For those of you who have already seen the video on the regulation of blood sugar, there are some redundancies with this video here. My apologies for that. I decided to repeat some of the essential information because it's critical to be clear that insulin resistance is not the same as glucose intolerance, i.e., it is very much possible to have normal blood glucose levels but still be very insulin resistant. As always, don't hesitate to post questions or requests for future content in the comment section. Cheers Mario
Why my doc order lipid test report does not have majority of the discussed test parameter but have other items which are not looked at even by my doctor? Did AMA ever thought about it?
My father, who suffered from type 2 diabetes for most of his adult life, passed away recently. Officially, it was from multi organ failure, but it all came as a result of diabetes. He also had both legs amputated some years before his death. My dad didn't really take his condition seriously and he paid a dear price for it. I'm really happy that more researchers and doctors are paying more attention to this "silent pandemic" of insulin resistance. So many people are walking around thinking that they are healthy but they aren't. Another thing to add is that my dad was never fat. Thinness doesn't equate to health either. That's why it is so important to go for your checkups and do the blood tests too. Better safe than sorry.
So sorry to hear of your loss. My dad also recently passed away, and he also had T2DM. His diabetes was better controlled, but he loved his white bread with syrup, his sweets, cakes, and baked goods, and didn't really want to make a more substantive change to his diet. He died of metastatic pancreatic cancer, which may or may not have been related to his diabetes. Diabetes clearly is a major risk factor, and I do keep wondering whether he may have had a few more years with us if he had taken his diabetes more seriously ... I'll try to do my best to help those people who are motivated to make a change avoid the types of long-term health issues that come with diabetes. Pancreatic cancer, amputated legs, dialysis from chronic kidney disease, blindness, heart attacks and strokes, there are no guarantees that any of this can be 100% prevented, but I do think the risks can be lowered substantially if we take this seriously and adopt a healthy diet and lifestyle. Thank you for sharing, and again, my deepest sympathies. Best, Mario
Yes i hv been lean all my life, I recently discovered tat my bg always 6ish even after I woke up fr 10hrs of fast. Not sure I'm already prediabetic or insulin resistant coz the place I stay has no doctor checking for insulin. I'm lost what to do to improve myself besides low carb diet. 😢
FYI for those in the U.S., it is possible to find your HOMA-IR pretty cheaply without a doctor or insurance. There are labs online where you can order a fasting glucose and insulin test. They send you to a local lab for the blood draw. I was just able to order one for only $37 with no prescription or insurance. From the results, I calculated my score to be 5.8, so I definitely have some work to do. Your videos on reducing IR will be extremely valuable to me, Dr. Kratz, as all your others have been.
I am cardiologist in Brazil. And after I read Dr. Krafts book i started to use insulin and glucose curve in many patients in risk for IR. I also did it in me (normal!). My HOMA IR is 1. Great videos! Very well done. Congratulations for the chanell. I will keep seeing.
You are doing your patients a great favor. It is now sufficiently clear that insulin resistance and hyperinsulinemia can lead to major health problems long-term, and it doesn't make sense to me that many physicians are resistant to even measure a fasting insulin in their high-risk patients. Considering the burden of associated disease, and costs related to these, we should be intervening way earlier in the development of diabetes. Thank you for your kind feedback. Cheers Mario
Thanks to all Dr. Who care about their patients educated provide guidance not just insist medication. I am struggling for 20yrs was searching for help because I was not informed or tested by my doctor 😢 I am on two metformin my dr. Said i have no other choice is to keep increasing medication
My Dr. Said A1C is only a 10th of a % over into pre diabetes. Not concerned, see ya for your yearly in October. Said nothing about nutrition/diet. I'm so glad I found you.
You are doing those who listen a great service. It is amazing how humans go through a great deal of trouble to avoid a minimal discomfort in the immediate when that slight discomfort would avoid major discomfort for the long run. I hope your videos help many to decide to do the work.
Your fastidious care and rigor to your research are evident. It is a pleasure to bask in the knowledge that you spread. More power to you, Super Mario !
As a Nutritionist , one of the best videos I came across, information so well talked and explained with thorough research , much needed for we Indians to understand this concept Of Insulin Resistance.
I think the best content on blood sugar regulation on youtube is on this channel - thanks Dr Mario for sharing evidence based knowledge translatable into practice with us !
Great video, without hype, promoting, or blame, just straight truth! Amazing! I listen this post twice and I’ll do more in the future…Thank you very, very much! Some confession to make: I already “bing watched”trough all your previous videos!
Tell me about it. It's bizarre how the 'normal' range for insulin is so ridiculously vast, and nothing is done about it. Then one day the dam breaks and your glucose sky rockets. As if insulin hadn't been creeping up, and up, and up for *years*. What's considered normal should be cranked way down, and it should be monitored at least annually.
My GP doesn't even think prediabetes is an issue! I managed to get rid of it with the low carb diet and other lifestyle changes. However, now I got a diagnosis of osteoarthritis and a higher fibre intake for example with legumes is suggested to improve gut bacteria. I am wondering what happens with my next HbA1C in a years time. Unfortunately I am not able to afford a HOMAR IR. Can I win?
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research . New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
Thanks for your efforts to bring the attention towards Insulin Resistance, including how doctors will not be of much help in spotting the trend in the beginning stage. Yes, I have been paying for my HOMA test as my insurance would not cover that and any GP would not prescribe it, even when one is diagnosed as diabetic. Just wanted to add one more popular surrogate measure of Insulin Resistance, that uses Lipid Profile test results, that are usually covered under annual check up -Triglyceride and HDL levels - Triglyceride divided by HDL levels (both are expressed in the same units by a lab, like mg/dl or mmol/l) is a good indicator of Insulin Resistance according to many, including Dr. Benjamin Bikman - any reading more than 2.0 -2.5 (triglyceride level more than 2 times of HDL level), indicates beginning stages of insulin resistance, just like the HOMA test ( but is covered under insurance, though under different context!!). However, for certain ethnicities, this may not be very accurate and threshold also lower for women (>1.75) than men (>2.5) to be tagged as Insulin Resistant. We can also use our previous annual test results to plot our own progression, as all reports would have these two measures available. Just a thought!
Very good point. I considered discussing the TG-to-HDL-ratio and also the TG-to-glucose-ratio in the video, but we do have a lot less data on these as surrogate measured in different populations, and also less data linking these to chronic disease risks. I still think they can be useful for log-term tracking of metabolic health. Cheers Mario
Wow, 2 lipid numbers I DO care about! Brilliant of Dr Bikman, et al. I actually want my TC around 300 (the old, prestatin number). Evidence shows THIS is protective, esp as we age. Big pHarma is the only reason they dropped the TC numbers -STATINS-
Thank you for giving us these videos. Your straight forward explanations make it easy to understand for us lay persons. You are doing a fantastic job!.
Great series of videos. Had a blood test last week, which included a HbA1C test, but if I had seen this video I would of asked for a Homa IR test. Thank you - you have a very balanced style of presentation with excellent information.
If you had fasting insulin and glucose levels done you can calculate your HOMA IR result yourself; it's not a blood test, just a calculation based on those two values, and there are many online calculators which will do it for you.
Just discovered your channel through your interview on Sigma Nutrition. I've been looking for a video like this for years! So clear, concise, precise and MUCH NEEDED! Thank you so much! I will support you and tell my clients about you. ~ Marian Blum
Great information and presentation. I have been wearing a CGM to see how much and why my glucose levels vary. I now understand from your videos, the CGM will not tell the whole story and that also need to look at my insulin levels. I wish there was a continuous insulin monitor also. Thank you Dr. Mario.
Yes, agree. However, you can get a sense of your insulin levels throughout the day by looking at your glucose levels under consideration of your HOMA-IR. The more your HOMA is elevated, the more your insulin levels will tend to rise with any given rise in blood glucose.
I think there is an issue with how Type 2 Diabetes is defined (I say this in 'reaction' to the standard medical statement that Insulin Resistance is a Risk Factor for Type 2 Diabetes). The definition of Type 2 Diabetes per a description I found from a Mayo Clinic article is: "..Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems..." Starting with THIS definition of Type 2 Diabetes, then yes - Insulin Resistance is a 'Risk Factor'. However - I would argue that the difficulty with regulating blood sugar is a side-effect of the primary disease factor which is Insulin Resistance. I would suggest that public health would be better served by measuring Fasting Insulin levels and Insulin Response Coupled With routine Blood Glucose and HbA1c tests. Type 2 Diabetes diagnosis under my suggested approach would be based on excessive levels of Insulin in the blood OR high HbA1c/blood glucose levels. Conversely, Type 1 Diabetes is a symptom of Low Blood Insulin levels AND high HbA1c/blood glucose levels. Only Type 1 Diabetes should (IMO) be treated with Insulin. In this regard - I must push back on the assertion made at 7:05 in regard to "Fred" where you Imply that he has low insulin sensitivity (i.e. high Insulin Resistance) because his PRODUCTION of insulin is too LOW and THUS has Type 2 Diabetes. There may be those that fall in that category but I believe there are sufficient studies to show that many diagnosed with Type 2 Diabetes are still producing very high amounts of insulin (in absolute mcU/ml terms). Though High, for those diagnosed with Type 2 Diabetes the amount is insufficient to overcome Insulin Resistance (despite the high Insulin level cells can no longer be stimulated to absorb/use blood glucose and the Liver thus converts the sugar to fat). This is, in fact, MY situation. I am not 'Fred', if anything my production might be HIGHER than Ben's. I am sensitive about this issue because my father passed away in large part because of High Insulin levels that contributed to Non Alcoholic Fatty Liver Disease and he was prescribed Insulin for Type 2 Diabetes rather than treated to LOWER his Insulin Resistance. The prescribed insulin just made his NAFLD worse, the insulin might have lowered his blood sugar but at the cost of destroying his liver and causing other health issues. He would have been better served by dietary changes (types of food he ate, eating frequency, ...) but his Doctors then followed the 'Standard of Practice' as do most today.
Appreciate your comment. However, note that the diagrams simply mean to illustrate principles, and the axes don't have units of measurement. Fred could be anywhere on the left side of the green shaded area, and you are correct to assert that many people with type 2 diabetes (at least among Caucasian or African race) tend to have quite high insulin levels. Note, however, that many Asians with type 2 diabetes tend to develop diabetes at fairly low insulin levels (because often their problem is more an inability to produce more insulin). About the definition of diabetes, given that it's focused on glucose levels, I am fine with the current definitions, but absolutely agree with you that much more emphasis in clinical practice should be on insulin and insulin resistance. Cheers Mario P.S.:Sorry to hear about your dad. Mine also had diabetes, and recently passed away from pancreatic cancer.
Thank you so much, Mario. I watched your two videos and can tell that I can save a lot of time and stop watching other health related videos. You are so right and to the point that I have literally tears in my eyes…I had to figure out myself a lot, including HOMA -IR. As a child I was accidentally poisoned by Death Cup mushroom and I think that I am paying for this all my life. My body never responded typically, many gut issues, immune system overreacted in strange way. Finally, when I am a senior I start to understand my body…. Hope to learn a lot from your channel. Thank you.
