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July 1, 1999

Family Planning

Question from California, USA:

I am 33 with type 2 diabetes, and I have had really long (3 or more months) menstrual cycles for many years now. I have started reading an on-line support group for Polycystic Ovarian Syndrome (PCOS). They say that studies conducted within the last 2 years have shown that PCOS is caused by insulin resistance. Many of the people in the group have said that their endocrinologists have recommended metformin (Glucophage) [a pill for Type 2 diabetes] and a low carbohydrate (approximately 60 gm per day) diet to keep their insulin levels lower to control their PCOS, and resume normal menses. I have been taking metformin to control my diabetes, and my cycles have gotten a bit shorter (every 2 months). I know I have insulin resistance because I have type 2 diabetes. Plus, I have acanthosis nigricans, which I read can be related to insulin resistance. Do you think I should try controlling my carbs more to see if that will help me get more regular? I am going to talk to my doctor about this at my next appointment, but that is not for months. I am attempting to conceive, so a regular cycle will be very helpful. I have excellent glycemic control.

Answer:

Yours sound like a very complicated case. Another medication that helps with insulin resistance is Rezulin (troglitazone), but here is the problem: you should be careful to not conceive while on Metformin or Rezulin. If you could get your glucose into perfect control and reduce your insulin resistance and PCOS so you can start ovulating and then switch to insulin, then get pregnant, you should be fine! But the bottom line is, you will need to be on insulin during the pregnancy, even if it takes a bunch of insulin! You will definitely need a specialist diabetes team to advise you.

VV