
Nursey's Corner
Help for Hep C Patients |
Silvia Hinojosa-Price, RN,
corresponds with Dr. Zobair
Younossi, M.D., M.P.H. Director, Center for Liver Diseases,
Medical Director, Liver Transplant Program, with questions
related to insulin resistance in advanced liver disease, as well
as lower response to antiviral therapy.
Dr.
Younossi,
I have
several questions related to the subject of insulin resistance.
Based on the information about insulin resistance lowering SVR,
I would like to know how many of you test for insulin resistance
and use insulin sensitizers even though the patient may not be
diagnosed as a diabetic yet--just insulin resistant. If so,
what are you using, and have you seen any toxic effects from
glitazones?
Since the HCV damages the mitochondria by a process of oxidative
stress and the same may be true for insulin resistance, are you
recommending anti-oxidants and if so, what amount?
Since aerobic exercise helps produce more mitochondria and a
high- protein diet boosts the benefit of exercise, possibly
decreasing insulin resistance, are you recommending compensated
patients do this and if so, how much protein?
As a diabetes educator, I find the subject of insulin resistance
fascinating. Thank you for your input.
Sources:
Insulin resistance impairs sustained response rate to
peginterferon plus ribavirin in chronic hepatitis C patients.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15765399&query_hl=1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15765399&query_hl=1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14976002&dopt=Citation
Is oxidative stress the pathogenic mechanism underlying insulin
resistance, diabetes, and cardiovascular disease? The common
soil hypothesis revisited.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14976002&dopt=Citation
Liver steatosis is an independent risk factor for treatment
failure in patients with chronic hepatitis C.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15674091&dopt=Citation
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15674091&dopt=Citation
Protein-rich diet boosts benefit of exercise.
http://www.eurekalert.org/pub_releases/2005-08/epr_pdb082505.php
RESPONSES TO DATE
(9/15/05):
The issue of metabolic syndrome in patients infected with HCV is
quite interesting.
It seems that HCV patients with components of metabolic syndrome
(diabetes mellitus, central obesity, insulin resistance) can
have more advanced liver disease as well as lower response to
antiviral therapy. The exact mechanism of this
interaction is not well known but could involve insulin
resistance (IR), adipokines (adiponectin, leptin), cytokines,
and associated oxidative stress.
Despite this interesting data, I don't routinely
check HCV patients for IR. However, assessing IR in patients
with nonalcoholic disease (NAFLD), a fasting serum glucose and
serum insulin can provide an easy method to calculate HOMA (HOMA
>2.2=IR).
Although theoretically
it makes sense to use medications/ strategies to improve IR and
oxidative stress, there are currently no
convincing data that these treatment strategies (including
amount of protein intake) improve outcomes in patients with HCV.
However, for overweight HCV
patients, I do recommend gradual weight loss. .....
Zobair Younossi, MD, MPH
Director, Center for Liver Diseases
Medical Direcor, Liver Transplant Program
Inova Fairfax Hospital
Co-Director, Center for the Study of Genomics in Liver Diseases
Affiliate Professor of Biomedical Sciences
George Mason University
Fairfax, Virginia .
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Take the test to access
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(*Note: this link will take you to Insulite Systems
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Insulite Systems. The information contained on Insulite Systems website,
is for the sole purpose of being informative. This information is not
and should not be used or relied upon as medical advice. Always seek the
advice of your physician, nurse or other qualified health care provider
before you undergo any treatment, take any medication, supplements or
other nutritional support, or for answers to any questions you may have
regarding a medical condition.)
MUST READ!
Insulin resistance is a cause of
steatosis and fibrosis progression in chronic hepatitis C
...insulin
resistance is the cause rather than the consequence of steatosis
and fibrosis in genotype 1 patients...
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