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  • insulin and glucose

    What does it mean if, in a blood test, insulin is high but glucose levels are normal? Doesn't this mean that a person's cells might be resistant to insulin?

    I ask because I had an extremely frustrating doctor's appointment today where the doctor looked over my blood test results from a few years ago when I was diagnosed as PCOS and insulin resistant. She said that because my glucose levels are normal (and I don't have problems with blood pressure or triglycerides), I don't have insulin resistance--she also said that fasting insulin is meaningless as a test, and that it doesn't really tell us anything medically.

    I know that my glucose levels are normal, but I have no idea what my base insulin levels are like these days (although I'm sure that with primal they're a lot better than they used to be), because doctors don't seem to find it a valuable test to run on someone who previously had ridiculously high insulin levels.

    WTF?? Someone please explain this to me. Did I just go to an incredibly stupid doctor, who won't recommend any treatment other than "continue losing weight, and eat more fruits and vegetables" unless a patient's hyperinsulinemia progresses to type 2 diabetes??

  • #2
    Have they done a glucose tolerance test (drink a glucose solution, see how long it takes for BS to fall)? If both fasting glucose and glucose tolerance show good results I imagine you should be fine, since the problem with insulin resistance is that it results in chronically elevated BS. I don't really know what an insulin test would show independently of glucose, but this isn't something I've researched a lot, sorry.

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    • #3
      Did your doctor do a HbA1C and a fasting glucose test?

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      • #4
        My fasting glucose has ranged from 70-95. And HbA1C = 5.4 or so.

        They did a glucose tolerance test back then and 2hr post-prandial glucose reading was somewhere between 100-120. 114 I think.

        I thought it was bad to have a lot of insulin circulating because insulin --> fat storage and weight gain, especially in the abdominal area. I always thought of it as an intermediary step to diabetes mellitus.

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        • #5
          Not a doctor, so don't take my word as gospel. But those are good results for both fasting glucose and glucose tolerance, and HbA1C is also within the normal range. I've not heard of insulin resistance happening alongside healthy glucose metabolism, which you do have, so your insulin levels are probably normal. If you did have high insulin but no resistance your glucose would be low as insulin causes the liver to halt or slow down gluconeogenesis and glycogenolysis. If you have insulin resistance you'd have higher fasting and post-prandial glucose figures. That does suggest to me that your basal insulin levels are healthy.

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          • #6
            Do you have actual test results? If so, please post.

            My understanding is, a clearly normal fasting insulin level is 5 or less. Anything over 10 indicates insulin resistance and anything over the range high indicates diabetes probability.

            Again, my understanding is-- with high fasting insulin, fasting glucose levels will be within normal limits until the pancreas becomes taxed and can't keep up with the needed demands to clear glucose from the bloodstream.

            A HbA1c of 5.4 equates to an average BGL of 115:
            http://www.rajeun.net/HbA1c_glucose.html

            As an example, I have a sister who has normal fasting glucose levels, over the range fasting insulin levels, and severe abdominal body fat. She has gained 20 lbs in the last few months. This says to me that she is, at least, severely insulin resistant. More likely, she is quickly developing diabetes--a disease that runs rampant in our family.

            Finally, my experience has taught me, too many doctors look at test results and if they see those results within the normal range they declare a healthy status. However I have learned, by experience, that being "in the normal range" does not mean being optimally healthy.

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            • #7
              Originally posted by imasin View Post
              What does it mean if, in a blood test, insulin is high but glucose levels are normal? Doesn't this mean that a person's cells might be resistant to insulin?
              According to Dr. Rosedale, 10IU/mL or higher total insulin is a sign of insulin resistance. The fact that glucose levels are normal but insulin is high says your body is requiring more insulin for its signalling to take effect. Elevated insulin levels will make fat metabolism difficult since the job of insulin is to store nutrients. Lowering blood sugar is a secondary effect of insulin. Dr. Rosedale recommends 16 blood test. The top four:
              1. Leptin
              2. Insulin
              3. HbgA1c
              4. Glucose

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              • #8
                Insulin is required to tell the cells to use up the glucose.
                Your glucose is normal. That means your cells are using up the glucose.
                Your insulin is high that means either your pancreas is creating more than required insulin or your cells require more insulin to use up the glucose.
                In the first case it would be a glandular problem, in the second case it is definitely insulin resistance.

