Pioglitazone reduces insulin resistance and improves beta-cell function according to baseline insulin levels, observational study results show.

The thiazolidinediones are known to lower insulin levels by decreasing insulin resistance, but have also demonstrated efficacy in hypoinsulinemic people with Type 2 diabetes.

To explore this further, Eiji Kutoh (Gyoda General Hospital, Saitama, Japan) and co-workers investigated the insulin-dependent actions of pioglitazone in newly diagnosed, drug naïve people with Type 2 diabetes.

The 120 patients were divided into three groups based on baseline insulin levels, namely, low (less than 5.9 lU/ml), medium (6??”11.9 lU/ml), and high (above 12 lU/ml) and received pioglitazone 15??”30 mg/day for 3 months.

Laboratory measurements taken at baseline and 3 months included levels of insulin, C-peptide, glycated hemoglobin (HbA1c), Homeostasis Model Assessment (HOMA)-R, HOMA-B, and body mass index.

The results, reported in the journal Endocrine, revealed differences in laboratory measurements among the groups at baseline. HbA1c levels were inversely associated with insulin (or C-peptide) levels. The magnitude of both insulin resistance (HOMA-R) and beta-cell function (HOMA-B) was in proportion to insulin levels.

Pioglitazone treatment was associated with significant reductions in insulin (38.7%) and C-peptide (27.6%) in the high-insulin group, while in the low-insulin group significant increases in insulin (113.5%) and C-peptide (32.1%) were observed. No significant changes were observed in the medium-insulin group.

Despite these observations, HbA1c significantly decreased in all three groups, by 14.9% in the high-, 19.0% in the medium-, and 16.6% in the low-insulin groups.

Significant correlations between pioglitazone-associated changes in insulin/C-peptide levels and baseline insulin/C-peptide levels were observed.

In the high-insulin group, HOMA-R significantly decreased by 32.3% while HOMA-B slightly increased by 11.2%. In the low-insulin group, HOMA-R significantly decreased by 18.6% and HOMA-B significantly increased by 218.3%. In the medium-insulin group, HOMA-R significantly decreased by 26.7% and HOMA-B significantly increased by 100%.

“These results indicate that pioglitazone differentially exerts its effects on reducing insulin resistance and improving beta-cell function according to baseline insulin levels,” conclude the authors.

They recognize that further randomized, double-blind studies with large numbers of individuals will be required to conclude that pioglitazone is capable of restoring the first-phase insulin response, improving secretory responses to plasma glucose levels, and consequently preventing or delaying the development of Type 2 diabetes.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Do you know if you are having a “hypo” Do your family and friends know what is happening if you start to sound vague and confused So what is it Hypo is the abbreviated word given for hypoglycemia and it means your blood glucose has dropped to a low level.

As you know, with diabetes type 1 or type 2, you are constantly dealing with high blood sugar levels. In order to bring your levels to within a normal range, your health care provider may have prescribed insulin,or insulin-stimulating pills. But drugs and treatments are not always perfect, so if you:

• take too much of the medication
• eat too little
• exercise too hard and too long, or even start to exercise when your levels are just a little low
• drink alcohol and don’t add appropriate snacks
• are in a hot environment, eg. bath or sauna

your blood glucose can drop to a level, usually between 50-75 mg/dl (2.8-4 mmol/l) where symptoms of hypoglycemia develop.

Symptoms that develop when the level falls rapidly:

the sympathetic nervous system is stimulated to produce adrenalin, causing

• sweating
• whiteness, or skin pallor
• tremor
• rapid heartbeat, or tachycardia
• palpitations, or the feeling your heart is beating far too fast
• nervousness
• hunger sensation

Symptoms that develop when the level falls slowly:

there is a depression of the central nervous system, resulting in:

• a headache
• lightheadedness
• confusion
• emotional changes
• memory lapses
• numbness of the tongue and lips
• slurred speech
• drowsiness
• staggering gait
• convulsions
• coma

The combination of symptoms varies considerably in different people and in the same people at different times. You may lose your ability to think clearly when you become hypoglycemic and people may assume you are drunk.

What should you do:

• if you take insulin or a sulphonylurea medication, wear a bracelet or carry some form of identification with you that shows you have diabetes
• be familiar with the warning signs, share the information around with your family, friends and work colleagues. Make sure they know how to treat you: sugar cubes, glucose tablets, jelly beans, sugary soft drink, orange juice, anything that contains about 15 grams of sugar. You may need to add a slower-acting carbohydrate food (a sandwich or a piece of fruit),10-15 minutes later to keep your blood sugar level up
• don’t wait for your level to drop below 75 mg/dl (4 mmol/l) … treat yourself for hypoglycemia immediately.

Your symptoms should warn your that your blood sugar level is low. If you have type 2 diabetes and take insulin injections or take insulin-stimulating pills, always carry candy or glucose tablets with you for prompt relief.

Resveratrol and diabetes is still being tested but it is one of the early human studies that have been done so far with cancer studies to come soon.

Resveratrol is an antibiotic type compound produced by plants to help them fend off bacteria and fungus. Recently, it has garnered massive attention after it was connected to the so called French Paradox where it was stated that as a group they have less cardiac disease compared to Americans.

This connection was made because the compound is found in the skin of grapes and also in red wine. This happens because red wine is aged with the skin still on the grapes as opposed to white wine where the skin is removed.

In the human test of Resveratrol and Diabetes, it was reported that the results were impressive. These patients were said to have a significant reduction in their glucose and insulin levels and that this change took place without any change of diet or taking outside drugs.

Even though it is too early to explain how Resveratrol actually works, many of the lab tests done thus far have shown great promise.

Another potential positive for these supplements is that the compound appears to have some kind of impact on reducing weight gain. In some of the lab tests, animals that were given the same high fat diets did not gain as much weight if they were on Resveratrol.

It is well known that obesity can have a major impact on the development of diabetes so this finding could be a major help in the future.

Despite being very new, consumers are still eager to use these supplements and hopefully experience some of the reported benefits. At the moment, most pills are made from dried grape skins or from Japanese knotwood. There are many manufacturers that offer some variation of the capsules and they are readily available online.