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Insulin and Insulin Resistance
By Sam Thatcher, MD, Ph.D.

Sam Thatcher, MD, Ph.D.Q. I have PCOS and my insulin level is 11. Is that enough of a resistance to be able to take metformin?

A. A fasting insulin level of 11 is not considered elevated by most. While some use 10 as a cut off level, many, many individuals have levels this high and are otherwise normal. Most who are overweight will have levels over 10. Almost all experts consider a level of over 20 as abnormal. I personally use 14, but there is no hard fast rule.

When the fasting insulin level is elevated, that is called hyperinsulinemia. Hyperinsulinemia is a marker of insulin resistance, but it is not the same as insulin resistance. There are a variety of tests that are used to measure insulin resistance. One test is the insulin level obtained during a glucose tolerance test.

Also, what is insulin resistance anyway? Insulin resistance can be thought of as deafness. The best way to explain insulin resistance is the at the organs that use insulin grow increasing hard of hearing, in order to compensate and keep the lines of communication open the pancreas, where insulin is made, starts to speaks loud and louder. Insulin resistance is deafness not to sound but to the action of glucose and insulin.

Now, when to be treated. This is a very controversial topic. Insulin resistance is clearly linked to increased risk of developing of type 2 diabetes. Insulin resistance is also clearly related to abnormal ovarian function and increased levels of androgens. However insulin resistance is not a disease as such. Some advocate a trial of insulin altering drugs in almost all those who do not ovulate. Others reserve therapy for those that have clearly been shown to be insulin resistant. Pregnancies have been reported after use of insulin altering drugs, such as metformin, when the insulin levels are completely normal. This is a decision that is best made in cooperation with an individual physician well versed in PCOS and insulin altering drugs.

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