How to quickly screen for diabetic risk - what tests are important for diabetics?

If you watch TV, you’re likely to see commercials about prescription medications for diabetes. These advertisements depict a scene that many want – happy, healthy, and functional. If you close your eyes and listen to the commercials, you’ll find that a significant amount of information is provided at the end about risks of taking the medication. Try it!

With so many people living with diabetes, the term is used so often that we either think that we will never get this, or that if we do there are many medications that will keep it under control. But what we can’t picture are all the risks – blindness, Alzheimer’s disease, amputation, debilitating heart attacks/strokes, weight gain, and the financial repercussions are among the many risks of having diabetes. If you have diabetes, and get to the point where you need to be on insulin, these risks increase even more. Medications will not stop the disease process or reverse damage.

Many of us may know our weight or our last blood pressure reading, but most of us do now know our fasting insulin, our vitamin D levels, or what type of cholesterol we have (i.e. the good type/quality or bad type/quality).

If you want to know your risk for developing diabetes, or want to know if your diabetes (or prediabetes) is putting you at risk for complications, here are some important labs to know:

• Fasting insulin: Insulin is your fat-promoting hormone, aka the “fat fertilizer”. People cannot live without insulin – but we cannot live a high quality life with too much insulin. We worry if this is chronically high, but we also worry if this is chronically low in the setting of high blood sugars. Why? If you have high insulin, you’re more likely to put on weight and have deceptively low blood sugar levels. You may even have periods of hypoglycemia. And if it’s chronically low in the setting of high blood sugar levels, this means that the pancreas if dying/failing and you may be progressing towards needing to take insulin injections for the remainder of your life.
• Fasting blood glucose levels and HgA1c: Your fasting blood glucose levels indicate how much glucose is being released in your bloodstream when there is no food available (to provide the glucose). It is dependent on what you eat, but it is also dependent on your sleep and stress. If you want to know your 3-month average of your blood glucose levels, you look at your HgA1c. If your fasting glucose levels AND your HgA1c levels are higher, your body has a glucose burden (which leads to diabetes and more).
• Vitamin D: Vitamin D becomes a hormone in the body, after it has been processed by the kidneys and the gut. We can get some of this from the sun, but unfortunately most people do not get adequate sun exposure and/or have poor absorption of this from the skin due to poor gut function. Vitamin D has many functions, and with regards to diabetes, it responsible for improving the function and use of insulin.
• Advanced cholesterol panel: This is a panel that looks at the “quality” of your cholesterol, not just the “calculated quantity”. Many doctors are unfortunately not well-versed in using this, and many cardiologists may use it but don’t have drugs that can address the “quality”, so they may not put a lot of importance in using this test. This test looks not only at the type of cholesterol you’ve heard before (HDL, LDL, triglycerides), but it looks at the “vehicles” (apolipoproteins) and “sub-particles” (individual types of LDL, HDL) that are circulating in the blood stream. You want your “vehicles” to be top-of-the-line Teslas, not unreliable exhaust-emitting chevy’s. And for your “sub-particles”, which look at the weight and size of your LDL and HDL, you want the the big, bouncy types. Hopkins compares these sub-particles to “children” – you want the straight-A students (the big, bouncy types), not the children that become obnoxious criminals (the small, heavy, sticky types).
• Inflammatory markers: All symptoms and diseases have a chronic inflammatory component. Inflammation is meant to be temporary and serve a quick purpose (such as stopping a bleeding wound or fighting off an infection), but if it’s chronic, it leads to all the complications (and more) listed previously.

Don’t wait for your doctor or health care practitioner to choose your health outcome know your biomarker risks, and change these if they are not optimal!

References:

Lakka HM, et al. Hyperinsulinemia and the Risk of Cardiovascular Death and Acute Coronary and Cerebrovascular Events in Men (The Kuopio Ischaeimic Heart Disease Risk Factor Study). JAMA Apr 2000:160: 1160-1168.

Templeman NM, et al. A causal role for hyperinsulinemia in obesity. J of Endo. Jan 2017. doi: 10.1530/JOE-16-0449.

Singh B, Saxena A. Surrogate markers of insulin resistance: A review. World Journal of Diabetes. 2010;1(2):36-47.