Measuring Insulin Resistance
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- čas přidán 8. 07. 2024
- A discussion of who may want to measure insulin resistance, why it’s important, which test to get done, and what the lab results mean.
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- VIDEO DESCRIPTION -
Insulin resistance is a common phenomenon, and not just in people with diabetes or prediabetes. This video discusses reasons for measuring insulin resistance, who should get tested, which lab test makes the most sense, and how lab results can be interpreted.
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- TIMESTAMPS -
0:00 Introduction
2:01 The relationship between blood glucose and blood insulin levels
5:41 Insulin resistance is a risk factor for type 2 diabetes
10:26 Who should get tested for insulin resistance?
14:16 How do we measure if we are insulin resistant?
20:24 Challenge
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For those of you who have already seen the video on the regulation of blood sugar, there are some redundancies with this video here. My apologies for that. I decided to repeat some of the essential information because it's critical to be clear that insulin resistance is not the same as glucose intolerance, i.e., it is very much possible to have normal blood glucose levels but still be very insulin resistant.
As always, don't hesitate to post questions or requests for future content in the comment section.
Cheers
Mario
dear doctor, what is the importance of C-peptide test ( fasting + stimulated) for checking insulin resistance or diabetes ?
Why my doc order lipid test report does not have majority of the discussed test parameter but have other items which are not looked at even by my doctor? Did AMA ever thought about it?
You are doing a great job
@lq😊lee
My father, who suffered from type 2 diabetes for most of his adult life, passed away recently. Officially, it was from multi organ failure, but it all came as a result of diabetes. He also had both legs amputated some years before his death. My dad didn't really take his condition seriously and he paid a dear price for it. I'm really happy that more researchers and doctors are paying more attention to this "silent pandemic" of insulin resistance. So many people are walking around thinking that they are healthy but they aren't. Another thing to add is that my dad was never fat. Thinness doesn't equate to health either. That's why it is so important to go for your checkups and do the blood tests too. Better safe than sorry.
So sorry to hear of your loss.
My dad also recently passed away, and he also had T2DM. His diabetes was better controlled, but he loved his white bread with syrup, his sweets, cakes, and baked goods, and didn't really want to make a more substantive change to his diet. He died of metastatic pancreatic cancer, which may or may not have been related to his diabetes. Diabetes clearly is a major risk factor, and I do keep wondering whether he may have had a few more years with us if he had taken his diabetes more seriously ...
I'll try to do my best to help those people who are motivated to make a change avoid the types of long-term health issues that come with diabetes. Pancreatic cancer, amputated legs, dialysis from chronic kidney disease, blindness, heart attacks and strokes, there are no guarantees that any of this can be 100% prevented, but I do think the risks can be lowered substantially if we take this seriously and adopt a healthy diet and lifestyle.
Thank you for sharing, and again, my deepest sympathies.
Best,
Mario
Professor Tim Noakes who is a marathon runner and very slim had type 2 diabetes. So yes. You can be slender and have diabetes.
Slim people are more prone to t2d. They have less fat cells to store energy so will present with lipid disregulation earlier
Yes i hv been lean all my life, I recently discovered tat my bg always 6ish even after I woke up fr 10hrs of fast. Not sure I'm already prediabetic or insulin resistant coz the place I stay has no doctor checking for insulin. I'm lost what to do to improve myself besides low carb diet. 😢
Agreed. Well said
FYI for those in the U.S., it is possible to find your HOMA-IR pretty cheaply without a doctor or insurance. There are labs online where you can order a fasting glucose and insulin test. They send you to a local lab for the blood draw. I was just able to order one for only $37 with no prescription or insurance.
From the results, I calculated my score to be 5.8, so I definitely have some work to do. Your videos on reducing IR will be extremely valuable to me, Dr. Kratz, as all your others have been.
Good suggestion. Thank you for sharing!
Cheers
Mario
My Dr. Said A1C is only a 10th of a % over into pre diabetes. Not concerned, see ya for your yearly in October. Said nothing about nutrition/diet. I'm so glad I found you.
Yes he is diabetic
I think the best content on blood sugar regulation on youtube is on this channel - thanks Dr Mario for sharing evidence based knowledge translatable into practice with us !
I am cardiologist in Brazil. And after I read Dr. Krafts book i started to use insulin and glucose curve in many patients in risk for IR. I also did it in me (normal!). My HOMA IR is 1. Great videos! Very well done. Congratulations for the chanell. I will keep seeing.
You are doing your patients a great favor. It is now sufficiently clear that insulin resistance and hyperinsulinemia can lead to major health problems long-term, and it doesn't make sense to me that many physicians are resistant to even measure a fasting insulin in their high-risk patients. Considering the burden of associated disease, and costs related to these, we should be intervening way earlier in the development of diabetes.
Thank you for your kind feedback.
Cheers
Mario
@@nourishedbyscience maybe you know the book from Ben Bickman - Why we get sick. He approaches a lot about hyperinsulinemia.
How is homa IR calculated
Thanks to all Dr. Who care about their patients educated provide guidance not just insist medication. I am struggling for 20yrs was searching for help because I was not informed or tested by my doctor 😢 I am on two metformin my dr. Said i have no other choice is to keep increasing medication
And what is your HOMA B doctor? Mine is 54% and HOMA IR 2.1
Finnaly this video has come, thank you! This is the topic of my biggest interest, and I cannot wait to see the rest of this series.
