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[IP] Re: Insulin Resistance = Predictor of Nephropathy

I'm sorry about bringing this up again (last time I did no one was 
interested...), but I'm wondering if this article is a reason to try to take 
the least amount of insulin that I can.  It claims that the insulin 
resistance is the problem, but nothing in this article makes me think that 
the researchers really teased out resistance vs. daily dose.  Of course, I 
am going to continue keeping my tdd to a minimum, I guess I'm just wondering 
if anyone knows anything about the effects of too much insulin (I mean, if 
you're resistant, not lows) on a body over time or if anyone has any 
thoughts on this subject.

My related Q is how do you know how much insulin a healthy person your size, 
age, etc would make?  Last time I was told, what ever it takes.  True 
enough.  I certainly wouldn't compromise my blood sugars to take less 
insulin, BUT I can have extraordinarily good numbers while doing 18 units a 
day, or I eat fun things and do as much as 50 units in a day (and usually 
not get quite as good numbers).


>Medscape Medical News
>Insulin Resistance Best Predictor of Diabetic Nephropathy
>Laurie Barclay, MD
>Sept. 3, 2002 - Insulin resistance is most predictive of diabetic
>nephropathy in the long-term, according to the results of a 10-year
>prospective study published in the September issue of Kidney
>International. Blood pressure and lipids were only predictive of
>nephropathy in the short-term. Type 1 diabetics without insulin
>resistance therefore appear to have a low risk of kidney disease, and
>the secret to preventing nephropathy appears to be through lifestyle
>changes that can help prevent insulin resistance.
>"Kidney disease is a major lethal complication for people with diabetes,
>particularly those with type 1 diabetes, and until now there has been no
>clear explanation for its cause beyond blood sugar itself," lead author
>Trevor Orchard, MBBCh, MMedSci, from the University of Pittsburgh
>Graduate School of Public Health in Pennsylvania, says in a news
>release. "We now suspect that reducing or preventing insulin resistance,
>possibly through exercise, weight loss and drugs, may help people with
>type 1 diabetes avoid nephropathy."
>Of 658 adults with type 1 diabetes enrolled in the Pittsburgh
>Epidemiology of Diabetes Complication Study, 485 did not have
>nephropathy at baseline. To measure insulin resistance, the
>investigators used a novel calculation based on waist-to-hip ratio,
>hypertension status, and long-term blood glucose levels.
>"Although our measure of insulin resistance is an estimate based on
>easier-to-measure factors, it is strongly correlated with the gold
>standard - euglycemic clamp studies - and clearly stands out as the
>leading predictor of kidney disease in this study," Orchard says.
>Over 10 years of follow-up, 56 of the 485 subjects developed
>nephropathy. Risk of developing nephropathy was strongly linked to
>insulin resistance throughout follow-up (P<.0001), but blood pressure,
>blood lipid profile, elevated low-density lipoprotein cholesterol,
>triglycerides, and white blood cell count only predicted nephropathy
>during the first five years of follow-up. Three genetic markers linked
>to blood pressure and blood lipids also increased risk of nephropathy,
>with odds ratios for each marker ranging from 2.9 to 7.1.
>"The good news is that not all people with type 1 diabetes are insulin
>resistant, and for them the risk of kidney disease now appears to be
>low," Orchard says. "Even for someone with type 1 diabetes who is
>genetically predisposed to insulin resistance, the secret to avoiding
>nephropathy may well be to prevent insulin resistance through lifestyle
>changes such as proper diet, exercise, smoking cessation and perhaps
>medication. Another intriguing finding from this study is that since
>insulin resistance also predicts heart disease, it may explain the
>longstanding observation that in type 1 diabetes, kidney disease
>predicts heart disease. In other words, insulin resistance may be the
>'common ground' for both complications."
>Kidney Int. 2002;62(3):963-970

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