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May 7, 2007


Question from Orlando, Florida, USA:

I am 39 years old. When I was a child, I was always experiencing low blood sugars. When I was 20, I had a six hour GTT and was told that I had hypoglycemia. Nothing was done. With my second child, I was told that I had gestational diabetes and it was controlled through diet. After the birth, I felt increasingly sick and two years later, I was diagnosed with hyperinsulinism. That was a year ago. I have lost 15 pounds and watch what I eat because I am still overweight. I lost all weight after both children, then immediately gained it back, lost again before I had my second child and now can't get the weight off. I am on thyroid medication because I have thyroiditis and adenomas. I am on metformin, 500 mg in the morning and 1000 mg at night and Actos, 15 mg at night. My insulin level was first tested at 63, then at three month intervals over the last year; it has subsequently tested at 70. From my understanding, there is not much more that can be done to bring my insulin level down. I have had my gall bladder removed in the last year and have had an MRCP (magnetic resonance cholangiopancreatography) and subsequent other MRIs which have not shown any pancreatic problems. What else can be done to bring my insulin levels down? My grandmother had type 2 and my mom was also diagnosed with type 2 in January. I love my doctor and have no desire to replace her and have not found any other specific solutions to even talk with her about other than continually raising my medications. I can't take too much metformin because then I have severe diarrhea which interferes with my IBS. Everything regarding hyperinsulinism deals with children not adults, I also don't still usually have hypoglycemic problems even though my insulin levels are ridiculously high.


It is likely that you have an inherited form of insulin resistance that may potentially be improved by medications that improve insulin sensitivity. However, this is not always the case. Weight loss helps. You are always going to be more insulin resistant and at increased risk for developing diabetes. The other drug that has been tried for insulin resistance comes from the groups of medications known as thiazolidinedione drugs (rosiglitazone, pioglitazone). Keeping your activity up through regular exercise will also decrease insulin resistance. Even if you cannot normalize insulin levels, you may be able to keep them at a lower level.