Low-carb Lab Testing – Part 2 – Fasting Insulin Test

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This is the second installment in a series of articles exploring pertinent lab tests for people following low-carb diets, and how a slightly different perspective is needed when interpreting the results compared to results from people following high-carb diets.

In the previous post in this series, we looked at three measurements related to blood glucose: fasting glucose, hemoglobin A1c, and fructosamine. We left off saying that while these are important to monitor regularly, they offer a limited view of a much larger metabolic control system. Blood glucose, hemoglobin A1c (HbA1c), and fructosamine indicate only what’s happening with blood glucose. They reveal nothing about insulin, which we will explore in this post.

Knowing your numbers is an important step for anyone who wants to transform their health. Heads Up Health was designed to empower you to manage all of your health data, including your lab test results, in one secure location. You can learn more on our homepage or by clicking below to create your account and start building your own centralized health portfolio.

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The Fasting Insulin Test

We said it last time, and it’s worth repeating:

A fasting insulin test is the most important test your doctor probably isn’t ordering. 

The reason it’s so important to track insulin is that in many cases, fasting glucose and A1c remain normal due to chronically elevated insulin—that is, sky-high insulin is keeping the glucose “in check.” Fasting glucose and HbA1c are often the last things to rise, and they become elevated only after one of two things has happened:

  1. The pancreas can no longer pump out the inordinate amounts of insulin required to keep blood glucose within a safe range (sometimes called “beta cell burnout”). This is relatively rare, except in type-1 diabetes, which is an autoimmune condition and not driven by a poor diet.
  2. The pancreas still secretes large amounts of insulin but some of the body’s cells no longer respond to it properly, resulting in high blood glucose. (These cells become resistant to the presence of insulin.) This is far more common.

This explains why many people are surprised by a diagnosis of type 2 diabetes or pre-diabetes. They—and their doctors—had been lulled into a false sense of security by glucose measurements that fell within normal ranges for years, because no one was measuring insulin.

Medical professionals who are aware of the wide-ranging effects of chronically elevated insulin would agree that a fasting insulin test should be included as a standard part of routine bloodwork. But until that happens, if you’re concerned with getting and remaining metabolically healthy, you will need to specifically request it from your doctor or order it on your own from a direct-to-consumer lab testing service.

Fasting insulin test

Insulin helps control blood glucose.

Here’s how to use a fasting insulin test as a gauge for metabolic health: 

  • Optimal range: 1- 9 μU/mL
  • Intermediate risk range: 10 -11 μU/mL
  • High risk range: ≥ 12 μU/mL

If your fasting insulin is in the double digits, it’s a sure sign something is awry. However, just as we explained regarding fasting glucose, if your fasting insulin falls within the optimal range, it doesn’t automatically mean everything’s fine. In some people, the fasting level is normal, but the level after meals rises very high and takes an extended length of time to come back to baseline—if it even does come down fully before the next meal. So it’s possible to have a fasting insulin level in the optimal range but have high insulin throughout most of the rest of the day.

Chronically elevated insulin ( called “hyperinsulinemia”) should be suspected when fasting glucose, HbA1c, and possibly fasting insulin are normal, but you experience unexplained or “idiopathic” health issues, such as:

  • Stubborn fat loss
  • Hypertension (high blood pressure)
  • Headaches; migraines
  • Gout
  • Skin tags
  • Vertigo
  • Tinnitus
  • Infertility (in women and men)
  • Erectile dysfunction
  • Benign prostatic hyperplasia
  • Polycystic ovarian syndrome (PCOS)
  • Gynecomastia (enlargement of breast tissue in males)

Unfortunately, owing to the complexity of the chemical assay used to measure insulin, there’s currently no way to measure insulin at home, the way you can do with glucose and HbA1c.

Why Track Insulin?

Medical professionals—particularly physicians, nutritionists, and researchers who work with individuals with obesity, type-2 diabetes, and metabolic syndrome—increasingly recognize that it is elevated insulin, rather than blood glucose, that’s responsible for many of the chronic illnesses that plague millions of people, robbing them of quality and quantity of life. Chronically elevated blood glucose (“hyperglycemia”) is dangerous and, over time, results in damage to the eyes, kidneys, liver, blood vessels, and extremities. Much of the organ and tissue damage that occurs in type-2 diabetics with poor blood sugar control results from chronic hyperglycemia.