Thank you Mario, my daughter is struggling and not getting the help she needs from her Dr. How is it that a Dr. gets himself so busy as to mot be able to see his patients in a timely manner. The PA or NP in office aren't helping her and told her Dr. booked into next year. I have told her to find another physician but in meantime to start looking at your videos. She has every indication of having metabolic syndrome and insulin resistance. I really think your videos are going to benefit her. You have helped me so much. Everything is reversing for me. Now my b/p for first time is low. Weight maintained and feeling good. Thank you.
@@YeshuaKingMessiah you really should read a little more before giving your advice. Metabolic syndrome, NAFLD and others require life long changes. KETO diet is not recommended to be on for more than few months. I see a hepatology Dr. for NAFLD and metabolic syndrome. The diet requires life change and that is for sugar. Sugar is the real danger. The Mediterranean diet is what is recommended and to start with very low calorie like 800 a day to start reversing the fat stored in the liver. She knows she has to do it on her own. Until someone knows the problem they don’t really know where to start. That’s where the Drs come in.
@@cathyellington7599 undereating is the worst thing to do for any issue. Fasting IS another avenue that can work to move out glycogen from liver. It is hard to do and some ppl have a lot of issues arise at first also. Fasting is very diff from starving. Your body responds very differently. The worst thing you can do for a metabolic condition is undereat/starve. It sets ur metabolic rate very low too. IF is a great middle ground or practice whereby u are eating enough, just in a daily window of several hrs. When u eat highfat, lowcarb u also don’t suffer in ur off-eating hrs. Endocrinologists of any ilk (hepatologists incl) are clueless. Look up nephrologist Jason Fung, he’s on YT also. He got tired of ineffective protocols for the diabetics losing their kidneys. IR, fatty liver, obesity, metabolic syndrome, diabetes all are the same thing. Diff names - they’re all related thru hyperinsulinemia. THAT takes time and lowcarb/keto to resolve. Then u must stay aware still of any creep backs, for life. There’s prob a genetic component but it’s majority a lifestyle choice and once you’re damaged, it never completely resolves. Ppl THRIVE on keto.
@@YeshuaKingMessiah yes, you are right about the epilepsy. I was a dialysis nurse for 32 years and RN for 38. Any diet carried to extremes can cause harm. My daughter is pre renal. Told to limit protein. You limit carbs, you limit protein then your body starts to get what it needs from itself. A balanced diet is what is recommended by AHA. Glad you are a fan of KETO. Sure it works but would recommend before anyone stays on it for extended period they get accurate information from non bias sources.
There is data from Dr. Bozworth that the ratio of the glucose to the ketones mirrors insulin. This is easy to test and might be a good practical test with good data
Very informative for lay person to understand and get the Homa ir test done. How does hba1c fit here? In India the test is very common to decide if you are prediabetic or diabetic.
Fasting glucose and HbA1c (and potentially the 2-hour value in an OGTT) are still the measurements used to diagnose diabetes, or pre-diabetes. HOMA-IR is not relevant for the diagnosis of any disease (which is why it's not commonly done). Think of fasting glucose, 2-h glucose in an OGTT, and HbA1c as diagnostic criteria of a disease, whereas HOMA-IR is a risk factor for disease (more similar to LDL-cholesterol). If someone has type 2 diabetes, they are almost always at least somewhat insulin resistant, but HOMA-IR can also be elevated in people without diabetes or pre-diabetes, so that's where it really has value because then you can intervene early to reverse the insulin resistance and prevent the progression to pre-diabetes and diabetes. Cheers Mario
@@KoiRun50 The problem is that even if someone has elevated fasting insulin/HOMA-IR, suggesting that they are at increased risk, on an individual basis it is still thought of as a poor marker of diabetes risk (because you never know how much insulin a specific patient will be able to make, i.e., they may never become glucose intolerant even if they are already very insulin resistant). I think this is inconsistent thinking. Similarly, one could argue that not all patients with hypertension and elevated apo B develop CVD. That is true, but still no reason to ignore these risk factors. Cheers Mario
@@nourishedbyscience Good explanation. Thank you. I think our government and doctors should give more publicity to homa ir considering India has large population of diabetics and prediabetics. An ounce of prevention is better than a tonne of cure.
I am loving your content. I was able to calculate my Homa IR at 2.6 to 2.9 (depending upon using my fasting blood sugar or my average bs of 120 from my A1c). Now to work on improving my sensitivity. I only have 1/2 a pancreas and I am committed to preserving what pancreatic function I have left.
Thank you for the very interesting, well produced and informative videos! May be the link between stress (and the other factors) and IR could be explored by you in a separate video(s).
I think the term "normal Insulin resistens" is worth a discussion. Most people in modern societies will get a Homa IR far Higher, hence the low one could be namened "good" or "healthy" but not "normal".
Another awesome, informative video! I’ll be anxiously waiting for more information on how to become more insulin sensitive. Right now, at 2.75, I know I’m insulin resistant. I was only able to get my fasting insulin down to 2 when I really backed off on the grains and starchy carbs. It’ll be interesting to see how your upcoming information aligns with my own experience with diet changes!
I’ve had diabetes for the last 15yrs. After watching your video I brought my HbA1c levels down by ,5 on just one month!! Another question : do you these videos in a German version for German speaking people? English is perfect for me. Thank you very much for these videos. They are extremely helpful.
Sorry, as much as I wish I were able to also make these videos in German, I don’t have the time to do that. As the number of people who can follow this in English is at least 20-fold larger, I decided to make them in English, at least initially.
why do you think infla... triggers IR but not vice versa? I have the opposite information: only when I had reduced my IR I got rid of my arthritis, not earlier... and nothing could help.
Did I say somewhere that IR does not cause inflammation? If so, I appologize. I have myself published that elevated insulin levels may play a role in activating the immune system, so this is something I am very familiar with. However, it's not the main point of the video, so that's why I didn't want to get into that specifically here. Cheers Mario
@@nourishedbysciencewow!thank you for the response and so fast! I was triggered for the comment at 13:05 of the video. Because I expected to hear "because inflammation can be an indicator of existing IR, or can be caused by IR..." And it's ok, as you have just explained. I was just amazed maybe you really meant that an inflammation can lead to IR too?
@@okritsky Ah, I see what you mean. I put this list at 13:05 together to help people assess whether they may be at risk of insulin resistance, so that's why I only talked about inflammation as a cause of IR. You are correct though that it can go both ways, and potentially lead to a viscious cycle over time. There is always so much to talk about. I try to be systematic when i make these videos, and stick with the main theme. Otherwise, it becomes confusing and too long (even though know I am already guilty of that ...;-). Cheers Mario
@@nourishedbysciencecool! thank you! and I think 20 minutes (+-5 min) is the best or optimal video length in this area of knowledge (even watching other channels - this length is like a "golden standard"). so, you have good videos: quite clear, optimal length, and yes, you are really well systematic)
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research. New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
Thank you for your comment. Yes, Dr. Kraft certainly is a pioneer in this area, but - to be honest - even if someone has never heard about Dr Kraft, we now have so much data that clearly links insulin resistance and hyperinsulinemia to numerous chronic diseases, it doesn't make sense that primary care medicine contiues to ignore it. Glad to hear you are helping patients get these tests done. Cheers Mario
Are the effects of stress on fasting insulin that you mentioned strong? I was on a whole food diet for a year when I wanted to check my insulin resistance. I have a really good lipid profile, very low inflammation markers, no chronic illness, phisically active daily, bmi 18.7, very good CGM results (eating lots of whole food carbs daily), hba1c is 5.0, i'm 37 yrs old. But still my fasting insulin is the only thing that is higher than I would expect, around 8-10. The only thing that i suspect is that I seem to have quite high stress/anxiety before and during the blood draw. Could that have such a strongh effect on fasting insulin?
It depends on how stressed someone is. If you are stressed enough to feel stressed and anxious when the blood is drawn, this alone could explain an increase in fasting insulin. Here, for example, is a scientific paper on 'stress-induced diabetes': www.ncbi.nlm.nih.gov/pmc/articles/PMC9561544/ Now, this is obviously if someone is chronically stressed. Considering your HbA1c, this doesn't seem the case for you, for sure, but it may explain slightly elevated fasting insulin levels when you have your blood drawn. Hard to know for sure though. Cheers Mario
Sounds like me except I'm 57. I would imagine, just like blood pressures , insulin levels could be very dynamic. My blood pressure readings tend to be higher at the doctor's office; "white coat syndrome." At the time of blood draw, I'm pretty sure there are blood markers that are more dynamic than other when faced with 'acute' 'perceived' stress levels. This would be an interesting topic for Mario to cover. I think he did cover this a bit here.
Lots of carbs daily is why ur IR is high Ur body isn’t politically correct. Carbs are carbs to it. Dr Wm Davis (cardiologist) speaks about BG not moving from food ingestion. When u eat this way, ur IR will come down, definitely. (Yes, this means keto/very lowcarb)
Thank you ever so much for your quick reply. Appreciated. I can go for 16 on average for fasting blood sugar. I watch your videos with interest. Success.
I’ve been battling IR for a year now with good, but not great, results using mostly NMR lipid profiles. I focused on Whole Foods plus low carb/low sat fat. But I’ve recently learned about high fat intake (even M/PUFA’s) creating IR by blocking the insulin receptors inside of the muscle cells. Do you agree that this contributes to IR and that dietary fats of all kinds should be limited? Thanks!
High carb low fat is effective for gaining insulin sensitivity. Avoiding carbs is counterproductive, it increases stress hormones which increases lipolysis. More fat circulating in the blood the more it impedes glucose uptake. Avoiding carbs increases insulin reactance
@@YeshuaKingMessiah Where’s the lie Yeshua? Check out Kempner’s rice diet. Or other low fat high carb diets treating IR. It’s usually high stress hormones or body fat creating high blood lipids which blocks glucose uptake via randle cycle. Avoiding carbs does not get to the root of IR
@@YeshuaKingMessiah Where’s the lie Yeshua? Check out Kempner’s rice diet. Or other low fat high carb diets treating IR. It’s usually high stress hormones or body fat creating high blood lipids which blocks glucose uptake via randle cycle. Avoiding carbs does not get to the root of IR
This video here covers reactive hypoglycemia: ruclips.net/video/kxUP0zzBECA/видео.html Age definitely affects insulin sensitivity and glucose tolerance, and age is the second most important risk factor for type 2 diabetes, behind body fat mass. As we will discuss in the very next video, this is because the ability of the subcutaneous fat tissue (=the only safe place to store fat in the body) to expand and store fat effectively declines with age. Cheers Mario
I would like you to do a video on your opinion of the keto lifestyle. I had an A1c of 5.8. I have been doing the keto diet for a year now my A1c is 5.5. But my glucose monitor the numbers are usually somewhere between 101 and 115. That would suggest I am still prediabetic. Please help me with this. Thank you and God bless you!🙏❤️
You are more then likely in an Adaptive Glucose Sparing state in your Keto Lifestyle.. Meaning: Your muscles are preferring fat as a fuel and saving your glucose to use for functions that require glucose. This stste is not a problem. I have the same Adaptive Glucose Sparing state. If you want to know more "clap back" to me and I'll give you the Science link(s)
Thank you for this video. I was recently diagnosed as Diabetic and I have immediately changed my diet to Whole Food Plant Based very-low fat and no refined carbs. I have not gone on meds yet as I asked for 3 months to try to reverse it with diet. I lost 13 pounds in my first month. Two to go. But I want to know if I am changing my insulin resistance and you just gave me a way to do it. I also need to take the C-Peptide test (according to Mastering Diabetes) to figure out if my body produces enough insulin to reverse it with diet alone.
