Biometric Screening: The Tests They Didn't Do (but should have)
A biometric screening is a set of laboratory tests and body measurements that help determine metabolic health. Many Americans complete a biometric screening annually, at their doctor’s office, a convenience clinic or perhaps even at their worksite. But many never receive much guidance around the results. This post is part of a five part series that will help you interpret your results and determine whether you need to take action to improve your metabolic health.
Part Four: Waist Circumference & BMI
Part Five: The Tests They Didn’t Do (but should have)
Part Five: The tests they didn’t do (but should have)
Fasting Insulin and HOMA-IR
what is insulin?
Every time you eat, your pancreas responds by producing the hormone insulin. Insulin has many roles in the body, and one very important one is to help usher glucose out of the blood and into the muscle cells (and some brain cells). Muscle cells love to use glucose for energy, and they have little tubes called glucose transporters inside them at all times. Insulin signals to the cells to move the transport tubes into the cell wall so that glucose can enter.
How much insulin is too much insulin?
A healthy individual produces between 18-40 units of insulin per day, or 0.2-0.5 units per kilogram body weight per day. About half of that is secreted slowly and steadily all day long, while the other half is secreted in response to eating or drinking. After eating or drinking, insulin will increase by up to six times the baseline level, and it peaks within about 60 minutes. People with type 1 diabetes cannot produce insulin, and must inject insulin every day in order for their body to process glucose properly. Most of my patients have an entirely different type of diabetes, referred to as type 2 diabetes or pre-diabetes. In this type of diabetes, the pancreas is perfectly capable of producing insulin. The issue is that the muscle cells don’t respond as well, and struggle to move the glucose transporter to the cell wall - this is called “insulin resistance.” Because of the poor insulin response, glucose gets “stuck” in the blood for longer. The pancreas senses the prolonged elevation in blood glucose and produces more and more insulin to help combat it. Thus, high insulin levels are a hallmark of early stage diabetes.
I like my patients to get a fasting insulin level at the same time as their fasting glucose test. Sometimes the fasting glucose will look OK - perhaps 95, but the insulin level will be sky high. This tells us that while the patient isn’t yet officially diabetic, it’s only because their pancreas is working in overdrive trying to force glucose into muscle cells.
Optimal fasting insulin is below 7 uIU/mL.
Acceptable fasting insulin is below 10 uIU/mL.
Another good metric is the HOMA-IR, which is a mathematical equation that tells us how hard your pancreas is working to obtain your fasting glucose level.
HOMA-IR = fasting insulin x fasting glucose / 405
Optimal HOMA-IR is below 1.
Acceptable HOMA-IR is below 1.9
Should You Worry?
Yes. This test is one of the earliest indicators of insulin resistance. Even if your glucose is still “OK,” you should take action if your insulin is high. The longer your insulin remains high, the higher your risk for fat accumulation in the liver and adipose tissue. The faster you act, the easier the process is to reverse. The good news is that diet and exercise is the primary intervention at this stage, and it is very effective.
What should you do?
Typical interventions involve increasing muscle glucose uptake through cardio and strength exercise, as well as dietary interventions to reduce the glucose load.
It’s helpful to have a care team on your side that can help you create a plan that is tailored to you. Click here to learn more about working with Tera to improve your metabolic health today.