Labs and Insulin Resistance: Where On The Spectrum Are You?

Are you ready to take control of your health?

In this episode of Metabolic Minutes, Nurse Practitioner Elizabeth dives deep into the science of insulin resistance and the key lab values that help identify and reverse metabolic diseases like obesity, prediabetes, and type 2 diabetes. Learn how your fasting glucose, fasting insulin, hemoglobin A1c, and C peptide levels provide critical insights into your metabolic health—and what steps you can take to regain control.

What You'll Learn:

• What insulin resistance is and how it affects your body
• The importance of fasting glucose, insulin, and C peptide in detecting metabolic diseases
• What hemoglobin A1c levels reveal about your long-term blood sugar control
• How stress, poor sleep, and diet contribute to insulin resistance
• Why HOMA scores are vital for understanding your metabolic health

Memorable Quotes:

• "Insulin resistance is like an annoying neighbor that keeps knocking on the door—your cells just stop opening up!"
• "A high fasting glucose means your liver is too busy cleaning up your diet's mess to do its actual job."
• "Understanding these labs is like creating a map to navigate your way out of metabolic disease."

Resources Mentioned:

1. Labs to Request from Your Doctor:
   • Fasting Glucose
   • Fasting Insulin
   • Hemoglobin A1c
   • C Peptide
   • HOMA IR and HOMA 2B Scores
2. Previous Episodes to Reference:
   • Episode 1: Why Your Diet Matters for Metabolic Health
   • Episode 2: Top Foods to Reverse Insulin Resistance
3. Recommended Reading:
   • The Diabetes Code by Dr. Jason Fung
   • The Obesity Code by Dr. Jason Fung

Take the first step towards reversing your metabolic disease by asking your healthcare provider for these key lab tests and start tracking your progress. Don’t forget to subscribe and share this episode with someone who might benefit!

Transcript

[00:00:00] Introduction to Metabolic Minutes
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Elizabeth, NP: What is happening is the muscle cell doors are getting fatigued of seeing. Insulin and glucose hanging outside its door all the time. It's like an annoying neighbor. Hello, can I get just one more ride? I promise I won't ask again.

Voice-Over: Welcome to Metabolic Minutes, the show where veteran nurse practitioner Elizabeth is going to break down all the science y stuff about how to reverse metabolic syndromes like obesity, prediabetes, and type 2 diabetes, all without needing a biology degree or a nap.

Ain't nobody got time for that. Just watch. Those quick tips to help you build your battle plan to repair your broken metabolism. Let's crush this.


[00:00:42] Understanding Insulin Resistance
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Elizabeth, NP: Today, we are going to tackle my favorite subject, which is the metabolic lab work that I would like everyone to have and how it relates to insulin resistance.

One in three Americans is insulin resistant, 2. 84 billion people in the world are insulin resistant. So, if you struggle with. Being overweight, having obesity, are type 2 diabetic, type 1 diabetic, we all have a degree of insulin resistance. And the labs we're going to go over today are going to help explain how that insulin resistance occurs in your body.

And what we can do about it. So let's get started.


[00:01:24] Hemoglobin A1c Explained
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Elizabeth, NP: Everyone that's listening to this that's ever been to a doctor may have heard of this lab value. So this is called the hemoglobin A1c. This is an estimate of what your blood sugar runs by looking at the glycosylated hemoglobin. Basically, your hemoglobin and how much sugar is around it.

And it gives us a percentage on what. your blood sugar has probably been in the last three months. So a hemoglobin A1c above 5. 6 to 6. 5 [00:02:00] is considered pre diabetic, which means you have insulin resistance. And if you are above 6. 5, you are into the diabetes. Now, with every degree it goes up, the more severe your diabetes is above 6.

5. So generally an 8 percent hemoglobin A1c is going to translate to an average daily blood glucose in the 180s. Our goal would be to have it below 140. And that would even be after you eat. So, this is an example of how much higher it is than what you want your baseline to be. 9 percent is going to be in the 200s, the low 200s.

10 or 11 percent is what we would call severe hyperglycemia. If you've been told you have a hemoglobin A1c in the 10 percent or 11 percentile, then your diabetes is considered severe and you need immediate intervention. Now. The other important and often unaddressed.


