Insulin Resistance: HbA1c, HOMA-IR and Fasting Insulin Explained

00:00:00: Forty-eight percent.

00:00:01: That's the percentage of adults in Western industrialized nations who already have insulin resistance today and, in most cases don't even know it.

00:00:10: A large study from Newcastle has shown that almost half them can actually reverse this insulin resistance.

00:00:17: But for that you need The Right Markers Today on the podcast HBA One C versus HOMA Index Fasting Glucose And Fasting Insulin.

00:00:27: What your values really mean?

00:00:30: Because what most family doctors don't measure and what most textbooks still don't sufficiently appreciate is the fact that insulin resistance starts a full thirteen years before diabetes.

00:00:43: Max, What actually IS your HBA-Ic?

00:00:47: My HBA Ic... Of course i know off of my head it's obvious!

00:00:51: Show me!

00:00:54: And you're Homer

00:00:54: Index?!

00:00:57: But my fasting glucose was no fasting insulin.

00:01:00: Was already very low last time.

00:01:01: it's somewhere between two and three.

00:01:04: I forgot the unit off to look at up again, okay

00:01:06: because today's episode is going To be about exactly those two values about blood sugar levels And specifically about HBA one C. in The HO MA index HBA once see as of course much better known the long-term blood sugar level As its so nicely called.

00:01:22: Then you've probably heard a fasting glucose.

00:01:25: You've heard of fasting insulin and you need both of these values in turn to calculate the HOMA index.

00:01:32: And, the HOME index is particularly relevant in functional medicine when it comes to an early assessment or early diagnosis of insulin resistance.

00:01:44: that's practically the precursor to diabetes.

00:01:49: so you don't have diabetes yet but your definitely on the highway.

00:01:56: instant resistance.

00:01:57: The nice thing about it is that in very, many cases It's simply reversible.

00:02:02: That means if you know early enough that you have instant resistance You can take a lot of steps Do a lot things to ensure that instant regulation in the body works as normally as possible again and you don't quickly slide into type two diabetes.

00:02:21: The HBA one see itself.

00:02:23: that actually starts off with a very intense discussion around the normal and optimal range.

00:02:31: So I think if someone has diabetes they've probably heard of these cutoffs.

00:02:36: we also heard about it in university, the cutoff is around six point four or six point five percent maybe just briefly why percent?

00:02:46: That uh...is practically percentage value.

00:02:49: so The HBA-Ic is a percentage value that expresses how much of the hemoglobin in this sample was taken, is glycated.

00:03:00: And um...the percentage values should ideally be low or as low as possible so somewhere around five ideally.

00:03:10: and from six point five on you would speak about manifest diabetes but super lot happens between

00:03:19: Exactly.

00:03:19: That's the thing, right?

00:03:22: So you mentioned that the cutoff is at six point four and um... At six point for your talking about exactly this diabetes before that starting at six would directly talk about pre-diabetes meaning You're right on the verge of diabetes And then below six are actually in a normal range.

00:03:40: so now Of course The question Is okay.

00:03:45: What is Normal?

00:03:47: That's the first question you obviously want to ask yourself.

00:03:50: And on the other hand, where do I actually wanna be?

00:03:54: Right and ideally with HPA-Ic... So now of course the question is okay.

00:04:01: what is normal?

00:04:02: that's the First Question You Obviously Want To Ask Yourself.

00:04:05: and On The Other Hand Where Do i Actually Wanna Be?

00:04:07: right and Ideally With HPA One C You Can Almost Guess Because It'S Basically This Long Term Blood Sugar.

00:04:13: You Actually Want To Be As Low as Humanly Possible.

00:04:16: That means to lower the value, the better tendentially.

00:04:20: Why?

00:04:20: Because elevated blood sugar also leads to more insulin being released and insulin in turn is actually one of the basic building blocks when it's elevated for most metabolic diseases.

00:04:30: that mean whoever has a higher insulin level will mostly likely have metabolic problems.

00:04:37: We're talking about diabetes then, cardiovascular diseases but also cancer becomes more likely because insulin is very relevant for simple cell growth.

00:04:46: Alzheimer's and generally of course aging right?

00:04:49: So all these diseases naturally play into the biological age somehow as well.

00:04:53: And that why you want to be low humanly possible with this HPA-Ic That in turn plays closely together at this level A big problem.

00:05:06: Theoretically can already have a high insulin level, but the HPA one C Can still be really good And that's a bit of a tricky thing.

00:05:14: That means you will through your You could have a wonderful hba-one see here at five point one like for example with me and My instant levels maybe already had a constant eight fasting right which Which tendentially is already not so ideal?

00:05:29: I mean when you're really fasting have slept well and everything is fine.

00:05:33: That's the problem with HPA-Ic, that you can simply overlook this insulin level.

00:05:38: This instant resistance that can develop over the years right?

00:05:43: It just comes a bit later.

00:05:45: it only comes when the insulin Can't really keep up anymore.

00:05:50: and thats why its very gradual marker Really for long term actually relevant.

00:05:57: And the insulin itself becomes more interesting When u also want to look short term what is actualy current status Right?

00:06:04: And that's why it is a very, very gradual marker.

00:06:07: That means really just for the long term actually very relevant and the insulin itself becomes more interesting when you also want to look short-term.

00:06:14: okay what is actualy current status right now?