                I would think that the second case would be more common.

                I think there are stages to insulin resistance. In the initial stages insulin resistance just forces your pancreas to produce more insulin, but glucose control remains fine. At later stages some cells will become completely resistance and higher insulin will do nothing to them. This will happen slowly. So not all cells will become completely resistant at once. This will cause the glucose uptake to slow down. I think the first organ to go bad is the Liver. Since liver is the major user of glucose and it gets the full load of insulin from pancreas being directly downstream. Its failure makes an immediate reduction in glucose tolerance.

                So yes you are most probably insulin resistant. I think that in most cases insulin resistant goes hand in hand with leptin resistance, probably because both are caused by the same factors. So most people who get insulin resistance also get leptin resistance and get fat. The weight gain does not have much to do with insulin resistance, except that keeping insulin low allows fat burning.

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                • #9
                  Hyperinsulinemia can be caused by a few things; cancers, impaired liver function, endocrine issues, pregnancy, lactation, sustained exercise. There's also metabolic syndrome X. Either way, in those cases your blood glucose would be elevated as well. Insulin is the carrier for glucose. Glucose can't get into your cells to be used unless it's carried in by insulin (with the exception of the brain/liver, they don't need insulin to use glucose.) Hyperinsulinemia/Metabolic Syndrome X can be controlled by a low glycemic index diet, which the primal diet would fall under, for the most part.

                  The reason the doctor isn't concerned is because having an elevated triglyceride level and high blood pressure combined with being overweight and having hyperinsulinemia = a metabolic syndrome x diagnosis.
                  Last edited by bionicsamm; 02-22-2011, 06:19 AM. Reason: spelling

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                  • #10
                    Dec 06:
                    glucose - 82
                    insulin - 29

                    Jan 07:
                    glucose - 90
                    insulin - 26
                    HbA1C - 5.7
                    C-peptide - 3.9 (range 0.8 - 3.1, so high)

                    March 07:
                    fasting glucose - 83
                    2hr pp glucose - 109

                    July 08:
                    glucose - 84
                    HbA1C - 5.7
                    insulin was tested but I don't have the results; I think it was 18?

                    August 10:
                    insulin - 8.6 (I had implemented primal and was staying away from sugar, wheat, and rice, for the most part)

                    October 10:
                    glucose - 79

                    November 10:
                    glucose - 92
                    HbA1C - 5.3

                    Leptin was never tested.

                    Since the results from August showed a normal insulin level, and I've kept myself from a long-term spiral into sugar binges, I'm pretty sure my insulin levels are decent now. However, I find it puzzling that doctors basically just disregard insulin testing, which seems to show early signs of the metabolic derangement that leads to diabetes, and wait until glucose is all messed up to make any kind of diagnosis. The doctor also told me that the high C-peptide indicates that "your pancreas is producing insulin so you don't have diabetes." Umm I know I don't... but if I'm producing over the range and serum levels of insulin are high, doesn't that mean that my cells were/are slightly resistant to insulin??

                    I'm also wondering if my insulin resistance is actually 'reversible.' I wonder if I'm still producing excess insulin in response to any carbohydrate that I eat, rather than just having overall low insulin because I'm not eating that much insulin-spiking crap. I still have a lot of stored abdominal fat and while I have lost the 30-40 lbs that coincided with a year of amenorrhea/high free testosterone/PCOS, I'm still overweight (and visibly over-fat) at between 150-160 lbs, and finding it difficult to shed more fat.
                    Last edited by spakesneaker; 02-22-2011, 08:13 AM.

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                    • #11
                      The other thing I find strange is that throughout these blood tests, my hemoglobin, hematocrit, MCV, and MCH were always either on the very low end of the range or slightly below the range.

