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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Results of insulin resistance test you suggested
Feb 5, 2004

Dr. Moyle, When I wrote to you about my truncal obesity (have put on 30 pounds on my stomach and waist), you suggested an insulin resistance test/glucose tolerance and Hepatitis tests.

I did the insulin resistance test and my doctor told me today that I have very high insulin, very high C peptides and "reactive hypoglycosemia" (or a word to that effect!).

Does that explain my large stomach and waist? My doctor does not want to do anything to treat it...says we just keep an eye on it. He said the same thing when a blood smear showed "reactive lymphocytes" and he again said the same thing when a skin biopsy showed findings "suggestive of cutaneous lupus erythematosus." He also said we should just keep an eye on some abnormal liver enzymes (ALT and LDH)! Hep B and C VL tests were negative, though some enzymes are elevated.

I am not well at all and need action - is there a common strand you see to these various results and directions you think worth pursuing to nail down the causes of the above? Would you place me on Metform if I were your patient? Will my stomach and waist shrink if I do go on Metform?

Do you think a glucose tolerance test is now needed in light of the above?

I would be very grateful if you could take a few moments to evaluate the above and recommend a course of action. Could you also please advise whether the liver could be the source of all these problems?

My CD4 count is 1,000 and my VL usually undetectable. I am treatment naive. My CBC's are also quite good. But, with a wide range of nasty symptoms, I feel I am coming apart here and would like to do more than just watch and observe all these signs that my metabolism is not doing very well.

Many thanks.

Response from Dr. Moyle

Central fat gain, raised liver functions and insulin resistnce are common bedfellows. They are part of our epidemic of 'the metabolic syndrome' the product of excess calorie intake. The first step is to cut you food intake, stop alcohol and start exercising. If you lose 30 pounds this way most of it will go from you stomach and your liver functions may well improve. You may subsequently wish to seek advice form a hormone specialist, an endochrinologist. A growing minority of these guys think insulin resistance and hyperglycemia are a big step on the road to diabetes and heart disease so should be treated with insulin sensitising drugs like metformin.

I hope this gives some starting points Regards Graeme Moyle


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