Subscribed! I'm 1,8 on the scale, but still insulin resistant judging from the glucose response after carbs. Coming from 3,8 though, so reversal seems very possible.
Always also consider that glucose tolerance is also dependent on the ability of the pancreatic beta-cell to make enough insulin. So even at HOMA-IR of 1.8, it is not out of the question that elevated blood sugar after a meal could be related to a reduced ability of the beta-cells to make enough insulin. Cheers Mario
@@nourishedbyscience Might be, but coming from a lot higher fasting insulin suggest that insulin resistance has been established for sure. So only craft test would tell the real story, but with or without it I would eat healthy anyways so spikes are not an issue anyways. Btw I spike to 140 with a 100gr of ice cream for example.
@@user-ij8no5zw6u- If you watch any of my last three videos, you will see that I define a blood sugar spike as an increase to 180 mg/dL, and I explain the rationale for this. To me, there is little to no evidence that fluctuations within the range from 70 to 140 mg/dL are harmful. Cheers Mario
@@nourishedbyscience Yes, just saw your definition, but I tend to prefer to be on the safe side because one more thing - I may not spike super high, but going back to normal takes too much time like 2-3 hours. For me the healthy individuals have a bit faster spike witch is both lower and also they go back to baseline a low faster in a 1-1,5 hours. There's bit of a correlation, it you spike over 140, you'll probably take a lot or time to get the 90 again. In all scenarios, carbs are fast energy and we have only 4gr of sugar in our bloodstream, so spike or not, if one is sanitary then 40gr of carbs are very unadvisable to consume. They have nowhere to go in the next hour except being stored by the use of insulin. Hyperinsulinemia will probably be inevitable ...
C-peptide is secreted with insulin, and a bit more reliable than insulin, and you can find formulas online on how to calculate HOMA-IR based on C-peptide. I didn't include it here because it adds another layer of complexity, and just getting doctors to order a fasting insulin test can be a challenge.
Hey Doc' Another great video - well explained. Since you encouraged us to post questions, here's one you might like to help explain. For some time I've been wondering if using blood ketone strips (to measure Blood BHB) might be a simple way of estimating the approximate level or variability of insulin at home? I suggest this for those, like me, who have been unable to get the Doctor to do an appropriate insulin check and/or find it too expensive - including transport costs to a Lab' etc. I thought of this when I heard Professor Ben Bikman say in one of his lectures, "the liver wont produce ketones unless insulin is low". No doubt the situation is much more complicated than I seem to think.......hence me asking the question. Would be great if you could mention something on the subject in a future Video. Kind Regards, Y
I don't think this would be very useful. Dr. Bikman is correct when he says that high insulin levels prevent ketosis; however, that is mostly related to the very high insulin levels after meals. So even if you were insulin resistant, your elevated fasting insulin levels would still be low enough to allow you to enter ketosis. Therefore, whether your fasting insulin levels are indicative of good or poor insulin sensitivity, I don't think you can measure well by looking at ketones. Best, Mario
Wonderful content Vielen dank! A suggestion though: possibly make a numerical reference to each video so one can easily follow the videos in order of production? I enjoy all of them though!
C-peptide would be similarly good, but the HOMA-IR based on fasting insulin is much more widely used and people are more familiar with it. I don't think fasting C-peptide-based measured are clearly better than those based on fasting insulin. Cheers Mario
Insulin resistance is a risk factor for type 2 diabetes, and all chronic metabolic diseases. . Insulin resistance risk factors : 1. 45 years and older 2. Overweight or obese , with excess fat/weight around the waist. 3. Sedentary lifestyle 4. High blood pressure 5. High stress lifestyle 6. Fasting triglycerides more than 150 mg/dl 7. Chronic inflammatory condition 8. Medications: cortecostetoids, antiretrovirals, antipsychotics. To measure insulin resistance - HOMA-IR blood test HOMA-IR: blood test in AM, after overnight fast ( only water) of 12 hrs , under no stress, no tooth extraction, no infection, no inflammation ( ex. Joint inflammation/ arthritis), no meds ( of cortecostetoids, antiretrovirals, anti psychotics )no vaccinations Formula: a) if Glucose data in mg/dl: Fasting Insulin ( microunits/ml)X fasting glucose ( mg/dl) divided by 405 b) if Glucose data in millimoles/L Fasting Insulin ( micromoles/ml) X fasting glucose ( millimoles/Liter) divided by 22.5 Interpretation: 1 is normal Less than 2.5 - insulin sensitive Greater than 2.5 - insulin resistant Or: Under 1.5 ideal or perfect Between 1.5 to 2.5 - mild insulin resistance. Between 2.5 to 7 - insulin resistant
Thank you for this video and upcoming series. This is tremendously informative. I have a question on insulin on storage -hopefully, I didn't miss it from a prior video. Does insulin trigger a simultaneous storage of glucose into muscles, liver, and fat cells? If so, does that mean that glucose just ends up in fat cells only because the former stores become full/saturated first?
Excellent question, but a straightforward and short answer would be difficult. However, this will be covered in future videos, including in the very next one in which we'll discuss the causes of insulin resistance (because what happens when all of the target tissues for insulin are 'full'?). Cheers Mario
I no longer bother going to doctors and begging for tests, I do all tests on my own🔴. Quest-on-demand offers many tests, although i still haven't seen them offering insulin resistance test. Will shop around and see which lab does it offer. 🍎🍎🍎 By the way, the lab prices are so discounted (when buy on your own) that it's cheaper to buy my own test than do it through insurance + doctor's fees.
I am diet agnostic, and see value in many different ways of eating. I'll cover different dietary approaches for glucose intolerance and insulin resistance in separate videos shortly. Cheers Mario
PCOS is simple IR. Eliminate the IR, heal the PCOS. Long process, but zero else works. So lowcarb/keto meaning animal based (the normal human diet). No.more.grains.ever. is the first step. No starchy vegs, no beans, very little fruit, nuts & seeds. Make ur own yogurt, cultured 24 hrs, for no carb. Kefir needs 24-36 hrs too, to be no carb. I’ve had PCOS since early 90s, if not before.
As Mario explained, insulin resistance does not tell the whole story regarding a person's ability to maintain healthy blood glucose levels. The ability of the pancreatic beta cells to produce insulin is also crucial. If the beta cells are capable of producing a lot of insulin, then insulin resistance can go very high before a person gets into trouble with glycemic control. On the other hand, if the beta cells are impaired, then glycemic control will begin to suffer at a lower level of insulin resistance. All of this to say that while measuring insulin resistance is crucial, we can get a fuller picture of metabolic health by also measuring beta cell function. I went looking for an inexpensive test of beta cell function and found that the HOMA model itself provides an indicator called HOMA-B (or HOMA-ß) that serves this purpose. Better still, it requires only the same two inputs that go into the HOMA-IR calculation: fasting glucose and fasting insulin. Higher HOMA-B numbers indicate a greater ability to produce insulin. I also discovered that there is an improved, more accurate version of the HOMA model called HOMA2. The HOMA2 model is considerably more complicated, so you need to use a HOMA2 calculator rather than trying to do the calculations by hand. I got mine from the Radcliffe Department of Medicine at the University of Oxford. Google 'oxford homa2' and you'll find it. Normal ranges vary by population, so you need to be careful in interpreting the results, but I found these ranges in one particular study: HOMA2-IR in non-diabetics: mean 1.16, standard deviation 0.31 HOMA2-IR in diabetics: mean 2.61, standard deviation 1.06 HOMA2-B in non-diabetics: mean 113.10, standard deviation 30.56 HOMA2-B in diabetics: mean 47.10, standard deviation 24.67
This is why normal just means common Not OPTIMAL (optimal is currently at no more than 1 on standard HOMA-IR) Getting a T2 “good enough” isn’t good enough! They can actually eliminate the T2 *and* NAFL (fatty liver) if they go keto. It takes a lot of patience and strict adherence but after months of it, change will be visible (fat loss), not just slowly internally healing. Thx for the calculator info, wish u had incl a link.😮
thanks for the video. Can you site any research that supports the statement "maximum beta cell output is largely genetically determined"? I was not aware of that. Thanks!
Hi thank you for this new video. Several years ago I started having hypoglycemic episodes, a doctor prescribed me a glucose tolerance test that also measured insulin and turned out my insulin rised really high after taking the glucose and continued high after 2hs. My glucose level was normal after 2 hours but probably turned too low after 3-4hs (as the insulin was still really high but measurements stopped after 2hs). My fasting insulin is totally normal. I have made changes to my diet, cut out simple sugars, and have carbs together with fiber fat and proteins, and I didn t experience hypoglicemic episodes anymore. However I m still a bit concerned about insulin situation. I repeated the exam some years after the first one and after the change in my diet and the post prandial insulin was still higher. Other interesting fact is that I m really thin, I m actually underweight and have always struggled to gain weight. Is there an explanation why an underweight person is aparantly insulin resistant? I m also looking forward to a video explaining how to improve insulin resistance. Thanks!
The reason why you have insulin resistance even though you’re not fat is because you don’t have much muscle. Most of the glucose we eat is stored in the muscle, so the more muscle you have, the more storage space there is for glucose. So I would highly recommend doing weight training to build muscle in order to improve insulin sensitivity. Plus, weight training is high intensity so it uses glucose instead of fat, which is great for lowering blood glucose. In addition to building muscle, weight training is also excellent for building strong bones.
Ok thanks, no one never told me about the relation between muscles and glucose and insulin. Really good info. Not sure it explains totally my insulin situation though. My glucose is normal, it is normal at fasting, doesn t have a huge spike after having the glucose solution (I think reached 140 no more) and comes back to normal quite quickly. However the insulin goes crazy and stays high even if glucose is back to normal. With your explanation I would understand having little muscles would trigger glucose spikes and so insulin spikes to get the glucose level down, but it s not exactly my situation.
Your situation is the first stage of insulin resistance, which is that insulin goes up to compensate for the resistance and glucose is still normal as a result of the extra insulin. Your glucose would be high if the insulin didn’t go up. Insulin resistance takes many years to develop, so if this continues, many years later, your glucose will rise. So fasting insulin level is an early indicator of insulin resistance, better than fasting glucose. Building muscle creates more space to store glucose. In addition, you also need to use muscle frequently so that muscle will take glucose. If you don’t use your muscle, then the muscle has no need to take up glucose, resulting in insulin resistance. Therefore, building muscle and using muscle frequently are crucial to maintaining insulin sensitivity.
The very next video will be on causes of insulin resistance. There are a few that could explain insulin resistance in the absence of overweight. Hope this will give you some clues for additional discussions with your doctor. Cheers Mario P.S.: Excellent suggestion as well by @justsaying7065. That is one potential cause of insulin resistance in a person with underweight. Doing resistance training is a good idea for everyone, but also be open that your insulin resistance could still be (partly) related to something else.
It would be wonderful to see what research you are familiar with for people living with T1D. We tend to be forgotten in favor of info pertaining to T2. I use both a CGM & an insulin pump. Thank you for your videos.
I do intend to have some videos for T1DM as well, but my primary expertise is on T2DM and related metabolic disease, as I have studied this professionally for ~20 years. Cheers Mario
Am I right in thinking that Insulin is the fat storage hormone and therefore more insulin > more fat > more insulin resistance > need more insulin and so on, A vicious cycle. How to interrupt that?