00:06:17: So HBA one C isn't really relevant at an early stage especially because its will almost always be normal in most cases.

00:06:26: What we haven't fully cleared up are these ranges like And they do a blood draw and something up to five point nine comes back.

00:06:34: Then every doctor will say, yeah that's fine it's normal uh... It is completely normal value.

00:06:39: now if you had six then already talk about pre-diabetes.

00:06:43: but actually this increase in risk of really getting cardiovascular disease later on for example ending at the hospital because of that disease starts much earlier.

00:06:52: If compare group people who have that has five point five to five point nine percent.

00:06:59: So actually within this normal range, then the group with a higher HBA one C already has a twelve percent higher probability of ending up in the hospital later on due to cardiovascular disease right?

00:07:10: It goes up even further if you're between six and six point four And Of course it's highest at six point five.

00:07:15: but what should You take away from That five point Nine is no longer good.

00:07:20: Five point nine might be Normal But its far From optimal In the blood sugar metabolism or metabolism in general for many, many years.

00:07:31: And that's the main thing you should take away.

00:07:33: regarding that value?

00:07:34: That means like you said when I eat something sugary my blood sugar rises because blood sugar raises insulin goes up and then blood sugar goes back down and everything in the body runs the way it supposed to.

00:07:46: The HBA one C stays normal for so long Because When more sugar arrives the body simply produces more insulin.

00:07:54: The HBA-Ic still remains normal because the body, through this crazy high insulin production.

00:08:01: Still manages to keep the sugar in a normal range and the HMA index is a bit better at predicting that.

00:08:10: but maybe first briefly Insulin resistance itself.

00:08:14: In the past people always thought And we actually still learned it this way in college.

00:08:20: That wasn't long ago right?

00:08:22: That was five six seven years ago.

00:08:25: Insulin resistance develops over so you always eat a lot of sugar.

00:08:31: then A certain insulin resistance develops.

00:08:33: because I ate a lot Of sugar, i Then have to compensate.

00:08:37: So the body compensates by producing?

00:08:39: A lot of insulin Over time.

00:08:41: this exhausts The pancreas so much that in the end not enough insulin can be produced To lower blood sugar.

00:08:49: and then i Have diabetes.

00:08:50: That was the classic textbook model but it's actually outdated now.

00:08:57: There is a new model that over the last ten to fifteen years has actually been, let us say agreed upon in the research community.

00:09:09: and this new model works a bit differently.

00:09:17: It basically means that high-fasting insulin predicts diabetes independent of insulin resistance.

00:09:27: Your cells don't even have to be insulin resistant yet if you already have very high fasting insulin anyway, simply because the regulation is a bit disrupted.

00:09:36: So in a way it's chicken and egg problem right?

00:09:39: What came first?

00:09:40: First the insulin resistance or that then the high-insulin.

00:09:44: as result The rather new model says just higher insulin can also be there before insulin resistance.

00:09:56: kind of

00:09:57: okay because i was just about to say when you have diabetes it's often even the case that you barely had any insulin left.

00:10:01: so thats why.

00:10:02: Okay

00:10:04: well once you have diabetes yes, this is just about the development of insulin resistance and not specifically about the developement of diabetes itself?

00:10:11: And they've kinda flipped around in past.

00:10:14: they said you become insulin resistant then insulin rises cause want compensate your pancreas gets exhausted.

00:10:20: And nowadays if you already have a high higher insulin concentration anyway and that can be totally different for us also simply because we have different genetics right there are people with the predisposition to hire fasting insulin.

00:10:33: And they actually automatically have a higher risk of diabetes.

00:10:36: built in quotes, maybe as one important driver shouldn't be forgotten will get it later on.

00:10:46: second main driver is simply diet.

00:10:49: way we eat.

00:10:50: There's so much processed stuff out there.

00:10:52: People eat so many processed products, processed carbohydrates very short chain carbohydrates that always cause insulin levels to spike very high.

00:11:02: industrial fats also play a role and simply one thousand years ago we didn't have food constantly available And nowadays at least in western nations is the case you can eat at any time And that simply leads to having higher fasting insulin, even though you might not have any insulin resistance yet.

00:11:28: That in turn is also a very important predictor for developing diabetes later on.

00:11:34: What about the genetic component?

00:11:37: Yeah so it's definitely hereditary.

00:11:40: You can definitely say there's a genetic component.

00:11:43: Um, there are many studies on this.

00:11:45: Some say more like a thirty percent some or like a seventy percent hereditary component.

00:11:50: I think that That certainly also has to do with the fact that you naturally adopt a certain lifestyle from your family right?

00:11:56: So then it's not actually classic Hereditary Component Not Classic Genetics But of course environmental factors that play a role Meaning i don't know maybe eight pancakes every morning in your childhood and indeed nothing decent then.

00:12:08: that was definitely not good for your insulin levels, and you'll have a worse start in life even when you come out of it as an adult than someone who ate healthier.

00:12:18: That's definitely a fact.

00:12:20: but what do we say is actually... Even with twins, credit genetics more because there are very strong correlations between twins if not one hundred percent or thirty seven and fifty percent which means Even if different lifestyles are lived after that, there's still a lot left over.

00:12:42: So yeah you just have to live with it and some people got let us say worse set of data or better one which is how it is unfortunately.

