insulin and glucose page

[spakesneaker]

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??

[AndreaReina]

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.

[O_O]

Did your doctor do a HbA1C and a fasting glucose test?

[spakesneaker]

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.

[AndreaReina]

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.

[marcadav]

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.

[js290]

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

[Anand Srivastava]

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.

[bionicsamm]

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.

[spakesneaker]

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.