We know, pretty clearly, that a big cause of insulin resistance, not the only cause mind you but a major cause, is insulin itself. I’ve spoken about this already, and I have also spoken about the concerns of people like Dr. Joseph Kraft about how we should be screening people not for glucose intolerance but for hyperinsulinemia instead, high insulin levels in the blood in other words.
Hyperglycemia, high blood sugar, even slightly elevated levels of high blood sugar, only appear when the disease of glucose dysregulation is at a pretty advanced stage, as it takes years and sometimes even decades of imbalance to get to the point where the body is no longer able to maintain normal blood sugar.
So this is not the time we want to be figuring this out, and we do know that type 2 diabetes is generally preceded by a long period of high insulin levels, and high insulin causes insulin resistance, and insulin resistance causes high insulin, so what happens is that eventually the levels of insulin that the pancreas is able to produce becomes no longer sufficient to maintain normal blood sugar in the face of escalating insulin resistance, especially hepatic or liver insulin resistance, which causes our livers to secrete more and more extra glucose into our blood.
So I’ve been of the view that it is just plain common sense that we need to be doing more screening for high insulin, although to be honest, conventional medicine doesn’t really have any answers to this anyway, they are quite eager to elevate insulin levels further. However, they have little to try to limit them, especially for those who don’t actually have diabetes yet, who they aren’t going to be putting then on standard anti diabetic medications, although patients could probably benefit from metformin at this stage, which is fairly benign.
That’s actually the bigger problem, the fact that conventional medicine doesn’t even do a very good job in managing our diabetes once we get it, and certainly doesn’t have much for us in the earlier stages before we even have elevated blood sugar.
So the problem is more than just our properly screening patients, and we do use obesity as a factor in this already, not that this does much good, because obesity is primarily caused by high insulin actually and the standard recommendation don’t do much to reduce it, so the beat goes on, more and more of us are becoming obese from hyperinsulinemia, and more and more of us are of course getting diabetes.
The other day, one of my readers, Dr. Sergio Castorena, a Mexican physician who runs an obesity clinic down there, and from what I can tell a pretty hip young physician indeed, asked me if I knew of any studies that showed that screening for high insulin is preferable to just screening for hyperglycemia, using an oral glucose tolerance test for instance.
My immediate response was that I wasn’t aware of any but we don’t really need any since the link is so obvious, but I realized that I’ve never really looked very hard, and did end up finding a very good study which took place over 24 years, taking non diabetic subjects and following them for all of these years to see what would allow us to best predict the onset of diabetes.
So they measured various things, such as fasting blood glucose, fasting insulin, triglycerides, BMI, blood pressure, and ethnicity, among other things, to see which ones are better predictive of diabetes.
So we would think without looking at the results that BMI would probably win this, as we know that being overweight is a big deal in getting diabetes, although high fasting insulin would probably also do pretty well, although we do see elevated triglycerides with diabetes as well and this does precede it.
Ethnicity does influence this but probably not to the degree that it can compete with these other factors, and high blood pressure is something that also is associated with diabetes but it probably isn’t all that predictive, as a lot of non diabetics have this as well.
So at the end of the study the results were in, and as it turned out, the most reliable predictor of diabetes was actually high fasting insulin, beating even the giant of BMI. When we think of it though, this makes sense, as the pathology here starts with high insulin, and things like obesity, high blood pressure, high triglycerides, and elevated fasting glucose all come later, as manifestations of the progression of the disease, the disease of hyperinsulinemia.
So high insulin won this contest with an odds ratio of of type 2 diabetes of 1.98, BMI over 27 did come in second at 1.86, ethnic origin for people from Yemen came in third at 1.84, although other ethnicities were less predictive, fasting glucose and triglycerides tied for fourth at 1.67, blood pressure was sixth at 1.49, being male came in seventh with 1.47, and then the significance really dropped off, having ever smoked was next at 1.22, followed by being sedentary at 1.11, which interestingly enough only increased the risk very slightly, in spite of popular belief about this.
So this is all pretty interesting and the big takeaway though is that we need to be measuring people’s insulin levels as well here, although coming up with a plan if they are high is an even bigger issue.