Good question. Complex answer. This is a common narrative, particularly in the low-carb community, but the science isn't clear on how much this is a factor in weight gain and obesity. The body indeed needs insulin to store fat effectively. However, even if you consume a low-carb diet, you usually have a little bit of insulin in your body, and it isn't clear that having slightly higher insulin levels that result from eating carbohydrates makes it more likely that you'll gain weight. In fact, if we look at human intervention studies, people can lose weight similarly effectively on low-carb and high-carb diets. Much more to say about this, and I'll cover this in separate videos at some point. Whether or not elevated insulin plays a key role in weight gain or not, however, I'd say it's abundantly clear that we would benefit from maintaining good insulin sensitivity and avoiding chronically elevated insulin levels, simply because insulin resistance and hyperinsulinemia are risk factors for other medical conditions such as type 2 diabetes, heart disease, cancer, and kidney disease. Best, Mario
Dear Dr, could you please advice me the correct method to prepare for fasting insulin blood taking as i am a t2dm with s/c insulin (long acting) treatment. should i omit the dose of insulin the night before for the next morning fasting insulin? will my results be affected if i've taken my night dose on insulin (long acting).. thank you
Definitely take the long acting insulin the night before. HOMA-IR is calculated from both insulin and glucose, so the test is still valid. Cheers Mario
Mario, could you at some point just touch briefly on the second meal phenomenon, that you’ve made reference to before? I eat oatmeal for breakfast and try to match the carbohydrates in the oatmeal with the carbohydrates in beans for lunch, I figure that since I consume more fiber at lunch I can add to the carbs that I ate with breakfast. Any studies on carb matching? If you’ve succinct information on this issue it’d be much appreciated Thanks, Rafael
Hi Rafael, I don't think it would be necessary to match the carb content of meals, and it would strike me as overly complicated to do that regularly. The general idea is simply that if you eat carbs at one meal, then the beta-cells store more insulin pre-made and they are better able to handle carbs at the next meal. I talk in more detail about the second meal effect in this video here: ruclips.net/video/LVw60RIhbzg/видео.html Cheers Mario
Es gibt ja "continuous glucose monitors", die man sich wochenweise als Nadel-Pflaster in den Arm macht, wie es im Video auch einmal erwähnt wird. Gibt es sowas auch als "continuous insulin monitor"? Warum ist Glukose im Blut so "einfach" zu bestimmen und Insulin anscheinend nicht?
@@shurrrig Doch, gibt es. Hatte ich früher auch schon. Freestyle Libre von Abbott. Zumindest für 2 Wochen kann man das sogar kostenlos testen (Aktion bis Dezember) und in 2 Wochen erfährt man auch schon viel über seinen Körper und gewisse Muster/Reaktionen. Hope that helps 🙂
For sure. At some point, there will be a similar series about body weight regulation. It's going to be a while, though, because I have a lot of plans for more videos about blood sugar. Cheers Mario
Great question. It's not entirely irrelevant for T1DM. However: as you probably know, Insulin resistance is not the primary problem in type 1 diabetes, but - maybe obviously - people with type 1 diabetes can also become insulin resistant on top of their diminished insulin production capacity. I personally would not use HOMA-IR in that case to determine how insulin sensitive/resistant I am, because IMO it's value is uncertain when most or all of the insulin in blood has been injected. However, given that the insulin doses needed to control blood sugar levels are dependent on the patients insulin sensitivity, a type 1 diabetic should have a pretty good sense anyways of their degree of insulin sensitivity. If this is unclear, maybe discuss your specific case and insulin dose relative to carb consumption with your doctor, and he/she should be able to give you a sense of whether insulin resistance seems to be a concern. By locking at basal and bolus insulin requirements relative to carb dose and the resulting blood glucose levels throughout the day, one should be able to get a better sense of insulin sensitivity than HOMA-IR could provide in a healthy person. Cheers Mario
Yes, and that's even better because c-peptide tends to be less volatile than insulin. However, the interpretation is not as straightforward, as we have fewer data linking c-peptide-based HOMA to health outcomes. Still, you can probably google the formula (depends on your units of measurement as well, so pay attention to that). Cheers Mario
My A1C was 6% to 6.1% I lost 55 lbs on a low carb diet and my A1C dropped to 5.4%. BUT my fast insulin only dropped from 15 to 13 to 12.4. Over about 1 yr. How long does it take for fasting insulin to drop to a healthy level (
Losing this much weight should have an effect, and it did, but please be clear that insulin resistance can be caused by a lot of different things. I'll cover most of the main causes and contributing factors in the next two videos, so maybe this information will provide some clues to you about what is going on. Cheers Mario
Is there any benefit in having a Homa-ir test if you are already diagnosed with T2 and are taking medication for that? Or is it purely for those who are either pre diabetic or concerned about pre diabetes.
There is value in HOMA-IR still, but less so, because therapy will aim to improve glucose control, and any improvements can more reliably be assessed by monitoring blood glucose or HbA1c. Also, depending on the type of diabetes, how advanced it is, and the causes of the glucose intolerance, HOMA-IR may be less reliable an indicator of insulin resistance in people with diabetes than in healthy people. At the same time, it’s even more important for people with type 2 diabetes to try to improve their insulin sensitivity. And any such improvement should be very quickly reflected in better glycemic control. Cheers Mario
Seems that you would need to know if insulin levels behave as expected (compared to a non diabetic) then it would somewhat rule out it being insulin levels (thus possibly not needing insulin shots for example) and if glucose levels drop during higher intensity exercise then that pathway may be normal bit the insulin pathway sensitivity or mechanisms aren't
Dr Kratz, I’ve recently watched Professor Taylor’s studies on T2DM regression and the role of the liver’s insulin resistance which, Dr Taylor says, is not the same as muscle tissue insulin resistance, I’m unsure as to the distinction. How is the Insulin Resistance [IR] test that you’ve posted here related to these two forms of IR? Thank you
Well, in general, all insulin sensitive tissue have their own level of sensitivity to insulin, and they change dynamically as certain things happen in the body. Also, the degree to which the different tissues are sensitive vs. resistant to insulin varies depending on the cause(s) of the insulin resistance. In practice, I'd say this is more of academic interest, because most people who develop insulin resistance in their fat tissue also develop insulin resistance in their liver and muscle, and vice versa. HOMA-IR is based on fasting insulin, and because insulin acts mostly on the liver in the fasting state, one could argue that HOMA-IR is mostly a measure of liver insulin resistance. However, HOMA-IR is also strongly associated with measures of overall insulin resistance, such as those based on dynamic tests (OGTT or clamp). What Dr. Taylor says is still correct, and particularly relevant in the context of the types of interventions he runs where people reverse insulin resistance and glucose intolerance by very low-calorie diets. He wants to understand the mechanisms of the interventions, and therefore he very particular about trying to figure out the time course of changes in insulin sensitivity in all of the different tissues. That makes sense for him, but personally, I don't think the average person needs to worry too much about these details. Cheers Mario
![Noob To Max With DRAGON REWORK In Blox Fruits [FULL MOVIE]](http://i.ytimg.com/vi/LnBMOinoOvA/mqdefault.jpg)
For those of you who have already seen the video on the regulation of blood sugar, there are some redundancies with this video here. My apologies for that. I decided to repeat some of the essential information because it's critical to be clear that insulin resistance is not the same as glucose intolerance, i.e., it is very much possible to have normal blood glucose levels but still be very insulin resistant.
As always, don't hesitate to post questions or requests for future content in the comment section.
Cheers
Mario
dear doctor, what is the importance of C-peptide test ( fasting + stimulated) for checking insulin resistance or diabetes ?
Why my doc order lipid test report does not have majority of the discussed test parameter but have other items which are not looked at even by my doctor? Did AMA ever thought about it?
You are doing a great job
@lq😊lee
My father, who suffered from type 2 diabetes for most of his adult life, passed away recently. Officially, it was from multi organ failure, but it all came as a result of diabetes. He also had both legs amputated some years before his death. My dad didn't really take his condition seriously and he paid a dear price for it. I'm really happy that more researchers and doctors are paying more attention to this "silent pandemic" of insulin resistance. So many people are walking around thinking that they are healthy but they aren't. Another thing to add is that my dad was never fat. Thinness doesn't equate to health either. That's why it is so important to go for your checkups and do the blood tests too. Better safe than sorry.
So sorry to hear of your loss.
My dad also recently passed away, and he also had T2DM. His diabetes was better controlled, but he loved his white bread with syrup, his sweets, cakes, and baked goods, and didn't really want to make a more substantive change to his diet. He died of metastatic pancreatic cancer, which may or may not have been related to his diabetes. Diabetes clearly is a major risk factor, and I do keep wondering whether he may have had a few more years with us if he had taken his diabetes more seriously ...
I'll try to do my best to help those people who are motivated to make a change avoid the types of long-term health issues that come with diabetes. Pancreatic cancer, amputated legs, dialysis from chronic kidney disease, blindness, heart attacks and strokes, there are no guarantees that any of this can be 100% prevented, but I do think the risks can be lowered substantially if we take this seriously and adopt a healthy diet and lifestyle.
Thank you for sharing, and again, my deepest sympathies.
Best,
Mario
Professor Tim Noakes who is a marathon runner and very slim had type 2 diabetes. So yes. You can be slender and have diabetes.
Slim people are more prone to t2d. They have less fat cells to store energy so will present with lipid disregulation earlier
Yes i hv been lean all my life, I recently discovered tat my bg always 6ish even after I woke up fr 10hrs of fast. Not sure I'm already prediabetic or insulin resistant coz the place I stay has no doctor checking for insulin. I'm lost what to do to improve myself besides low carb diet. 😢
Agreed. Well said
FYI for those in the U.S., it is possible to find your HOMA-IR pretty cheaply without a doctor or insurance. There are labs online where you can order a fasting glucose and insulin test. They send you to a local lab for the blood draw. I was just able to order one for only $37 with no prescription or insurance.
From the results, I calculated my score to be 5.8, so I definitely have some work to do. Your videos on reducing IR will be extremely valuable to me, Dr. Kratz, as all your others have been.
Good suggestion. Thank you for sharing!
Cheers
Mario
which website did you use? Thank you
Your plain speaking and presentation is excellent
Kindly be doing what you are doing
It will help a great many of the population
I am cardiologist in Brazil. And after I read Dr. Krafts book i started to use insulin and glucose curve in many patients in risk for IR. I also did it in me (normal!). My HOMA IR is 1. Great videos! Very well done. Congratulations for the chanell. I will keep seeing.
You are doing your patients a great favor. It is now sufficiently clear that insulin resistance and hyperinsulinemia can lead to major health problems long-term, and it doesn't make sense to me that many physicians are resistant to even measure a fasting insulin in their high-risk patients. Considering the burden of associated disease, and costs related to these, we should be intervening way earlier in the development of diabetes.
Thank you for your kind feedback.
Cheers
Mario
@@nourishedbyscience maybe you know the book from Ben Bickman - Why we get sick. He approaches a lot about hyperinsulinemia.
How is homa IR calculated
Thanks to all Dr. Who care about their patients educated provide guidance not just insist medication. I am struggling for 20yrs was searching for help because I was not informed or tested by my doctor 😢 I am on two metformin my dr. Said i have no other choice is to keep increasing medication
And what is your HOMA B doctor? Mine is 54% and HOMA IR 2.1
My Dr. Said A1C is only a 10th of a % over into pre diabetes. Not concerned, see ya for your yearly in October. Said nothing about nutrition/diet. I'm so glad I found you.
