I am sure you have heard the term “Insulin Resistant”, “Syndrome X”, Pre-diabetic”. Those are all terms used to describe a situation where your pancreas works extra hard to keep up with the demand placed on it to secrete insulin in response to the foods you are eating. The higher the carb content of the foods you are eating, the more insulin you need. Over time, your pancreas can become desensitized to this and struggle to keep up. That is what is happening if you are becoming Insulin Resistant or Pre-diabetic. Keep it up long enough and eventually the dreaded diagnose of Type II Diabetes can show up. Nobody wants that!
Unfortunately, many people are headed that way. I believe that knowing you are on that path is very empowering. You can jump in and make changes before a diagnosis is made. Most people know they are eating a diet that is not the best for their health. They have a few extra pounds are the middle (a spare tire) and they make off-handed comments like “I know I need to eat better”. Most people also know that they need less sugar and more veggies, healthy protein and heart healthy fats like avocados. The problem is that they don’t really have a way to analyze the situation and monitor the progress they are making in response to the lifestyle changes they are implementing. In other words, talk is cheap and usually gets us nowhere.
On the flip side, we can see that measuring a few numbers gives us a great lens through which to view the situation and monitor progress. These are simple lab tests that can be run. Often, however, they don’t get run because of insurance limitations and the focus on only looking at labs with a traditional rather than root cause or functional mentality. For example, if a fasting glucose is “normal” (which isn’t necessarily healthy!) no further evaluation is done. I see this all the time. Many times there is actually an issue that needs addressed and we are super thankful we ran the testing and have the opportunity to make some changes before the issue gets worse.
So, What do we look at:
1) Fasting Glucose. This is a simple one-time assessment of the amount of sugar in someone’s blood stream right at the time of testing. You can have this done at a lab, or use an at home finger-prick glucose meter. This is the test done most commonly. The “Reference range” for most labs is 65-99. However, the functional range is 70-86. That is where you want this to be. Values in the high 90’s repeatedly can signal an issue even though most people are told “Everything looks fine” because they are still technically in range. In my opinion, this is the least helpful marker since it’s just a snapshot.
2) Hemoglobin A1c with Estimated Average Glucose (EAG) – This is the measure of your average glucose over a 3 month period of time. This, in my opinion is Way more valuable than just a one-time value. Unfortunately, this is usually only done once the glucose is “out of range”. The Reference Range of this is 5.7-6.4 pre-diabetic and 6.5 being the cut-off for Type II Diabetes. When levels get to 7.0 and higher, the risks of developing complications of diabetes are higher. This means things like diabetic neuropathy, as well kidney and heart problems. (1) Obviously, we want to keep this in a healthy range. A healthy, or Functional range is 4.8 – 5.2. That is where I advise my clients to keep their levels. If they are elevated, we work toward naturally lowering them with a combination of diet and lifestyle changes and certain supplements, if needed.
3) Insulin. I run fasted Insulin levels on anyone I test for blood sugar handling issues or “Insulin Resistance”. This is a bit different from fasting glucose or A1c. Insulin is secreted by your pancreas in response to eating foods that elevate blood sugar. So, elevated levels of insulin indicate that your body is receiving the signal to secrete more insulin. Over time, as we discussed, this makes your body less sensitive to insulin. Elevated insulin signals the body to store fat and can cause inflammation. The testing of fasting insulin has research to suggest it is very helpful in evaluating the risk of developing diabetes (2). The “Reference Ranges” again are wildly over-inflated in my opinion. The “Refence Range for most labs is 2.6−24.9 μIU/mL. However, if you read the research, you will find that below 6 is really a healthy level. I suggest levels less than 6 for my clients because of the research I have done and my clinical experience.
Once we collect fasting insulin and fasting glucose, we can also calculate a HOMA-IR score, which stands for Insulin Resistance score. This is a handy little number that tells whether Insulin Resistance is an issue for you. It is backed by research and was created by Dr. David Matthews, an MD who has done extensive research on diabetes. You can use his calculator and read more about that here. I actually really like to calculate this with people because it really makes it objective. Instead of thinking “I may have an issue with my blood sugar and could be insulin resistant”, you can say “I have this score, which indicates that not Insulin resistant, am mildly insulin resistant or severely insulin resistant” (Whichever the case may be) Then, you can implement strategies and track your progress. If what you are doing works, you do more of it. If not, you do something different. It is very powerful!
If you track those lab values and find that you are Insulin Resistant, what should you do?
- You should start with your diet. Reducing sugar and carbohydrates is the #1 thing you can do. White flour and White Sugar are the 2 things to begin to eliminate. Focus on Healthy proteins (Grass fed, pastured and organic meat, eggs and dairy if you are consuming it. Add in large helpings of non-starchy veggies like broccoli, spinach, kale, cabbage, cucumbers, zucchini, onions, etc. and small amounts of fruits (about 2 servings per day max and focusing on berries which are lowest in sugar). Consume plenty of healthy fats in the form of fish, flax seeds, walnuts, avocados, coconut products and nuts.
- Up your exercise. Exercise helps the body utilize excess sugar, so get moving! Walk, ride your bike, go for a jog, lift weights. Do whatever you enjoy and will consistently commit to. At a minimum, 5 days per week of 30 minutes, but you can certainly do more!
- Consider supplements to help improve blood sugar handling. Two of my favorites are Berberine and Gymnema. I created a product called “Weight Loss Paks” that contains my favorites supplements to help optimize blood sugar levels and weight (which are very often connected!). You can learn more about those here
I hope you have found this article helpful. Blood sugar handling is a HUGE deal and many people are shocked when they find out that they are pre-diabetic or headed that way. I am always thankful when we catch that early enough to make a change.
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To your health,
Dr. Jeni