But, many non-diabetics will experience physical deterioration in the absence of high blood glucose. In these individuals, it’s the insulin that’s the problem. These folks are essentially diabetic, but because their blood glucose is normal, they won’t be officially diagnosed. This is what Dr. Joseph Kraft called “diabetes in-situ,” or “occult diabetes”—occult, meaning hidden. The high blood sugar is hidden or masked by the pathologically high insulin.

A large and still growing body of scientific research indicates that chronic hyperinsulinemia is the unifying factor behind some of the most common chronic illnesses of our time. Michael Eades, MD, Mary Dan Eades, MD, and Loren Cordain, PhD, some of the earliest proponents of low-carb and Paleo diets, explained over a decade ago that hyperinsulinemia may be the driving force behind acne, skin tags, PCOS, myopia, and male pattern baldness (it’s not all genetic!). Chronically elevated insulin is also a risk factor for Alzheimer’s disease, infertility and sexual dysfunction, inner-ear and balance disorders (e.g., vertigo, tinnitus, Ménière’s disease), some forms of cancer (coupled with worse prognosis in those undergoing treatment), and cardiovascular disease. In fact, Dr. Kraft wrote, “Those with cardiovascular disease not identified with diabetes are simply undiagnosed.”

Test fasting insulin to remain healthy.

Want to stay healthy? Measure insulin!

Something to keep in mind is that hyperinsulinemia occurs in people of all shapes and sizes. Obesity is more often an effect, rather than a cause, of disturbed insulin and glucose signaling in the body. So individuals who are lean and appear healthy on the outside are not immune to the adverse effects of high insulin. These individuals have personal body fat set points that prevent them from becoming overweight or obese, but they’re not spared the other undesirable outcomes from derailed metabolism. (Researchers call this “normal weight obesity,” but more casually it’s referred to as TOFI – thin outside, fat inside. Even though these folks remain at a “normal” weight, their biomarkers indicate metabolic syndrome or insulin resistance.)

Tracking insulin is the canary in the coal mine – the “check engine light.” It’s an early warning sign that your diet and lifestyle need adjustments. You don’t have to wait until your blood glucose is high enough to prompt a type-2 or pre-diabetes diagnosis. Elevated fasting insulin might be one of the first indicators that something’s amiss, and you can take action to correct it.

Track your progress

The Heads Up Health app was designed specifically for individuals to take control of their health data so it can be used for better decision making. For our users within the United States, you can electronically link your medical facility to your Heads Up account and instantly import your lab test results. If we can’t connect to your medical facility or you live outside the US, you can easily enter your results manually:

Track your fasting insulin results with Heads Up Health

Track your fasting insulin results with Heads Up Health

With subsequent tests, you can also trend your results over time to see how your low-carb lifestyle is impacting important markers like fasting insulin:

Trending your fasting insulin results over time

Trending your fasting insulin results over time

Heads Up can also integrate the data you are collecting at home – everything from weight to blood sugar and steps per day – so you can compare how your healthy lifestyle choices are impacting your lab test results.

GET STARTED!

Coming up next…

In the next post, we’ll introduce you to the HOMA-IR test that will help you connect your fasting insulin and glucose levels for a deeper analysis of your level of metabolic health.

About the Author


Amy Berger, MS, CNS, NTP, is a USAF veteran, Certified Nutrition Specialist and Nutritional Therapy Practitioner who specializes in using low-carbohydrate nutrition to help people reclaim their vitality through eating delicious foods, and showing them that getting and staying well doesn't require starvation, deprivation, or living at the gym. Her motto is, “Real people need real food!” She blogs at www.tuitnutrition.com, where she writes about a wide range of health and nutrition-related topics, such as insulin, metabolism, weight loss, thyroid function, and more.
 
 
36 Responses to "Low-carb Lab Testing – Part 2 – Fasting Insulin Test"
  1. Miche says:

    Thanks, Amy. My latest fasing insulin test was 3.7 uIU/mL. Does fasting insulin fluctuate based on what you’ve eaten? My previous results were 5.4 and even though I had fasted the requisite 12 hours, I had dinner in a restaurant that included a glass of wine and higher protein (for me) the night before.