Yes he is diabetic
You are doing those who listen a great service. It is amazing how humans go through a great deal of trouble to avoid a minimal discomfort in the immediate when that slight discomfort would avoid major discomfort for the long run. I hope your videos help many to decide to do the work.
Agreed
Your fastidious care and rigor to your research are evident. It is a pleasure to bask in the knowledge that you spread. More power to you, Super Mario !
As a Nutritionist , one of the best videos I came across, information so well talked and explained with thorough research , much needed for we Indians to understand this concept Of Insulin Resistance.
I think the best content on blood sugar regulation on youtube is on this channel - thanks Dr Mario for sharing evidence based knowledge translatable into practice with us !
This is my favourite channel. Over the time I've learnt tones of information. A big thank you. I always looking forward to your videos.
I´ve never clicked on a video so fast! 🙂 So helpful and insightful! Dankeschön! :)
Me too!
Me too!
and Me Three...thx Mario..:-)))
Great video, without hype, promoting, or blame, just straight truth! Amazing! I listen this post twice and I’ll do more in the future…Thank you very, very much! Some confession to make: I already “bing watched”trough all your previous videos!
What an amazing, timely series.Time and time again I tell friends to get their insulin tested only to have their doctors refuse !
Some don’t even know there is a homa ir test?
Tell me about it. It's bizarre how the 'normal' range for insulin is so ridiculously vast, and nothing is done about it. Then one day the dam breaks and your glucose sky rockets. As if insulin hadn't been creeping up, and up, and up for *years*. What's considered normal should be cranked way down, and it should be monitored at least annually.
My GP doesn't even think prediabetes is an issue! I managed to get rid of it with the low carb diet and other lifestyle changes. However, now I got a diagnosis of osteoarthritis and a higher fibre intake for example with legumes is suggested to improve gut bacteria. I am wondering what happens with my next HbA1C in a years time. Unfortunately I am not able to afford a HOMAR IR. Can I win?
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research . New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
They can order it themselves
Thanks!
Thank you!
This video series has been incredibly helpful and informative. Please keep making content, the quality of the information is excellent. Thank you!
Thanks for your efforts to bring the attention towards Insulin Resistance, including how doctors will not be of much help in spotting the trend in the beginning stage. Yes, I have been paying for my HOMA test as my insurance would not cover that and any GP would not prescribe it, even when one is diagnosed as diabetic.
Just wanted to add one more popular surrogate measure of Insulin Resistance, that uses Lipid Profile test results, that are usually covered under annual check up -Triglyceride and HDL levels - Triglyceride divided by HDL levels (both are expressed in the same units by a lab, like mg/dl or mmol/l) is a good indicator of Insulin Resistance according to many, including Dr. Benjamin Bikman - any reading more than 2.0 -2.5 (triglyceride level more than 2 times of HDL level), indicates beginning stages of insulin resistance, just like the HOMA test ( but is covered under insurance, though under different context!!). However, for certain ethnicities, this may not be very accurate and threshold also lower for women (>1.75) than men (>2.5) to be tagged as Insulin Resistant. We can also use our previous annual test results to plot our own progression, as all reports would have these two measures available. Just a thought!
Very good point. I considered discussing the TG-to-HDL-ratio and also the TG-to-glucose-ratio in the video, but we do have a lot less data on these as surrogate measured in different populations, and also less data linking these to chronic disease risks. I still think they can be useful for log-term tracking of metabolic health.
Cheers
Mario
Wow, 2 lipid numbers I DO care about! Brilliant of Dr Bikman, et al.
I actually want my TC around 300 (the old, prestatin number). Evidence shows THIS is protective, esp as we age.
Big pHarma is the only reason they dropped the TC numbers -STATINS-
excellent video. well presented and not directly or indirectly pushing a million products and services. Very impressed with this doctor.
Thank you for giving us these videos. Your straight forward explanations make it easy to understand for us lay persons. You are doing a fantastic job!.
Great series of videos. Had a blood test last week, which included a HbA1C test, but if I had seen this video I would of asked for a Homa IR test. Thank you - you have a very balanced style of presentation with excellent information.
Is that test available in the usa
If you had fasting insulin and glucose levels done you can calculate your HOMA IR result yourself; it's not a blood test, just a calculation based on those two values, and there are many online calculators which will do it for you.
I've recently discovered your channel and enjoy the well balanced and researched content as well as your calm delivery. Greetings from Austria 🇦🇹.
Thank you for your kind feedback!
Just discovered your channel through your interview on Sigma Nutrition. I've been looking for a video like this for years! So clear, concise, precise and MUCH NEEDED! Thank you so much! I will support you and tell my clients about you. ~ Marian Blum
Yesss, I was impatiently waiting for another video!
Sorry. I am very slow, I know …
@@nourishedbyscience Do not worry one bit, its absolutely worth waiting.
Great information and presentation. I have been wearing a CGM to see how much and why my glucose levels vary. I now understand from your videos, the CGM will not tell the whole story and that also need to look at my insulin levels. I wish there was a continuous insulin monitor also. Thank you Dr. Mario.
Yes, agree. However, you can get a sense of your insulin levels throughout the day by looking at your glucose levels under consideration of your HOMA-IR. The more your HOMA is elevated, the more your insulin levels will tend to rise with any given rise in blood glucose.
Suggestion well taken, thank you Doc.
Excellent, informative video. Thank you for making this information widely available and accessible. Delighted to subscribe to your channel.
thank you for all the excellent information. this is my favourite channel for learning about insulin resistance.
Thank you very much for very informative video 👌👌👌
I love your videos and I appreciate your adherence to science based data.
I think there is an issue with how Type 2 Diabetes is defined (I say this in 'reaction' to the standard medical statement that Insulin Resistance is a Risk Factor for Type 2 Diabetes). The definition of Type 2 Diabetes per a description I found from a Mayo Clinic article is:
"..Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems..."
Starting with THIS definition of Type 2 Diabetes, then yes - Insulin Resistance is a 'Risk Factor'. However - I would argue that the difficulty with regulating blood sugar is a side-effect of the primary disease factor which is Insulin Resistance. I would suggest that public health would be better served by measuring Fasting Insulin levels and Insulin Response Coupled With routine Blood Glucose and HbA1c tests. Type 2 Diabetes diagnosis under my suggested approach would be based on excessive levels of Insulin in the blood OR high HbA1c/blood glucose levels. Conversely, Type 1 Diabetes is a symptom of Low Blood Insulin levels AND high HbA1c/blood glucose levels. Only Type 1 Diabetes should (IMO) be treated with Insulin.
In this regard - I must push back on the assertion made at 7:05 in regard to "Fred" where you Imply that he has low insulin sensitivity (i.e. high Insulin Resistance) because his PRODUCTION of insulin is too LOW and THUS has Type 2 Diabetes. There may be those that fall in that category but I believe there are sufficient studies to show that many diagnosed with Type 2 Diabetes are still producing very high amounts of insulin (in absolute mcU/ml terms). Though High, for those diagnosed with Type 2 Diabetes the amount is insufficient to overcome Insulin Resistance (despite the high Insulin level cells can no longer be stimulated to absorb/use blood glucose and the Liver thus converts the sugar to fat). This is, in fact, MY situation. I am not 'Fred', if anything my production might be HIGHER than Ben's.
I am sensitive about this issue because my father passed away in large part because of High Insulin levels that contributed to Non Alcoholic Fatty Liver Disease and he was prescribed Insulin for Type 2 Diabetes rather than treated to LOWER his Insulin Resistance. The prescribed insulin just made his NAFLD worse, the insulin might have lowered his blood sugar but at the cost of destroying his liver and causing other health issues. He would have been better served by dietary changes (types of food he ate, eating frequency, ...) but his Doctors then followed the 'Standard of Practice' as do most today.
Appreciate your comment. However, note that the diagrams simply mean to illustrate principles, and the axes don't have units of measurement. Fred could be anywhere on the left side of the green shaded area, and you are correct to assert that many people with type 2 diabetes (at least among Caucasian or African race) tend to have quite high insulin levels. Note, however, that many Asians with type 2 diabetes tend to develop diabetes at fairly low insulin levels (because often their problem is more an inability to produce more insulin).
About the definition of diabetes, given that it's focused on glucose levels, I am fine with the current definitions, but absolutely agree with you that much more emphasis in clinical practice should be on insulin and insulin resistance.
Cheers
Mario
P.S.:Sorry to hear about your dad. Mine also had diabetes, and recently passed away from pancreatic cancer.
These RUclips videos are excellent. Thank you for taking the time and effort to make these!
Great video -- lots of quality information. Very well done. Thank you.
So glad I found this channel - great presentation, thanks.
Finnaly this video has come, thank you! This is the topic of my biggest interest, and I cannot wait to see the rest of this series.
Thank you so much, Mario. I watched your two videos and can tell that I can save a lot of time and stop watching other health related videos. You are so right and to the point that I have literally tears in my eyes…I had to figure out myself a lot, including HOMA -IR. As a child I was accidentally poisoned by Death Cup mushroom and I think that I am paying for this all my life. My body never responded typically, many gut issues, immune system overreacted in strange way. Finally, when I am a senior I start to understand my body…. Hope to learn a lot from your channel. Thank you.
Sorry to hear about your death cap mushroom experience, but glad to hear you made it through alive!
Thank you for your kind feedback.
Cheers
Mario
You are awesome Mario! Bless you for helping us all keep healthier😊
The pharmaceutical industry do not want you to get an early warning of metabolic disease.
Another great presentation - learnt so much.
Thank you so much for this content, very informative.
Thank you Mario, my daughter is struggling and not getting the help she needs from her Dr. How is it that a Dr. gets himself so busy as to mot be able to see his patients in a timely manner. The PA or NP in office aren't helping her and told her Dr. booked into next year. I have told her to find another physician but in meantime to start looking at your videos. She has every indication of having metabolic syndrome and insulin resistance. I really think your videos are going to benefit her. You have helped me so much. Everything is reversing for me. Now my b/p for first time is low. Weight maintained and feeling good. Thank you.
Her dr or any dr isn’t going to do anything
She needs to take it on herself to go lowcarb/keto.
@@YeshuaKingMessiah you really should read a little more before giving your advice. Metabolic syndrome, NAFLD and others require life long changes. KETO diet is not recommended to be on for more than few months. I see a hepatology Dr. for NAFLD and metabolic syndrome. The diet requires life change and that is for sugar. Sugar is the real danger. The Mediterranean diet is what is recommended and to start with very low calorie like 800 a day to start reversing the fat stored in the liver. She knows she has to do it on her own.
Until someone knows the problem they don’t really know where to start. That’s where the Drs come in.
@@cathyellington7599 epileptics and others live on keto for life. Keto is very healthy. Besides the many many ppl who live on it more “by choice”.
@@cathyellington7599 undereating is the worst thing to do for any issue.
Fasting IS another avenue that can work to move out glycogen from liver. It is hard to do and some ppl have a lot of issues arise at first also.
Fasting is very diff from starving. Your body responds very differently. The worst thing you can do for a metabolic condition is undereat/starve. It sets ur metabolic rate very low too.