00:12:50: but this doesn't mean we can not influence in any way

00:12:54: Yeah like already said so predisposition to metabolize sugar poorly.

00:13:00: This tendency is highly hereditary But whether that turns into diabetes you actually still have that in your own hands.

00:13:08: Yeah, exactly so.

00:13:08: diabetes per se isn't actually hereditary...

00:13:11: Exactly!

00:13:12: Rather it's more about this predisposition how you metabolize sugar and how well the body can handle whether something comes of it or not.

00:13:20: just keep that in back-of-your-mind like we also talked about in the pre discussion.

00:13:25: we talk epigenetics once That is somehow passed on but at end its about imprinting.

00:13:35: So that you have, I'll say with obesity so being overweight.

00:13:40: That's very common right?

00:14:05: And with sugar metabolism or glucose metabolism, it's then exactly the same.

00:14:11: But to maybe dive deeper into values that we also discussed earlier right?

00:14:16: There are like four very important values actually three because the HOMA index as I already said is calculated from fasting insulin and fasting glucose.

00:14:25: That means you have to measure three things The HBA-Ic, Fasting Glucose and Fasting Insulin.

00:14:30: Then calculate the HMA Index from those latter two values And then you can actually already at least estimate very well which path your currently on to develop diabetes or not.

00:14:44: To develop diabetes with fasting glucose, it's actually important that You really are fasting right?

00:14:50: That's actually already in the name of the value Atleast eight hours off Not eating.

00:14:57: because what do want a measure With this value?

00:15:01: A lot of glucose metabolism is regulated by the liver, right?

00:15:06: So sure.

00:15:06: The insulin is produced in the pancreas but generally a lot of the metabolism –the master–is basically the liver and here you look at how well the liver—in a fasting state practically copes with blood sugar whether it can also be kept constantly low because over…at night...you don't eat anything!

00:15:27: That means that the liver starts to produce glucose itself from stored glycogen and that is then basically broken down again, converted into sugar.

00:15:40: The insulin should limit this nightly rise in bloodsugar.

00:15:47: if this fasting glucose is high then you know that the liver is actually already insulin resistant, right?

00:15:54: Because then it keeps producing glucose and can no longer be down-regulated by the insulin.

00:15:59: That means this fasting glucose if that gets out of hand which is why its also used for diabetes diagnosis in the end... ...that's already very late.

00:16:11: so there are already massive damage done If the body cannot keep the fasting glucose from getting out of hands.

00:16:20: I think there's the cut-off, I think ninety six milligrams per deciliter and then they're still this gray area up to one hundred ten or one hundred twenty milligrams per desiliter.

00:16:30: And anything above that would already be manifest diabetes if you measure it on two different days.

00:16:35: That means if something is actually used for diabetes diagnosis Then its all ready.

00:16:39: a very late marker with HBA One C. It like that too right?

00:16:44: HBA one c also use for Diabetes diagnosis?

00:16:48: Yeah, no exactly.

00:16:49: So I mean with both of these markers we have a bit of a problem that they only react very late right?

00:16:55: Fasting glucose is then again also a bit an individual topic.

00:17:00: That means there you just have yeah You have a marker that will fit great for a long time.

00:17:05: For some it might be a tad higher or some a tad lower but It would fit for a longtime and being in the normal range And all of sudden that moment Will come like this can happen within a few months where it just flips.

00:17:15: And that's then again, very similar with HBA-Ic.

00:17:20: It can flip from one year to the next and also get worse because simply... Yeah!

00:17:25: The body can't quite keep up anymore.

00:17:28: Then we come to a value which is fasting insulin.

00:17:30: I touched on this at first.

00:17:33: That is basically actually the bodies reaction of sugar.

00:17:39: Ideally you already said it You have to be fasting Which means if you haven't eaten anything overnight Then the insulin should actually also be very low because only the body's own production is taking place.

00:17:51: And then, um... The body doesn't really need to release much insulin except maybe like a baseline right?

00:17:58: That means if you suddenly have higher value there and that already bit more sensitive Because it shows us beforehand even though maybe HBA-Ic or fasting glucose still fit with insulin It can again already be significantly higher than it actually should.

00:18:14: There's a there.

00:18:16: we really have a sensitive and predictive marker as we had already made it clear at the beginning.

00:18:20: And that's why nowadays you do this mix of the fasting glucose, and the fasting insulin.

00:18:26: because you kind of merge both worlds with that?

00:18:30: You then basically multiply it and divide by twenty two point five right!

00:18:34: Then you basically have this HOMA index.

00:18:36: if thats high than your very clear indicator that something is wrong there that you might also just be on the way to diabetes.

00:18:46: And if it's low, then it's definitely all very positive right?

00:18:50: That means You have one hand a sensitive marker that reacts immediately or react Very quickly and early-on.

00:18:55: On your other hand a marker tends to react later.

00:18:59: Both together can influence the HOMA index.

00:19:03: So in that respect actually The much better marker which is rather rarely measured In everyday life.

00:19:10: If look at how like how insulin resistance develops and then progresses to diabetes in a time-lapse or overtime, it's like this.

00:19:22: If you're on the road to diabetes... ...you would sometimes see decades before you even get a diagnosis that fasting insulin is elevated.

