Best way to test insulin sensitivity?

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
sandyt
Contributor
Contributor
Posts: 37
Joined: Thu Nov 08, 2018 2:49 pm

Best way to test insulin sensitivity?

Post by sandyt »

After reading through the primer and tons of posts I realize how important insulin sensitivity probably is in trying to avoid future problems that apoe4 disposes us to. My lipid are not good (TC 248, LDL 163, LDL-P 1763, LDL SMALL 253, HDL 70, TRIG 55). But my HS-CRP is good (.3) and glucose appears to be ok (88).
My question is...is the glucose test enough to ensure sensitivity or should I ask for an fasting insulin test? I have heard that you can have low glucose but high insulin. Is regularly testing with a home glucometer enough to check for insulin sensitivity? Do most of you use a glucometer? If so, how do you use it (what info are you looking for)?
I have been following a Weston A. Price-ish diet for years. I would say it is moderate carbs. (Probably low compared to SAD. But not paleo low.) I have tried to start scaling back on carbs a little, but it would be nice to have some "data" to see if it is doing anything AND to decide how low to go.
Any advice/info would be appreciated.
User avatar
slacker
Contributor
Contributor
Posts: 2127
Joined: Wed Aug 03, 2016 6:20 pm
Location: Kentucky

Re: Best way to test insulin sensitivity?

Post by slacker »

sandyt wrote:After reading through the primer and tons of posts I realize how important insulin sensitivity probably is in trying to avoid future problems that apoe4 disposes us to. My lipid are not good (TC 248, LDL 163, LDL-P 1763, LDL SMALL 253, HDL 70, TRIG 55). But my HS-CRP is good (.3) and glucose appears to be ok (88).
My question is...is the glucose test enough to ensure sensitivity or should I ask for an fasting insulin test? I have heard that you can have low glucose but high insulin. Is regularly testing with a home glucometer enough to check for insulin sensitivity? Do most of you use a glucometer? If so, how do you use it (what info are you looking for)?
Hi Sandy;

Following glucose alone will not be enough to determine insulin sensitivity or resistance. There's a chapter in the Primer that talks about IR and testing for IR.
Slacker
E4/E4
mike
Senior Contributor
Senior Contributor
Posts: 851
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: Best way to test insulin sensitivity?

Post by mike »

sandyt wrote:After reading through the primer and tons of posts I realize how important insulin sensitivity probably is in trying to avoid future problems that apoe4 disposes us to. My lipid are not good (TC 248, LDL 163, LDL-P 1763, LDL SMALL 253, HDL 70, TRIG 55). But my HS-CRP is good (.3) and glucose appears to be ok (88).
My question is...is the glucose test enough to ensure sensitivity or should I ask for an fasting insulin test? I have heard that you can have low glucose but high insulin. Is regularly testing with a home glucometer enough to check for insulin sensitivity? Do most of you use a glucometer? If so, how do you use it (what info are you looking for)?
I have been following a Weston A. Price-ish diet for years. I would say it is moderate carbs. (Probably low compared to SAD. But not paleo low.) I have tried to start scaling back on carbs a little, but it would be nice to have some "data" to see if it is doing anything AND to decide how low to go.
Any advice/info would be appreciated.
sandyt, yes it's possible to have normal blood sugar and high insulin. If you become insulin resistant, it takes more insulin to bring down your blood sugar. This can get worse and worse to the point where you can no longer maintain your blood sugar at an acceptable level, it is considered type 2 diabetes. Before that, it is still not okay. Lowering carbs is the best way to slow this down. Blood sugar is just one part, and doesn't get you IR, but can also be useful.
Sonoma Mike
4/4
NewRon
Senior Contributor
Senior Contributor
Posts: 450
Joined: Fri Nov 07, 2014 3:04 am

Re: Best way to test insulin sensitivity?

Post by NewRon »

This is interesting.

I argued with the nurse when I asked for a fasting insulin test at a recent blood draw and she refused. She said that she'd worked most of her life in a diabetes clinic and that if my insulin was high even with normal blood glucose, that I would have dysregulated potassium and liver function results (and I haven't).