IF is a great middle ground or practice whereby u are eating enough, just in a daily window of several hrs. When u eat highfat, lowcarb u also don’t suffer in ur off-eating hrs.
Endocrinologists of any ilk (hepatologists incl) are clueless.
Look up nephrologist Jason Fung, he’s on YT also. He got tired of ineffective protocols for the diabetics losing their kidneys.
IR, fatty liver, obesity, metabolic syndrome, diabetes all are the same thing. Diff names - they’re all related thru hyperinsulinemia. THAT takes time and lowcarb/keto to resolve. Then u must stay aware still of any creep backs, for life. There’s prob a genetic component but it’s majority a lifestyle choice and once you’re damaged, it never completely resolves. Ppl THRIVE on keto.
@@YeshuaKingMessiah yes, you are right about the epilepsy. I was a dialysis nurse for 32 years and RN for 38. Any diet carried to extremes can cause harm. My daughter is pre renal. Told to limit protein. You limit carbs, you limit protein then your body starts to get what it needs from itself. A balanced diet is what is recommended by AHA. Glad you are a fan of KETO. Sure it works but would recommend before anyone stays on it for extended period they get accurate information from non bias sources.
Why HOMA-IR is not a standard test is crazy. This measurement is the gold standard for health. Anything below 1 is super.
Agree… HOMA-IR is a must go test for all routinely
I benefited from this chanel. When u plan to eat big amount of carbo eat little carbo before that meal
Always excellent content 👍🏼
There is data from Dr. Bozworth that the ratio of the glucose to the ketones mirrors insulin. This is easy to test and might be a good practical test with good data
For people consuming low-carb diets, this may work reasonably well. Not so for the general population eating a mixed diet, however.
Very informative for lay person to understand and get the Homa ir test done. How does hba1c fit here? In India the test is very common to decide if you are prediabetic or diabetic.
Fasting glucose and HbA1c (and potentially the 2-hour value in an OGTT) are still the measurements used to diagnose diabetes, or pre-diabetes. HOMA-IR is not relevant for the diagnosis of any disease (which is why it's not commonly done).
Think of fasting glucose, 2-h glucose in an OGTT, and HbA1c as diagnostic criteria of a disease, whereas HOMA-IR is a risk factor for disease (more similar to LDL-cholesterol). If someone has type 2 diabetes, they are almost always at least somewhat insulin resistant, but HOMA-IR can also be elevated in people without diabetes or pre-diabetes, so that's where it really has value because then you can intervene early to reverse the insulin resistance and prevent the progression to pre-diabetes and diabetes.
Cheers
Mario
@@nourishedbyscience Just call it PPD test. Pre-pre-diabetic test and it would make sense.
@@KoiRun50 The problem is that even if someone has elevated fasting insulin/HOMA-IR, suggesting that they are at increased risk, on an individual basis it is still thought of as a poor marker of diabetes risk (because you never know how much insulin a specific patient will be able to make, i.e., they may never become glucose intolerant even if they are already very insulin resistant). I think this is inconsistent thinking. Similarly, one could argue that not all patients with hypertension and elevated apo B develop CVD. That is true, but still no reason to ignore these risk factors.
Cheers
Mario
@@nourishedbyscience Good explanation. Thank you. I think our government and doctors should give more publicity to homa ir considering India has large population of diabetics and prediabetics. An ounce of prevention is better than a tonne of cure.
I miss your videos, only so many times that I can re watch the old videos
Really sorry, lots going on recently, and currently, I am on vacation. It's my goal to post more regularly.
Best,
Mario
I am loving your content. I was able to calculate my Homa IR at 2.6 to 2.9 (depending upon using my fasting blood sugar or my average bs of 120 from my A1c). Now to work on improving my sensitivity. I only have 1/2 a pancreas and I am committed to preserving what pancreatic function I have left.
HOMA-IR is based on fasting glucose only, so your HOMA-IR is 2.6.
Cheers
Mario
@@nourishedbyscience unfortunately 2.9.
Thank you for the very interesting, well produced and informative videos! May be the link between stress (and the other factors) and IR could be explored by you in a separate video(s).
I think the term "normal Insulin resistens" is worth a discussion. Most people in modern societies will get a Homa IR far Higher, hence the low one could be namened "good" or "healthy" but not "normal".
Exactly
He does name a fairly low number as normal tho
Optimal seems to be no more than 1 actually
Danke für ein weiteres, sehr informatives Video!!
Another awesome, informative video! I’ll be anxiously waiting for more information on how to become more insulin sensitive. Right now, at 2.75, I know I’m insulin resistant. I was only able to get my fasting insulin down to 2 when I really backed off on the grains and starchy carbs. It’ll be interesting to see how your upcoming information aligns with my own experience with diet changes!
Thanks.This lecture to my ears like classic music to those love music .
Thank you doctor for your video, I will see if I can get this test.
I’ve had diabetes for the last 15yrs. After watching your video I brought my HbA1c levels down by ,5 on just one month!! Another question : do you these videos in a German version for German speaking people? English is perfect for me. Thank you very much for these videos. They are extremely helpful.
Sorry, as much as I wish I were able to also make these videos in German, I don’t have the time to do that. As the number of people who can follow this in English is at least 20-fold larger, I decided to make them in English, at least initially.
I thought as much. I went for my regular check up this week and my doctor asked me for your u tube details to pass onto other patients. 👍🏼👍🏼
Most Germans speak English
Love it, love it, love it❤, can’t wait to see your next videos and some of your CGMs results/data etc
They should teach this stuff at school.
Excellent explanation. It matches my observation of 18 months of glucose testing.
why do you think infla... triggers IR but not vice versa? I have the opposite information: only when I had reduced my IR I got rid of my arthritis, not earlier... and nothing could help.
Did I say somewhere that IR does not cause inflammation? If so, I appologize. I have myself published that elevated insulin levels may play a role in activating the immune system, so this is something I am very familiar with. However, it's not the main point of the video, so that's why I didn't want to get into that specifically here.
Cheers
Mario
@@nourishedbysciencewow!thank you for the response and so fast! I was triggered for the comment at 13:05 of the video. Because I expected to hear "because inflammation can be an indicator of existing IR, or can be caused by IR..." And it's ok, as you have just explained. I was just amazed maybe you really meant that an inflammation can lead to IR too?
@@okritsky Ah, I see what you mean. I put this list at 13:05 together to help people assess whether they may be at risk of insulin resistance, so that's why I only talked about inflammation as a cause of IR. You are correct though that it can go both ways, and potentially lead to a viscious cycle over time.
There is always so much to talk about. I try to be systematic when i make these videos, and stick with the main theme. Otherwise, it becomes confusing and too long (even though know I am already guilty of that ...;-).
Cheers
Mario
@@nourishedbysciencecool! thank you! and I think 20 minutes (+-5 min) is the best or optimal video length in this area of knowledge (even watching other channels - this length is like a "golden standard"). so, you have good videos: quite clear, optimal length, and yes, you are really well systematic)
Dr Joseph Kraft showed in the 1970 s there was a 10-year period where glucose stayed normal in the face of rising insulin levels. This is a strong argument for doctors to add fasting insulin to the laboratory request form. ( this will cost the Australian government about $47) Early recognition of insulin resistance saves lives. If your doctor does not understand this basic preventative medicine, get him or her to watch this video. I have had about 90% success rate getting GPs and oncologists to put fasting insulin on the laboratory request form once the patient tells them about the research of Dr Joseph Kraft. Only 1% of GPs know of the Joseph Kraft research. New Zealander Dr Catherine Croft did her PhD on Insulin resistance re analysing Kraft's data
Thank you for your comment. Yes, Dr. Kraft certainly is a pioneer in this area, but - to be honest - even if someone has never heard about Dr Kraft, we now have so much data that clearly links insulin resistance and hyperinsulinemia to numerous chronic diseases, it doesn't make sense that primary care medicine contiues to ignore it. Glad to hear you are helping patients get these tests done.
Cheers
Mario
Good informative podcast.
Examples are perfect.
Dr. Bipin Deshpande, INDIA.
Are the effects of stress on fasting insulin that you mentioned strong? I was on a whole food diet for a year when I wanted to check my insulin resistance. I have a really good lipid profile, very low inflammation markers, no chronic illness, phisically active daily, bmi 18.7, very good CGM results (eating lots of whole food carbs daily), hba1c is 5.0, i'm 37 yrs old. But still my fasting insulin is the only thing that is higher than I would expect, around 8-10. The only thing that i suspect is that I seem to have quite high stress/anxiety before and during the blood draw. Could that have such a strongh effect on fasting insulin?
It depends on how stressed someone is. If you are stressed enough to feel stressed and anxious when the blood is drawn, this alone could explain an increase in fasting insulin. Here, for example, is a scientific paper on 'stress-induced diabetes':
www.ncbi.nlm.nih.gov/pmc/articles/PMC9561544/
Now, this is obviously if someone is chronically stressed. Considering your HbA1c, this doesn't seem the case for you, for sure, but it may explain slightly elevated fasting insulin levels when you have your blood drawn. Hard to know for sure though.
Cheers
Mario
Thank you so much for the reply! Great video, as always
Sounds like me except I'm 57. I would imagine, just like blood pressures , insulin levels could be very dynamic. My blood pressure readings tend to be higher at the doctor's office; "white coat syndrome." At the time of blood draw, I'm pretty sure there are blood markers that are more dynamic than other when faced with 'acute' 'perceived' stress levels. This would be an interesting topic for Mario to cover. I think he did cover this a bit here.
@@nourishedbyscienceThank you for that important link to Review on Stress and Insulin/resistance if chronic.
Lots of carbs daily is why ur IR is high
Ur body isn’t politically correct. Carbs are carbs to it.
Dr Wm Davis (cardiologist) speaks about BG not moving from food ingestion. When u eat this way, ur IR will come down, definitely. (Yes, this means keto/very lowcarb)
Thank you ever so much for your quick reply. Appreciated. I can go for 16 on average for fasting blood sugar. I watch your videos with interest. Success.
I’ve been battling IR for a year now with good, but not great, results using mostly NMR lipid profiles. I focused on Whole Foods plus low carb/low sat fat. But I’ve recently learned about high fat intake (even M/PUFA’s) creating IR by blocking the insulin receptors inside of the muscle cells. Do you agree that this contributes to IR and that dietary fats of all kinds should be limited? Thanks!
SAT fats don’t do this, stay away from seed oils (ur M/PUFAs). Eat animal fats.
High carb low fat is effective for gaining insulin sensitivity. Avoiding carbs is counterproductive, it increases stress hormones which increases lipolysis. More fat circulating in the blood the more it impedes glucose uptake. Avoiding carbs increases insulin reactance
@@aspiresk8boarding flat out lies
Besides the word salad
@@YeshuaKingMessiah Where’s the lie Yeshua? Check out Kempner’s rice diet. Or other low fat high carb diets treating IR. It’s usually high stress hormones or body fat creating high blood lipids which blocks glucose uptake via randle cycle. Avoiding carbs does not get to the root of IR
@@YeshuaKingMessiah Where’s the lie Yeshua? Check out Kempner’s rice diet. Or other low fat high carb diets treating IR. It’s usually high stress hormones or body fat creating high blood lipids which blocks glucose uptake via randle cycle. Avoiding carbs does not get to the root of IR
I'd love to hear about how/whether age impacts insulin sensitivity and glucose tolerance and about reactive hypoglycemia. Thanks!