00:19:31: That means if you measure fasting insulin as probably the most sensitive marker for finding out what goes into your body regarding sugar metabolism But then the HOMA index would probably also be slightly elevated.

00:19:45: Not crazy high, but at least slightly elevated

00:19:47: Yeah.

00:19:48: Then when you only have several like five six seven years left until diabetes... ...then these glucose spikes after lunch Would probably also Be slightly elevated.

00:19:58: not Crazy High, but Atleast Slightly Elevated yeah?

00:20:01: Then When You Only Have Several Like Five Six Seven Years Left Until Diabetes Then these glucose spikes after lunch, for example.

00:20:08: After dinner or breakfast already start to increase.

00:20:10: beta cells get fewer and fewer.

00:20:12: they also get exhausted to some extent.

00:20:14: that's still part of this development of diabetes.

00:20:17: but the HMA index would be highly elevated so it'd be significantly elevated right?

00:20:21: But HPA-Ic and fasting glucose are probably both normal And only then, like one to three years before the diagnosis where it's already relatively late in the diagnostics.

00:20:32: Would the HBA-Ic rise above six?

00:20:34: It would probably be six point two.

00:20:37: Fasting glucose begins to rise too simply because this regulation doesn't work well anymore at night.

00:20:43: Then its really down to the wire.

00:20:45: and if purely diagnostically the Hba Ic is than six point five and above you have diabetes.

00:20:53: I think the highest i've ever seen in HBA one C was thirteen percent.

00:20:57: Um, on the other hand, I haven't seen anyone yet with an HBA One C of under four.

00:21:01: that's also something that I in a single hba one c is often also determined as standard exactly.

00:21:07: so there is indeed uh lower range.

00:21:09: where you say like around five would be great but it doesn't have to be three and a half or something right because You do need blood sugar That's not normal Bloods So that you can perform And energy can practically be transported.

00:21:23: That's basically not a bad thing, but just like with antioxidants.

00:21:25: So with oxidative stress you need a little bit But just not too much right?

00:21:29: that in the end The mechanism behind it.

00:21:33: what you should especially look at With the HOMA index and hba one c is um the so-called confounders And those are circumstances That distort these values.

00:21:53: There are actually quite a lot of them, right?

00:21:56: If you have certain types of anemia for example iron deficiency anemia Right with iron deficiency Anemia.

00:22:03: You have a low hematocrit Which means you have few so fewer red blood cells.

00:22:08: the Red Blood Cells you do Have.

00:22:10: they are also A bit smaller than normal blood cells would be.

00:22:13: For example that Means if someone has an Iron Deficiency.

00:22:17: those Are women With heavy menstruation Those are women who have a period, those are people who eat a vegan diet simply because plant-based iron is so much less bioavailable.

00:22:29: or often of course older people.

00:22:31: They have a falsely high HBA one C. that means especially with older people or people who fall into these groups always check the iron level and see if you might have iron deficiency anemia Because then you can't really use the HBA One C. So just keep that in mind.

00:22:50: Then there are also many diseases of the red blood cells or diseases of hemoglobin, they're actually not that common in our latitudes.

00:22:59: Also They can make the HbA-Ic appear falsely low.

00:23:07: If you have for example alpha or beta thalassemia right?

00:23:10: Or sickle cell anemia it can go up or down.

00:23:13: Just keep that and mind a bit.

00:23:15: if someone has one of these diseases it's not incredibly common, especially in our latitudes.

00:23:20: It is mainly in the Mediterranean region or Southeast Asian and African populations.

00:23:24: then just remember that this could be a reason why you can't use HBA-Ic like that.

00:23:29: Just mention to your trusted doctor If you get iron substitution so iron through the vein through an infusion for example.

00:23:40: Then that can lower the HBA Ic without however improving blood sugar control because the body can then freshly produce more of these red blood cells.

00:23:50: And accordingly that also dilutes the HBA one C a bit, because in a very short time A lot of new Red Blood cells are produced and they don't sugarcoat or glycate so quickly.

00:24:03: That means it has like a dilution effect The same if you get a blood transfusion for example right?

00:24:09: In the end all have this background.

00:24:11: If something is wrong with the red blood cell then that can also distort the HbA-Ic because it simply depends on the red blood cells.

00:24:21: With the Homer index there are a few confounders, so I'll say circumstances to make sure you don't use them too

00:24:34: much.

00:24:34: The Homer Index is kind of... That actually again depends mainly on the fasting insulin a bit on the fasting glucose too, but mainly on the fast-fasting insulin.

00:24:45: It's just the problem that there are few lifestyle factors that simply can't affect blood glucose or insulin levels right?

00:24:54: On one hand it could be you have crazy stress level for some reason.

00:24:58: then the insulin level definitely goes up.

00:25:01: But at same time the fasting glucose also goes and therefore reactively the fasting insulin also goes.

00:25:07: That means you definetly have distortion in them But in the end caused by the insulin because that simply has to be released in larger amounts.

00:25:15: It can also with women, especially relevant which cycle phase it's drawn right?

00:25:23: In the luteal phase blood sugar or fasting insulin is just slightly elevated.

00:25:29: Just pay attention there actually only a very short window for when you should draw such things Especially when it comes to hormonal issues.

00:25:37: Definitely talk about your gynecologist.

00:25:41: You should, as said pay very close attention to being fasting.

