Early Detection and Intervention for Metabolic Dysfunction

 

This Clinical Tip lands in the category of the assessments you need Today to avoid disease diagnoses Tomorrow:  often unexplored evidence – cues’n’clues – of functional imbalance to help clients avoid disease.

Metabolic dysfunction is known to be ongoing for years – maybe even decades – before a diagnosis of Type 2 Diabetes Mellitus (T2DM). Yet many (most?) primary care providers still rely on out-of-normal-range fasting glucose or HbA1c as prompts to explore the health of metabolic function further.  Unfortunately, elevations in blood sugar usually happen after entrenched insulin resistance has been at play for quite some time. 

Check out this short video to learn more about why fasting insulin (or even better, fasting c-peptide) is a critical labwork marker for helping identify the early stages of insulin resistance – when this dynamic is easier to reverse.  

Both of these markers help us to assess adaptive pancreatic function – how hard is the pancreas working to meet the glycemic load of life? How much insulin is it secreting in a fasted state in anticipation of the glucose load it’s likely to experience from our current life system?

“Among individuals who developed diabetes,… insulin secretion [was] higher and insulin sensitivity was lower than those among the controls already 13 years before the diagnosis.”

This is a quote from a prospective study published in Lancet that highlights the utility of looking at markers, including fasting insulin, as a predictor of future T2DM or a progressive worsening of metabolic health.  It turns out elevations in fasting insulin may occur up to 13 years ahead of an eventual T2DM diagnosis.

Check out this article for more on the utility of fasting insulin, both for its predictive value as well as a gauge of metabolic dis-ease progression – both in positive and negative directions. This article also highlights why lab reference ranges can be confusing and overtly counterproductive. Even mid-normal values of fasting insulin turn out to be predictive of future T2DM! 

Ideal fasting insulin levels are typically well below the midpoint of conventional normal ranges (e.g. 5-8 mIU/L). This has been proposed for quite some time but hasn’t yet made its way into typical clinical practice. A great reminder too that norms in a disease-riddled community are often not healthy targets.

C-peptide may be less familiar to you; it’s a substance released by the pancreas at the same time that it releases insulin.  It’s less commonly available today in some communities, but because of its longer half-life, fasting c-peptide may be the marker with better predictive value than fasting insulin.  To learn more about c-peptide, look here for confirmation of it as a predictive marker of T2DM onset in postpartum women. And here for the same in the general population.

I hope you are inspired to start including one of these markers in routine labwork (even well “annual physical” check ups!) and especially in cases of suspected metabolic dysfunction. Look early. Act early. Take the opportunity to practice prevention – before our patients’ diet and lifestyle have the opportunity to cause advanced metabolic dysfunction (and its hallmark elevated blood sugar).