This video here covers reactive hypoglycemia:
ruclips.net/video/kxUP0zzBECA/видео.html
Age definitely affects insulin sensitivity and glucose tolerance, and age is the second most important risk factor for type 2 diabetes, behind body fat mass. As we will discuss in the very next video, this is because the ability of the subcutaneous fat tissue (=the only safe place to store fat in the body) to expand and store fat effectively declines with age.
Cheers
Mario
Thank you for your videos. They are so informative and helpful! ❤
Thanks Mario very interesting
I would like you to do a video on your opinion of the keto lifestyle. I had an A1c of 5.8. I have been doing the keto diet for a year now my A1c is 5.5. But my glucose monitor the numbers are usually somewhere between 101 and 115. That would suggest I am still prediabetic. Please help me with this. Thank you and God bless you!🙏❤️
You are more then likely in an Adaptive Glucose Sparing state in your Keto Lifestyle.. Meaning: Your muscles are preferring fat as a fuel and saving your glucose to use for functions that require glucose. This stste is not a problem. I have the same Adaptive Glucose Sparing state. If you want to know more "clap back" to me and I'll give you the Science link(s)
@@anomarnamloh7444 please send me that information. Thank you so much for responding to me. God bless you!🙏❤️
Lol, sock puppet
Avoiding carbs increases insulin resistance. We would pass out from hypoglycemia of this weren’t the case
Fast and carnivore
I would like a video about control of blood sugar (type 2 diabetic) + breast cancer.
Added to the list!
Thank you for the suggestion.
Cheers
Mario
@@nourishedbyscience thanks it would be very helpful. My mom is going through this and I want to help as much as I can.
Simple and clear👍
I agree , that can exist high insulin resistant and chronic diseases ….
Thank you for this video. I was recently diagnosed as Diabetic and I have immediately changed my diet to Whole Food Plant Based very-low fat and no refined carbs. I have not gone on meds yet as I asked for 3 months to try to reverse it with diet. I lost 13 pounds in my first month. Two to go. But I want to know if I am changing my insulin resistance and you just gave me a way to do it. I also need to take the C-Peptide test (according to Mastering Diabetes) to figure out if my body produces enough insulin to reverse it with diet alone.
Excellent video, thank you so much
Amazing and informative video thank you!
Subscribed! I'm 1,8 on the scale, but still insulin resistant judging from the glucose response after carbs. Coming from 3,8 though, so reversal seems very possible.
Always also consider that glucose tolerance is also dependent on the ability of the pancreatic beta-cell to make enough insulin. So even at HOMA-IR of 1.8, it is not out of the question that elevated blood sugar after a meal could be related to a reduced ability of the beta-cells to make enough insulin.
Cheers
Mario
@@nourishedbyscience Might be, but coming from a lot higher fasting insulin suggest that insulin resistance has been established for sure. So only craft test would tell the real story, but with or without it I would eat healthy anyways so spikes are not an issue anyways. Btw I spike to 140 with a 100gr of ice cream for example.
@@user-ij8no5zw6u- If you watch any of my last three videos, you will see that I define a blood sugar spike as an increase to 180 mg/dL, and I explain the rationale for this. To me, there is little to no evidence that fluctuations within the range from 70 to 140 mg/dL are harmful.
Cheers
Mario
@@nourishedbyscience Yes, just saw your definition, but I tend to prefer to be on the safe side because one more thing - I may not spike super high, but going back to normal takes too much time like 2-3 hours. For me the healthy individuals have a bit faster spike witch is both lower and also they go back to baseline a low faster in a 1-1,5 hours. There's bit of a correlation, it you spike over 140, you'll probably take a lot or time to get the 90 again.
In all scenarios, carbs are fast energy and we have only 4gr of sugar in our bloodstream, so spike or not, if one is sanitary then 40gr of carbs are very unadvisable to consume. They have nowhere to go in the next hour except being stored by the use of insulin. Hyperinsulinemia will probably be inevitable ...
@@user-ij8no5zw6u- If you are happy with it, certainly nothing wrong with trying to keep your blood sugar lower.
I obtained a HOMA-IR of 1.1 based on my 3/18/24 lab report: Fasting insulin = 4.7 and glucose level = 95. 😊
Please explain C peptide use
C-peptide is secreted with insulin, and a bit more reliable than insulin, and you can find formulas online on how to calculate HOMA-IR based on C-peptide. I didn't include it here because it adds another layer of complexity, and just getting doctors to order a fasting insulin test can be a challenge.
Hey Doc' Another great video - well explained. Since you encouraged us to post questions, here's one you might like to help explain. For some time I've been wondering if using blood ketone strips (to measure Blood BHB) might be a simple way of estimating the approximate level or variability of insulin at home? I suggest this for those, like me, who have been unable to get the Doctor to do an appropriate insulin check and/or find it too expensive - including transport costs to a Lab' etc. I thought of this when I heard Professor Ben Bikman say in one of his lectures, "the liver wont produce ketones unless insulin is low". No doubt the situation is much more complicated than I seem to think.......hence me asking the question. Would be great if you could mention something on the subject in a future Video. Kind Regards, Y
I don't think this would be very useful. Dr. Bikman is correct when he says that high insulin levels prevent ketosis; however, that is mostly related to the very high insulin levels after meals. So even if you were insulin resistant, your elevated fasting insulin levels would still be low enough to allow you to enter ketosis. Therefore, whether your fasting insulin levels are indicative of good or poor insulin sensitivity, I don't think you can measure well by looking at ketones.
Best,
Mario
Wonderful content Vielen dank! A suggestion though: possibly make a numerical reference to each video so one can easily follow the videos in order of production? I enjoy all of them though!
Thank you!
Good idea. As an alternative, you can go to my channel page and look up my 'playlists'. These are in order.
Cheers
Mario
Why do you not recommend the C peptide blood test?
C-peptide would be similarly good, but the HOMA-IR based on fasting insulin is much more widely used and people are more familiar with it. I don't think fasting C-peptide-based measured are clearly better than those based on fasting insulin.
Cheers
Mario
Insulin resistance is a risk factor for type 2 diabetes, and all chronic metabolic diseases. .
Insulin resistance risk factors :
1. 45 years and older
2. Overweight or obese , with excess fat/weight around the waist.
3. Sedentary lifestyle
4. High blood pressure
5. High stress lifestyle
6. Fasting triglycerides more than 150 mg/dl
7. Chronic inflammatory condition
8. Medications: cortecostetoids, antiretrovirals, antipsychotics.
To measure insulin resistance - HOMA-IR blood test
HOMA-IR: blood test in AM, after overnight fast ( only water) of 12 hrs , under no stress, no tooth extraction, no infection, no inflammation ( ex. Joint inflammation/ arthritis), no meds ( of cortecostetoids, antiretrovirals, anti psychotics )no vaccinations
Formula:
a) if Glucose data in mg/dl:
Fasting Insulin ( microunits/ml)X fasting glucose ( mg/dl) divided by 405
b) if Glucose data in millimoles/L
Fasting Insulin ( micromoles/ml) X fasting glucose ( millimoles/Liter) divided by 22.5
Interpretation:
1 is normal
Less than 2.5 - insulin sensitive
Greater than 2.5 - insulin resistant
Or:
Under 1.5 ideal or perfect
Between 1.5 to 2.5 - mild insulin resistance.
Between 2.5 to 7 - insulin resistant
Thank you for this video and upcoming series. This is tremendously informative. I have a question on insulin on storage -hopefully, I didn't miss it from a prior video.
Does insulin trigger a simultaneous storage of glucose into muscles, liver, and fat cells? If so, does that mean that glucose just ends up in fat cells only because the former stores become full/saturated first?
Excellent question, but a straightforward and short answer would be difficult. However, this will be covered in future videos, including in the very next one in which we'll discuss the causes of insulin resistance (because what happens when all of the target tissues for insulin are 'full'?).
Cheers
Mario
@@nourishedbyscience Excellent. Thank you!
I no longer bother going to doctors and begging for tests, I do all tests on my own🔴. Quest-on-demand offers many tests, although i still haven't seen them offering insulin resistance test. Will shop around and see which lab does it offer. 🍎🍎🍎 By the way, the lab prices are so discounted (when buy on your own) that it's cheaper to buy my own test than do it through insurance + doctor's fees.
Very valuable, objective and scientific knowledge covering various aspects of Insulin resistance...
Great videos. I would like to add PCOS to the list of predispositions! Do you recommend plant based diet to your patients?
I am diet agnostic, and see value in many different ways of eating. I'll cover different dietary approaches for glucose intolerance and insulin resistance in separate videos shortly.
Cheers
Mario
PCOS is simple IR. Eliminate the IR, heal the PCOS.
Long process, but zero else works.
So lowcarb/keto meaning animal based (the normal human diet). No.more.grains.ever. is the first step. No starchy vegs, no beans, very little fruit, nuts & seeds. Make ur own yogurt, cultured 24 hrs, for no carb. Kefir needs 24-36 hrs too, to be no carb.
I’ve had PCOS since early 90s, if not before.
Animal fats
As Mario explained, insulin resistance does not tell the whole story regarding a person's ability to maintain healthy blood glucose levels. The ability of the pancreatic beta cells to produce insulin is also crucial. If the beta cells are capable of producing a lot of insulin, then insulin resistance can go very high before a person gets into trouble with glycemic control. On the other hand, if the beta cells are impaired, then glycemic control will begin to suffer at a lower level of insulin resistance.
All of this to say that while measuring insulin resistance is crucial, we can get a fuller picture of metabolic health by also measuring beta cell function. I went looking for an inexpensive test of beta cell function and found that the HOMA model itself provides an indicator called HOMA-B (or HOMA-ß) that serves this purpose. Better still, it requires only the same two inputs that go into the HOMA-IR calculation: fasting glucose and fasting insulin. Higher HOMA-B numbers indicate a greater ability to produce insulin.
I also discovered that there is an improved, more accurate version of the HOMA model called HOMA2. The HOMA2 model is considerably more complicated, so you need to use a HOMA2 calculator rather than trying to do the calculations by hand. I got mine from the Radcliffe Department of Medicine at the University of Oxford. Google 'oxford homa2' and you'll find it.
Normal ranges vary by population, so you need to be careful in interpreting the results, but I found these ranges in one particular study:
HOMA2-IR in non-diabetics: mean 1.16, standard deviation 0.31
HOMA2-IR in diabetics: mean 2.61, standard deviation 1.06
HOMA2-B in non-diabetics: mean 113.10, standard deviation 30.56
HOMA2-B in diabetics: mean 47.10, standard deviation 24.67
This is why normal just means common
Not OPTIMAL (optimal is currently at no more than 1 on standard HOMA-IR)
Getting a T2 “good enough” isn’t good enough! They can actually eliminate the T2 *and* NAFL (fatty liver) if they go keto. It takes a lot of patience and strict adherence but after months of it, change will be visible (fat loss), not just slowly internally healing.
Thx for the calculator info, wish u had incl a link.😮
thanks for the video. Can you site any research that supports the statement "maximum beta cell output is largely genetically determined"? I was not aware of that. Thanks!
