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  • Insulin

    So, I've been on the Lp(a) foundation patient portal facebook page and many are saying we should have our insulin levels checked. Well, I did the Oral Glucose Tolerance Test, isn't that good enough? Is that a different test altogether? And can you be normal in insulin and not in glucose? What would warrant an insulin test? Thanks.

  • #2
    Robin:

    Good question.

    There is good and bad information on the Lp(a) Foundation website. Sandra looks at Lp(a) as a condition that can only be treated with drugs. She ignores niacin, diet and lifestyle.

    Both insufficient or excess insulin are dangerous states to have. Insufficient insulin production will allow blood glucose to remain high for too long of period of time. That is typical of T1 diabetics. Too high of insulin (hyperinsulinemia) levels typically indicates a state where a person is insulin resistant so the pancreas continues to secrete higher and higher levels of insulin to get the glucose out of circulation and into our tissues. That is typical of T2 diabetes.

    That is the long way of saying that people should have both their insulin and glucose levels checked. Fasting insulin, fasting glucose and HbA1c miss a lot of people who are insulin resistant or diabetic. Even as good as an OGTT is, it misses a lot of people with extended postprandial glucose rise time. I am one of them. I have normal fasting blood glucose, normal fasting insulin and a normal HbA1c, but I am diabetic according to the Kraft test.

    The most telling test to have is the Kraft Insulin Survey done. It looks at both glucose and insulin at the same time under dynamic conditions. Amy can order the test for you and you do it at home.

    Here are a couple of videos to help you.

    https://www.youtube.com/watch?v=ZBvzghDKzBU

    https://www.youtube.com/watch?v=RKzShbfyssU

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    • #3
      We usually test for insulin as part of our routine evals. Give us a call if you have any questions

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      • #4
        Amy did let me know I was tested in my initial blood draw at the same time as the OGTT. She said my insulin level was 2.9 - so I guess that is good enough and I just have the glucose problem on it's own. Yesterday after a very low carb and small lunch my libre went to 132 and basically stayed in that range for hours. I was shocked. This means insulin resistance. Now today, after eating it is hovering around 110 max. And I ate literally the exact same thing. Such a mystery.

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        • #5
          There is no question that our blood glucose response is a mystery. The Libre provides more than 10 times the information that glucometers provide. Yes, it brings a lot of answers. But it generates a lot of questions we never knew to ask. Many of us are discovering reactions we never knew we had. Couple that with the “train effect” -and maybe even a few reliability questions, and you get a lot to think about. And yes, I agree with your label of what you described, “that’s insulin resistance “. It sounds like you may have an insulin delay problem as well, at least at this point in time. Keep in mind we can get significant variation from one day to another.

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          • Robin
            Robin commented
            Editing a comment
            Today for instance I got up and my libre said 79 -- I had a hard boiled egg and water and went on a 4 mile walk with my dog. It climbed to 100 then dropped to 90 half hour later. Then I ate an Rxbar (5 ingredients) recommended by Amy as a quick grab to eat...low carb, dates, eggs whites, cashews and cocoa. It went to 130 in 20 min. then climbed to 157! 10min later to 145 and still sitting at 144. Baffling. (I also have two dips into the 50s at night like you John.) I'm currently at day 10 of 500mg x 2 a day of metformin. I don't think it works for me at this dosage?

        • #6
          My Libre is pretty consistent and didn’t notice any discrepancies in a fasting state. I really like the 24/7 continuous curve and the convenience. I still have a recurring pattern of hypoglycemia at certain times of the day and night and probably always will. I've tried pushing dinner time back from 5:30 to 6:00 PM to 7:00 PM but I still have the nocturnal hypoglycemic pattern.

          I did find on the Abbott Libre-Australia website that the postprandial lag time between BG and ISF glucose is normally only 5-10 minutes, either on the increase or decrease. That holds true for me most of the time. There are other times where my postprandial lag time has been close to 1-hour according to my Freestyle Lite that I compare the Libre to. I speculate that delayed lag may be due to increased dietary fats in some meals slowing the absorption carbohydrates along, with the effects of Metformin. Here is what Abbott has to say:

          “Interstitial fluid-based glucose readings are a reliable indicator of blood glucose levels
          • The physiological lag in ISF glucose, with respect to changes in blood glucose, is about 5-10 minutes
          • The average lag time of the FreeStyle Libre system is approximately 5 minutes, which is unlikely to impact routine day-to-day treatment decisions"

          They don’t show this information on the US website for some unknown reason. https://www.freestylelibre.com.au/page/faqs/

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          • Robin
            Robin commented
            Editing a comment
            John, I haven't even checked my blood glucose much in the past week, just using the libre....see my above reply to Dr. Brewer.

        • #7
          Another question.....since my insulin is low (2.9) why it is that doctors say that type 2 diabetes is simply an overflow phenomenon that occurs when there is too much glucose in the entire body....and in response to too much glucose in the blood the body secretes even more insulin to overcome this resistance...this forces more glucose into the overflowing cells to keep blood levels normal...this works but the effect is only temporary because it has not addressed the problem of excess sugar: it has only moved the excess from the blood to the cells, making insulin resistance worse. At some point, even with more insulin, the body cannot force any more glucose into the cells. This is all from Dr Jason Fung's book, The Diabetes Code -- So if this is true, my insulin should be very high and it's not. Which confuses me.

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          • #8
            I would suggest checking insulin levels using a glucometer rather than going to the lab. They are convenient and easy to use. At some point, even with more insulin, the body cannot force any more glucose into the cells. This is all from Dr Jason Fung's book, The Diabetes Code -- So if this is true, my insulin should be very high and it's not. Which confuses me.

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            • #9
              Unfortunately you can't check insulin at home using a glucometer. It takes specialized lab equipment to measure insulin. Hopefully somebody will invent a way to do this as a home test as it would be very useful.
              As to why you can have normal insulin levels and still have problems with disposing of large amounts of glucose, I think that there is a difference between our underlying glucose metabolism and our current/recent lifestyle typically as measured by fasting blood glucose or A1C levels.
              As we age, I get the feeling that eventually our pancreas and glucose metabolism become inherently less able to deal with relatively large amounts of glucose. In addition the mitochondria in our cells start to become less efficient, and that in itself causes insulin resistance. There is a permanent amount of insulin resistance that we cannot diet, exercise or fast away. I can't point to a study, and I don't know if any researchers even care to try to study this aspect of aging, but it sure seems a likely reason. I thought that a five day fast would fundamentally re-set my insulin resistance to a degree. Multiple 3-5 day fasts did not. I could have low insulin afterwards, but the underlying glucose metabolism always reset to the same insulin resistance. Perhaps a younger person could experience a significant enough lowering in their insulin resistance given the same fasting scenario, but with age epigenetic changes and wear-and-tear on the body parts just make it less likely.
              We have to deal with that growing insulin resistance as best we can using diet and exercise.
              Last edited by Tom; 05-01-2019, 11:33 PM.

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              • #10
                So what is only option? Metformin ?

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                • #11
                  I think that metformin in combination with a healthy diet and exercise give us the best outcome. I know of people who started on metformin without changing their lifestyle, blew threw whatever positive effects it could have and eventually went on to become insulin-injecting diabetics.
                  Last edited by Tom; 05-02-2019, 07:23 AM.

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                  • #12
                    Yeah I'm trying to avoid it only because it drops my glucose too much.

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                    • #13
                      What about TRF = Time restricted feeding?

                      https://onlinelibrary.wiley.com/doi/...1002/oby.22449

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                      • #14
                        I have been doing that literally my whole life.

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