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INSULININSULIN

SENSITIZERSSENSITIZERS

DR.SUJATHA. T. L

ASSISTANT PROFESSER

S.A.T.HOSPITAL

TRIVANDRUM

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MetforminMetformin

Decreases Hepatic Gluconeogensis

Increases Peripheral Tissue Sensitivity Decreases Intestinal Absorption Increases SHBG Decreases LH Decreases Appetite and Obesity

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MetforminMetformin

o Direct Action on Pancreatic Beta

cells

NO HYPOGLYCEMIA

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MetforminMetformin

Side effects

Gastro intenstinal disturbancesLactic acidosis in renal dysfunction

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Selection CriteriaSelection Criteria

Typical PCOS-Obese, Hirsute, Oligomenorrhoeic

Family h/o Diabetes

Fasting Glucose/Insulin Ratio

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Treatment ProtocolsTreatment Protocols

Metformin alone

Combination with- Clomiphene Citrate

- Ovarian Follicular Puncture- Gonadotropins

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ThiazolidinedionesThiazolidinediones

Enhance cellular Insulin Action

Peroxisome Proliferator Activated Receptor

Troglitazone-Hepatotoxicity

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D-chiro-inositolD-chiro-inositol

PhosphoglycanPost-receptor Insulin actionIncrease Intracellular glucose disposalDose-1200mg/day for 6-8 weeks

Hyponidd-epicatechinMonotherapy or combinationDose-Two tablets B.D before meals

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Results of TreatmentResults of Treatment

PregnancyRate

Pregnancyloss

Pregnancy>10 wks

Regimewith ISA

51.48% 14.65% 43.93%

Regimewithout ISA

49.60% 34.40% 32.54%

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THANK YOUTHANK YOU

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