    • Amy Berger says:

      Hi Miche, the fasting insulin level shouldn’t be affected much by what you eat the night before, especially if you were fasted for 12 hours before the blood draw. Both of your results – 3.7 and 5.4 are great, so I wouldn’t be concerned if I were you. (But I am not a doctor, so you may want to consult with your MD.)

      • Miche says:

        Thanks for clarification, Amy. I was just curious, because I’ve had 3 fasting insulin tests, first in Nov. was 3.7, in Feb 5.4 and then 3.7 last week. I am not worried but was just curious; since I’ve now had two at 3.7, I’ll assume that the 5.4 was the anomaly 🙂

        Thanks for all your work! I love to read all of your writing!

  2. Eunice Dockrell says:

    Forgive my ignorance, is fasting glucose, HbA1c and fasting insulin two different blood tests that needs to be done to determine the insulin level? I live a low carb lifestyle and generally do intermittent fasting (16:8) most days. I have blood tests done every year and have a blood test monitor at home (where I just prick my finger) and my last reading was 5.3 mmol/L

    • Amy Berger says:

      Hi Eunice,
      Thanks for reading. Fasting glucose, HbA1c and fasting insulin are *three* different tests. Fasting glucose is usually included as a standard part of routine bloodwork in the U.S., but you have to specifically ask for the A1c and fasting insulin, as they are not usually included unless you ask for them.

  3. tosjac says:

    “This is relatively rare, except in type-1 diabetes, which is an autoimmune condition and not driven by a poor diet.
    The pancreas still secretes large amounts of insulin but some of the body’s cells no longer respond to it properly, resulting in high blood glucose”
    I don’t agree. Read
    http://scarysymptoms.com/2014/09/does-fasting-glucose-reading-of-106/

  4. Julie says:

    Hi Amy, I have been on low carb diet and daily intermittent fasting (eating only 2x a day) for approx 2 & 1/2 months. Had blood work last month with following results: fasting insulin: 1.9; fasting glucose 88; A1C of 5.9. Should I be concerned with such a low fasting insulin and high A1C that I have LADA/diabetes 1? I have been checking my sugar levels at home and fasting glucose usually in mid to high 90s. My primary doctor made no note of these levels when reviewing my labs so any guidance would be greatly appreciated. Thanks.

    • Amy Berger says:

      Hi Julie,
      It would be difficult for me to comment without knowing more about your situation. Do you have an endocrinologist? Do you test your BG at other times during the day besides fasting? What was your A1c prior to starting low carb? There’s a chance it’s actually come down quite a bit; perhaps it was even higher before you adopted this way of eating. It’s possible your fasting glucose is normal, but it’s going higher after meals and/or remaining elevated throughout some of the rest of the day, which would account for the higher A1c despite a low fasting level. It’s hard for me to say more. Lab values really have to evaluated as a mosaic — a whole made up of many smaller individual parts. Having a fuller picture would give a better indication as to what might be going on besides just seeing these 3 levels related to blood glucose and insulin. If you have any lab values from *before* going low carb, I would compare to those, because you might actually already be doing better than you were.

      • Julie says:

        Thank you so much for your response. I forgot to mention perhaps an important factor in that my A1C in April before starting in June with low carb diet and intermittent fasting was 5.6. Looking back through recent years my A1C levels have consistently been at 5.6 or 5.7 since the year 2014 with one reading of 5.9 in 2015. I July i have taken BS readings at 1 hour and 2 hours after eating and usually n the 105 to 110 range with couple readings at approx 125 range.
        My lipid panel are in normal to good range. Normal weight and am 61 years old. This was the first time I had fasting insulin test ever, at my direct request to my doctor, after realizing it is necessary to get the big picture. I can’t believe it is not routinely done. I don’t know if 1.9 insulin level is anything to be alarmed about. I have not been to an endro doctor yet. Thanks for any additional guidance.

  5. Ian says:

    Unfortunately different insulin assays give different results, so it is not possible to use the cut-offs in this article reliably. If you send a sample to different laboratories, the values that come back will be quite different. Each laboratory will have its own reference interval, and this needs to be taken into account when interpreting results.

