The Diabetes Epidemic: Insulin Recap

Today on the radio I heard that 4 million people have been diagnosed with diabetes.

A further 630,000 are estimated to have diabetes and not been diagnosed.

In 2013, 3.2 million people had diabetes so this has risen by 800,000 in the last 6 years.

By 2025, 5 million people are predicated to have diabetes.

A further 7 million people are estimated by diabetes UK to have ‘pre-diabetes’ a condition where your blood glucose is higher than normal but not so high as to be considered diabetes.

So by 2025 or in 7 years 12 million people will either have diabetes or pre-diabetes. In 2015 the population is estimated to be 68 million. So 17% of the population will be in this category.

Symptoms of poor blood sugar regulation can include;

Fatigue
Irritable or shaky when hungry
Rapid mood swing
Sleeping problems
Poor concentration
Forgetfulness
Excessive sweating
Stubborn body fat which does not seem to shift no matter how restrictive you are with your diet
Tiredness after meals containing even small amounts of grains or high GI carbs
Drowsy, tired or hungry during the day

One of the problems with looking at fasting blood glucose and the average 2-3 month level of fasting blood glucose HBA1C is that it doesn’t consider the first step in this process which is dysregulated insulin production in relation to total glucose and calorie load. It’s insulin resistance which leads to pre-diabetes and diabetes.

To understand how this works let’s have a quick recap on insulin levels.

Insulin is a storage hormone released in the presence of glucose and other nutrients in the blood.

Its release is normally dose-dependant, the greater the blood glucose the more insulin required to store this in the cells. Amino acids and protein (like whey) also trigger insulin release.

The body has two storage points, muscle as glycogen and fat as adipose tissue.

Tissues can become insulin resistance, this means you need more insulin to dispose of glucose.

Over time a raised requirement for insulin production puts a strain on the pancreas which produces this hormone. This can eventually lead to burn out or lack of response of these cells.

This process is called insulin resistance and leads to pre-diabetes.

You can measure how well your body is disposing of glucose by looking at fasting glucose. If this is raised it means your body cannot dispose of the glucose easily and you have a degree of insulin resistance.

You can also measure fasting insulin which will tell you how much insulin you are producing in order to dispose of the glucose.

If you don’t measure insulin you have ZERO idea of the functional status of the glucose management system. It’s a bit like waiting for your radiator to leak not knowing how hard your boiler is working or whether it’s going to pack up or not.

I’ll repeat that in case it’s not clear.

You can measure insulin or the functional state of insulin resistance along with fasting glucose OR you can wait until blood glucose and HBA1C are raised (you’ve already got limited capacity for glucose disposal).

HbA1C is a marker of sugar damage in the red blood cell so gives a picture of average glucose levels over 2-3 months. Keeping this less than 6.5% is good if you’ve got diabetes. The American diabetes association now has a high risk category of 5.7-6.4%

Good thing is if you measure this early you can see raised insulin and normal glucose. This enables you to nip the process in the bud as it were and increase insulin sensitivity through various means.

It’s a reversible situation if you get in there early enough. Pre-diabetes is reversible.

Now there’s a couple of cool indexes which can help you measure this. Functional insulin resistance index which is glucose x insulin / 25. Over 1 means you have a degree of insulin resistance. Let’s say your fasting glucose is 5.5 and fasting insulin 20. This is comes out at 4.4. So 4 x over the normal optimal range. You can also use HOMA calculator. Using this calculator you can pop in your numbers and you get an output like this;

Here you can see the IR or insulin resistance index is 2.92 so almost 3 x the optimal range (above 1), insulin sensitivity is 34% (normal 100% or more) and beta cells are working at over 164% of their capacity less than 100% is better.

This is a poor score and cause for concern.

Now if you simply measure fasting glucose or HBA1C these can be completely normal with very high levels of insulin.

Normal range for insulin fasted is less than 10 pmol/l fasting glucose is normally between 3.9-5.8 mmol/L

So if you tell someone you are fine – without knowing their fasting insulin OR if they’ve had their fasting insulin measured out of range beforehand and you don’t repeat the test.

What does that make you? If you are a Dr and you ignore raised insulin and instead prefer fasting glucose and HBA1C as markers, knowing someone has previously had raised insulin in relation to meals and also raised fasting insulin then this is a mistake.

You could send your patient or client away with a false sense of security. High insulin is an early warning sign, why wait for raised blood glucose or HBA1C?

The next time you see them, they might have pre-diabetes or diabetes. They already have impaired insulin resistance.

It would be your fault.

This decision to ignore fasting insulin readings would lack both duty of care and be verging if not be completely negligent.

Want to know what to do about it?

Read this.

And this.

Worried about this? Contact your GP for a fasting insulin and glucose blood test and then book a consultation with me. matt@aminoman.com

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891203/

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/hba1c

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/hba1c#target