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Blood Tests to Ask your Doctor For That You Aren’t Getting.

August 15, 2024

If you’ve ever gotten blood work done, you’ve no doubt gotten your fasting blood glucose numbers. 

It’s sort of like one of those pass/fail tests: You either have diabetes (or prediabetes)... or you don’t. There’s nothing in between.

Yet we know diabetes doesn’t happen overnight. It develops over years, often beginning with a condition known as “diabesity”—a combination of obesity and metabolic changes that gradually lead to diabetes.

But if fasting blood glucose isn’t an early warning sign, what is?

Fortunately, there are ways you can diagnose diabesity long before it becomes diabetes. Knowing the right lab tests to ask for can make all the difference in catching issues early. 

Yet many people, and even some doctors, aren’t fully aware of which tests are essential for diagnosing diabesity effectively.

So let’s explore those key tests so you can take control of your health.

Why Measuring Blood Sugar Alone Isn’t Enough

Historically, diabetes was diagnosed when fasting blood sugar levels were higher than 140 mg/dL. However, we now understand that diabetes complications can begin at much lower blood sugar levels. 

That’s why the cutoff was recently lowered to 126 mg/dL, and why glucose intolerance (when blood sugar is higher than normal but not at diabetic levels yet), once diagnosed at 110 mg/dL, is now identified at 100 mg/dL.

But turns out, even having “normal” blood sugar doesn’t mean you’re safe from future diabetes (and all the increased health risks that come with it). 

This is why simply testing blood glucose isn’t enough. Instead, you need a special kind of insulin test, too.

The Hidden Threat to Your Health

If you want the tldr (too long didn’t read) version, here it is: A condition called “insulin resistance” is what ultimately leads to dangerously high blood sugar levels. And it can be detected long before you start to see problems with fasting blood sugar. The earlier you detect it—and take action—the better. 

Now for the long version. (If you don’t want a quick biology lesson, scroll down to the next section: “The Insulin Response Test.”) 

Insulin is a hormone that’s crucial for managing your blood sugar levels. When you eat carbohydrates like sugar and starch, they’re quickly absorbed into your bloodstream as glucose, raising your blood glucose (a.k.a. blood sugar) levels.

Your body is designed to tightly regulate blood sugar levels because when they get too high, it triggers inflammation that damages blood vessels. On the other hand, if blood sugar drops too low, it can impair your ability to function and, in extreme cases, even be life-threatening.

This is where insulin comes in. When your blood sugar rises, your pancreas releases insulin. Insulin is needed to help move glucose from your bloodstream into your cells, where it can be used for energy or stored for later use. Under normal circumstances, your pancreas releases just the right amount of insulin to bring your blood sugar back to the normal range of 70-100 mg/dL.

However, problems start when your cells become resistant to insulin, a condition known as, you guessed it, insulin resistance. When this occurs, your blood sugar rises, but your cells don’t respond to insulin as effectively. Instead of glucose being absorbed into the cells, it lingers in your bloodstream, causing elevated blood sugar levels.

In an attempt to compensate, your pancreas produces even more insulin to push the glucose into your cells. Over time, this leads to consistently high levels of insulin in your blood, a condition called hyperinsulinemia. Despite the extra insulin, your cells continue to resist, and your blood sugar levels remain higher than they should be. 

This can eventually lead to chronically high blood sugar, a hallmark of prediabetes and type 2 diabetes.

Chronically high blood sugar can damage your organs and blood vessels, and raise your risk of serious conditions like heart disease, stroke, and diabetes.

So the earlier insulin resistance is detected, the better your chances of preventing these complications and managing your health proactively.

The Insulin Response Test—A Critical Tool for Early Detection

Most doctors use a test called the oral glucose tolerance test (OGTT) to check for insulin resistance or diabetes.¹ This involves drinking a solution with 75 grams of glucose (equivalent amount of sugar to two 12 oz sodas) and then having your blood sugar measured at 30 minutes, one hour, and two hours afterward. 

This test shows how your body handles a large dose of carbohydrates. If your blood sugar rises too high or stays elevated too long, it may indicate insulin resistance or diabetes. 

However, by the time your blood sugar levels are assessed in a typical OGTT, you may already be far down the path of insulin resistance. That’s because many doctors won’t order this test unless you already have high fasting blood sugar. What’s more, the conventional OGTT often misses many cases of insulin problems.

Enter the insulin response test. It’s the most sensitive test available for early detection of insulin resistance and diabesity. It not only helps identify the condition early on but also guides more aggressive treatment strategies.