  6. Chrissy says:

    I was wondering how accurate insulin levels are when your NOT fasted. I had my blood drawn about an hour after I had eaten and the insulin number was rather high so I’m thinking I need to have it redone when im fasted to be more accurate.

  7. Amy Berger says:

    Hi Chrissy,
    Thanks for reading. Yes, have the test redone when you are fasted. It’s very important that it be fasted because insulin will rise significantly after a meal even when you eat low-carb. Not as much as if you were eating a high carb meal, but it will still be significantly higher than it would have been if you were fasted.

  8. Samantha says:

    Hi Amy,
    Thanks for the article. I was recently diagnosed with PCOS/metob syndrome, after having 5 kids…my periods stopped. My dad was type 1 diabetic. The Dr gave me metformin, which I am hesitant to take. I requested an insulin test which he did, and the results were :
    GLUCOSE: 89 (70-99)
    INSULIN: 13 uIU/mL (4-13)
    Much of what I’ve read is saying despite the lab range, anything double digit is dangerous. I’ve also read metformin shouldn’t be used so often. What do you think?
    Also, I just got a bowflex trainer which is high intensity. I’ve read high intensity increases testosterone production. Should I not do high intensity since i suspect high insulin has caused my PCOS, which means my male hormones are already too high?
    Thanks!

    • Amy Berger says:

      Hey Samantha,
      I’m not a physician, so all I can do is give you my thoughts. This is not medical advice.
      Fasting insulin of 13 is higher than most of us would like to see, but I’ve seen much, much higher. Are you doing a low carb diet? That would be the place to start…more effective than exercise, and more effective than metformin, although those other things can help. Starting with some variation of a low carb diet would be the first and most important step, in my opinion. Metformin actually seems to be one of the drugs that actually helps people and is not riddled with a ton of dangerous and undesirable side-effects. It has *some* (no drug doesn’t), but on balance, metformin does seem pretty helpful. I don’t think it’s a problem to take it, but hopefully the MD didn’t prescribe some kind of super high dose.

      For the most part, exercise — even high intensity exercise — is beneficial for insulin issues. I don’t think you’ll be messing with your testosterone from intense exercise alone. The #1 thing contributing to the high testosterone is the high insulin, so the way to address the T is with that combination of low carb diet, metformin, and exercise. Also make sure you get enough quality and quantity of sleep. Probably a tall order with 5 kids, but you really do need to rest and repair, and your body does that best during sleep. If this is difficult for you, or you are constantly overwhelmed and stressed out, see if you can work something out with your spouse/SO, friends, or family members to give you a night off once a week. (At least!)

  9. Anna says:

    Thank you for these wonderful posts! I have struggled with weight especially over the last couple of years. Had success on ketogenic diet, but gained most back when I went back to moderate carb, lower calorie diet. I just recently started Intermittent Fasting and keto again, about 2 weeks before blood panels. My #s look like this: Fasting blood glucose = 101 (low pre-diabetes). Insulin = 11 (show “normal” on MD range and “intermediate risk” based on your post). HA1C = 5.1 (normal). And if I calculated correctly, HOMA-IR of 2.74 (high range of “early insulin resistance”). My doctor was not concerned with me developing pre-diabetes based on my HA1C and fasting insulin, but my gut tells me that I am insulin resistant based on my history of gaining weight with even moderately low carbohydrate diets and losing only on ketogenic diet. Would you consider these numbers in the pre-diabetic range, and do you believe intermittent fasting combined with a low carb or ketogenic diet would be beneficial?

    • Amy Berger says:

      Hi Anna, I am not a physician, so I absolutely cannot “diagnose” anything. In my opinion, a fasting glucose of 101 and a fasting insulin of 11 are not terrible, but they’re obviously not ideal. They’re both a little higher than I’d be happy with, and also higher than with what most of the low carb and keto-oriented MDs I know would like to see as well. But I wouldn’t worry at all if I were you. If I’m understanding your comment correctly, you were only back to a low carb way of eating for 2 weeks before having this blood test. Give things a bit more time to take effect. I would imagine if you re-test in 60 or 90 days, both measurements will have come down a little.