Hi thank you for this new video. Several years ago I started having hypoglycemic episodes, a doctor prescribed me a glucose tolerance test that also measured insulin and turned out my insulin rised really high after taking the glucose and continued high after 2hs. My glucose level was normal after 2 hours but probably turned too low after 3-4hs (as the insulin was still really high but measurements stopped after 2hs). My fasting insulin is totally normal. I have made changes to my diet, cut out simple sugars, and have carbs together with fiber fat and proteins, and I didn t experience hypoglicemic episodes anymore. However I m still a bit concerned about insulin situation. I repeated the exam some years after the first one and after the change in my diet and the post prandial insulin was still higher. Other interesting fact is that I m really thin, I m actually underweight and have always struggled to gain weight. Is there an explanation why an underweight person is aparantly insulin resistant? I m also looking forward to a video explaining how to improve insulin resistance. Thanks!
The reason why you have insulin resistance even though you’re not fat is because you don’t have much muscle.
Most of the glucose we eat is stored in the muscle, so the more muscle you have, the more storage space there is for glucose.
So I would highly recommend doing weight training to build muscle in order to improve insulin sensitivity. Plus, weight training is high intensity so it uses glucose instead of fat, which is great for lowering blood glucose. In addition to building muscle, weight training is also excellent for building strong bones.
Ok thanks, no one never told me about the relation between muscles and glucose and insulin. Really good info. Not sure it explains totally my insulin situation though. My glucose is normal, it is normal at fasting, doesn t have a huge spike after having the glucose solution (I think reached 140 no more) and comes back to normal quite quickly. However the insulin goes crazy and stays high even if glucose is back to normal. With your explanation I would understand having little muscles would trigger glucose spikes and so insulin spikes to get the glucose level down, but it s not exactly my situation.
Your situation is the first stage of insulin resistance, which is that insulin goes up to compensate for the resistance and glucose is still normal as a result of the extra insulin. Your glucose would be high if the insulin didn’t go up. Insulin resistance takes many years to develop, so if this continues, many years later, your glucose will rise. So fasting insulin level is an early indicator of insulin resistance, better than fasting glucose.
Building muscle creates more space to store glucose. In addition, you also need to use muscle frequently so that muscle will take glucose. If you don’t use your muscle, then the muscle has no need to take up glucose, resulting in insulin resistance. Therefore, building muscle and using muscle frequently are crucial to maintaining insulin sensitivity.
Ok let s exercise! Thanks
The very next video will be on causes of insulin resistance. There are a few that could explain insulin resistance in the absence of overweight. Hope this will give you some clues for additional discussions with your doctor.
Cheers
Mario
P.S.: Excellent suggestion as well by @justsaying7065. That is one potential cause of insulin resistance in a person with underweight. Doing resistance training is a good idea for everyone, but also be open that your insulin resistance could still be (partly) related to something else.
It would be wonderful to see what research you are familiar with for people living with T1D. We tend to be forgotten in favor of info pertaining to T2. I use both a CGM & an insulin pump. Thank you for your videos.
I do intend to have some videos for T1DM as well, but my primary expertise is on T2DM and related metabolic disease, as I have studied this professionally for ~20 years.
Cheers
Mario
There is a channel called "Type 1 Talks" He shares a ton of information with his personal 30+ years of being Type 1. Tons of great info
Am I right in thinking that Insulin is the fat storage hormone and therefore more insulin > more fat > more insulin resistance > need more insulin and so on, A vicious cycle. How to interrupt that?
Good question. Complex answer.
This is a common narrative, particularly in the low-carb community, but the science isn't clear on how much this is a factor in weight gain and obesity. The body indeed needs insulin to store fat effectively. However, even if you consume a low-carb diet, you usually have a little bit of insulin in your body, and it isn't clear that having slightly higher insulin levels that result from eating carbohydrates makes it more likely that you'll gain weight. In fact, if we look at human intervention studies, people can lose weight similarly effectively on low-carb and high-carb diets.
Much more to say about this, and I'll cover this in separate videos at some point. Whether or not elevated insulin plays a key role in weight gain or not, however, I'd say it's abundantly clear that we would benefit from maintaining good insulin sensitivity and avoiding chronically elevated insulin levels, simply because insulin resistance and hyperinsulinemia are risk factors for other medical conditions such as type 2 diabetes, heart disease, cancer, and kidney disease.
Best,
Mario
Dear Dr, could you please advice me the correct method to prepare for fasting insulin blood taking as i am a t2dm with s/c insulin (long acting) treatment. should i omit the dose of insulin the night before for the next morning fasting insulin? will my results be affected if i've taken my night dose on insulin (long acting).. thank you
Definitely take the long acting insulin the night before. HOMA-IR is calculated from both insulin and glucose, so the test is still valid.
Cheers
Mario
Mario, could you at some point just touch briefly on the second meal phenomenon, that you’ve made reference to before? I eat oatmeal for breakfast and try to match the carbohydrates in the oatmeal with the carbohydrates in beans for lunch, I figure that since I consume more fiber at lunch I can add to the carbs that I ate with breakfast. Any studies on carb matching? If you’ve succinct information on this issue it’d be much appreciated
Thanks,
Rafael
Hi Rafael,
I don't think it would be necessary to match the carb content of meals, and it would strike me as overly complicated to do that regularly. The general idea is simply that if you eat carbs at one meal, then the beta-cells store more insulin pre-made and they are better able to handle carbs at the next meal.
I talk in more detail about the second meal effect in this video here:
ruclips.net/video/LVw60RIhbzg/видео.html
Cheers
Mario
Dr. Mario, thank you for your wonderful information. It's so comforting to have things explained the way you do. God bless you.
Es gibt ja "continuous glucose monitors", die man sich wochenweise als Nadel-Pflaster in den Arm macht, wie es im Video auch einmal erwähnt wird. Gibt es sowas auch als "continuous insulin monitor"? Warum ist Glukose im Blut so "einfach" zu bestimmen und Insulin anscheinend nicht?
Das wäre schön. Leider nicht. Ich glaube wenn es das gäbe würde viel mehr Augenmerk auf Insulin und Insulinresistenz gelegt.
LG
Mario
@@nourishedbyscience Danke für die schnelle Antwort☺
ich finde es schade, dass man in deutschland diese CGM nicht als prä-diabeter oder nicht-diabetiker bekommt!
@@shurrrig Doch, gibt es. Hatte ich früher auch schon. Freestyle Libre von Abbott. Zumindest für 2 Wochen kann man das sogar kostenlos testen (Aktion bis Dezember) und in 2 Wochen erfährt man auch schon viel über seinen Körper und gewisse Muster/Reaktionen. Hope that helps 🙂
oh, das muss ich mal austesten! dankeschön!
Thank you for the video! It would be interesting if you could make a video on leptin resistance.
For sure. At some point, there will be a similar series about body weight regulation. It's going to be a while, though, because I have a lot of plans for more videos about blood sugar.
Cheers
Mario
Is this information relevant for Type 1 diabetes?
Great question. It's not entirely irrelevant for T1DM. However: as you probably know, Insulin resistance is not the primary problem in type 1 diabetes, but - maybe obviously - people with type 1 diabetes can also become insulin resistant on top of their diminished insulin production capacity. I personally would not use HOMA-IR in that case to determine how insulin sensitive/resistant I am, because IMO it's value is uncertain when most or all of the insulin in blood has been injected. However, given that the insulin doses needed to control blood sugar levels are dependent on the patients insulin sensitivity, a type 1 diabetic should have a pretty good sense anyways of their degree of insulin sensitivity. If this is unclear, maybe discuss your specific case and insulin dose relative to carb consumption with your doctor, and he/she should be able to give you a sense of whether insulin resistance seems to be a concern. By locking at basal and bolus insulin requirements relative to carb dose and the resulting blood glucose levels throughout the day, one should be able to get a better sense of insulin sensitivity than HOMA-IR could provide in a healthy person.
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Mario
Is there a way to calculate this whit fasting Glucose and C-peptide value??
Yes, and that's even better because c-peptide tends to be less volatile than insulin. However, the interpretation is not as straightforward, as we have fewer data linking c-peptide-based HOMA to health outcomes. Still, you can probably google the formula (depends on your units of measurement as well, so pay attention to that).
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Mario
My A1C was 6% to 6.1% I lost 55 lbs on a low carb diet and my A1C dropped to 5.4%. BUT my fast insulin only dropped from 15 to 13 to 12.4. Over about 1 yr. How long does it take for fasting insulin to drop to a healthy level (
Losing this much weight should have an effect, and it did, but please be clear that insulin resistance can be caused by a lot of different things. I'll cover most of the main causes and contributing factors in the next two videos, so maybe this information will provide some clues to you about what is going on.
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Mario
@@nourishedbyscience thank you for your message I’ll be watching.
Useful information!!👍
Is there any benefit in having a Homa-ir test if you are already diagnosed with T2 and are taking medication for that? Or is it purely for those who are either pre diabetic or concerned about pre diabetes.
There is value in HOMA-IR still, but less so, because therapy will aim to improve glucose control, and any improvements can more reliably be assessed by monitoring blood glucose or HbA1c. Also, depending on the type of diabetes, how advanced it is, and the causes of the glucose intolerance, HOMA-IR may be less reliable an indicator of insulin resistance in people with diabetes than in healthy people.
At the same time, it’s even more important for people with type 2 diabetes to try to improve their insulin sensitivity. And any such improvement should be very quickly reflected in better glycemic control.
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Mario
Seems that you would need to know if insulin levels behave as expected (compared to a non diabetic) then it would somewhat rule out it being insulin levels (thus possibly not needing insulin shots for example) and if glucose levels drop during higher intensity exercise then that pathway may be normal bit the insulin pathway sensitivity or mechanisms aren't
Dr Kratz, I’ve recently watched Professor Taylor’s studies on T2DM regression and the role of the liver’s insulin resistance which, Dr Taylor says, is not the same as muscle tissue insulin resistance, I’m unsure as to the distinction. How is the Insulin Resistance [IR] test that you’ve posted here related to these two forms of IR?
Thank you
Well, in general, all insulin sensitive tissue have their own level of sensitivity to insulin, and they change dynamically as certain things happen in the body. Also, the degree to which the different tissues are sensitive vs. resistant to insulin varies depending on the cause(s) of the insulin resistance. In practice, I'd say this is more of academic interest, because most people who develop insulin resistance in their fat tissue also develop insulin resistance in their liver and muscle, and vice versa.
HOMA-IR is based on fasting insulin, and because insulin acts mostly on the liver in the fasting state, one could argue that HOMA-IR is mostly a measure of liver insulin resistance. However, HOMA-IR is also strongly associated with measures of overall insulin resistance, such as those based on dynamic tests (OGTT or clamp).
What Dr. Taylor says is still correct, and particularly relevant in the context of the types of interventions he runs where people reverse insulin resistance and glucose intolerance by very low-calorie diets. He wants to understand the mechanisms of the interventions, and therefore he very particular about trying to figure out the time course of changes in insulin sensitivity in all of the different tissues. That makes sense for him, but personally, I don't think the average person needs to worry too much about these details.
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Mario
hey
love your videos.. discovering this channel was an absolute bless
have a question here.. whats the difference between Homa-IR & Homa IR2 tests?
One is calculated with the simple formula I shared in the video, the other is calculated by computer.
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Mario
thanks for answering
will the same range apply in this case? i was diagnosed with 2.35 Homa2 does that make me borderline?
My HOMA-IR is 4,4. I do not know, what this number means. Is it so bad?
@@inasbriek i guess u need to see a doctor for further examination just to be more in the safe side.. stay safe