Your plain speaking and presentation is excellent
Kindly be doing what you are doing
It will help a great many of the population
I love your videos and I appreciate your adherence to science based data.
Your fastidious care and rigor to your research are evident. It is a pleasure to bask in the knowledge that you spread. More power to you, Super Mario !
This is my favourite channel. Over the time I've learnt tones of information. A big thank you. I always looking forward to your videos.
These CZcams videos are excellent. Thank you for taking the time and effort to make these!
You are doing those who listen a great service. It is amazing how humans go through a great deal of trouble to avoid a minimal discomfort in the immediate when that slight discomfort would avoid major discomfort for the long run. I hope your videos help many to decide to do the work.
Agreed
This video series has been incredibly helpful and informative. Please keep making content, the quality of the information is excellent. Thank you!
Great video, without hype, promoting, or blame, just straight truth! Amazing! I listen this post twice and I’ll do more in the future…Thank you very, very much! Some confession to make: I already “bing watched”trough all your previous videos!
Thank you for giving us these videos. Your straight forward explanations make it easy to understand for us lay persons. You are doing a fantastic job!.
So glad I found this channel - great presentation, thanks.
excellent video. well presented and not directly or indirectly pushing a million products and services. Very impressed with this doctor.
Thank you so much for this content, very informative.
thank you for all the excellent information. this is my favourite channel for learning about insulin resistance.
You are awesome Mario! Bless you for helping us all keep healthier😊
Another great presentation - learnt so much.
Just discovered your channel through your interview on Sigma Nutrition. I've been looking for a video like this for years! So clear, concise, precise and MUCH NEEDED! Thank you so much! I will support you and tell my clients about you. ~ Marian Blum
I've recently discovered your channel and enjoy the well balanced and researched content as well as your calm delivery. Greetings from Austria 🇦🇹.
Thank you for your kind feedback!
Thank you for your videos. They are so informative and helpful! ❤
As a Nutritionist , one of the best videos I came across, information so well talked and explained with thorough research , much needed for we Indians to understand this concept Of Insulin Resistance.
I´ve never clicked on a video so fast! 🙂 So helpful and insightful! Dankeschön! :)
Me too!
Me too!
and Me Three...thx Mario..:-)))
Why HOMA-IR is not a standard test is crazy. This measurement is the gold standard for health. Anything below 1 is super.
Agree… HOMA-IR is a must go test for all routinely
Excellent explanation. It matches my observation of 18 months of glucose testing.
What an amazing, timely series.Time and time again I tell friends to get their insulin tested only to have their doctors refuse !
Some don’t even know there is a homa ir test?
Tell me about it. It's bizarre how the 'normal' range for insulin is so ridiculously vast, and nothing is done about it. Then one day the dam breaks and your glucose sky rockets. As if insulin hadn't been creeping up, and up, and up for *years*. What's considered normal should be cranked way down, and it should be monitored at least annually.
My GP doesn't even think prediabetes is an issue! I managed to get rid of it with the low carb diet and other lifestyle changes. However, now I got a diagnosis of osteoarthritis and a higher fibre intake for example with legumes is suggested to improve gut bacteria. I am wondering what happens with my next HbA1C in a years time. Unfortunately I am not able to afford a HOMAR IR. Can I win?
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research . New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
They can order it themselves
Always excellent content 👍🏼
Yesss, I was impatiently waiting for another video!
Sorry. I am very slow, I know …
@@nourishedbyscience Do not worry one bit, its absolutely worth waiting.
Excellent, informative video. Thank you for making this information widely available and accessible. Delighted to subscribe to your channel.
Love it, love it, love it❤, can’t wait to see your next videos and some of your CGMs results/data etc
Amazing and informative video thank you!
Great video -- lots of quality information. Very well done. Thank you.
Excellent video, thank you so much
Thank you doctor for your video, I will see if I can get this test.
Thanks for your efforts to bring the attention towards Insulin Resistance, including how doctors will not be of much help in spotting the trend in the beginning stage. Yes, I have been paying for my HOMA test as my insurance would not cover that and any GP would not prescribe it, even when one is diagnosed as diabetic.
Just wanted to add one more popular surrogate measure of Insulin Resistance, that uses Lipid Profile test results, that are usually covered under annual check up -Triglyceride and HDL levels - Triglyceride divided by HDL levels (both are expressed in the same units by a lab, like mg/dl or mmol/l) is a good indicator of Insulin Resistance according to many, including Dr. Benjamin Bikman - any reading more than 2.0 -2.5 (triglyceride level more than 2 times of HDL level), indicates beginning stages of insulin resistance, just like the HOMA test ( but is covered under insurance, though under different context!!). However, for certain ethnicities, this may not be very accurate and threshold also lower for women (>1.75) than men (>2.5) to be tagged as Insulin Resistant. We can also use our previous annual test results to plot our own progression, as all reports would have these two measures available. Just a thought!
Very good point. I considered discussing the TG-to-HDL-ratio and also the TG-to-glucose-ratio in the video, but we do have a lot less data on these as surrogate measured in different populations, and also less data linking these to chronic disease risks. I still think they can be useful for log-term tracking of metabolic health.
Cheers
Mario
Wow, 2 lipid numbers I DO care about! Brilliant of Dr Bikman, et al.
I actually want my TC around 300 (the old, prestatin number). Evidence shows THIS is protective, esp as we age.