      In the meantime, I think you’ve already proven to yourself by your own experiment here (although you didn’t intend it as one) that a lower-carb way of eating seems to be best for you. You might not have to be strictly ketogenic all the time, but *some* variation of a reduced carb diet is probably the way to go.

      • Amy Berger says:

        Also, you don’t “have to” wait 60 or 90 days to re-test. You might even see a difference in 30-45 days, but I just wouldn’t drive yourself crazy over it. Stay the course, keep carbs low, and you should be fine. And the glucose of 101 and insulin of 11 really aren’t that bad. Yes, you’d like them to come down a little (and I’m sure they will), but you’re starting back to low carb from a very good place. Honestly, some people out there are in really dangerous territory…fasting glucose in the 200s, insulin in the 20s or even 30s…so you’re doing yourself a world of good by getting back on the horse *now,* before things got further out of hand. 🙂

        • Anna says:

          Thank you so much for sharing your thoughts and experience with me. I feel much better about my numbers now and am committed to making changes to bring those numbers down into the “good” range. I am so glad I found your blog and excellent information!

  10. Alex says:

    Great article! Unfortunately I live in Sweden and it doesn’t look like I can order a fasting insulin test from anywhere, even privately. Can you think of other proxies I could potentially use to assess if I’m doing OK or not?

    • Amy Berger says:

      Hey Alex, look at your triglycerides and HDL. You want trigs low and HDL high. That ratio is usually a good sign of where insulin is. Different experts cite a different ratio as being the cutoff point for being at lower risk for cardiovascular problems and being metabolically healthy, so it’s hard to give an exact ratio, but certainly no more than 3.5 (trigs no higher than 3.5 times the HDL). Many people who do a low carb or ketogenic diet have a ratio <1.0 -- HDL is actually higher than trigs. But I would say under 2.0 is probably okay for most people.

  11. Anonymous says:

    Hi. What’s the highest you’ve seen insulin go on a test? I’m trying to find other cases of super high insulin levels. I have reactive hyperinsulinemia caused by an insulinoma. I’m strictly reactive. I have no problem fasting. During a 5 ht ogtt my insulin spiked to 522. Sugar went to 143 before dropping to the 70’s. Then we did a mixed meal test. Sugar peaked at 167 ( it as a super high carb meal. More than I would eat in a week) and my insulin went to 780. This is in universal units.

  12. Kara says:

    Hi, I just found this site and am hoping to get a little reassurance. I recently ordered an extensive panel of bloodwork through DirectLabs.com, but when I got the results back I realized that the panel did not include a fasting insulin test. Frustrating. I went back for just the one test, and I have to say it was an odd experience in that the phlebotomist could not get a full vial during the draw. He asked his supervisor if it was enough, and she said it was fine. It looked to me like it was about 1/2 full. When I finally got the insulin test results back, it says my levels were <1.0. Every other test that I took previously came back in the normal range except for Vitamin D which was below normal at 21. Is it even possible to have insulin levels that low? Could it be that the test was flawed? Or, if not, what do insulin levels that low indicate when everything else is normal? Fasting Glucose was 84, Tri was 64 and HDL was 61. Thanks for your help!

    • Amy Berger says:

      Hi Kara, I’m not a physician, so this is not medical information. All I can give you is my professional opinion as a nutritionist. I, myself, have also had fasting insulin tests in the past come back at <1.0. I don't think it's cause for concern. In fact, it's actually very good, assuming you're not a type 1 diabetic, which, looking at the other numbers you've provided here, you are not. So I wouldn't worry. Don't know if you're following a very low carb diet or not, but fasting insulin is generally very low in people on very low carb diets, or even on other ways of eating, if they are very metabolically healthy. Your numbers look great to me.

  13. Renee says:

    Hello Amy,
    I really gain a lot from reading your information. I have had TD2 since I was a teenager. I was not overweight. Now I am 55 and have been using the KETO diet to help me gain control of an ever increasing problem with my blood sugar. I have use the low carb life style for years and this helped a lot but didn’t make my blood sugar stable. After being on the KETO diet (under 25 carbs a day) for over 40 days, my blood sugar still stays at around 250 fasting. I use
    insulin (N and R) to bring it down but have gained 25 pounds as a result of the dose required to bring it under 150. Any suggestions about what else I can do
    The only solution for me at this time is to take Farxiga. This drug works wonderfully well but has an awful potential for kidney cancer in the future after long
    use. My most current blood work still shows my A1c at 10.7.