00:25:44: If you're not fasting it's by no means usable.

00:25:46: then you don't really need to look at anymore.

00:25:49: Another topic is sleep.

00:25:51: if you really slept poorly the night before Then the homa index will also spike mainly again due to insulin because the body is in a more acute state of stress.

00:26:02: When you've slept super poorly Then you're somehow a bit unbalanced, maybe also constantly craving snacks and stuff.

00:26:07: And that's exactly this insulin level That's going up and down the whole time like in a game of ping-pong right?

00:26:13: So that's definitely also relevant.

00:26:15: if You ran I don't know half marathon or a marathon The day before then you'll definitely also have a problem.

00:26:20: Or if you did a very intense muscular workout that can Also throw it off a bit.

00:26:25: write the homa index.

00:26:26: so you see those are incredibly many different topics Like lifestyle topics that in the end, uh play into it and actually make it unusable.

00:26:35: That means you should actually just see okay are you on that day?

00:26:39: Are you reasonably fit not feeling bad or anything?

00:26:43: maybe You Should also ideally Just take It easy The Day Before And If You Keep That In Mind Then The Homa Index Will Definitely Be The Best Value.

00:26:51: Exactly There Is Something That is Actually even a bit more sensitive than the Homer index and that would be the oral glucose tolerance test, actually.

00:27:00: Which we also just did a few weeks ago.

00:27:03: I'm already very excited about the results And what you basically do there.

00:27:07: they draw blood.

00:27:09: then Right after the blood draw You drink a bunch of glucose.

00:27:14: yeah me too.

00:27:14: seventy five grams seventy-five grams right in like so dissolved In a bit of water.

00:27:19: it's very very sweet A bit Like drinking Very highly concentrated syrup.

00:27:23: Then you measure once after one hour and then again, after two hours.

00:27:27: And then you see how much the glucose has changed.

00:27:29: that's also a very good test for the body to see the insulin response.

00:27:34: so How quickly does the body manage to lower this crazy amount of glucose directly?

00:27:42: and bring it into the normal range, then surely the HMA index would come or also just a fasting insulin.

00:27:48: And then the fasting glucose and then also the HPA one C. that has certainly not made its way in to the guidelines yet.

00:27:56: I think That will also make its way into the guidelines at some point especially when it comes to this very early diagnostics.

00:28:02: basically though It always makes sense to determine both values.

00:28:05: so HPA One C an HMA Index Also just exciting because an HPA one C under five, for example.

00:28:13: Because we also talked about these normal ranges earlier the sweet spot is always between five point zero and five point four I would say And under five that can sometimes be an indication That you might also have a bleed somewhere right?

00:28:25: Because then so if you lose red blood Red blood cells a bleed very many people Have that in the stomach or in the intestine because they might have an ulcer Or an inflammation Somewhere even Just A small Bleed.

00:28:38: That doesn't always make itself noticeable immediately, but if you're permanently losing blood there then it can also make the HPA one see appear falsely low because your always losing some of these sugared blood cells and the body therefore simply has to strive for a higher new production.

00:28:53: So you should also think off other illnesses that exactly what

00:28:58: do we want us to see in the blood count?

00:28:59: Of course There's a tendency for anemia to maybe

00:29:03: either anemia or, Or you would at least look at the reticulocytes as well.

00:29:07: Right?

00:29:07: So that you know how much is actually so precursor cells of the red blood cell so that you also know How Much Is Being Reproduced.

00:29:14: It does make sense To Look At A Few Different Values If The HBA One C Should Ever Be Incredibly Low.

00:29:21: That's Why As I Said i've Never Seen A Three In Front And in Very Rare cases A Four Point Eight Or Four Point Nine.

00:29:26: That Probably All Still Totally Fine Now.

00:29:29: But If it's four point, or four point five then you can definitely think a bit further and question whether there might be another illness behind.

00:29:36: And Then at least the screening as part of the blood sugar check led to in The end maybe finding out something else that you wouldn't have seen otherwise.

00:29:46: with the HMA index itself They say an ideal value is under one.

00:29:53: So what do you call?

00:29:55: It right yeah normal is basically up to one point five Okay.

00:29:59: But optimal would be under one.

00:30:01: and then there's this gray area, right?

00:30:03: With these early insulin resistance which is one point five to two-point-five a manifest insulin resistance would be from two point five And the severe insulin resistance Would Then Be Beyond A Value Of Four.

00:30:15: So There'S Also Five And Six And Higher.

00:30:18: That Is Then of Course In People Who Have Already Had Manifest Diabetes For Years Or Decades but Just Keep that in Mind As An Important Value.

00:30:27: Ideally, it should just be under one.

00:30:30: And then you're doing very well and definitely don't have a risk of developing insulin resistance at some point for example.

00:30:38: Just keep that in mind.

00:30:40: with fasting glucose we already said right ideally under one hundred or ninety six.

00:30:44: That differs a bit depending on the lab.

00:30:46: We are always talking about milligrams per deciliter there because as also nanomoles per liter.

00:30:51: But milligrams per desiliter is certainly The standard value in the vast majority of labs in Germany, Austria and Switzerland.

00:30:58: And ideally you're somewhere so normal is up to one hundred.

00:31:02: optimal would be somewhere in the range of seventy two ninety right?

00:31:05: That's where you actually want to be if you want to have the best possible prerequisite for a healthy long life.

