Re: Apoe 4/4 and high triglycerides
Posted: Tue Dec 31, 2019 11:08 am
mike wrote:binxlyostrich wrote:Thank you I will definitely read into them. I do not have diabetes and my blood sugar is always in the normal range. Just another weird thing about my situation.
Hi from another 4/4 and welcome. I had similar situation at your age, but not so high TG. Now at age 59, I've been a Type 2 diabetic for 20 years... Just because your blood sugar is normal, it does not mean that you do not have metabolic issues - your body is able to maintain blood sugar by raising insulin levels. Higher and higher. At some point this no longer works, and you "suddenly" have diabetes. I would get a HOMA-IR test done (basically testing both fasting sugar and insulin) to see how Insulin Sensitive you are. This will tell you if you have underlying metabolic issues (pre-diabetes). I'm guessing you do. If so, then you will want to cut out ALL added sugar.
I must agree with Mike. The late Joseph Kraft MD (he passed at age 96 in 2017) ran about 15,000 oral glucose tolerance tests with insulin assays during his career. The upshot of his work is that 75-80% of people with a normal glucose profile had an abnormal insulin profile (from memory, it has been a while since I read his work). This doesn't count all those with an abnormal glucose profile. Kraft called this "diabetes in-situ." Essentially insulin resistance and T2 diabetes are part of a continuum. Early in the course of the disease, the pancreas pumps out more insulin to keep the glucose in check. Then, at some point this no longer works and you get to full blown T2 diabetes with elevated glucose. In Kraft's test, people were fasted overnight, glucose and insulin tested, then given a bolus of glucose (100g in Kraft's day, usually 70g now). Insulin and glucose were sampled at 30, 60, 120 and so on minutes up to 5 hours. This is Kraft's original paper from the 1970's, reformatted for readability. Ivor Cummins interviewed Dr. Kraft in 2015.
More recently, Catherine Crofts of NZ used Kraft's data for her PhD thesis. She was looking to determine a simpler test than Kraft's 5 hour assay. She came up with just testing insulin at 2 hours after a glucose dose. She concluded that an insulin value of >30 μU/mL at 2 hours after a 100 g glucose dose was diagnostic of hyperinsulinemia. Essentially a "stress test" for the pancreas. She determined this was much better than fasting tests.
Because such a high percentage of Kraft's sample data had a poor insulin response, it would be reasonable to just assume someone with lipid issues has a poor insulin response and proceed accordingly without testing.
Correcting metabolic issues is the low hanging fruit for getting healthy for those with our genetics, in my opinion.