Interesting Study on Insulin Resistance

[MYS]

J Hepatol. 2009 Apr;50(4):712-718.

Insulin resistance predicts response to peginterferon-alpha/ribavirin combination therapy in chronic hepatitis C patients.

Dai CY, Huang JF, Hsieh MY, Hou NJ, Lin ZY, Chen SC, Hsieh MY, Wang LY, Chang WY, Chuang WL, Yu ML.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung 807, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational and Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

BACKGROUND/AIMS: Insulin resistance (IR) might be associated with hepatitis C virus (HCV) infection. This study aimed to elucidate impact of IR and beta-cell function on the response to peginterferon-alpha (PEG-IFN)/ribavirin combination therapy in chronic hepatitis C (CHC) patients.

METHODS: Three hundred and thirty patients without overt diabetes were treated with combination therapy with (PEG-IFN)/ribavirin for 24 weeks. The IR and beta-cell function were evaluated by homeostasis model assessment of IR (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-beta) before treatment.

RESULTS: HCV genotype, pretreatment HCV RNA level and pretreatment HOMA-IR, but not HOMA-beta, were independent factors associated with sustained virologic response (SVR). In 150 patients with genotype 1b infection, pretreatment HCV RNA level, HOMA-IR and age were independent predictors for SVR. The significantly lower SVR rate in high HOMA-IR patients was observed in 76 patients with high HCV RNA levels (400,000IU/mL) who were defined as 'difficult-to-treat' patients. The mean HOMA-IR of 'difficult-to-treat' patients was significantly lower in 42 sustained responders than in 34 non-responders.

CONCLUSIONS: IR was associated with SVR to (PEG-IFN)/ribavirin therapy for CHC, especially among 'difficult-to-treat' patients. These findings suggested clinical application of pretreatment HOMA-IR could enable treatment outcome to be predicted and treatment regimens to be determined.

[Trinity4]

I know Co can read this and HR.  What the heck is that supposed to mean?  That was a rather cynical.

[GreatBird]

I just checked out the South Beach Diet Phase 1 and that's as close to the high-protein, low carb diet that worked for me as I've ever seen.

The thing is that both diabetics and hypoglycemics have to eat about the same even though the way their bodies handle the insulin is different.

In fact, it's a really healthy diet for anyone. (I just wouldn't touch the artificial sweeteners myself.)

[portann]

Five months is not a very long time to expect big changes based on your lifestyle improvements. I hope you recognize your excellent achievements and exercise patience for at least another year or two. Like being on HCV tx, you have to take it a day at a time and eventually, miraculously, you arrive at your goal. It takes time to reap the rewards, the road can be rough but the prize is worth it. Like tx.

Most of the people I know on the forum are slim, including me, so weight loss is not a priority. In fact, many of us are trying to put on weight. You have a difficult challenge but you can do it, a day at a time. Never give up hope.

That said, I also see a liver biopsy as a priority. How else can you make an informed treatment plan whether to wait, without such a critical piece of information?

[bajawoman]

I felt very comfortable in HR's hands with my Fibroscan and he had all my charts I am meeting with a nutritionist here next week to see what we can do to get the weight off but as we all know our own bodies  I would have thought I would have lost more weight

yes I agree without a complete record of all my tests so far it is hard to tell  I prefer not to get a bx at this point  CAT scan show no abnormalities at all and was different than the ultra sound in the respect showed no gall stones nor fatty liver
Higado sin alteraciones actuales
sin esteatosis ni abscesos
ni actividad neoplasica primaria ni mts
vesicula biliar, bazo, pancreas normales
sin evidencia de adenomegalias retropertoneales
sin ascitis ni colecciones adbominales
grandes vasos normales
rinones normales

bases pleuropulmonares si engrosamientos ni derrames pleurales, sin  datos de reflujo gastroesofagico, a nivel abdominal, espacios retrocrurales sin adenomegalias, ni plastrones ni evidencia de tumoraciones, estomago y duodeno sin alteraciones, bazo sin  megalias, higado, de forma, tamano, situacion, contorrios normales, sin evidencia de tumoraciounes soidas ni quisticas, ni abscesos, ni lesiones de caracteristicas metastasicas, sin datos de infiltracion grasa hepatica, con densidad de 64 UH, sin dilationcion de las vias biliares intra ni extrahepaticas, sistema venoso suprahepatico sin alteraciounes.  VESICULA bilar piriforme sin septos,ne vegetaciones,ni calcificaciones intralumianles, sin edema de pared, ni colecciones peridcolecisticas, mide 65x24 mm. retroperitoneo sin ademomegalias ni plastrones actuales. pancreas de forma, tamano, situacion, contornos y densidad normal, sin tumoraciones solidas ni quistacas, ni calificaciones ni pseudoquistes mide a nivel de acbeza 24 mm. cuerpoo y cola de 25 ateromas parciales de pared, sin evidencia de compresion de la via billar extrahepatica, espacios de Morrison, gastrohepatico, esplenomenal y correderas paretocolicas sin colecciones ni aspecto normal, rinones de forma, tamano, situacion, contornos y densidad normal, sin tumoraciones solidas ni quisticas, sistemos pielocalicial sin litos ni ectasias ni hidronetrosis, RD mide 105 x 50 x 56 mm. RI mide 105 x 48 x 51 mm. grasa mesenterica y asas intestinales sin alteraciones.

Tras la adminmistracion del medio de contraste se obeserva perfusion hpatica, esplenica y renal normales, sin neformaciones vasculares.

I know Co can read this and HR which I plan to send it to I have a cd of the CAT scan
From what I read you would think I am a health person
except for the HCV  IR  RA  and Depression   lol

[GreatBird]

Check the ingredients in your beef jerky. It's almost always cured with sugar.

[GreatBird]

When I was about twenty, I was diagnosed with hypoglycemia (something they don't seem to talk about anymore) and put on a *very* strict high-protein, low carbohydrate diet.

I'm wondering if you are low carb/low sugar enough? You said you eat oatmeal? I was allowed 1/2 cup. I got 1/2 a piece of fruit in an entire day and my carb portion per meal would be the equivalent of 1/2 a piece of bread.

I was supposed to have six meals a day (breakfast, snack, lunch, snack, dinner, snack) and they all had 2 or more ounces of protein in them, some fat, and a small amount of carb.

Are peanuts fat or carb? Technically they are legumes. Maybe you would do better snacking on cashews or almonds?

That diet they gave me eased up slightly after four weeks, (so that I got a whole slice of bread at lunch, for instance), but it was still very strict and there were certain foods I was supposed to stay away from completely: corn, potatoes, and the easy burning starches. They even differentiated between low sugar and high sugar veggies (like onions, carrots, artichokes were high sugar and to be eaten in very limited quantity). Absolutely NO refined sugar.

If CoWriter reads this, can you tell me why I am not IR but my blood sugar still does a  crash at hour four? I had a four hour GT test done over a year ago and my numbers were:

Fasting 84
1 hour 119 (that was after drinking that gawdawful stuff)
2 hour 83
3 hour 76
4 hour 53

Which indicates I'm still hypoglycemic.

The fasting insulin was 7.8 so my HOMA is okay at 1.6.

Anyway, sorry if I've rambled on and slightly hi-jacked the thread, but I'm very curious about this.

BTW--I just cranked up the protein back up in my diet and I'm noticing that I'm feeling much better overall. (I had slacked off during the weeks I felt nauseous because carbs were gentler on my tummy.)