Advice needed: low insulin, high glucose, high HbA1c

[Lindy]

Hi everyone, I’m trying to learn more about insulin sensitivity and how it interacts with blood glucose. My latest bloodwork included the following:

Glucose (fasting) 90 mg/dL [74 – 100]
HbA1c 5.7% [4.0 – 6.0]
Insulin fasting level 2.05 uIU/mL [1.90 – 23.00]

This is the first time I’ve had the fasting insulin taken – I’ve been on the Bredesen protocol since January - and I’m not sure how to respond to this. On the one hand, insulin is below 5 which sounds like I’m insulin sensitive – maybe my moderate macro ratio, which after a lot of experimentation has settled at 25 protein/30 carb/45 fat, is working. On the other hand it seems counterintuitive to have very low insulin levels with uncomfortably high short- and long-term blood sugar levels (which I was not happy to see), unless there’s something wrong with my pancreas – though I had very good amylase and lipase levels when tested in March.

My genetic inheritance includes lots of Type 2 diabetes risk SNPs and a few that raise the risk specifically for elevated glucose test levels, but as far as I can tell I can’t really blame them for this level of fasting glucose (it was 76 in March). I’m guessing it’s the gluten-free rolled oats and quinoa I added to my diet to add calories and try to keep my weight stable while still keeping a relatively low carb diet. I refrain from any added sugars or sugar replacements but I do eat berries and occasional oranges in addition to the leafy greens, healthy fats, low-GI root veggies, fish, tempeh, etc., and I figured since diabetics and heart patients are encouraged to eat rolled oats and quinoa, and I don’t react to them, maybe they’re OK in my diet.

I suspect that I’m an inefficient metabolizer, since my weight drops so easily. But I have been noticing that when I don’t actively exercise and just putter around instead (during recent weeks of heat waves for example), I gain some belly fat though I don’t gain weight. I'm not sure how this correlates with low insulin, but I feel like there's some relationship.

My gynecologist ordered this panel along with an adrenal panel we don’t have back yet, to see how a growing pile of life stressors are affecting me. Although she isn’t familiar with E4 issues, she is cross-training in functional medicine and trying to provide a holistic approach within the constraints of my insurance, for which I am grateful. She sent me the results with the comment: “Your HbA1C is still in the high range. I would like to see it below 5.3. Your fasting glucose is 90 (I would like to see that under 85). Your insulin is low at 2 – I typically want to see that closer to 4 – 8. When your insulin is not working as effectively it can be allowing your blood sugars to creep back up.” I don’t disagree with any of this, I just don’t know what exactly to do. I also wonder if this is an area where the Bredesen protocol is a little bit at odds with conventional ideas about insulin levels.

Any ideas on how to get my insulin level up? Or should I not worry about it and focus instead on getting the glucose levels down? Is it true that low insulin leads to higher blood sugar? Should I drop the conveniently calorific “heart-healthy” carbs and look for another way to maintain a stable body weight? All suggestions appreciated.

[slacker]

Hi everyone, I’m trying to learn more about insulin sensitivity and how it interacts with blood glucose. My latest bloodwork included the following:

Glucose (fasting) 90 mg/dL [74 – 100]
HbA1c 5.7% [4.0 – 6.0]
Insulin fasting level 2.05 uIU/mL [1.90 – 23.00]

Hi Lindy;

I don’t think your results are all that unusual, especially since I’ve had similar results in the past. Insulin levels alone don’t tell you if you are “insulin sensitive”; it has to be evaluated along with fasting glucose, HgA1C, trigs, etc. You may want to review the section on insulin resistance in the Primer.

I doubt that you are having trouble with your pancreas - if your pancreas was unable to produce adequate insulin, your fasting glucose and HgA1C would be much higher, similar to developing type 1 diabetes. The amylase and lipase don’t tell us anything about beta cell function (producers of insulin) in the pancreas.

If you have high cortisol due to stress, this can contribute to your glucose and A1C results.

I too have struggled with the carb and weight loss issues. I too am careful about carb “quality” and intake, but don’t go as low as others on the site. I’ve focused on adding healthy fats. My A1C has finally shifted from 5.6% to 5.1%, and I’ve put some weight back on. I wonder if it takes more than 3 months in some of us to see our lifestyle changes reflected in our test results. One day at a time.

Fasting insulin testing is rarely if ever ordered at a conventional medical practice. A conventional provider would have little concern about your glucose and A1C results. From a Bredesen perspective, your insulin level is not a problem. Interestingly, my insulin level increased a few points, but was still low, once I hit the A1C of 5.1%. I think that focusing on lowering your A1C will reap more rewards than worrying about your insulin level.

[Lindy]

Thanks, Slacker, for your very helpful response. I would love to replicate your success with shifting your A1c - what healthy fats have you emphasized? I'm on EVOO, nuts, avocado also one pastured egg and some fish each day, though I'm not completely sure those aren't among the animal fats E4s need to watch out for. SusanJ's recent post about a stearic acid study suggested they might be helpful for mitochondrial processing.

I've read the primer section on insulin resistance a few times now, but I didn't see anything about a minimum point for insulin level, just a maximum. My doc is suggesting there is a minimum as well, that she thinks I'm below. That really was what prompted my question. Obviously we have to have some insulin, but how little is too little, or is it all the balancing of various factors?

Anyway, your thought that it might take a while to see results is certainly something I need to keep remembering, so thanks again.

[slacker]

The bulk of my breakfast is nuts, I try to have 1/2 avocado daily, add a bit more olive oil, and have an egg or fish daily. Improved sleep, stress reduction, and exercise are helpful to improve insulin resistance (IR). I can't say for sure what exactly changed between my 5.6% and 5.1% A1C, except for slow steady changes - and trying to worry less! Patience...

I understand that your doctor suggests a specific minimum level of insulin. I doubt that anyone knows for sure what this should be. Those in ketosis can have very low insulin much of the time because their glucose levels are also quite low most of the time. Insulin will be lowest after a fast - with minimal glucose in circulation other than gluconeogenesis (production of glucose) from the liver. A two hour post prandial insulin level, after a "bolus" of carbohydrate, may be a better measurement of both insulin and glucose. It tells us how quickly the glucose and insulin go down after a big shot of glucose. There's been some discussion about this on the site in the past. You can try searching on "prandial" or "Kraft" for starters. (magnifying glass right toolbar). Dr Kraft was a pioneer in insulin study. The wiki also has some good info on insulin resistance as well.