00:31:12: let say With the confounders, we already said so just keep that in mind.

00:31:20: There are simply things with HBA.

00:31:22: one see there Are things with the homa index?

00:31:24: That can also distort The value.

00:31:26: that's why you should never rely on a single Value but always check it again right.

00:31:31: Just again if I had a homa Index of One point seven now and i couldn't for the life Of me explain Why I have an elevated homa Index based On my diet or My lifestyle then just Check Again A few weeks later.

00:31:45: make sure that you don't have crazy stress beforehand, but also do too long of a fasting period.

00:31:51: They say like eight to twelve hours fasting is great.

00:31:53: anything that goes beyond fourteen to sixteen hours in turn not good right because then the glucose level is regulated autonomously by body itself again and for example homo index can be distorted.

00:32:07: so there as I said just pay attention sleep well beforehand, and then you can also interpret the value.

00:32:14: And you should measure everything in life at least twice anyway Also so that you can see if there is a dynamic over time or not.

00:32:22: What is also very common question?

00:32:24: Is whether everyone Doesn't just become a bit insulin resistant overtime any way.

00:32:31: Yeah So yes and no probably almost every one little bit right but That's not because it's an absolute must But actually just lifestyle related.

00:32:44: so it is definitely possible to also get very old without becoming insulin resistant.

00:32:50: Um, but then you also have two I'll say eat differently than most people right.

00:32:57: that's just how it is.

00:32:59: So in the end You don't want to eat processed food.

00:33:01: You want to, as much as possible.

00:33:04: just pay a little attention to carbohydrates that if anything they are complex carbohydrates.

00:33:09: So all the classic nutrition tips you always hear If implement them cleanly and don't do crazy things all of time or Don't drive yourself crazy with like wildest diets Then come out relatively well And then not be insulin resistant in old age.

00:33:25: That is absolutely realistic But still most people will become it.

00:33:31: You have to say that too, right?

00:33:33: Yeah.

00:33:34: Very very worrying was also a study.

00:33:38: so the study itself it went on for twenty one years is from the NH-ANES database.

00:33:43: That's like huge data base of USA.

00:33:46: and there they looked at period from nineteen ninety nine to twenty twenty.

00:33:50: how proportion of hyperinsulinemia.

00:33:55: So people who had high who have a high insulin level in their blood without having diabetes.

00:34:02: And they looked at that specifically, in adolescence and In nineteen ninety nine this proportion was fifteen point two percent and in twenty-twenty It was already twenty one point five mind you in non diabetic adolescents.

00:34:16: So those would actually still be considered metabolically healthy right?

00:34:20: And an adolescence aren't sixty yet.

00:34:22: so it's already crazy That every five more than every fifth adolescent already has problems with insulin regulation actually.

00:34:29: Yeah, what you have to consider there of course I mean sure adolescents are also getting fatter and fatter right?

00:34:34: So that's also a fact which you'll see epidemiologically people or young people simply more and more problems with overweight.

00:34:41: And um... That is somehow connected Right!

00:34:44: From the moment when this higher insulin level naturally You will find it incredibly hard just lose weight again because Insulin ensures that fat settles and is actually stored.

00:34:56: That means that then already somehow all logically connects, right?

00:35:00: It's not surprising but it's so crazy also getting worse and worst!

00:35:05: And the most important thing we haven't even talked about yet... We've only talk about nutrition & fat & cow.

00:35:10: But over this process, overtime So with age people have more insulin resistance or at least feels like everyone eventually becomes insulin resistant.

00:35:21: Diet is one reason for that but above all the loss of muscle mass, right?

00:35:26: Because muscle mass we mustn't forget doesn't just look nice when you have a lot of it.

00:35:31: But It's also an incredibly large metabolically active organ in the end-a muscle!

00:35:36: A lot very so... The majority of the blood sugar So off to glucose.

00:35:44: that gets into the blood after eating That goes into the muscle.

00:35:47: Eighty percent of it.

00:35:48: If You Have a Lot Of Muscle Now You Also Move It Regularly.

00:35:51: Don't Sit All Day go to the gym, go swimming cycling running.

00:35:56: Then of course this glucose is actually consumed right?

00:35:59: And then the muscles always remain sensitive to insulin because they constantly need these new glucose.

00:36:04: that means you really shouldn't underestimate how important exercise also and by exercise I don't just mean going for a walk but actually also the strength training becomes in old age so that you can even maintain your muscle mass.

00:36:19: That is certainly also a reason for this actually worrying increase in adolescence.

00:36:25: On the other hand, there was also cool Japanese study where it came out that every one percent higher leg muscle mass percentage so more muscle mass you have on your legs per percent more and twelve percent lower risk of developing insulin resistance In a period of two years.

00:36:48: So in the end, it definitely means doing many squats right?

00:36:51: Of course that doesn't only apply to leg muscle mass But of course also too to the upper body Right and for abdominal muscles and back muscles because those are off course Also very large Very large muscle groups.

00:37:03: And what we I think want to say with that in The End is that It's not A problem of aging That you become insulin resistant but its actually a pure lifestyle Problem Because you move less, because you have less muscle mass.

00:37:15: Because you eat worse sit more and so on.

00:37:19: that is simply very important.

00:37:23: And On the topic of reversibility That's also something that gives hope basically.