                      And in Jan 07:
                      iron 49 (range 35-175)
                      TIBC 421, High (range 250-400)
                      transferrin saturation 12, Low (range 15-50 percent)

                      If the iron had been lower (and the Dec 06 result was 35, but that didn't test TIBC or transferrin saturation), someone might have f**king told me that I had iron deficiency anemia. But no, it wasn't until four years later, when I looked up what my always-high platelet counts might mean, that I realized that I might have anemia/iron issues. Got it tested through a dermatologist, because my PCP told me that my hair loss must be due to the PCOS (when she had my blood results and saw that all testosterone values were NORMAL or even LOW) or stress (this is the least stressed I've been since I was a child), and told me to get a humidifier since it was winter. Turns out I have extremely low iron stores (ferritin level of 9)... no f**king wonder the hair I had lost due to high testosterone or telogen effluvium wasn't growing back!!

                      So I'm pretty wary of trusting the ranges, as marcadav said. Or doctors... I don't know why I even bother.

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                      • #12
                        Originally posted by imasin View Post
                        Dec 06:
                        glucose - 82
                        insulin - 29

                        Jan 07:
                        glucose - 90
                        insulin - 26
                        HbA1C - 5.7
                        C-peptide - 3.9 (range 0.8 - 3.1, so high)

                        March 07:
                        fasting glucose - 83
                        2hr pp glucose - 109

                        July 08:
                        glucose - 84
                        HbA1C - 5.7
                        insulin was tested but I don't have the results; I think it was 18?

                        August 10:
                        insulin - 8.6 (I had implemented primal and was staying away from sugar, wheat, and rice, for the most part)

                        October 10:
                        glucose - 79

                        November 10:
                        glucose - 92
                        HbA1C - 5.3
                        These insulin numbers are too high for a normal glucose levels. I would suspect something wrong with some glands. I am not a doctor so you might as well take a huge bag of salt with that.

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                        • #13
                          having iron deficiency anemia will throw off a leptin, hba1c, and all glucose/insulin tests....FWIW
                          Get on my Level
                          http://malpaz.wordpress.com/

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                          • #14
                            Anand - my insulin levels are normal now, so I'm not too worried about insulin levels so much as about how to increase insulin sensitivity (I'm aware of IF) and lose weight. I just found it so strange that the doctor basically just dismissed the (ridiculously) high insulin level, and said that the testosterone levels must have come down because I lost weight... yes, but most people who know anything about the connection between PCOS and IR are aware of the hypothesis that excess insulin stimulates the ovaries to release excess testosterone. And it would mean that ALL obese women lose their periods, which isn't the case. Her whole way of looking at things just annoyed me; she looked at it from a "lose weight and your problems will go away" rather than "to lose weight you must tackle those underlying problems." I'm sure the first part of it is at least partly true because of leptin, but I'm not sure how that works. But still, I'm just so confused by this standard of care... now wonder so many Americans become diabetic.

                            Originally posted by MalPaz View Post
                            having iron deficiency anemia will throw off a leptin, hba1c, and all glucose/insulin tests....FWIW
                            Do you mean that the test results aren't valid, or that iron deficiency affects those hormonal pathways somehow? I'd be really interested in reading more about this.
                            Last edited by spakesneaker; 02-22-2011, 08:23 AM.

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                            • #15
                              You were in bad shape.....I'd say you were just a small step away from Diabetes.

                              YES, insulin resistance is reversible, but probably not until you shed the majority of your existing fat mass. I remember Robb Wolf talking about how your adipose tissue.....especially around your stomach.....holds onto to insulin resistance, until the visceral adipose tissue is greatly reduced or gone. The only thing you can do is to keep avoiding ALL Grains, Legumes, Sugar, Milk, and go easy on the cheese. Maybe Taking up to 10grams of fish oil per day would help to reverse the insulin resistance of your cells, because of the strong Omega 3 content.

                              If you've still got 150+ pounds to lose, personally I would drop your calories down to the "extreme fat-loss" zone, eat Very-Low Carb/Ketogenic, and avoid snacking completely, to accelerate your fat-loss to the max. Just my two cents.

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