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High insulin and elevated cortisol
Apr 26, 2004

Dear Dr.Moyle,

Can you please help me understand some test results?

Insulin is 34.6(normal is <17), C Peptides are 4.9 (normal from 0.8 to 3.1).

Serum cortisol is elevated at 9AM (25.6 versus normal range of 4 to 22mcg)...the cortisol went down to 3.9 by 4PM.

Are the above insulin and C peptide level high and could it explain why my waist size went from 32 inches to 38 inches as well as new truncal obesity? Any link to cortisol that would cause you to suspect or at least test for some specific diseases...or is this just HIV doing its wicked work?My doctor does not want to give me Metformin, nor a glucose challenge test. Could all of this explain symptoms of weakness in legs, numbness in feet, hands and face periodically, occasional burning skin in feet and legs, difficulty breathing,sore throat and skin rashes (plus skid marks on the tongue that come and go all the time)?

What tests would you do based on the above results and could the insulin, C Peptide and cortisol results suggest any diseases as well as explain some of the above symptoms? My VL is 1,200 and my CD4 is 990 (treatment naive).

Many thanks.

Response from Dr. Moyle

The elevations in insulin and c-peptide (assuming this was a fasted sample) would explain tha body changes. Insulin resistance is a common partner of truncal and visceral (inside the abdomen) fat accumulations. Metformin could be considered without a glucose tolerance test and has been shown to help insulin resistance aand fat accumulations. However, the firts line of therapy is diet and exercise. See a dietitian and work on losing some weight...that may be enough to normalise the insulin levels and delay/prevent the onset of diabetes in the future.

The cortisol elevation is no substantial and is unlikely to be contributor to your problems.

Kind regards

Graeme Moyle


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