Prevention - the early bird gets the worm!

Have you been told that you have insulin resistance or pre-diabetes? Does type 2 diabetes run in your family and you would like to avoid it? Or are you simply health conscious and interested in not just living longer - but living longer healthier?

Whatever your situation, I would like to say - bravo! The fact that you are here reading this means that you have already done more than the average person - you are considering taking steps to improve your health before someone gives you a diagnosis.

How diabetes is diagnosed 

Modern medicine will tell you you have type 2 diabetes if:

• Your fasting blood glucose level is > 125 mg/dl; or
• Your haemoglobin a1c (HbA1c) is ≥ 6,5 % (This is the percentage of your red blood cells to which glucose is stuck).

This is usually when your doctor will react and perhaps suggest medication. Of course, if your doctor sees that you are heading that way - i.e. your fasting blood glucose is between 100-125 mg/dl and your HbA1c is between 5.7 - 6.4%, they may warn you that you have "pre-diabetes" and tell you to "eat healthy and exercise". 

Room for improvement

How does the body reach the point where too much glucose is floating in the blood instead of going into the cells and being turned into energy? Do you just wake up one day and, hey presto, you have diabetes? You know the answer. The process starts decades before the dysregulation reaches the level where it is given the label of "type 2 diabetes". But here is the nuance:

The body regulates very tightly what is going on in the blood.

It needs things to be within a certain narrow bracket - not more not less - whether it is blood pH, gases, minerals, or glucose. As for glucose, the body needs it be between around 80-90 mg/dl when you are not eating.

In an average adult that equates to about 

1 teaspoon of sugar floating around in the blood.

Imagine now what will happen when you put 20-25 teaspoons equivalent of sugar into the blood stream all in one go. (Does that sound like a lot? In fact, that can be an average breakfast that includes things like cereal (out of a box), instant oats, fruit juice, bread with jam ... you get the idea). 

When your body sees all that glucose, the first thing it will try to do in order to protect you is to try to get it out of the blood as fast as possible. In order to do that your pancreas will secrete the hormone insulin - and it will secrete a lot of it if there is a lot of glucose. It will do that every time it sees too much glucose - so if you constantly have a lot of glucose going into the blood your insulin levels will reflect that.

If this happens often and over a long time and if your cells are already full to the brim with stored energy in the form of fat, they will start closing the door and not letting that glucose in (this is called "insulin resistance"). 

When that happens, your pancreas will keep making more and more insulin to try and force that glucose into the cells and out of the blood. Initially, this strategy will work and the glucose will be stuffed into the cells whether they like it or not. But the longer this goes on, the harder it will become. That is when glucose will stay floating in the blood for longer and will show on a blood test as a higher fasting blood glucose and higher HbA1C and a diabetes diagnosis will be given - years, if not decades, after the damage began.

A high insulin level in the blood is an early indicator that the body is struggling and will go on to develop type 2 diabetes is no action is taken.

How you can be proactive

Ask your doctor to measure your insulin levels

This higher insulin level can appear on a blood test many years before high fasting blood glucose. That's why it is important to be proactive and ask your doctor to test that in your blood test. It can be done fasting. 

You can also ask for the Homa/Quicki index. These are simple calculations based on your fasting glucose and fasting insulin levels and will give you an indication of how insulin resistant/sensitive you are. The lab should be able to do this for free by putting your glucose and insulin values into a formula - or you can do that yourself by using an online calculator. 

However, the absolute best way is to test insulin, together with glucose, during a 2hr glucose tolerance test. If glucose is normal but insulin is high it means that your body already has to work too hard to get the glucose out of your blood and into your cells and its time to take action to reverse that.

Unfortunately, these tests are not the standard of care, so you would need to specifically request (and perhaps insist) that they be done. Modern medicine will not treat insulin resistance with medication until blood sugar appears high, thus resources are not prioritised to detect it. Reversing insulin resistance is done with adjustments to "lifestyle" and doctors do not have time for this. It is, therefore, up to you to be proactive to find out and take action early. 

What if you don't want to wait until another blood test?

Measure your blood glucose yourself

The good news is that there are diagnostic tools you can use yourself without going to the lab or to a doctor. You would need to buy a blood testing kit at the pharmacy - it costs around 30€ - and test your blood sugar 1hr and 2hrs after the start of your meal. Do that especially with meals that contain a lot of carbs (i.e. starches or sugar.) 

If you see that your blood sugar regularly goes about 140 mg/dl at the 1hr or 2hr mark - its time to take action!

If you want to take self diagnosis to the next level, you can invest in the Rolls Royce of blood sugar testing - a continuous glucose monitor (CGM). It costs about 65€ for a two week patch. It will be like watching a movie instead of a snap shot. You can see your blood glucose constantly on an app on your phone over the entire period. You will see exactly what that innocent and healthy looking bowl of oatmeal really does in the background (Spoiler Alert: its not pretty!) Why is this the absolute best diagnostic tool? Because your CGM metrics start to look concerning years before you might fail an Oral Glucose Tolerance Test and a decade or so before your HbA1c starts to look concerning. (The famous longevity doctor, Peter Attia, explains the merits of a CGM very well in this article).  

If after 2 weeks your cgm shows that your average blood glucose is >100mg/dl and your standard deviation (how much your blood sugar varies up and down) is >15 - it's time to take action!

A note of warning: CGMs are not for everyone. If you are struggling or have struggled with an eating disorder or just know that constant tracking would stress you out - there is no need to add extra stress. Use one of the other ways described above. 

However you decide to do it - do not delay! There is plenty of science out there that shows that constantly high insulin levels and glucose peaks of > 140mg/dl cause cumulative damage in the body over time. I will spare you the details - my aim is not to stress you out. Unfortunately, despite the evidence, modern medicine only intervenes with the tools it has only when the fire is already raging. 

I am absolutely convinced that if more people took these simple diagnostic steps and took early action to help their body return to a place of balance we would not be seeing the rates of chronic metabolic illness that we see today. 

My aim is to empower you to be proactive about your own health and to help you to take action now so that you never have to receive a diagnosis.