How to test your insulin levels

At Real Life Medicine we help everybody, but in particular, our passion is women who have tried everything, who have done every diet known to (wo)man, who are almost ready to give up on themselves. They're our people. They're our tribe, and we help them by understanding the physiology and the psychology. It is so important to marry those together and do a whole person approach, not just for weight loss, but overall health.

Now this week, talking about insulin-again! In our 12-week Mind Body Rebalance program, we give our participants a  letter to give to their doctor. We want to include their GP in this whole health revolution that they're undertaking. Fascinatingly, some people have come back to us and said, "Oh, my doctor doesn't want to order these tests. They don't know how to interpret them." One of them said, "My doctor said in 40 years, he has never ordered an insulin level," and I'm thinking, “Wow-Really?”

So, unfortunately, there are some doctors that just haven't been exposed perhaps to insulin, insulin testing and insulin’s effects of the human body, beyond glucose control. I'm going to give them the benefit of the doubt, because I would love to think that, in general, doctors want to help their patients. 

That's what we as doctors do. We want to help you. We are carers. We want you to do well. But for some doctors, they just haven't had the fortune of coming across low carb and understanding how insulin levels affect every system in the body.

Now, for any of you who have a good relationship with your doctor, but perhaps they've said to you, "I don't know about this insulin business," I have done a presentation to doctors a couple of years ago on this exact topic. I was involved with organising a conference for Low Carb Down Under,  called “Low Carb for Doctors”. I did a talk called The Hormonal Theory of Obesity. It's freely available. Just Google my name, Dr Lucy Burns, Hormonal Theory of Obesity, and it comes up.

It's about 25 minutes. It is presented to doctors, but it's actually also really easy for laypeople to understand. So I really would encourage you to have a look at that You can find it here 

So insulin levels, my loves.  Insulin is the king hormone in metabolic dysfunction. So how do you know if you have high insulin? People want to know this. Many patients ask me” how do I know if I've got high insulin?” So we've given you a few ideas for physical things. Particularly the skin tags. And waist circumference. Read more here.

Now sadly you cannot check your insulin levels at home, like you can with blood glucose. It's important to understand the difference between insulin and glucose. Insulin is a hormone secreted by the pancreas in response to glucose. Glucose is found in our food that we eat-  sugar and starch. Glucose can also be made by our liver in a process called gluconeogenesis. Glucose is easy for us to check. We can do it with a finger prick any time. Insulin, you can only check on a blood test ordered at a pathology lab.

So there are two ways that we can check it. 

1. We can do a fasting insulin level. It's just a one-off test. It's okay. It's not perfect, and the reason for that is that insulin is a pulsatile hormone. That means it comes out in shoots, in spurts, in pulses. So when we do just a one-off level, we don't know necessarily, are we at the peak of the pulse? Are we at the bottom of the pulse? It gives us a rough idea, but it's not super accurate.

1. The gold standard test is what we call an insulin curve. So it's actually a glucose tolerance test, which people may know about from pregnancy or from diabetes checks. But the gold with this is that you have to order an insulin level. So you get both glucose and insulin at the same time. So if you imagine you're at the path lab and you're fasting. You have a blood test. It will tell us our fasting level of both insulin and glucose. You then have a glucose drink. It's the only time in your whole life I recommend a big slog of glucose. Then what will happen is, at one hour they'll check again and we’ll know, what has your insulin done in response to this glucose load? Then at two hours, we will know what is your insulin doing at the two hours mark 

Now, it should look like a curve, like an upside-down U.

The fasting insulin level should be under 12. 

The one-hour should be under 45.

The two-hour should be under 30. In Australian we use mmol/l as our units. 

I'm going to tell you, I mean, I rarely see these results in clinical practice. Part of it is, of course, the population of people I see. I help people who have obesity or overweight, particularly around their middle. The majority of the people I see are insulin resistant.

Now, the thing is that I see all sorts of things. I see a curve that just has numbers higher than it should. I see these other people that are doing a straight line up. So at two hours, instead of returning to normal, like 30, their pancreas is still pumping out more, saying, "Oh my God, if I don't keep pumping out this insulin, the glucose is going to get higher." So really what we're wanting is a lovely insulin curve, and what we're getting is either a curve that goes up, up up or a curve that follows the normal pattern, but is just way higher than it should be.

The blue curve is normal. All the others will lead to diabetes.

2 hours 

The numbers that I see with fasting insulin might be 20, right up to 90. I  see a one-hour result that should be maximum 45, is often in the hundreds. That's not unusual. 200, 500. 500. Insulin should be coming down at the two-hour mark. It should be below 30, again, all sorts of numbers, going up, plateauing out, so 100 and still 100, continuing to rise, 200, 300.

So what all that means is that your body is producing more insulin than what it should be producing. This locks  the metaphorical  woodshed that I often talk about. You can read about the woodshed here. Insulin stops you burning your own fat. If you have high circulating insulin for long periods of the day, then you cannot burn your fat stores no matter what. So we need to keep the insulin low.

And you know what I'm going to say...

Eat Low Carb Real Food

Dr Lucy Burns and Dr Mary Barson