PCOS and insulin sensitivity.....anyone?

[mandypumpkin]

I went to the Dr. today for a checkup. He's an endocrinologist that I have been seeing for about 13 years. When I was 15, I was diagnosed with Polycycstic Ovarian Syndrom (PCOS). It actually has another name, but I can't remember what it is. Anyway, when I was 15, he put me on birth control to regulate my cycles, to help with acne, and to prevent excess hair from growing. AUGH! It worked wonders. Because I have this syndrome, I produce a little more testosterone naturally than other females, so that helps with putting muscle on. Yesterday, I weighed in at a whopping 156 and we talked about how that was 20 lbs. higher than my visit 2 years ago. This may also have something to do with the fact that I started taking Paxil, an antidepresant drug that works miracles! I told him that I am excercising and eating much better, but it doesn't seem to work for loosing weight. I was told that since I have this syndrome, my body is basically in a pre-diabetic stage that could either develop in to diabetes or not. If my weight doesn't go back down, then my chances of becoming diabetic rise. This syndrome makes my body either insulin sensitive or resistant...I'll have to research it to figure that part out. (By the way, this is something that I inherited. Many women have it and don't even know it. )
Even when my body is thin, my insulin sensitivity is worse than an obese person without PCOS. This makes it very hard for my body to lose weight. So, what I am wondering is what you guys think about that info. I will research PCOS some more and fill you in on the insulin part. If anyone else has had experience with this, please help me out!
I posted this in my journal, but decided to post out here to see if anyone knew anything about PCOS and insulin sensitivity.
One solution may be to get off the paxil and see what my weight does. I just don't know if I'm ready to try that. I don't get suicidal or anything like that, I just get really emotional about my weight. If I'm losing, then I'm usually fine. If I'm not, then I am a basketcase. Anyway, I've written too much.
Thanks in advance....

 

[bandaidwoman]

With your PCOS you are in a contstant state of hyperinsulinemia.....insulin, being anabolic, you will always have difficulty losing weight. You are actually in a state of insulin resistance most of the time. I have women who, though they do not have diabetes, their problems get alot better with glucophage or metformin, now approved for treatment of this disorder. (Women with PCOS usually have difficulty conceiving and glucophage does also help regain their fertility by reversing this relative insulin resistance and they become pregnant.)

You are smart to be eating right and excercising. You may want to ask you doc about a similar substitute to paxil which does not have the weight gaining effects such as lexapro, effexor or celexa.

 

[mandypumpkin]

wow! You seem to know a lot about this topic. Are you a dr? I just looked at your occupation (geek! ) and saw that you are an associate prof.

 

[bandaidwoman]

Your endocrinologist is rightfully worried as 40% of those with PCOS will have type 2 diabetes or impaired glucose tolerance by the time they reach 40 years of age.

To clarify your question regarding insulin resistance....when I mean resistance, your pancreas secretes more insulin than a non diabetic or non PCO but the body's peripheral tissues (mostly muscle) does not use it efficiently.

Thus, you are secreting more insulin at any one time but the body may not be using it efficiently and thus you are prone to low blood sugar and increased hunger and all sorts of nasty side effects associated with high levels of insulin:

Some of this includes high cholesterol (usually high triglycerides and low good cholesterol, HDL) , high insulin levels cause the body to store fat and increases male hormone production from the ovaries by stimulating an ovarian enzyme complex cytochrome P450c17, either directly and/or by stimulating pituitary luteinising hormone secretion.

Insulin resistance in type 2 diabetes and polycystic ovary syndrome occurs mainly in muscles, but also in the liver in obese women with polycystic ovary syndrome. Insulin resistance is made worse by physical inactivity, upper abdominal obesity, pregnancy, the ageing process and by medications such as thiazide diuretics, corticosteroids and certain hormonal steroid preparations.

However, insulin resistance in polycystic ovary syndrome is not due primarily to obesity (as lean women with polycystic ovary syndrome are insulin resistant).


That's why PCOS responds to medicines that work on insulin resistance such as metformin ( and they are now studying the triglitazones such as avandia and actos) since they bring down the overall insulin levels and reverses the bad effects on the abnormal hair development, high cholesterol, weight gain, irregular periods etc.

 

[mandypumpkin]

Thanks sooooo much!! You have been very helpful.