Big pHarma is the only reason they dropped the TC numbers -STATINS-
Simple and clear👍
Thank you so much, Mario. I watched your two videos and can tell that I can save a lot of time and stop watching other health related videos. You are so right and to the point that I have literally tears in my eyes…I had to figure out myself a lot, including HOMA -IR. As a child I was accidentally poisoned by Death Cup mushroom and I think that I am paying for this all my life. My body never responded typically, many gut issues, immune system overreacted in strange way. Finally, when I am a senior I start to understand my body…. Hope to learn a lot from your channel. Thank you.
Sorry to hear about your death cap mushroom experience, but glad to hear you made it through alive!
Thank you for your kind feedback.
Cheers
Mario
Thank you ever so much for your quick reply. Appreciated. I can go for 16 on average for fasting blood sugar. I watch your videos with interest. Success.
Great series of videos. Had a blood test last week, which included a HbA1C test, but if I had seen this video I would of asked for a Homa IR test. Thank you - you have a very balanced style of presentation with excellent information.
Is that test available in the usa
If you had fasting insulin and glucose levels done you can calculate your HOMA IR result yourself; it's not a blood test, just a calculation based on those two values, and there are many online calculators which will do it for you.
Thanks.This lecture to my ears like classic music to those love music .
I miss your videos, only so many times that I can re watch the old videos
Really sorry, lots going on recently, and currently, I am on vacation. It's my goal to post more regularly.
Best,
Mario
Please do a video about hyperinsulinemia. When a person has chronic insulin resistance it means they also have chronic high levels of blood insulin. High levels of this powerful hormone circulating in the blood all the time has terrible health consequences; the number one of which is it makes it impossible for the person to burn body fat. So the person has to rely on frequent meals of carbs, sugar, or alcohol - which further increase the insulin resistance and hyperinsulinemia. A vicious cycle disease plaguing the majority of humans on earth. Symptoms of hyperinsulinemia include: Weight gain..
Cravings for sugar.
Intense hunger.
Feeling frequently hungry.
Difficulty concentrating.
Feeling anxious or panicky.
Lacking focus or motivation.
Fatigue.
A number of complications may occur as a result of having hyperinsulinemia, including: Increased uric acid level
Raised triglycerides
Atherosclerosis
Weight gain
Hypertension
Type 2 diabetes.
The earlier a person with hyperinsulinemia is diagnosed, the more likely it is that the above complications can be prevented or the extent of these complications can be reduced.
Thank you kindly
Good informative podcast.
Examples are perfect.
Dr. Bipin Deshpande, INDIA.
Useful information!!👍
I am loving your content. I was able to calculate my Homa IR at 2.6 to 2.9 (depending upon using my fasting blood sugar or my average bs of 120 from my A1c). Now to work on improving my sensitivity. I only have 1/2 a pancreas and I am committed to preserving what pancreatic function I have left.
HOMA-IR is based on fasting glucose only, so your HOMA-IR is 2.6.
Cheers
Mario
@@nourishedbyscience unfortunately 2.9.
I benefited from this chanel. When u plan to eat big amount of carbo eat little carbo before that meal
Thanks Mario very interesting
Danke für ein weiteres, sehr informatives Video!!
Thank You!
Thanks!
Thank you!
Thank you for the very interesting, well produced and informative videos! May be the link between stress (and the other factors) and IR could be explored by you in a separate video(s).
Another awesome, informative video! I’ll be anxiously waiting for more information on how to become more insulin sensitive. Right now, at 2.75, I know I’m insulin resistant. I was only able to get my fasting insulin down to 2 when I really backed off on the grains and starchy carbs. It’ll be interesting to see how your upcoming information aligns with my own experience with diet changes!
great video!
I'd love to hear about how/whether age impacts insulin sensitivity and glucose tolerance and about reactive hypoglycemia. Thanks!
This video here covers reactive hypoglycemia:
czcams.com/video/kxUP0zzBECA/video.html
Age definitely affects insulin sensitivity and glucose tolerance, and age is the second most important risk factor for type 2 diabetes, behind body fat mass. As we will discuss in the very next video, this is because the ability of the subcutaneous fat tissue (=the only safe place to store fat in the body) to expand and store fat effectively declines with age.
Cheers
Mario
I think the term "normal Insulin resistens" is worth a discussion. Most people in modern societies will get a Homa IR far Higher, hence the low one could be namened "good" or "healthy" but not "normal".
Exactly
He does name a fairly low number as normal tho
Optimal seems to be no more than 1 actually
I’ve had diabetes for the last 15yrs. After watching your video I brought my HbA1c levels down by ,5 on just one month!! Another question : do you these videos in a German version for German speaking people? English is perfect for me. Thank you very much for these videos. They are extremely helpful.
Sorry, as much as I wish I were able to also make these videos in German, I don’t have the time to do that. As the number of people who can follow this in English is at least 20-fold larger, I decided to make them in English, at least initially.
I thought as much. I went for my regular check up this week and my doctor asked me for your u tube details to pass onto other patients. 👍🏼👍🏼
Most Germans speak English
I obtained a HOMA-IR of 1.1 based on my 3/18/24 lab report: Fasting insulin = 4.7 and glucose level = 95. 😊
Thx.
