What is the choicest method of estimating insulin resistance useful for clinicians, How often IR should be evaluated in PCO women

  There have been debates about which method will be clinically superior to establish the diagnosis of insulin resistance?? HOMA index though very accurate is not a very comfortable  method  and it is  also expensive  and time consuming for this   reason the need for a simple way of measuring   insulin resistance   has led to the creation  of a large  number   of insulin sensitivity  indices.  The most    used model is the HOMA  index.    

Q.1. Then , what is the best acceptable method of assessing  Insulin resistance in day to day clinical practice ?? Anms:  A) OGTT is most acceptable method till date which is useful in day to day practice. Other available methods are cumbersome and not feasible for clinical use though may be of help in research settings.  OGTT, is still  the most accurate    method to diagnose insulin   resistance. One has to ingest  75  g glucose challenge even   in adolescent  women. Normal values are the following a) Normoglycemia: fasting 70-100  mg/ dL

60 min after   glucose administration < 180  mg / dL

120 min after glucose administration < 140 mg/ dL

 b) Impaired  glucose   tolerance is defined  when glucose level is > 140  mg/ dL 2 hour  after glucose load   but < 200 mg /dL  .

  c) Diabetes   is defined   when glycemia  is > 200 mg/ dL   2 h after   glucose  load

 Q. 2: What is the normal insulin level in healthy women & men??  Ans:-What do we mean by normo insulinaemiac?? Ans:- normoinsulinemia : implies when a)  Fasting  insulin is  < 10 mUI /mL b) 60 min after glucose administration  < 60 mUI/mL c) 120 min after  glucose   administration , =  10 mUI/mL .Of course   the majority  of PCOS   patients   are not diabetic yet but only insulin resistant .

 Q.3:-How to define then insulin resitance based on serum insulin level?? Ans:-Insulin resistance is defined when insulin value   one h after OGTT is > 60 mUI/ mL  and / or   its level   is not very   close   to the fasting   insulin  value   after 2 h   post glucose administration.

Q. 4:  In a diagnosed case of PCO how often one should perform PPBS then ?? It has  been suggested  that an OGTT    be performed   every   2 years   for those  with normal   glucose tolerance and annually if IFG  or IGT    is present . Glucose screening recommendation for PCOS  women are  summarized  .

 Q.5: What about HOMA index??  Ans- The homeostatic model for assessment   of insulin resistance    is a simple and noninvasive   method of estimating    insulin   sensitivity from the steady glucose   and insulin concentrations measured under fasting  conditions