The Six Stages of Insulin Resistance

There are six stages of insulin resistance. Unfortunately, most doctors only take action when patients reach the fifth stage. 

• Stage 1: During an OGTT, insulin spikes sharply 30 minutes, one hour, and two hours after consuming the glucose drink, even though blood sugar levels may still look normal.
  
  
• Stage 2: Fasting insulin levels are high, but blood sugar levels are normal, both while fasting and after an OGTT.
  
  
• Stage 3: Both blood sugar and insulin levels go up after drinking the glucose solution at 30 minutes, one hour, or two hours.
  
  
• Stage 4: Fasting blood sugar levels rise above 90 or 100 mg/dL, along with elevated fasting insulin.
  
  
• Stage 5: Fasting blood sugar levels go above 126 mg/dL.
  
  
• Stage 6: Fasting insulin levels drop, the pancreas begins to fail, and fasting blood sugar levels continue to rise.

The insulin response test can also be valuable for patients already diagnosed with diabetes to assess whether their pancreas is still producing insulin or if its function has significantly declined. In some cases, even a “burned out” pancreas can recover, and diabetes can be reversed. To be sure, after decades of poor diet and lack of exercise, reversing diabetes completely may not be possible for everyone. But with a comprehensive approach, further complications can be effectively managed.

This test is rarely performed in medical practices today, which is why diabesity often goes undiagnosed in those who have it. Alternatively, a “fasting and 30-minute post-glucose-load glucose and insulin test” can be a quick and effective alternative for diagnosing insulin resistance.

Also, recent research shows that the fasting 30-minute glucose and insulin test can be just as effective as the traditional two-hour insulin response test to diagnose insulin resistance.² Some people have a delayed insulin response, meaning their body takes longer to release insulin after eating, but the 30-minute test can be a quick way to do the test for most people. 

Optimal Blood Sugar and Insulin Levels: What to Aim For

There are no universally agreed-upon “normals” for these tests, but after conducting thousands of them over the past 20 years, I can share what I believe are optimal and ideal ranges:

• Blood Sugar Levels: Fasting blood sugar should be less than 80 mg/dL. Thirty-minute, one-hour, and two-hour glucose levels should not rise above 110 mg/dL (some say 120 mg/dL).
• Insulin Levels: Fasting insulin should be between 2 and 5 mIU/dL. Anything greater than 10 mIU/dL is significantly elevated. Thirty-minute, one-hour, and two-hour insulin levels should be less than 25 mIU/dL to 30 mIU/dL. Levels higher than 30 mIU/dL indicate some degree of insulin resistance.

Check Your Hemoglobin A1c

The hemoglobin A1c test measures your average blood sugar over the past six weeks. It’s typically used to monitor diabetics, but it’s also an effective tool for diagnosing diabetes, potentially even better than a fasting blood sugar test.³

Even if your fasting blood sugar is normal, your hemoglobin A1c could be high, as it accounts for all the food you consume throughout the day. I use it to screen for overall blood sugar balance.

Ideally, your hemoglobin A1c should be less than 5.5 percent of total hemoglobin. Anything above 6.0 percent is considered diabetes, and higher than 7.0 percent indicates poorly controlled diabetes.

Taking Control of Your Health

There is still controversy in conventional medicine circles about the utility of these laboratory tests, but I’ve used them with great success for over 20 years on thousands of patients. Rather than providing a simple “yes” or “no” diagnosis, these tests give you a comprehensive picture of where you stand on the continuum from optimal health to full-blown disease.

Don’t wait for symptoms to appear—take control of your health today by asking for the right tests and making informed decisions about your care.

References.

1. Kuo FY, Cheng KC, Li Y, Cheng JT. Oral glucose tolerance test in diabetes, the old method revisited. World J Diabetes. 2021 Jun 15;12(6):786-793. doi: 10.4239/wjd.v12.i6.786. PMID: 34168728; PMCID: PMC8192259.

2. Hirakawa Y, Hata J, Yoshinari M, Higashioka M, Yoshida D, Shibata M, Honda T, Sakata S, Kato H, Teramoto T, Maki H, Nishimoto S, Kitazono T, Ninomiya T. 30-minute postload plasma glucose levels during an oral glucose tolerance test predict the risk of future type 2 diabetes: the Hisayama Study. BMJ Open Diabetes Res Care. 2020 Jul;8(1):e001156. doi: 10.1136/bmjdrc-2019-001156. PMID: 32675171; PMCID: PMC7368480.
   
   
3. Eyth E, Naik R. Hemoglobin A1C. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549816/