Thank you Mario, my daughter is struggling and not getting the help she needs from her Dr. How is it that a Dr. gets himself so busy as to mot be able to see his patients in a timely manner. The PA or NP in office aren't helping her and told her Dr. booked into next year. I have told her to find another physician but in meantime to start looking at your videos. She has every indication of having metabolic syndrome and insulin resistance. I really think your videos are going to benefit her. You have helped me so much. Everything is reversing for me. Now my b/p for first time is low. Weight maintained and feeling good. Thank you.
Her dr or any dr isn’t going to do anything
She needs to take it on herself to go lowcarb/keto.
@@YeshuaKingMessiah you really should read a little more before giving your advice. Metabolic syndrome, NAFLD and others require life long changes. KETO diet is not recommended to be on for more than few months. I see a hepatology Dr. for NAFLD and metabolic syndrome. The diet requires life change and that is for sugar. Sugar is the real danger. The Mediterranean diet is what is recommended and to start with very low calorie like 800 a day to start reversing the fat stored in the liver. She knows she has to do it on her own.
Until someone knows the problem they don’t really know where to start. That’s where the Drs come in.
@@cathyellington7599 epileptics and others live on keto for life. Keto is very healthy. Besides the many many ppl who live on it more “by choice”.
@@cathyellington7599 undereating is the worst thing to do for any issue.
Fasting IS another avenue that can work to move out glycogen from liver. It is hard to do and some ppl have a lot of issues arise at first also.
Fasting is very diff from starving. Your body responds very differently. The worst thing you can do for a metabolic condition is undereat/starve. It sets ur metabolic rate very low too.
IF is a great middle ground or practice whereby u are eating enough, just in a daily window of several hrs. When u eat highfat, lowcarb u also don’t suffer in ur off-eating hrs.
Endocrinologists of any ilk (hepatologists incl) are clueless.
Look up nephrologist Jason Fung, he’s on YT also. He got tired of ineffective protocols for the diabetics losing their kidneys.
IR, fatty liver, obesity, metabolic syndrome, diabetes all are the same thing. Diff names - they’re all related thru hyperinsulinemia. THAT takes time and lowcarb/keto to resolve. Then u must stay aware still of any creep backs, for life. There’s prob a genetic component but it’s majority a lifestyle choice and once you’re damaged, it never completely resolves. Ppl THRIVE on keto.
@@YeshuaKingMessiah yes, you are right about the epilepsy. I was a dialysis nurse for 32 years and RN for 38. Any diet carried to extremes can cause harm. My daughter is pre renal. Told to limit protein. You limit carbs, you limit protein then your body starts to get what it needs from itself. A balanced diet is what is recommended by AHA. Glad you are a fan of KETO. Sure it works but would recommend before anyone stays on it for extended period they get accurate information from non bias sources.
Great video
They should teach this stuff at school.
There is data from Dr. Bozworth that the ratio of the glucose to the ketones mirrors insulin. This is easy to test and might be a good practical test with good data
For people consuming low-carb diets, this may work reasonably well. Not so for the general population eating a mixed diet, however.
Thank you for the video! It would be interesting if you could make a video on leptin resistance.
For sure. At some point, there will be a similar series about body weight regulation. It's going to be a while, though, because I have a lot of plans for more videos about blood sugar.
Cheers
Mario
Dr. Mario, thank you for your wonderful information. It's so comforting to have things explained the way you do. God bless you.
I agree , that can exist high insulin resistant and chronic diseases ….
I think there is an issue with how Type 2 Diabetes is defined (I say this in 'reaction' to the standard medical statement that Insulin Resistance is a Risk Factor for Type 2 Diabetes). The definition of Type 2 Diabetes per a description I found from a Mayo Clinic article is:
"..Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems..."
Starting with THIS definition of Type 2 Diabetes, then yes - Insulin Resistance is a 'Risk Factor'. However - I would argue that the difficulty with regulating blood sugar is a side-effect of the primary disease factor which is Insulin Resistance. I would suggest that public health would be better served by measuring Fasting Insulin levels and Insulin Response Coupled With routine Blood Glucose and HbA1c tests. Type 2 Diabetes diagnosis under my suggested approach would be based on excessive levels of Insulin in the blood OR high HbA1c/blood glucose levels. Conversely, Type 1 Diabetes is a symptom of Low Blood Insulin levels AND high HbA1c/blood glucose levels. Only Type 1 Diabetes should (IMO) be treated with Insulin.
In this regard - I must push back on the assertion made at 7:05 in regard to "Fred" where you Imply that he has low insulin sensitivity (i.e. high Insulin Resistance) because his PRODUCTION of insulin is too LOW and THUS has Type 2 Diabetes. There may be those that fall in that category but I believe there are sufficient studies to show that many diagnosed with Type 2 Diabetes are still producing very high amounts of insulin (in absolute mcU/ml terms). Though High, for those diagnosed with Type 2 Diabetes the amount is insufficient to overcome Insulin Resistance (despite the high Insulin level cells can no longer be stimulated to absorb/use blood glucose and the Liver thus converts the sugar to fat). This is, in fact, MY situation. I am not 'Fred', if anything my production might be HIGHER than Ben's.
I am sensitive about this issue because my father passed away in large part because of High Insulin levels that contributed to Non Alcoholic Fatty Liver Disease and he was prescribed Insulin for Type 2 Diabetes rather than treated to LOWER his Insulin Resistance. The prescribed insulin just made his NAFLD worse, the insulin might have lowered his blood sugar but at the cost of destroying his liver and causing other health issues. He would have been better served by dietary changes (types of food he ate, eating frequency, ...) but his Doctors then followed the 'Standard of Practice' as do most today.
