Lab Diagnosis of insulin Resistance

 

Quick Revision on  Insulin resistance &  Metabolic syndrome

Q.1: What % of PCOS are the effects of IR(insulin Resitance) ? Insulin resistance (IR) is the cause of up to 35% of PCOS.

Q.2:’How do we differentiate it (such phenotype) from conventional?

Ans: This hyperinsulinaemia- induced- PCOS is differentiated from “classic” PCOS by A) elevated insulin levels, B) a normal LH-to-FSH ratio and C) failure to respond to clomiphene until insulin levels return to normal.

 

 Q 3: What is the most common cause’s of CC resistance in India? Therefore all clinicians should seriously consider possibility of insulin resistance  etilogy of in PCOS infertile   women who are cc resistance. In such cases primary therapy will be Metformin or other OAD. The first line of treatment for women with borderline and mild IR should be weight loss. Metformin 500-1,000 mg twice a day with meals is indicated for anovulatory women who continue to have elevated insulin levels after weight loss. Addition of CC is often necessary for ovulation.

 

What is Met syndrome?  Or Syndrome X?

Q.4: Hyperinsulinemia, if left untreated, leads to What ? Ans: hypertension, an increased risk of cardiovascular disease and gestational diabetes. Insulin resistance is considered to be one component of a condition formerly called syndrome X and now labeled metabolic syndrome. In addition to insulin resistance and obesity, the metabolic syndrome requires there to be three or more of the following.

Hypertension 130/85 mmHg or higher

Triglyceride levels 150mg/dL or higher

HDL cholesterol levels less than 50mg/dL

Abdominal obesity: waist circumference greater than 35 inches (89 cm)

Fasting glucose 110mg/dL or higher.

What are the Lab findings of IR?

 

Q.5:   What are the Lab parameters of Insulin resistance ? Ans: Laboratory findings in IR are: fasting insulin levels greater than 20 μU/mL and a fasting glucose-to-insulin ratio less than 4.5

 Due to wide variability among different ethnic groups, the 2-hour glucose/insulin response to a 75 g glucose load is considered more reliable. A 2-hour insulin level of 100-150 μU/mL indicates probable IR; 150-300 μU/mL is diagnostic of IR; and above 300 μU/mL indicates severe IR. 

 

Q.7: What is the common method of estimating insulin resistance in day to day clinical Practice? Ans: 2-hour glucose of 140-199mg/dL indicates impaired glucose tolerance. 2-hour glucose above 200 mg/dL indicates non-insulin-dependent diabetes (type II diabetes). Patients with IR should not be labeled as type II diabetes unless, in addition to elevated insulin, the 2-hour glucose is also elevated.