Insulin Sensitizes -An overview

The problem & Solution: Why at all subfertility problem arises in PCO women which is mainly  due to insulin resistance ? Ans:-Polycystic ovary syndrome (PCOS) affects 5%-10% of women in reproductive age, and it is the most common cause of infertility due to ovarian dysfunction and menstrual irregularity. Hyperinsulinemia causes somehow or other induces dysfunction of ovarian response to endogenous gonadotropins. For last three decades researchers have shown that if insulin sensitizers are administered this abnormal response of gonadotrophins at ovary is corrected to a great extent. This degree of normalization of abnormal response of ovaries is rectified by Insulin sensitizers alone and no other exogenous agent  (like  CC/Letrozole or  Gonadotrophins)  are warranted in many cases.

Doctor, “Can I have other options except metformin. It(Met)  causes s much fkatulence-diarrhoea!!! What is  Myo-inositol??

Can , I repeat Can , Myo-inositol (MYO) have positive role in “noninsulin-related mechanisms of action “-- that allow achieving benefits in those patients with negative HOMA-index in addition to HOA Index positive cases??  Many studies since 1980 reported that insulin resistance is common in PCOS women, regardless of the body mass index. The importance of insulin resistance in PCOS is also suggested by the fact that insulin-sensitizing compounds have been proposed as putative treatments to solve the hyperinsulinemia-induced dysfunction of ovarian response to endogenous gonadotropins. MI or DCI either given alone or in combination rescue the ovarian response to endogenous gonadotropins ijn PCO women & reduces hyperandrogenemia and re-establishes menstrual cyclicity and ovulation, increasing the chance of a spontaneous pregnancy. Among the insulin-sensitizing compounds, there is myo-inositol (MYO). Myoinositol acts as a second messenger in insulin signaling pathway Literature data suggest inositol deficiency in insulin-resistant women with the polycystic ovary syndrome. Supplementation of myo-inositol decreases insulin resistance as it works as an insulin sensitizing agent. The positive role of myo-inositol in the treatment of polycystic ovary syndrome has been of increased evidence recently

PMID:

24505965

[PubMed - indexed for MEDLINE] N-acetyl cystei;)N-acetyl cysteine (NAC)

N-acetyl-cysteine (NAC) is a stable derivative of the sulfur-containing amino acid cysteine and an antioxidant that is needed for the production of glutathione, one of the body's most important natural antioxidants and detoxifiers. While cysteine is found in high protein foods, n-acetyl cysteine is not. A large body of evidence supports the use of NAC in women with PCOS.

·         Improving Insulin Sensitivity
Women with PCOS frequently have an abnormally high insulin response to sugars and refined starches. A 2002 study evaluated the effect of NAC on insulin secretion and peripheral insulin resistance in women with PCOS The study subjects who had an exaggerated insulin response to a glucose challenge and were treated with NAC showed an improvement in insulin function in their peripheral tissues. The NAC treatment also produced a significant decline in testosterone levels and in free androgen index values. The researchers concluded, "NAC may be a new treatment for the improvement of circulating insulin levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome." .

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What is MI?? Ans:-Myo-inositol is a stereoisomer of DCI. Like DCI, it is a key factor in insulin signaling, and serves also as a precursor to DCI in endogenous inositol metabolism. It should then come as no surprise that studies using myo-inositol in women with PCOS produced results as promising as those obtained with DCI.

Drug treatment in PCO other than Metformin & Ovulatory agents :: Go as you like :Option 1:- MI alone :-Where is the evidence that women receiving MI(Myo-inositol) fared better when compared to the placebo group, in terms of regularization of ovulation &  correcting PCO induced metabolic abnormal profiles. Therefore MI can be given after childbirth to PCO women for persistence decreases in testosterone, triglycerides, and blood pressure; a significant improvement in insulin sensitivity. This is in addition to greatly increased frequency of ovulation (Constantine 2009).

Go as you like :Option 2: Drug treatment in PCO other than Metformin & Ovulatory agents -Be bold like a Lion: prescribe 4 Gm MI per day à achieve not only ovulation but also guaranteed wt loss, If no desired result  you can hang me at TIHAR !!!!! :-  One may administer  2 grams of myo-inositol plus 200 mcg folic acid daily in anovulatory PCO . After 12 weeks, such women taking myo-inositol & FA showed improved insulin sensitivity and androgen levels. Strikingly, all the subjects receiving myo-inositol returned to normal menstrual cycles (Genazzani 2008).

Purchase one Saree get another Saree free!!!! Associated benefits with 2 Gm OD MI therapy?? Ans:- Not only regularization of Mens but combination of MI & F acid also showed  almost 50% significant weight loss and reduced leptin levels after receiving myo-inositol plus folic acid 4 g myo-inositol plus 400 mcg folic acid).

Weight loss by MI therapy: Purchase one Saree get another Saree free!!!!  Yes , it is possible not a gossip:  After a 14-wk treatment, the myo-inositol plus folic acid group lost weight, whereas the placebo group gained weight (Gerli 2007).

Purchase one Saree get another Saree free!!!! Decrees of abnormal hair growth in women If no benefit then catch hold of  Dr  S K Pal and take him o TIHAR  JAIL for------ —Yes it is possible by MI at the dose 4 gm OD –six months ,If no benefit then cut the throat of Dr  S K Pal :  : Yes , it is possible not a gossip For reduction of hirsutism (better termed as abnormal hair growth in women) –A

 six-month therapy with high dose of MI 4 gm daily in PCOS women will almost certainly yield  satisfactory results in addition to previously mentioned  decreases in testosterone and insulin levels, Myo-inositol administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.” (Zacchè 2009). Go as you like .  Option 4:  Offer MI & NAC :-May prescribe MI,& NAC:-à Yes, you can use Myo inositol and N-acetylcysteine (NAC) combination  have been recently shown to be effective in treatment of PCOS patients.  The efficacy of NAC + Inositol + folic acid on ovulation rate and menstrual regularity in PCOS patients with and without insulin resistance has been evaluated by couple of workers. In both groups there was a significant increase in ovulation rate and no significant differences were found in the primary outcome between two groups. In group A, a significant reduction of HOMA-index was observed.