Appreciate your comment. However, note that the diagrams simply mean to illustrate principles, and the axes don't have units of measurement. Fred could be anywhere on the left side of the green shaded area, and you are correct to assert that many people with type 2 diabetes (at least among Caucasian or African race) tend to have quite high insulin levels. Note, however, that many Asians with type 2 diabetes tend to develop diabetes at fairly low insulin levels (because often their problem is more an inability to produce more insulin).
About the definition of diabetes, given that it's focused on glucose levels, I am fine with the current definitions, but absolutely agree with you that much more emphasis in clinical practice should be on insulin and insulin resistance.
Cheers
Mario
P.S.:Sorry to hear about your dad. Mine also had diabetes, and recently passed away from pancreatic cancer.
Thank you for this video. I was recently diagnosed as Diabetic and I have immediately changed my diet to Whole Food Plant Based very-low fat and no refined carbs. I have not gone on meds yet as I asked for 3 months to try to reverse it with diet. I lost 13 pounds in my first month. Two to go. But I want to know if I am changing my insulin resistance and you just gave me a way to do it. I also need to take the C-Peptide test (according to Mastering Diabetes) to figure out if my body produces enough insulin to reverse it with diet alone.
Thank you for this video and upcoming series. This is tremendously informative. I have a question on insulin on storage -hopefully, I didn't miss it from a prior video.
Does insulin trigger a simultaneous storage of glucose into muscles, liver, and fat cells? If so, does that mean that glucose just ends up in fat cells only because the former stores become full/saturated first?
Excellent question, but a straightforward and short answer would be difficult. However, this will be covered in future videos, including in the very next one in which we'll discuss the causes of insulin resistance (because what happens when all of the target tissues for insulin are 'full'?).
Cheers
Mario
@@nourishedbyscience Excellent. Thank you!
Hey Doc' Another great video - well explained. Since you encouraged us to post questions, here's one you might like to help explain. For some time I've been wondering if using blood ketone strips (to measure Blood BHB) might be a simple way of estimating the approximate level or variability of insulin at home? I suggest this for those, like me, who have been unable to get the Doctor to do an appropriate insulin check and/or find it too expensive - including transport costs to a Lab' etc. I thought of this when I heard Professor Ben Bikman say in one of his lectures, "the liver wont produce ketones unless insulin is low". No doubt the situation is much more complicated than I seem to think.......hence me asking the question. Would be great if you could mention something on the subject in a future Video. Kind Regards, Y
I don't think this would be very useful. Dr. Bikman is correct when he says that high insulin levels prevent ketosis; however, that is mostly related to the very high insulin levels after meals. So even if you were insulin resistant, your elevated fasting insulin levels would still be low enough to allow you to enter ketosis. Therefore, whether your fasting insulin levels are indicative of good or poor insulin sensitivity, I don't think you can measure well by looking at ketones.
Best,
Mario
Taking my NMR blood test, I saw that my switch to low carb, non processed food eating has lowered my LP- IR marker/score from 65 to 39.
This was after 3 months of low carb whole food eating. 👍👍👍
That's great. Congrats!
Low carb is KEY
The pharmaceutical industry do not want you to get an early warning of metabolic disease.
It has absolutely blown my mind to learn about how EXTREMELY IMPORTANT it is to control insulin. Insulin management is probably the most important aspect of one’s health. Everything ties back to insulin somehow!
I shy away from making strong statements, and always want to be open to new data to change my mind, but I agree that insulin resistance and hyperinsulinemia (and the issues causing them) are very much underappreciated in preventive medicine.
Cheers
Mario
Wonderful content Vielen dank! A suggestion though: possibly make a numerical reference to each video so one can easily follow the videos in order of production? I enjoy all of them though!
Thank you!
Good idea. As an alternative, you can go to my channel page and look up my 'playlists'. These are in order.
Cheers
Mario
As Mario explained, insulin resistance does not tell the whole story regarding a person's ability to maintain healthy blood glucose levels. The ability of the pancreatic beta cells to produce insulin is also crucial. If the beta cells are capable of producing a lot of insulin, then insulin resistance can go very high before a person gets into trouble with glycemic control. On the other hand, if the beta cells are impaired, then glycemic control will begin to suffer at a lower level of insulin resistance.
All of this to say that while measuring insulin resistance is crucial, we can get a fuller picture of metabolic health by also measuring beta cell function. I went looking for an inexpensive test of beta cell function and found that the HOMA model itself provides an indicator called HOMA-B (or HOMA-ß) that serves this purpose. Better still, it requires only the same two inputs that go into the HOMA-IR calculation: fasting glucose and fasting insulin. Higher HOMA-B numbers indicate a greater ability to produce insulin.
I also discovered that there is an improved, more accurate version of the HOMA model called HOMA2. The HOMA2 model is considerably more complicated, so you need to use a HOMA2 calculator rather than trying to do the calculations by hand. I got mine from the Radcliffe Department of Medicine at the University of Oxford. Google 'oxford homa2' and you'll find it.
