Insulin Resistance at the

Perimenopause

• Dr.A.Jaishree Gajaraj
FRCOG.,FRCS. MD.,DGO
Apollo and Fortis Malar Hospitals
MANGAI Women,s Health Exclusive-
I R - Perimenopause
Definition
• Reduced glucose response to a given
amount of Insulin
• Resistance to glucose uptake is sometimes
referred to as SYNDROME X
• Metabolic syndrome – central obesity,IR ,
Dyslipidaemia ( Inc risk CVD )
Insulin – the way it should work
• Food we eat
• Fats Proteins CHO
• Proteins Micronutrients Glucose
• Glucose --- blood stream to cells
• Insulin signals the cells to absorb gl from
the blood stream
• A healthy body is insulin sensitive
Today’s Diet
• Simple CHOs ( sugars that quickly enter the
blood stream )
• High levels of Insulin released
• Gradual decrease in response of cells to
insulin - hyperinsulinaemia
• INSULIN RESISTANCE
• IR 3
 INSULIN AND LEPTIN
Food Intake
Energy
Expenditure

Fat Cells Pancreas

Hypothalamus(NPY and
Leptin others)
Sympathetic nervous
system

Insulin

The Physiologic feedback loop for energy expenditure and food intake.
 INSULIN AND LEPTIN

Eating

Fat Cells Pancreas

↑Leptin ↓NPY and / or

↑Melanocartin
↑Insulin

The effect of eating on the physiologic feedback loop.

 INSULIN AND LEPTIN

Fasting

Fat Cells Pancreas

↓Leptin
↑NPY

↓Insulin

The effect of fasting on the physiologic feedback loop.

• Increased circulating blood glucose
• Increased circulating Insulin levels
• Decrease in available intracellular glucose
• Liver – gluconeogenesis

• Weight gain / inc body fat

Pre to Post menopause – the transition

• Increased central ( intra abd ) body fat

• Shift towards more atherogenic lipid profile
• Inc LDL, TGL, Red HDL
• Inc glucose & insulin levels
• Above due to – Oestrogen def
- consequence of central obesity
Changes assoctd with ageing

• IAF increases > Total fat

• Loss of lean body mass – Sarcopaenia
• IAF responsible for IR
• resistance to Leptin
• Evaluation of IR
• Risk factors – Genetic
- Known PCO
- Obesity / Inc BMI
- Pear shaped body / Inc WHR
- Perimenopause
- Smoking, Alcohol
- Dyslipidaemia / HT
Evaluation of IR

• Biochemical
FBS, FI
Lipid profile
Management
• Nutrition
• Exercise
• Lifestyle
• Counselling – mood changes
• Treatment of specific medical disorders
• HT, DM, Dyslipidaemia
• Hormone therapy
Principles of management
• Awareness – patient & physician
• Early recognition – protocols
Ht, Wt, BMI, WHR
• Explanation & counselling
• Lifestyle changes
• Should be part of Preventive health checks
• Dedicated Clinics
Nutrition & Diet
• Include Protein, complex CHO, Healthy fat,
non starchy fruits & vegetables
• This will balance insulin levels
• Less fat storage
• Better hormonal balance – cortisol, E, P
• Glycaemic Index – a measure for how
quickly insulin rises in response to the amt
of glucose entering the blood stream

• Low GI – high protein foods, complex

carbs, fibre
• High GI – simple carbs,
Dedicated Clinics
• Thorough evaluation
• Multidisciplinary setup
• Nutritionist/ Dietician
• Exercise guidance
• Pschychological counselling
• Longterm follow up
• Menopausal transition – hormonal
instability
• Endocrine changes – Dec in Inhibin B,AMH,Inc
FSH, Dec Estrogen
• Estrogen responsible for intracellular utilization of
glucose – Deficiency results in IR

• HRT with Estrogen will improve IR

• Addition of progestin may adversely affect lipid
profile
• pcos
A case of Acopia !!
• 46 yr old lady,para 1,came with anxious
husband and son in plus 2
• Irreg heavy bleeding, left her job
• BMI 30
• Tearful
• Clinical & biochemical eval – metabolic
syndrome
• Insulin Resistance
• Metabolic Syndrome
• Syndrome X
• Thank you