00:37:33: So we know the number of insulin resistant people Is incredibly high almost half of population right?

00:37:39: But also half actually manages, could easily manage to reverse this insulin resistance and return to metabolic health.

00:37:52: And that is quite nice!

00:37:53: So I would just claim anyone who still has a functioning pancreas – meaning it can produce insulin – can reverse their diabetes or insulin resistance?

00:38:07: Now of course... What you also have to know is that from the moment, you have diabetes and I've had it for several years.

00:38:15: That leads to the pancreas being an overdrive the whole time And at some point just can't anymore.

00:38:21: It's just broken You know?

00:38:22: Then then doesn't release anything any more But that takes many years.

00:38:26: So you have be in really bad shape For a long time.

00:38:30: As long as its still working.

00:38:32: Its actually all reversible and curable.

00:38:36: Really just question of how ambitious your are about it and in many cases people actually aren't that ambitious.

00:38:44: What's often done is at some point they even give insulin which only makes the problem worse, right?

00:38:51: That means... In the end that pushes everything in a wrong direction.

00:38:55: you continue to have an insulin problem or weight problems.

00:38:59: so this means.. You never want get into such situation!

00:39:03: Even if from the moment you've started it, It's incredibly difficult.

00:39:07: Right?

00:39:07: So I don't want to downplay that at all but in any case theoretically You can manage it beautifully and The numbers show That too.

00:39:15: i mean within twelve months Forty-six percent of diabetics.

00:39:19: In a study right that was recently done They actually managed To get forty six percent Of these people Out of diabetes again.

00:39:27: so that is really crazy!

00:39:29: Thats only twelve months thats Only A year.

00:39:32: They were probably trapped for years in this, I'll say metabolic disease.

00:39:37: And after a year they're healthy again and then probably also have far fewer weight problems, far fewer general metabolic cardiovascular problems that somehow come with it right?

00:39:47: So that is already impressive when you actually look

00:39:52: at it.

00:39:53: Yeah so if i'm on the stage where only my HOMA index is elevated practically, one hundred percent managed to reverse that right?

00:40:04: Yeah.

00:40:04: Well theoretically they should managing it is another...

00:40:06: No no I'm saying actually for almost all people who already have an elevated HOMA index It would be possible to reverse if the HBA-Ic is let's say still relatively normal.

00:40:17: If i had prediabetes meaning im already in range of like six point zero two six point four or six point five for HBA One C Or Like Two Point Five For The HOMA Index.

00:40:27: Then its Still The Case That A good two thirds managed to reverse it with a lot of consistency.

00:40:34: So one third doesn't manage it anymore, about sixty-to eighty percent can still manage if they really consistently watch their calorie reduction weight loss and so on and so forth.

00:40:46: If I already have early stage diabetes meaning i have diabetes but only for few years then half Can still manage it?

00:40:59: Quote-unquote much easier to do nowadays thanks to ozempic wegovi and the like.

00:41:04: so simply because of all these GLP one agonists that can support this weight loss.

00:41:08: So strongly, but if you've already had diabetes for a really long time Like five years or more then it becomes very very hard.

00:41:18: Then you probably won't get completely out of this out of this vicious cycle simply because the pancreas is already so exhausted that even with a perfect diet, you can't regulate it yourself anymore.

00:41:30: Then you can still improve your levels and make sure to not take too much medication on but in the end yeah... You're kind of trapped!

00:41:40: But as I said In every one of these stages i just listed It's worth changing lifestyle And especially doing a lot of strength training and focusing on building muscle because in the end that's like a metabolic sponge.

00:41:54: That soaks up all the glucose, and then metabolizes it... ...and then it has no way to damage all the other areas of the body right?

00:42:02: From skin-to blood vessels.. ..to brain and so on and so forth.... To basically throw all of them into trash!

00:42:09: And thats' beautiful thing about this.

00:42:11: That should actually give everyone listening today hope Because with these four stages, actually one hundred percent of the population is covered and no matter where you are it's definitely worth stepping on the gas.

00:42:22: And setting certain priorities.

00:42:25: how should do that in practice now?

00:42:28: if I want to do prevention Now i don't have well at least not knowingly a blood sugar problem?

00:42:35: How how should proceed in practice?

00:42:39: Yeah, well I mean if you don't knowingly have anything yet It would of course make sense for you to just get blood work done regularly even If it's only every two years but to get proper bloodwork Done.

00:42:50: and now specifically regarding that those values we mentioned are important.

00:42:54: Um You can also makes sense too.

00:42:56: maybe do a lipid profile as Well.

00:42:58: um Just to also see okay?

00:42:59: If i have A higher insulin level how does That Also affect the rest Of my lipid metabolism.

00:43:05: so everything that has To Do with cholesterol and triglycerides, right?

00:43:10: It definitely makes sense to include that.

00:43:13: But as I said it's simply about measuring it regularly just tracking over time.

00:43:17: even anyone who is super healthy should do at least every two years.

00:43:23: And see where do i stand.

00:43:28: Because the problem with a whole thing is that it's just so incredibly gradual and It can be, you have great levels for super long time And then something changes.

00:43:37: Then there are also scenarios where people actually get an autoimmune disease.

00:43:40: The pancreas gives out.