Normal ranges vary by population, so you need to be careful in interpreting the results, but I found these ranges in one particular study:
HOMA2-IR in non-diabetics: mean 1.16, standard deviation 0.31
HOMA2-IR in diabetics: mean 2.61, standard deviation 1.06
HOMA2-B in non-diabetics: mean 113.10, standard deviation 30.56
HOMA2-B in diabetics: mean 47.10, standard deviation 24.67
This is why normal just means common
Not OPTIMAL (optimal is currently at no more than 1 on standard HOMA-IR)
Getting a T2 “good enough” isn’t good enough! They can actually eliminate the T2 *and* NAFL (fatty liver) if they go keto. It takes a lot of patience and strict adherence but after months of it, change will be visible (fat loss), not just slowly internally healing.
Thx for the calculator info, wish u had incl a link.😮
I would like a video about control of blood sugar (type 2 diabetic) + breast cancer.
Added to the list!
Thank you for the suggestion.
Cheers
Mario
@@nourishedbyscience thanks it would be very helpful. My mom is going through this and I want to help as much as I can.
It would be wonderful to see what research you are familiar with for people living with T1D. We tend to be forgotten in favor of info pertaining to T2. I use both a CGM & an insulin pump. Thank you for your videos.
I do intend to have some videos for T1DM as well, but my primary expertise is on T2DM and related metabolic disease, as I have studied this professionally for ~20 years.
Cheers
Mario
There is a channel called "Type 1 Talks" He shares a ton of information with his personal 30+ years of being Type 1. Tons of great info
thanks for the video. Can you site any research that supports the statement "maximum beta cell output is largely genetically determined"? I was not aware of that. Thanks!
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research. New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
Thank you for your comment. Yes, Dr. Kraft certainly is a pioneer in this area, but - to be honest - even if someone has never heard about Dr Kraft, we now have so much data that clearly links insulin resistance and hyperinsulinemia to numerous chronic diseases, it doesn't make sense that primary care medicine contiues to ignore it. Glad to hear you are helping patients get these tests done.
Cheers
Mario
I requested the Fasting Ins test, but they gave me c-peptide instead. do you know if there is a calculation using cpep? OR is there a 1:1 ratio for the c-pep and Ins?
A few measures of insulin resistance based on C-peptide have been proposed, but none of these is as widely used as HOMA-IR. If your fasting glucose is in the normal range, C-peptide at the low end of the normal range (whatever that is for the lab that ran your test) will be indicative of good insulin sensitivity.
Cheers
Mario
Subscribed! I'm 1,8 on the scale, but still insulin resistant judging from the glucose response after carbs. Coming from 3,8 though, so reversal seems very possible.
Always also consider that glucose tolerance is also dependent on the ability of the pancreatic beta-cell to make enough insulin. So even at HOMA-IR of 1.8, it is not out of the question that elevated blood sugar after a meal could be related to a reduced ability of the beta-cells to make enough insulin.
Cheers
Mario
@@nourishedbyscience Might be, but coming from a lot higher fasting insulin suggest that insulin resistance has been established for sure. So only craft test would tell the real story, but with or without it I would eat healthy anyways so spikes are not an issue anyways. Btw I spike to 140 with a 100gr of ice cream for example.
@@user-ij8no5zw6u- If you watch any of my last three videos, you will see that I define a blood sugar spike as an increase to 180 mg/dL, and I explain the rationale for this. To me, there is little to no evidence that fluctuations within the range from 70 to 140 mg/dL are harmful.
Cheers
Mario
@@nourishedbyscience Yes, just saw your definition, but I tend to prefer to be on the safe side because one more thing - I may not spike super high, but going back to normal takes too much time like 2-3 hours. For me the healthy individuals have a bit faster spike witch is both lower and also they go back to baseline a low faster in a 1-1,5 hours. There's bit of a correlation, it you spike over 140, you'll probably take a lot or time to get the 90 again.
In all scenarios, carbs are fast energy and we have only 4gr of sugar in our bloodstream, so spike or not, if one is sanitary then 40gr of carbs are very unadvisable to consume. They have nowhere to go in the next hour except being stored by the use of insulin. Hyperinsulinemia will probably be inevitable ...
@@user-ij8no5zw6u- If you are happy with it, certainly nothing wrong with trying to keep your blood sugar lower.
Dr Kratz, I’ve recently watched Professor Taylor’s studies on T2DM regression and the role of the liver’s insulin resistance which, Dr Taylor says, is not the same as muscle tissue insulin resistance, I’m unsure as to the distinction. How is the Insulin Resistance [IR] test that you’ve posted here related to these two forms of IR?
Thank you
Well, in general, all insulin sensitive tissue have their own level of sensitivity to insulin, and they change dynamically as certain things happen in the body. Also, the degree to which the different tissues are sensitive vs. resistant to insulin varies depending on the cause(s) of the insulin resistance. In practice, I'd say this is more of academic interest, because most people who develop insulin resistance in their fat tissue also develop insulin resistance in their liver and muscle, and vice versa.
HOMA-IR is based on fasting insulin, and because insulin acts mostly on the liver in the fasting state, one could argue that HOMA-IR is mostly a measure of liver insulin resistance. However, HOMA-IR is also strongly associated with measures of overall insulin resistance, such as those based on dynamic tests (OGTT or clamp).
What Dr. Taylor says is still correct, and particularly relevant in the context of the types of interventions he runs where people reverse insulin resistance and glucose intolerance by very low-calorie diets. He wants to understand the mechanisms of the interventions, and therefore he very particular about trying to figure out the time course of changes in insulin sensitivity in all of the different tissues. That makes sense for him, but personally, I don't think the average person needs to worry too much about these details.
