach for risk

2. Another doctor friend we unofficially consulted said Androgel won't hurt but he recommends letting the Metformin do its job (normalizing testosterone amongst other thigns) and re-check T in December and supplement at that point if necessary - any thoughts?

3. Could it be that the Androgel might be the potentiator to make this metformin do its job (lower glucose closer to normal levels) and get the weight off? I testify that he's doing everything right and the weight just sits there

4. Is ED and lack of libido in this case most likely due only to very low T and hopefully not to nerve damage or blood vessel damage? I'm under the impression that the pretty-good bloodwork shows no evidence of vessel blockage.

5. Cialis doens't do a whole lot (works some, but in my view doesn't improve the inconsistent and definitely not "lost" but definitely not "normal" erectile function) which leads me to believe the problem is not local (blood vessel) but rather all based in the low T, which Cialis obviously doesn't do a danged thing for. The dr. we consulted unofficially has said: "But please for now he needs to avoid any Viagra and related product, they do not work on increasing the testosterone level but just
bringing more blood to the area, and with vascular issues it can be dangerous."

I've aked for clarification on that but none yet - I believe it has something to do with the diabetes/pre-diabetes (there's already been very limited nerve damage to a toe, but it seems to be reversible or at least not perceptible - feeling returning to feet was first thing noted upon bringing A1C down.) We were under the impression that PDE-5 inhibitors are safe and in fact benefiicial in the "use it or lose it" sense. Any comments, Marianco, since this is obviously clear as mud to me? THANKS.

1. A systolic blood pressure of less than 118 could be regarded as low. Adrenal fatigue/suboptimal adrenal function is one cause of low blood pressure. Adrenal fatigue can lead to a lack of libido and erectile dysfunction, besides a lack of energy. Lack of energy can be counteracted by increased sympathetic nervous system activity, which can increase one's stress and anxiety.

2. A total cholesterol below 140 could be considered low. I don't advocate treatment excessively low cholesterol since neurologic and endocrine system problems may result. The brain, for example, has a very high choleterol content. Reducing cholesterol excessively may impair brain function. Reproductive and adrenal cortex hormones are made from cholesterol - these would be impaired in production by too low a cholesterol.

3. Weight loss from Metformin occurs when it impairs the absorption of carbohydrates from the intestines. This is essentially a forced diet - which is not very pleasant for many people, given diarrhea as a resulting problem.

4. Weight loss is difficult if metabolism is slow. The two systems that control metabolism are the the thyroids and the adrenals. It is useful to assess both when contemplating weight loss. It is difficult with hypothyroidism and adrenal fatigue to lose weight. The signals to essentially burn fat are lost.

5. Androgel is very expensive. 10 grams a day runs about $450/month. If cost is an issue, Testosterone cypionate or enanthate injections are much less expensive. Compounded higher strength testosterone gels or creams are also less expensive.

6. When blood sugar is barely reduced with Metformin or other oral diabetes medication, diet, and exercise, then multiple factors are in play to cause insulin resistance - including low thyroid hormone activity, low testosterone, low DHEA (which occurs with adrenal fatigue), etc. It is useful to examine these other factors. Addressing them may better help reduce blood sugar. Remember that Metformin and other oral diabetes medications are essentially bandages to the underlying problems which may be be causing insulin resistance, which still remain unaddressed, just as antihypertensive medications are bandages, not direct treatments to the actual causes of hypertension.

7. A blood sugar over 175 is toxic to pancreatic beta cells - which produce insulin. Prolonged blood sugars over 175 can essentially convert a type-2 diabetic to a type-1 insulin-dependent diabetic.

8. A testosterone level less than 300 ng/dl at age 45 may be difficult to optimize on Metformin alone since multiple factors reducing the testosterone may be in play, including age-related reductions in testosterone production, hypothyroidism, etc.

9. Optimizing thyroid hormone function can reduce insulin resistance and improve testosterone production.

10. Testosterone optimization can improve libido and erectile dysfunction. An important component of sexual function is having enough energy. For this, having optimum thyroid hormone activity and adrenal function is highly important. Too often, many patients on TRT still have sexual dysfunction despite having high testosterone levels. The answer is that there are other problems besides testosterone that need to be searched for and addressed.

11. Excessively high testosterone levels may result in insulin resistance - the opposite of what is desired, unless all the other hormones are also optimized. For example, high testosterone levels can lead to high DHT levels, which then promotes an increase in abdominal fat, which then increases the risk not only of high estrogen production but also functional hypothyroidism (from increased thyroid binding globulin) and insulin resistance.

12. Cialis does not work when there is no drive or energy for sex. Drive in men is increased by testosterone increasing dopamine levels in the brain. Energy is supplied by the thyroid glands and adrenals. Other neurotransmitter/hormone/cytokine problems can also affect sex drive. For example, high or low estradiol levels can cause a loss of sex drive.

13. Testosterone, from the data, does not cause prostate cancer. A theory about prostate cancer is that prostate cancer cells start showing around the age of 25 y.o. in all men. The immune system, however is strong enough, when young to kill the cells. As the immune system worsens with age, it cannot keep up with the growth of cancer cells and prostate cancer develops. Estrogen can promote prostate cancer when not balanced by testosterone. High testosterone levels in young men may be protective from prostate cancer. The risk of prostate cancer can be higher in men with low testosterone.

14. When prostate cancer exists, growth promoting hormones such as estrogens, testosterone, growth hormone and insulin can accelerate the cancer's growth. It is important then to monitor for prostate cancer then withdraw testosterone replacement when signs occur.

15. When a person is insulin resistant, the high insulin levels that result may be the greatest factor in promoting prostate and other cancers.

16. Optimizing thyroid hormone activity is one way to promote reduction in the risk of cancer and improve cardiovascular function - through its ability to reduce insulin resistance and reduce inflammatory processes in the body and improving immune system function.

17. Inflammation is what promotes atherosclerotic changes in blood vessels. Medications such as Lipitor, which reduce cholesterol, may have their most important effect by acting as anti-inflammatory agents rather than by reducing cholesterol.

[DAVID]

great post- but can you explain when you mean adrenal fatigue and slow metabolism.
IF you take hydrocortisone for "adrenal fatigue" , do you known if your metabolism is much higher ?

[marianco]

Originally Posted by DAVID

great post- but can you explain when you mean adrenal fatigue and slow metabolism.
IF you take hydrocortisone for "adrenal fatigue" , do you known if your metabolism is much higher ?

Please read the adrenal thread.

Some call the condition "adrenal fatigue" as "cortisol deficiency". It results in a lack of energy, difficulty in utilizing fatty acids to create more glucose to use as an energy source for the brain, muscle, and rest of the body.

It is more than a cortisol deficiency, however, since there usually results a deficiency in the adrenal productions of other hormones such as aldosterone, DHEA, progesterone, testosterone (and estrogen, particularly in women).

Cortisol is probably the most important hormone produced in the body. It is particularly important in coping with stress. Without it, one may die in less than a day.