I wonder if this is actually the case?
Apo E4/E4, Male, Age 60
donbob
Contributor
Contributor
Posts: 76
Joined: Wed Oct 31, 2018 6:59 am

Re: Best way to test insulin sensitivity?

Post by donbob »

sandyt wrote:After reading through the primer and tons of posts I realize how important insulin sensitivity probably is in trying to avoid future problems that apoe4 disposes us to. My lipid are not good (TC 248, LDL 163, LDL-P 1763, LDL SMALL 253, HDL 70, TRIG 55). But my HS-CRP is good (.3) and glucose appears to be ok (88).
My question is...is the glucose test enough to ensure sensitivity or should I ask for an fasting insulin test? I have heard that you can have low glucose but high insulin. Is regularly testing with a home glucometer enough to check for insulin sensitivity? Do most of you use a glucometer? If so, how do you use it (what info are you looking for)?
I have been following a Weston A. Price-ish diet for years. I would say it is moderate carbs. (Probably low compared to SAD. But not paleo low.) I have tried to start scaling back on carbs a little, but it would be nice to have some "data" to see if it is doing anything AND to decide how low to go.
Any advice/info would be appreciated.
I recently used the HOMA-IR correlation for insulin resistance. Had a local testing outfit give me a simultaneous fasting insulin test and a fasting glucose test. I plugged those results into the HOMA-IR formula to get a proxy for my insulin resistance. $18 per test and a $20 blood draw fee for a total of $56. The results indicated I had very low insulin resistance.

I probably didn’t need the test since my last 8 clinical lipid results each did yield a Tri/HDL less than one. But I had never had an insulin test and wanted verification of my lipid insulin resistance prediction.

By the way, some might say your lipids are good. Your Tri/HDL is less than one and fasting glucose is ok. You can probably save yourself $56. Especially if you get similar lipid results in the future.
User avatar
slacker
Contributor
Contributor
Posts: 2127
Joined: Wed Aug 03, 2016 6:20 pm
Location: Kentucky

Re: Best way to test insulin sensitivity?

Post by slacker »

NewRon wrote: I argued with the nurse when I asked for a fasting insulin test at a recent blood draw and she refused. She said that she'd worked most of her life in a diabetes clinic and that if my insulin was high even with normal blood glucose, that I would have dysregulated potassium and liver function results (and I haven't).

I wonder if this is actually the case?
Ask her (nicely) for a reference, something you can read and understand?
Slacker
E4/E4
sandyt
Contributor
Contributor
Posts: 37
Joined: Thu Nov 08, 2018 2:49 pm

Re: Best way to test insulin sensitivity?

Post by sandyt »

mike wrote:Following glucose alone will not be enough to determine insulin sensitivity or resistance. There's a chapter in the Primer that talks about IR and testing for IR.
Thanks, I think that part of the primer is what originally got me thinking about this whole thing. My HA1C is decent (5.3) and has been the last couple of times I have had it measured. I exercise religiously. My body composition seems good (BMI about 20, with slightly more muscle than the average person my age - so I am not "skinny fat"). And my diet is better than 99% of the people I know. So I guess I was hoping that would be enough to show that I am insulin sensitive without going for more tests. Maybe using the glucometer could help me narrow what foods I should avoid. But it looks like I should bite the bullet and try and convince my doctor to test insulin. I really wouldn't even be considering this except I AM HUNGRY ALL THE TIME. I eat a lot (more than my husband :D ) but within 2 hours I am hungry again...did I mention ALL THE TIME? Until I started investigating APOE4 I didn't realize this could be an insulin issue. Or maybe it is a postmenopausal issue. But whatever it is, it makes life difficult.
NewRon wrote:This is interesting.

I argued with the nurse when I asked for a fasting insulin test at a recent blood draw and she refused. She said that she'd worked most of her life in a diabetes clinic and that if my insulin was high even with normal blood glucose, that I would have dysregulated potassium and liver function results (and I haven't).

I wonder if this is actually the case?
This is so interesting. I went back and checked and my liver enzymes and potassium are good. Yay!

donbob wrote:I recently used the HOMA-IR correlation for insulin resistance. Had a local testing outfit give me a simultaneous fasting insulin test and a fasting glucose test. I plugged those results into the HOMA-IR formula to get a proxy for my insulin resistance. $18 per test and a $20 blood draw fee for a total of $56. The results indicated I had very low insulin resistance.