Cheers
Mario
Mario, could you at some point just touch briefly on the second meal phenomenon, that you’ve made reference to before? I eat oatmeal for breakfast and try to match the carbohydrates in the oatmeal with the carbohydrates in beans for lunch, I figure that since I consume more fiber at lunch I can add to the carbs that I ate with breakfast. Any studies on carb matching? If you’ve succinct information on this issue it’d be much appreciated
Thanks,
Rafael
Hi Rafael,
I don't think it would be necessary to match the carb content of meals, and it would strike me as overly complicated to do that regularly. The general idea is simply that if you eat carbs at one meal, then the beta-cells store more insulin pre-made and they are better able to handle carbs at the next meal.
I talk in more detail about the second meal effect in this video here:
czcams.com/video/LVw60RIhbzg/video.html
Cheers
Mario
y tambien pudiera ser al contrario?, que la glucosa en ayunas sea mayor a 100 y que ya no haya resistencia a la insulina?
It's possible to have fasting glucose > 100 mg/dL and still be insulin sensitive, if the beta-cell fails (as in type 1 diabetes). It's more common though that someone with fasting glucose > 100 mg/dL will be at least a little bit insulin resistant though.
Cheers
Mario
Very informative for lay person to understand and get the Homa ir test done. How does hba1c fit here? In India the test is very common to decide if you are prediabetic or diabetic.
Fasting glucose and HbA1c (and potentially the 2-hour value in an OGTT) are still the measurements used to diagnose diabetes, or pre-diabetes. HOMA-IR is not relevant for the diagnosis of any disease (which is why it's not commonly done).
Think of fasting glucose, 2-h glucose in an OGTT, and HbA1c as diagnostic criteria of a disease, whereas HOMA-IR is a risk factor for disease (more similar to LDL-cholesterol). If someone has type 2 diabetes, they are almost always at least somewhat insulin resistant, but HOMA-IR can also be elevated in people without diabetes or pre-diabetes, so that's where it really has value because then you can intervene early to reverse the insulin resistance and prevent the progression to pre-diabetes and diabetes.
Cheers
Mario
@@nourishedbyscience Just call it PPD test. Pre-pre-diabetic test and it would make sense.
@@KoiRun50 The problem is that even if someone has elevated fasting insulin/HOMA-IR, suggesting that they are at increased risk, on an individual basis it is still thought of as a poor marker of diabetes risk (because you never know how much insulin a specific patient will be able to make, i.e., they may never become glucose intolerant even if they are already very insulin resistant). I think this is inconsistent thinking. Similarly, one could argue that not all patients with hypertension and elevated apo B develop CVD. That is true, but still no reason to ignore these risk factors.
Cheers
Mario
@@nourishedbyscience Good explanation. Thank you. I think our government and doctors should give more publicity to homa ir considering India has large population of diabetics and prediabetics. An ounce of prevention is better than a tonne of cure.
Exceptionally good video, thanks Mario! Is waist circumference not a good proxy for insulin resistance without all the trouble and loss of time?
Thank you.
Yes, waist circumference is reasonably good to detect obesity-associated insulin resistance, which accounts for most cases these days. However, there are many other causes of insulin resistance (as we'll discuss in the next video), such as certain medical conditions, certain medications, chronic stress or sleep deprivation, very low muscle mass/sarcopenia, etc., and none of these would necessarily be reflected in waist circumference.
Cheers
Mario
@@nourishedbyscience Agreed! But even stress induced IR will probably have a big waist (cortisol). If anything, i'd say that if one has a big waist to start with and has a lab confirmed IR, then the dynamics of the waist mirrors the dynamic of IR. Would you agree?
@@Jack_SchularickI have chronic high stress, concerns about diabetes, and ZERO excess fat (perfect/narrow “waistline”, size 0 clothes), so I’m with our PhD here, that waistline IS useful for many - but other factors must also weigh in.
@@eugeniebreida1583 Agreed. Yesterday i had a patient with a normal waist, a biologically young and fit 60 ys old lady, and already type 2 diabetes and breast cancer. Sad. Probably a very strong family disposition. But most insulin resistant do have big bellies.
@@Jack_Schularick That is very sad . . . yes, could be a disposition for eaither or both.
In that you are an MD, may I ask which woul be teh best IR labs I could request of less enlightened GP in order to get the highest level data w/least strain on his/her ego?
Much appreciated. (there is no concern as to lab cost). Thanks, if you would be so kind. (and thank you, as well, for giving me hope that I am a pretty healthy skinny 64 yr old in terms of diabetes potential. I have an inflammatory issue, however, which leaves me nervous, and impatient to know IR status)
Is there any benefit in having a Homa-ir test if you are already diagnosed with T2 and are taking medication for that? Or is it purely for those who are either pre diabetic or concerned about pre diabetes.
There is value in HOMA-IR still, but less so, because therapy will aim to improve glucose control, and any improvements can more reliably be assessed by monitoring blood glucose or HbA1c. Also, depending on the type of diabetes, how advanced it is, and the causes of the glucose intolerance, HOMA-IR may be less reliable an indicator of insulin resistance in people with diabetes than in healthy people.
At the same time, it’s even more important for people with type 2 diabetes to try to improve their insulin sensitivity. And any such improvement should be very quickly reflected in better glycemic control.