    • Amy Berger says:

      Hi Renee,

      I’m sorry you’re still having a hard time bringing your glucose down even with keto. It’s difficult for me to comment without knowing more about your situation, and it wouldn’t be appropriate for me to offer any suggestions without knowing more. Feel free to email me privately at tuitnutrition@gmail.com

      Do you have sleep apnea? Poor/disrupted sleep can really mess with blood sugar, even when you’re low carb/keto. Are you on any medications besides the diabetes meds? Several different kinds of medication can keep blood glucose elevated even when someone eats low carb, so there are lots of things that might be getting in the way for you.

  14. Dan Britt says:

    Amy,

    Wondering if you have a thought on this… For those that have a fasting Insulin level of below 2 or below 1 and levels of Fasting Glucose, HgA1C, Triglycerides, and HDL that are considered fine and in range(such as the 84 Glucose, 64 Tri, 61 HDL above), would you say that a good way to definitively know that everything is fine with Insulin capabilities would be to do a Glucose and Insulin 2 or 3 hour challenge test and see how Insulin responds? Would you say that if Insulin levels increased normally in response to rising Glucose levels from the challenge sugar or carbohydrate meal, that the person would definitely have no concerns about Type 1 Diabetes being a possibility as the result of the “lower” fasting Insulin levels? If this is correct, I would think this test would be of great assistance to those who are trying to improve a health challenge and are seeing fasting Insulin below 2 or below 1 and may then be concerned about an Insulin or Type 1 fear… I’m thinking, if Insulin is produced during the test, then the pancreas is working as it should in producing Insulin and as you mention, the fasting level may be below 2 be below 1 because of “lower carbohydrate eating, or other types of eating if the person is metabolically healthy”… Make sense? I would appreciate your take… Thank you…

    • Amy Berger says:

      Hi Dan, frankly, if everything looks good, I would really not recommend the Kraft test. I see no reason for it.
      If there were a problem with the pancreas producing adequate insulin (heading toward T1D), then the glucose would be elevated. In someone with very normal glucose, trigs, HDL, etc., and very low fasting insulin, I’d say all is well and that’s exactly what you *want* — low fasting insulin. In fact, this describes my personal labwork. I just see no reason for the Kraft test in someone who by all parameters seems healthy and metabolically well. Maybe if someone had unresolved/unexplained health problems, but not otherwise. However, my caveat here is that I am a nutritionist, not a physician. That being said, most of the low carb/keto MDs I know don’t recommend the Kraft test either. There are some exceptions, but most people really just don’t need it.

      • Amy Berger says:

        Bottom line: if your pancreas wasn’t producing adequate insulin, you’d have signs & symptoms of T1D. It wouldn’t happen silently.

        • Dan says:

