A random insulin level does not really mean a lot - there are many factors that can influence your blood insulin levels - such as stress, fasting or not, other hormones, etc. It is best to look at your clinical presentation and decide, based on that what to do. Both Metformin and Pioglitazone works to improve insulin resistance. Another important aspect is, however, the question if you are exercising, as that has been proven to be also very successful in improving insulin resistance.
All medications have side-effects - for Seroquel weight gain is listed as a side-effect and thus if you gain weight you may also develop/increase insulin resistance. The best will be to discuss it with your doctor and see if you really still need the medication. One must weigh the risk vs benefits of your specific situation.
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