Cheers
Mario
Seems that you would need to know if insulin levels behave as expected (compared to a non diabetic) then it would somewhat rule out it being insulin levels (thus possibly not needing insulin shots for example) and if glucose levels drop during higher intensity exercise then that pathway may be normal bit the insulin pathway sensitivity or mechanisms aren't
information.. should need to be known everybody whether above 45 or below 45 .. to be his own health care guy🐸🐸
You have answered a lot of my questions. I still not sure about the relationship between my higher morning numbers that continue to rise especially is I am busy around the house. Low carb eating keeps number in good range but not eating make them rise. Is my body not producing insulin when bs goes up even if I have not eaten. BTW. I’m 75 and managing my T2D without medication.
I cannot comment on your case specifically, as I know too little of your medical history. Just two things to consider in general: one is the dawn phenomenon, where blood sugar levels rise upon waking. This happens in everyone, but tends to be stronger both in people with diabetes and also in people on low-carb or Keri diets. This means that both the diabetes and the low-carb diet could lead to a more pronounced dawn effect. The second point is that we cannot forget about glucagon when discussing blood sugar. I may make a separate video about it. One known issue is that usually, insulin being secreted by the pancreatic beta-cell inhibits glucagon secretion by the alpha cells. If now someone with diabetes, even type 2, makes too little insulin, in the fed as well as the fasting state, it would make sense that the suppression of glucagon production could be insufficient. And maintaining higher glucagon levels could then lead to elevated fasting glucose levels. Only when getting another boost to insulin secretion with a meal is then the insulin release and the glucagon suppression sufficient to lower blood glucose. And yes, by the way, there is a boost to insulin secretion even to low-carb meals, as long as some protein is eaten.
Sorry if this is too complicated, but it should make more sense once you look up what glucagon does.
Cheers
Mario
Thank you for your response. Keep making these great videos. Since I am managing my blood sugar without medicine your information has been very helpful. Looking forward to a Video on understanding more about glucagon.
Question :
My A1C has been 5.5% for a long time, but fasting glucose was 111, so higher than the A1C might lead one to expect. Am I pre-diabetes?
Also, I often eat a huge bowl of steel-cut oats for breakfast. 200grams when dry, soaked in water overnight, and then eaten with cinnamon and blueberries added. No milk, and no added sugar. Is that too large of a glycemic load? I thought that steel-cut oats are safe, but is the quantity I eat too high for it to be daily or near-daily?
With a HbA1c close to the pre-diabetic range and fasting glucose in the pre-diabetic range, you may want to discuss with your doctor whether it makes sense for you to wear a continuous glucose meter (CGM) for a couple weeks. It is well possible that you realize to which foods your blood sugar responds the most, which would allow you to minimize these, or to change the meals to lower the blood sugar impacts of these meals, as I outline here:
czcams.com/video/yg0Y3eNSANg/video.html
Cheers
Mario
This is a very accessible channel. Still - it seems to have synthesized the works of people I've been following for years if not decades - Lustig, Ludwig, Attia, Fung, Diet Doctor, and on and on. I'm always wondering how much these youtube experts are cribbing from each other!
Ha, always good to be skeptical.
I am certainly not claiming to be perfect, but I do not watch other people's content when making these videos. Instead, it's all based on my own research. In many cases literally my own research in my own lab (I was an academic clinical researcher for about 25 years), and otherwise by studying the scientific literature. I invite you to click on the links to my blog post that you'll find in the description box underneath each video, and that will show you all of the scientific publications that were considered for each video.
Best,
Mario
@@nourishedbyscience Thank you, good to know.
hey
love your videos.. discovering this channel was an absolute bless
have a question here.. whats the difference between Homa-IR & Homa IR2 tests?
One is calculated with the simple formula I shared in the video, the other is calculated by computer.
Cheers
Mario
thanks for answering
will the same range apply in this case? i was diagnosed with 2.35 Homa2 does that make me borderline?
My HOMA-IR is 4,4. I do not know, what this number means. Is it so bad?
@@inasbriek i guess u need to see a doctor for further examination just to be more in the safe side.. stay safe
Por favor videos traducidos al español
Very valuable, objective and scientific knowledge covering various aspects of Insulin resistance...
Is there a way to calculate this whit fasting Glucose and C-peptide value??
Yes, and that's even better because c-peptide tends to be less volatile than insulin. However, the interpretation is not as straightforward, as we have fewer data linking c-peptide-based HOMA to health outcomes. Still, you can probably google the formula (depends on your units of measurement as well, so pay attention to that).
Cheers
Mario
It is very unfortunate that the whole medical world is corrupt. As a diabetic for past 18 years, not even one doctor has suggested HOMA IR until recently. I reduced my A1C from 12.4 to 6.0 in about 30 days just by changing diet and exercise. HOMA IR came out at 4.2. Imagine, if any Doctor would have tested this and asked me to make lifestyle changes earlier. The world is just too corrupt. Fortunately, I signed up for a remission program that has already resulted in lower LDL, Pressure and Diabetes medications. Hoping to get to A1C under 6. Looking for help on Insulin Resistance reduction back to under 2
Is the fasting time at least 12 hours? What about if the fasting time is 16 hours? Is there a time frame like between 12 hours and 16 or 18 hours of fasting or what you recommend? Thanks.
In general, the recommendation is to do it after at least 12 hours of fasting. Could.be longer.
Cheers
Mario