          Thank you for the reply… I guess I was just wondering if that test was done amid fasting insulin of less than 1 and it showed normal insulin response in the wake of glucose increasing with the sugar solution, can one definitively rule out Type 1 diabetes… I can see why you would think it not necessary for folks in these good ranges to not have to fork over any more $$$ for tests… I have seen so much discussion on insulin lately with Keto and the Keto diet and the ranges Keto proponents are looking for, yet not easily finding them discussing what their fasting insulin actually is, and how many of them are below 2 and below 1… They all seem to say get it under 5 and you’re good, with 3 better, and below 2 outstanding… I have been working with “unresolved/unexplained” health challenges for quite some time that appear to be neurological in nature and have done many glucose-insulin challenge tests, primarily at my request after the first one… I am recognizing that upon first seeing a naturopath years ago to try to sort out the difficulty, it seems she was way ahead of the game as she ordered the fasting insulin test along with the challenge test among all the tests she did… At the time, when I really was not so focused on “mindful” eating but was still eating in a way I believed was healthy, the glucose was 88, Insulin 3.5, Triglycerides were 73, and HDL was 49… Since then, as I have been focusing on eating as well as possible and been made aware of the “lower” carb approach to help neurological challenge, I have dabbled in just eating lower carbohydrate without really doing a specific Paleo or Keto plan… I think it just happened… And ever since, for years and multiple blood tests, the fasting insulin has been below 2, which is the lowest number on my lab report… Other markers great, Tri closer to 50-60, HDL 65-70, Glucose 82-90… Glucose has never been under 80 for me… I may be in some degree of ketosis frequently, as I’ve done two beta hydroxybutyrate tests and my numbers were 2.5 a year and a half ago and 1 this past November… One time in the past 3 years insulin elevated again over 2, barely, and this was after a trip I took where I just ate anything with the rest of the group because I was tired of looking at all this eating stuff with no results, and I know I had quite a few more carbohydrates and restaurant food than usual… I also know that the C Reactive Protein goes up during extended “party times” and I just have fun eating with the group… But not much, barely over 1, and it comes right back down to .5 in a few weeks once I get back to eating more mindfully again… RF has been slightly elevated since day 1 as well but has the Rheumetologist baffled because it is not a “meaningful profile”, i.e only 1 of the 5 markers are elevated… The respected Immunologist says 50% of all people over 50 will show slightly elevated RF as the Immune system “ages” and it reacts to more things… Anyway, I appreciate your thoughts, my naturopath says to forget about any form of restrictive diet in my case, she thinks my thinking like this does more harm than good, it has never helped me and with this the stress levels rise, my test results are “fine” and show no blood sugar issues other than occasional mild reactive hypoglycemia on the challenge test, but the nerve pain/discomfort is frustrating, idiopathic according to the Neurologist, and I have been just trying to figure things out… I came across this thread when I looking for a discussion on fasting insulin and results below 2 and 1, and I appreciate your comments to people as a nutritionist who has some awareness and thoughts of this… I know some people who have different health challenges will definitely benefit by dietary changes being the most important factor in their improvement…

          • Amy Berger says:

            Again, caveat that I am not a physician, but based on the (limited) information I have here, you sound exceedingly healthy, and are what we call the “worried well” — you’re in excellent health but are consumed with worry and anxiety over it nonetheless. I think your naturopath is right — take a breather, Dan! I would absolutely NOT bother with a Kraft test for you. And not for most people. Not because of the expense, but because why would I want anyone to subject themselves to drinking 75-100g of liquid glucose? Especially if it’s someone who follows a low carb or ketogenic diet anyway? Even if that person were to reintroduce some sweeter or starchier foods back into their diet, 100g of liquid glucose does not at all mimic the physiological effects of a mixed meal containing, for example, a steak, some asparagus, and a sweet potato, or a mixed greens salad with blue cheese, walnuts, and roasted beets. If anything, people should do something more like *that* — an OGTT or Kraft test with actual *food* that more closely resembles something they might actually eat. Not to mention, for someone who’s been on a ketogenic or low carb diet for a significant length of time, it is NOT recommended that you randomly go out one day and do an OGTT or Kraft test, as you will likely get a false result. The keto-savvy MDs I know recommend “carbing up” for 5-7 days with about 150g of carbs per day before doing those tests, otherwise you might look severely diabetic when in fact, you’re in excellent metabolic health and it’s just that your body isn’t used to handling a huge load of liquid glucose out of nowhere. I just fail to see the point in any low carber or keto dieter doing this anyway, since that doesn’t at all resemble what and how they eat in the real world anyway.

            If you have nerve pain or some kind of rheumatoid issue going on, it’s possible you’re consuming a particular food you’re sensitive to and are not aware you’re sensitive to it. Some people with rheumatoid arthritis are sensitive to nightshade vegetables. Possibly there’s also some kind of autoimmune situation going on, but honestly, it sounds like you’re doing very, very well, and the stress of worrying about each tiny detail is likely only making things worse and possibly even contributing to things in some way.

