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June 10, 2000

Medications: Pills for Diabetes

Question from North Carolina, USA:

I am a 32 year old female. I was diagnosed with Type 1 diabetes when I was 18 after presenting with DKA. I am currently on a insulin pump with Humalog. My only long-term complications involve some autonomic neuropathy which cause gastroparesis, and an elevated heart rate. Over the last 2 years, I have had an increasing problem with insulin resistance. My doctors think that I have Polycystic Ovarian Syndrome (PCO). I was started on Rezulin and my insulin needs fell dramatically and I felt great. When Rezulin was pulled from the market, I was placed on Avandia, and I have not had a great response to this. In fact, I am again taking over 100 units of Insulin a day. Do you have any information on other women with diabetes and PCO who are taking oral medication in addition to Insulin? Do you have any information on treatment of insulin resistance in a woman with Type 1 diabetes?

Answer:

If you responded to Rezulin, but not Avandia, there is a third similar drug, Actos, that you might discuss with your doctor.

You didn’t mention if you were overweight when you were diagnosed or if you have become overweight on treatment. You also didn’t mention what criteria your doctor is using to diagnose polycystic ovary syndrome such as irregular periods, infertility, cysts on ultrasound, or excess body hair (hirsutism).

Many patients with polycystic ovary syndrome with normal blood sugars will have improvement of their PCO symptoms with using one of the newer oral hypoglycemic agents such as Rezulin (troglitazone), Avandia (rosiglitazone), Actos (pioglitazone), or another type of drug called Glucophage (metformin). The first three are similar in chemical structure and action. Metformin is different, but is also considered an “insulin sensitizer” — that is it helps counteract insulin resistance and maintain lower blood sugars with less insulin. Although not usually used in typical type 1 diabetics (and I assume you are sure you have Type 1 diabetes), it theoretically could be of use in addition to insulin if you have polycystic ovary syndrome or are overweight and have secondary insulin resistance.

TGL