I probably didn’t need the test since my last 8 clinical lipid results each did yield a Tri/HDL less than one. But I had never had an insulin test and wanted verification of my lipid insulin resistance prediction.

By the way, some might say your lipids are good. Your Tri/HDL is less than one and fasting glucose is ok. You can probably save yourself $56. Especially if you get similar lipid results in the future.
I have to admit the only part of my lipids that concerns me is the LDL-P. I don't mind my a high LDL-C or TC. But from what I have been hearing about particle number and my bad family history I figured it wouldn't hurt to look at the low hanging fruit - insulin sensitivity and inflammation. If I do decide to wrestle with my doctor for an insulin test maybe I will take it a step further and ask for HOMA-IR. My insurance won't cover it, but I do get their "negotiated rate" which is usually pretty good.

And if anyone would like to give me a lesson on how to include more than one quote in a post I would love to learn :D
User avatar
Stavia
Contributor
Contributor
Posts: 5255
Joined: Tue Apr 29, 2014 6:47 pm
Location: Middle Earth

Re: RE: Re: Best way to test insulin sensitivity?

Post by Stavia »

NewRon wrote:This is interesting.

I argued with the nurse when I asked for a fasting insulin test at a recent blood draw and she refused. She said that she'd worked most of her life in a diabetes clinic and that if my insulin was high even with normal blood glucose, that I would have dysregulated potassium and liver function results (and I haven't).

I wonder if this is actually the case?
Well with IR, often there is associated fatty liver, so this statement of hers is often true. Fatty liver shows as raised GGT, ALT, AST usually. If I see a low GGT, especially with a lean active person, I take it as a surrogate marker of insulin sensitivity. (medical term is NASH = non alcoholic steatohepatitis). Not a clue why she thinks K+ would be abnormal with a bit of IR.

Sent from my SM-G930F using Tapatalk
User avatar
slacker
Contributor
Contributor
Posts: 2127
Joined: Wed Aug 03, 2016 6:20 pm
Location: Kentucky

Re: RE: Re: Best way to test insulin sensitivity?

Post by slacker »

Stavia wrote:
Well with IR, often there is associated fatty liver, so this statement of hers is often true. Fatty liver shows as raised GGT, ALT, AST usually. If I see a low GGT, especially with a lean active person, I take it as a surrogate marker of insulin sensitivity. (medical term is NASH = non alcoholic steatohepatitis).
In the US, liver function tests are usually ordered in one of two panels; either the CMP (complete metabolic panel) or Liver Function Tests. Neither includes GGT. The ALT and AST are ordered in both.

And of course, ALT and AST can be elevated for liver problems other than fatty liver, and for reasons other than liver.
Slacker
E4/E4
User avatar
Stavia
Contributor
Contributor
Posts: 5255
Joined: Tue Apr 29, 2014 6:47 pm
Location: Middle Earth

Re: RE: Re: RE: Re: Best way to test insulin sensitivity?

Post by Stavia »

slacker wrote:
Stavia wrote:
Well with IR, often there is associated fatty liver, so this statement of hers is often true. Fatty liver shows as raised GGT, ALT, AST usually. If I see a low GGT, especially with a lean active person, I take it as a surrogate marker of insulin sensitivity. (medical term is NASH = non alcoholic steatohepatitis).
In the US, liver function tests are usually ordered in one of two panels; either the CMP (complete metabolic panel) or Liver Function Tests. Neither includes GGT. The ALT and AST are ordered in both.

And of course, ALT and AST can be elevated for liver problems other than fatty liver, and for reasons other than liver.
Oh, ok. Here we get Bilirubin, GGT, Alk Phos, AST ALT and albumin if we order LFTs.
I cant imagine not needing GGT. Its necessary to interpret raised AST ALT accurately. Alk phos isnt specific enough and it rises late. Plus GGT rises early. Weird that its not standard for you guys..

Sent from my SM-G930F using Tapatalk
Post Reply