Insulin Gemfibrozil

A 76-year-old woman with type 2 diabetes taking gemfibrozil for pronounced hypertriglyceridemia had recurrent episodes of hypoglycemia her insulin requirements fell by 65 % and her HbAic concentration fell from 9 to 6.5% over 5 months (7). 

A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia developed myalgias, nausea, and vomiting, which began 4 days after he started working as a jackhammer operator (52). His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which had previously been respectively mildly raised and normal, were markedly raised, consistent with rhabdomyolysis with acute renal insufficiency. 

Based upon these data, it seems reasonable to conclude that insulin resistance/compensatory hyperinsulinemia is highly likely to be present in apparently healthy individuals displaying the atherogenic lipoprotein profile characteristic of the IRS, and such persons will benefit from treatment with gemfibrozil. 

TABLE 5.7 Effect of gemfibrozil and itraconazole on the pharmacokinetics of two insulin secretogogues."... 

A 54-year-old diabetic man taking 150 micrograms of levothyroxine daily for Hashimoto s thyroiditis, and a number of other drugs (gemfibrozil, elofibrate, propranolol, diltiazem, quinidine, aspirin, dipyridamole, insulin) started taking lovastatin 20 mg daily. Weakness and muscle aches (with a normal creatinine phosphokinase) developed within 2 to 3 days and over a 27-day period he lost 10% of his body weight. His serum levothyroxine levels rose liom 11.3 to 27.2 micrograms/dL. The author of... 

Among patients with hyperinsulinemia, the benefit of gemfibrozil therapy increased as the severity of insulin resistance rose (145). Of considerable importance is the fact that VA-HIT was the first trial to show a reduction in cardiovascular and cerebrovascular events with an antilipedmic medication independent of changes in serum LDL. Most of the benefit of fibrate therapy in this trial was attributed to HDL elevation and the pleiotropic effects of gemfibrozil (145). 

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