00:43:42: That of course could happen But per se... ...it makes sense to stay on top because its process takes many years Doesn't just happened overnight.

00:43:54: You can track very well.

00:43:57: how is my fasting insulin developing over the years, for example.

00:44:01: And then you'll already see okay somehow this going in the wrong direction.

00:44:04: maybe I need to keep myself on a bit of tighter leash now and just be more careful.

00:44:11: change my diet a little step up the exercise it will get better again.

00:44:15: also sleep is big topic that could certainly address.

00:44:17: so there are many different possibilities.

00:44:19: You have know that problem actually there right?

00:44:23: That's biggest factor And you definitely don't want to get into a situation where this problem even arises because as we've learned it gets harder and harder.

00:44:33: To get out of the later, you realize.

00:44:35: what can certainly also help is if now let's assume that in the values were all fine so far?

00:44:44: That means that either still very young or have done things right over the last few years.

00:44:49: A CGM, a continuous glucose monitor is certainly also helpful.

00:44:54: Why's that now?

00:44:55: Less to somehow less specifically because of the individual blood sugar profile but much more because of their reaction to certain foods.

00:45:03: Because it very different right.

00:45:05: you can look at for two weeks and see which foods make your glucose shoot through the roof.

00:45:11: You then reduce those or eat little less than them And beacuse.

00:45:14: they are individually different.

00:45:15: I find something like this quite exciting.

00:45:17: It costs about seventy euros.

00:45:18: You can get it nowadays, it's also accessible for non-diabetics.

00:45:22: now you Can also order it online and then just test it out and try it And see what comes out for you?

00:45:27: Then optimize a bit further.

00:45:32: Yeah in the end its like coach right who says okay maybe shouldn't eat that so often That fits well and is of course super helpful and do that once

00:45:45: And when it comes to intervention, meaning I have insulin resistance now.

00:45:48: Then actually the very best thing you can do even better than diet is exercise.

00:45:53: so exercises are also much more effective.

00:45:57: then if you were just take metformin for pre-diabetes and that's already powerful right?

00:46:03: For some lifestyle interventions they're already more effective in such disease states.

00:46:09: That is already very, uh, very exciting.

00:46:12: And the main focus there as especially on strength training.

00:46:15: so just building muscle, building this metabolic sponge So that the glucose can be used better again and then you're on a very good track with diet.

00:46:23: Very classic I mean.

00:46:24: many have already heard of The Mediterranean Diet right?

00:46:27: That still seems to Be positive for it.

00:46:30: Just eat few processed foods Eat little sugar and sugar Is practically in everything.

00:46:34: Thats why i start reading the labels.

00:46:36: That definitely makes sense.

00:46:39: eat plenty of protein because that keeps you full better and longer than carbohydrates in fats do.

00:46:44: That's why I also just keep that in mind.

00:46:47: those, those protein goals.

00:46:48: they don't come from nowhere but they do have their justification.

00:46:53: always remember fiber two and not just protein.

00:46:55: that should perhaps be set as well.

00:46:56: But if you design the diet roughly as we've discussed now very important sleep You had already mentioned right?

00:47:03: Always try to have the same bedtime Same wake up time and sleep seven to nine hours Then you're on a very good track simply because the cortisol stays within limits.

00:47:12: Cortisol brings us straight to the next point, it's stress management chronic stress-very bad for insulin regulation and sooner or later you will also quickly end up with insulin resistance that um... You should keep in mind if you have a lot of stress even when your'e young then just accelerate towards diabetes which might already be on anyway.

00:47:34: nobody really wants Otherwise, weight loss we had already discussed anyway.

00:47:40: That is the most common intervention to get from diabetes or pre-diabetes back into a normal range?

00:47:48: Yeah that's where the GLP one agonist come in and play really big way again which are simply getting extremely many people out of diabetes now because you have got super fast weight loss somehow And that in the end is also an ultra important predictor and of course, generally just reduces insulin resistance.

00:48:07: That means you become more receptive to the insulin already there anyway... ...and it's extremely potent with weight loss!

00:48:19: In such a case if you are really significantly overweight and notice everything going in the wrong direction then this definitely makes sense.

00:48:29: look into that direction and talk to a doctor about it because, uh...that can help very quickly.

00:48:34: And get you back where at least doing well in terms of insulin resistance right?

00:48:39: That was already nice closing word.

00:48:41: I have a nice closing fact now is that insulin resistance usually begins more than thirteen years before the diabetes diagnosis so an incredibly long time.

00:48:52: If you wait now until the hba one c changes, You're already wasting a lot of time.

00:48:56: That's why also just look at the overall picture with fasting glucose and fasting insulin And definitely measure them these two values.

00:49:04: they won't ruin you financially either in case The health insurance shouldn't pay for it Also.

00:49:09: uh so Homa index that is all very affordable.

00:49:13: I don't remember the exact prices from last time but It was definitely in the double digits.

00:49:17: That's Why manageable if you do that every few years to check which direction you are currently heading in or not heading.

00:49:26: Max, thank you so much!

00:49:27: To everyone at home Thank You So Much for listening and watching.

00:49:30: If you have any questions write an email to podcastatbeyondlifespan.de Or just leave a comment on Spotify or YouTube.

00:49:39: We'll look into it And we will definitely do another Q&A episode together to answer all your questions Until next time.

00:49:46: Thanks & Bye.