[00:03:06] The Role of Fasting Glucose
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Elizabeth, NP: value that is in your yearly labs or quarterly labs is the fasting glucose.

And that's one important caveat to understand when you go to get labs, we're going to get the best information when you are fasting. What is fasting? Fasting means you have not eaten for eight to preferably 12 hours. So say you finish dinner at six, you don't eat again until After your lab, say your labs are at 6 a.

m., that would be ideal to get the best values. Your fasting glucose tells us how well your liver is working at night. And you're sitting there going, well, wait, I knew diabetes had to do with, you know, my muscles and my pancreas, but Where does my liver play? So the liver is very important at fat energy storage [00:04:00] and basically repackaging.

So when you go to bed at night, when the sun goes down, you have a lot of hormones that start turning on and your liver tries very hard to basically clean house, get rid of energy stores that you do not need. So. Unused glucose that was packaged. Um, it's it gets rid of unused fat that you don't need. Okay, this this works best when you are in a fasting state, which should be when you sleep.

Now, if your fasting glucose is high, it generally means that you are well in your In your way to insulin resistance, your body has accumulated way too many unused energy stores. It's trying to get rid of them by putting all that extra glucose that it didn't use into the bloodstream so that it can be metabolized.

So whether by the muscle cells while you're fasting or flushed out through your kidneys. If you eat a carby meal at night, especially after say six, then it's kind of like. You're getting ready for the maid to come and then all of a sudden you let your kids run around the house and everything's on the floor.

So the maid comes in, which is the liver, and goes, Oh, this is not doable. And one, one day, one night, and they spend their time. Dealing with picking stuff off the floor rather than dusting and doing all the details. So that's what's happening. If you have a high fasting glucose, you are on your way. If you haven't been told you're diabetic, you're on your way to it.

And many, many, many of us have been faced with a high fasting glucose at some point. It can also be impacted by stress. It can be impacted by poor sleep. All of these things are very important to address. when you're trying to correct your broken metabolism.


[00:05:56] Importance of Fasting Insulin Levels
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Elizabeth, NP: The next thing that we like to draw [00:06:00] is what we call a fasting insulin level.

So what the insulin level is in the blood when you're fasting. A high insulin level, generally above six means that Your pancreas is having to secrete a lot of insulin. Well, why does the pancreas secrete a lot of insulin? It does in response to the amount of carbohydrates you consume. And if we see that your insulin is high fasting, it is concerning that your pancreas is having to work extra long and extra hard secreting insulin because even when you're sleeping, your liver is too busy picking up the stuff off the floor and then going, Oh, I have all this other stuff to clean.

And when it puts glucose in the bloodstream that it wants to be metabolized, your pancreas is having to respond to that. And if it's having to secrete too much insulin, it tells us that you're wearing your pancreas out. You are driving at 200 miles an hour, and the belt on your car is going to break, okay, or your gear shift is going to get stripped.

So know that just as important as fasting glucose is a fasting insulin. It gives us much better insight into how poor your diet is, what poor energy sources you're consuming. And it also tells us, How far along in the insulin resistance you are. So how severe is your metabolic disease?


[00:07:35] C Peptide and Pancreatic Health
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Elizabeth, NP: The other value that I don't see done enough, in my opinion, um, and I've been practicing almost 20 years, It's a lab called a C peptide.

So the C peptide is basically a protein that gets released when your beta cells in your pancreas are having to secrete insulin. Why do we care about that? So remember when I was talking [00:08:00] about wearing your pancreas out? The C peptide gives us a little bit of an idea on how worn out these cells are in the pancreas that make the insulin.

So If you have a normal C peptide, but don't worry as much, it usually means that your beta cells are functioning fine. If your C peptide is on the higher side, so above, say, 4. 5, it depends on the lab parameter, but just even slightly higher than 4. 5, We would consider that you are starting to wear your pancreas out.

It's getting tired. It is, it is, it's going to burn out if we don't make an intervention. If your C peptide is low, this tells us that you may actually have Injured some of your beta cells, it's actually not able to keep up with the amount of glucose that is put in your bloodstream by you through your diet or through your liver.