  15. Dan says:

    I really appreciate your taking the time to share your thoughts, seeking to help people with threads like this…

    In full disclosure, I have actually done many of the OGITT tolerance tests after eating meals… Ha! Ultimately she has let me do whatever I wanted and I wanted to see how things looked with actual food as opposed to the sugar solution… So I did one with bacon and eggs, one with a smoothie that would not be considered Keto that included fruit, vegetable, avocado, nuts, egg, and protein powder, one with blended vegetables and green apple, one a cereal creation with quinoa, blueberry, banana, coconut butter, and cinnamon, and one with almond milk, a gluten free grain blend flakes, and banana. I looked at many varieties of meals and the results were predictable for someone who likely does not have a significant blood sugar challenge… I truly did see that insulin is produced when carbohydrate is present but with the bacon and eggs and no carbohydrate, it simply is not called upon… Fascinating… The mystery of my situation compelled me to do these tests… I have never seen any result with my challenge by altering diet or food approach in any way… But this “contraction” sure can create more stress if nothing changes… It’s massively stressful for an heretofore active and engaged person who has eaten everything under the sun for 30 years with no issues to change that and suddenly be on the lookout for “something” that may contain “something” or be stressed by having to think about avoiding the group meal at a fun event you have done your whole life… If you try this for 6 months, a year and see no benefit… However, for those that do see benefit and feel good about the benefit they see, then hallelujah to that because something has changed for them and, in theory, they will not have stress over it…

    With the tests my Naturopath has done, I’ve looked at and tried just about every functional medicine thing imaginable over the years… In truth, I am becoming more open to the idea that the real limiting factor for many of the idiopathic and autoimmune health challenges that appear have to do with the stress system, unfelt “trauma” with repressed emotion, and how people engage with their life over time in the midst of this. Mind-body work as opposed to “other” needs to be done… But the ego has a hard time admitting this, and mine’s no exception… But this is where I am going now…
    Thank you again for your thoughts Amy…

  16. Rosanne Hadlock says:

    Hi is a low carb diet the answer to high insulin?

    • Amy Berger says:

      In my opinion, yes. The truth is, many different types of diets can help with elevated insulin, but I believe that low carb is the most effective.

  17. Matt says:

    Hi Amy, love your work and the podcasts you do with the various keto folks. I’m a 53 year old male, very active (calisthenics) lean mass hyper-responder. I have a history of elevated fasting blood glucose (105-115) and A1c in the 5.7-5.9 range even before keto and the numbers haven’t come down (2 years on keto). Went on keto to try and lower the numbers to no avail. I had my fasting insulin checked in January and April (4.3 and 2.6) with A1c’s (5.7 and 5.8). Seems like it takes a long time for my postprandial blood sugar levels to come down. Rarely do I have a fasting BG below 100. I’m concerned about elevated blood sugar levels above 100, 24/7. Is it possible my pancreas isn’t producing enough insulin? Any other tests you would suggest? I calculated my HOMA-IR and the result is 0.7, clearly an indicator that insulin resistance isn’t an issue. I can eat the same diet day in and day out with the same exercise and experience significant differences in blood sugar results.

    • Amy Berger says:

      Hi Matt,

      Your numbers are not at all abnormal for a lean mass hyper-responder who is very athletically active. I don’t know if you’re following the work of Shawn Baker, MD, who is spearheading the “carnivore”/zero carb movement, but it seems that for people who do a great deal of athletic activity, it’s not unusual to see higher fasting glucose and A1c, with low insulin. What do you typically eat? If you’re eating a very, *very* large amount of protein, you might consider cutting back and going slightly higher in the fat, or even cutting back a little on your workouts for a few weeks and see what happens. The numbers you’re seeing do seem to be not uncommon in people in similar situations to yours, but what is not yet known is whether this is problematic or not. The slightly elevated FBG is very common (and most low carb MDs I know don’t really worry about it unless it was *very* high, which yours is not). The A1c is more telling, as are the post prandials, but you’ve only said that it takes awhile for them to come down — you haven’t said what they typically are. People are often getting the wrong idea about BG now…it’s normal for it to go up a bit after a meal, so unless you’re talking a very large excursion, don’t give yourself unnecessary anxiety and worry about something that is not even really a problem or cause for concern.

      If a lot of the exercise you do is more “glycolytic” — requires quick bursts (which are more fueled by glucose than slightly lower intensity longer duration activities), then it’s not unreasonable that your body wants to keep just a little bit more glucose available right away in the bloodstream. Dave Feldman writes about this.

      As I said, though, your situation is not uncommon, but we don’t know for sure whether the slightly elevated sugars (and they are just that — only slightly elevated) are something that could lead to trouble down the line. If you’d like more detailed info, please contact me privately through my website.

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