HOMA Index :L Measuring serum insulin -How?

 

Rationality of insulin testing before initiating Metformin: - Metformin in usually prescribed with Lab documentation of insulin Resistance. Forprescription of Metformin  there is no necessity to assess the insulin. One should keep in mind that lean PCOS too can exhibit insulin resistance, and measuring insulin after oral glucose load is not synonymous with assessing IR (insulin resistance).

 

HOMA index is most accurate   method for diagnosing IR but costly, hazardous and understandably used only in research settings and not in day to day clinical practice.

In clinical practice OGTT (preferably 3 hrs after 100 Gm Glucose   load) is a better marker for glycaemic status of the PCOS girl /woman. This test (OGTT) is familiar to us and we are used to this test rather than jumping to insulin test which probably leads us nowhere.

Uncommon drugs used in PCOS women:-Sadly, metabolic blood tests are rarely contemplated in PCOS girls in contrast to endocrine evaluation. Metformin however is occasionally used in PCOS women as an adjunct in cases of ART to prevent OHSS. Similarly the role of adding statins (in case of PCOS induced dyslipidaema) and drugs for preventing inflammatory damage of vascular endothelium including anti-oxidants are debatable. Some rarely  co prescribe Metformin or other insulin sensitizers (like Myo-inositol, DCI, Chromium, Magnesium, Vit D –all are insulin sensitizers –but act by diff pathways .

How useful is serum tests of insulin?? Limitations of insulin tests:-Moreover like TT4 levels, there are great inter Lab variations in insulin reports too.   Therefore most fertility specialists and endocrinologists do not routinely advocate insulin testing and nether co prescribe Metformin or other insulin sensitizers (like Myo-inositol, DCI, Chromium, Magnesium, Vit D –all are insulin sensitizers –but act by diff pathways in carbohydrate metabolism).

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Is the proverb insulin is co-gonadotropin right?  The fact remains that excessive serum insulinà insulin augments the action of LH on theca cells to synthesize ovarian androgens. Therefore some biologist suggests that insulin should be regarded as “Reproductive hormone” rather than hormone for metabolism it has been documented that serine kinase inhibitors corrects the key defect i e phosphorylatin defect.

 

Should we perform fast insulin?? Most endocrinologists recommend PP Insulin (2 hours after oral glucose load) & PP Sugar, if at all done and not FBS and fasting insulin as we were used earlier.