Now we come to my favorite. These are not necessarily labs, but they are fancy calculations that we get from all the values that I just went over. What we're going to be talking about now is something that I would love for you to ask your primary care provider to perform on you, and it gives us an idea of where on the insulin resistance spectrum you are, whether you are overweight, you have obesity, You have some kind of diabetes.


[00:09:30] HOMA Scores and Insulin Resistance
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Elizabeth, NP: These are called the HOMA scores. And what they do is they let us know to what degree, what section of the metabolism is broken. They tell us what your insulin resistance levels are. and your pancreatic function is. So the HOMA IR scores, they are telling us how the muscle cells are [00:10:00] responding to the insulin and to the glucose.

So when you eat, you start digesting the food. It goes into small particles. It goes into your bloodstream. Once it's in your bloodstream with insulin, which has been secreted in response to feedback it's getting from the small intestine. What is supposed to happen is that the insulin acts like a key and it opens these doors on your muscle cells and lets the glucose in to be metabolized.

Now, if you are running a marathon, there would be no problem. It needs that energy. But if you're sitting at your desk after you had a brownie and there's a lot of glucose in the bloodstream. And this is a frequent habit of ours of being sedentary and eating ultra processed foods. then eventually you're going to develop insulin resistance.

And that key being the insulin is not going to be able to unlock that muscle cell door. What is happening is the muscle cell doors are getting fatigued of seeing. insulin and glucose hanging outside its door all the time. It's like an annoying neighbor. Hello, can I get just one more ride? I promise I won't ask again.

And they're constantly pestering you and the muscle cell door just goes, you know, I'm not, I'm not going to be hospitable anymore. I don't want these. These things in here, I am changing the lock on the door and I'm not going to let it in. So that is essentially what insulin resistance is, is that your muscle cells just stop receiving the insulin, which is the key to unlock the door and they will not let glucose in anymore.

And you may ask, well, what happens then? You know, the glucose just sits in the bloodstream. Well, let's imagine what that would do. That is causing blood sludge. Oh, yuck. Like that is so gross. Blood sludge might. give you cardiovascular [00:12:00] disease. Another thing that's going on is your kidneys are trying really hard to get rid of the excess.

So they go, Oh, wow, this is really building up in the bloodstream. I really need to help, help the body get rid of this. And so they work hard trying to get rid of the glucose, which puts strain on them. So you can see why it's of great urgency when someone is in the insulin resistant spectrum, whether they're overweight, obese, It's pre diabetic or anywhere on the diabetic spectrum.

We are trying very hard to get that glucose out of the bloodstream. And unfortunately, in medicine we've always just relied on meds. We don't do a lot. At least until now with dietary management. So the HOMA IR scores tell us how receptive your muscle cells are to glucose and insulin. Now there's another set of HOMA scores.

These are called the HOMA 2B. And the HOMA 2S scores, and they are telling us what degree your pancreas is involved in its production of insulin and how the sensitivity is in your body as far as that lock and key mechanism. So, if you have a low HOMA 2B, we generally are concerned that you've Kind of worn your pancreas out, we will look at the score along with that one that I referred to earlier that C peptide to see just how worn out it looks because you may find yourself being more insulin dependent.

Now, miraculous things happen with nutrition, if you have good inputs and you are eating the foods that I mentioned in the first and second episode. Then you can actually help your pancreas rest. You just need a Licensed practitioner doctor to help you through this, [00:14:00] and I'm hoping that that's what this podcast can help you do too, is start to have these good conversations with your healthcare provider and see if we can move the needle and reverse your metabolic disease.


[00:14:13] Conclusion and Final Thoughts
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Elizabeth, NP: Alright, I know that was a lot to digest. You may find that you need to listen to this episode a few times and that is totally normal. The first step to change is knowledge, which was. Hopefully provided to you in this episode, and then to reflect on awareness. How aware are you of what you are putting into your body?

All right. That gives you enough to think about deep thoughts until next time. 

Voice-Over: The information provided in this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified health care provider with any questions you may have regarding your condition. Never disregard professional medical advice. Or delay seeking it because of something you have heard cast. The opinions shared are our own and may not reflect the views of your healthcare provider.