How is insulin resistance managed?

From the Guidelines

Insulin resistance is best managed through a combination of lifestyle modifications, including regular physical activity of at least 150 minutes of moderate exercise weekly, and weight loss of 5-10% of body weight for overweight individuals, as recommended by the most recent guidelines 1.

Lifestyle Modifications

• Regular physical activity: aim for at least 150 minutes of moderate exercise weekly, with daily exercise or no more than 2 days between exercise sessions to decrease insulin resistance 1
• Weight loss: 5-10% of body weight for overweight individuals, through a combination of diet and exercise 1
• Healthy diet: low in refined carbohydrates and high in fiber, with consideration of glycemic indexing to classify carbohydrate-containing foods 1

Medications

• Metformin: typically the first-line medication, usually started at 500mg once or twice daily and potentially increased to 1000mg twice daily as tolerated
• Other medications: thiazolidinediones like pioglitazone (15-45mg daily), GLP-1 receptor agonists such as semaglutide or liraglutide, and SGLT-2 inhibitors like empagliflozin or dapagliflozin may be prescribed

Monitoring and Screening

• Regular monitoring of blood glucose levels and HbA1c (every 3-6 months) to assess the effectiveness of management and adjust treatment as needed
• Annual screening for complications, such as cardiovascular disease, nephropathy, and retinopathy, to prevent and manage long-term consequences of insulin resistance 1

From the FDA Drug Label

ACTOS (pioglitazone hydrochloride) is an oral antidiabetic agent that acts primarily by decreasing insulin resistance. ACTOS improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis. ACTOS improves glycemic control while reducing circulating insulin levels

Insulin Resistance Management:

• Pioglitazone (ACTOS) is used to manage type 2 diabetes mellitus by decreasing insulin resistance.
• It improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis.
• The management of antidiabetic therapy should be individualized, and the response to therapy should be evaluated using HbA1c 2.
• Patients should be treated with ACTOS for a period of time adequate to evaluate change in HbA1c (three months) unless glycemic control deteriorates 2.

From the Research

Management of Insulin Resistance

Insulin resistance can be managed through various approaches, including:

• Lifestyle modifications, such as diet and exercise, which can help improve insulin sensitivity 3, 4, 5
• Medications, such as metformin and thiazolidinediones, which can help counter insulin resistance and improve glycemic control 6, 7
• Nutritional interventions, such as increasing intake of minerals like magnesium, calcium, and potassium, and amino acids like L-carnitine and taurine, which may help improve insulin sensitivity 3, 5

Lifestyle Modifications

Lifestyle modifications play a critical role in managing insulin resistance, and include:

• Diet: a healthy diet that is low in sugar and saturated fats, and high in fiber and nutrients can help improve insulin sensitivity 3, 5
• Exercise: regular physical activity, such as walking or other aerobic exercises, can help improve insulin sensitivity and reduce the risk of developing type 2 diabetes 3, 4
• Stress management: stress can exacerbate insulin resistance, and stress management techniques like yoga or meditation may help improve insulin sensitivity 3

Medications

Medications like metformin and thiazolidinediones can help manage insulin resistance by:

• Improving insulin sensitivity: metformin and thiazolidinediones can help improve insulin sensitivity, reducing the amount of glucose in the blood 6, 7
• Reducing glucose production: metformin can help reduce glucose production in the liver, while thiazolidinediones can help increase glucose uptake in the muscles 7
• Reducing cardiovascular risk: metformin and thiazolidinediones may also help reduce the risk of cardiovascular disease, which is often associated with insulin resistance 6, 7

Nutritional Interventions

Nutritional interventions may also play a role in managing insulin resistance, and include:

• Increasing intake of minerals like magnesium, calcium, and potassium, which may help improve insulin sensitivity 3, 5
• Increasing intake of amino acids like L-carnitine and taurine, which may help improve insulin sensitivity 3
• Increasing intake of other nutrients like glutathione, coenzyme Q10, and lipoic acid, which may help improve insulin sensitivity 3