You don’t need to undergo fancy expensive tests to know your insulin resistance status – your TyG index is a good proxy and it can be calculated from routine lab work
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How to know if you’re insulin resistant using routine blood tests
You don’t need to undergo fancy expensive tests to know your insulin resistance status – your TyG number is a good proxy and it can be calculated from routine lab work
The easiest way……….look in the mirror.
What you’re looking for is not fat per se, but where the fat is distributed. Anytime there is a protruding belly AND you’re NOT pregnant, odds are you’re insulin resistant.
If you want to put a number on this “look”, you can calculate the waist to hip ratio.
NOTE : Don’t PANIC. You are getting wider even if you’re not getting fatter, this is why the absolute number is not used.
The waist to hip ratio
To do this………
- Measure how wide you are around the hips and then
- Measure how wide you are around the belly (waist).
Take the number you got for the waist and divide this, by the number you got for the belly.
Waist width = ratio
Hip width
A number bigger than 1 is a sign of trouble.
The waist to hip ratio is a crude measure.
NOTE : Metabolically healthy obese are typically wide ALL over i.e. although the absolute numbers are big, the ratio is less than one.
Hyperinsulinemic-euglycemic clamp
The way to KNOW for sure, you’re insulin resistant is to undergo a procedure known as a hyperinsulinemic-euglycemic clamp.
It is a PROCEDURE.
And it is a rather unnatural situation.
Briefly, what happens is you get hooked up to two IV lines i.e. little plastic pipes, draining directly into your blood vessels, now you know why it is a procedure. The one IV line pumps in a fixed dose of insulin.
Since insulin’s job is to put away the groceries, the body responds to this outside insulin, the same way it would respond to naturally produced insulin. It starts putting the groceries away, specifically sugar levels drop. Now low sugar levels ARE potentially a BIG PROBLEM, for the brain. So to keep this from being a catastrophe, glucose is pumped in at the same time. Exactly how much glucose needs to be pumped in, to counterbalance the insulin, depends on…………
Your level of insulin resistance.
When you’re insulin resistant
If you’re seriously insulin resistant, you need less glucose, because the insulin that is going in, is not doing it’s job. On the flip side, if you’re insulin sensitive, you need lots of glucose, because the insulin is efficiently putting the sugar away, so glucose is in short supply.
The required glucose infusion reflects your insulin resistance.
The name of the variable measured is the M score.
Limitations of hyperinsulinemic-euglycemic clamp
The trouble with this PROCEDURE….. it is
- Time consuming
- Has to be done in a hospital setting
- Expensive and
- Traumatic
So…….. it is not done on a routine basis.
Measuring fasting insulin plan B
Instead proxy measurements are used.
The best proxy for insulin resistance is probably fasting insulin.
The reason it is helpful, is when you’re insulin resistant, insulin levels are high, morning, noon and night, not just in the moments post dinner.
So a high fasting insulin levels speaks volumes about what is going on in metabolism.
Measures of fasting insulin
Fasting insulin levels are not so easy to interpret…………..
So to make the number a little more “meaningful”, it is plugged into one of several formulas, to give a final number. The final number is represented as a cute little acronym on the blood work panel.
These acronyms include
- HOMA which stands for the homeostasis model assessment
- QUICKI which stands for quantitative insulin sensitivity check index
- FGIR which stands for fasting glucose to insulin ratio
- FIGP which stands for fasting insulin glucose product
The number is calculated and then compared with reference ranges, to establish the level of insulin resistance / sensitivity.
The problem with fasting insulin levels
It works………..
But measuring insulin levels is expensive.
And……variable.
So although it is “best” it is also not something measured on a routine basis.
Are there other proxy measures ?
TyG a proxy for everyone
The short answer is yes.
One is a pretty new one. It is the TyG index.
The TyG stands for the product of triglycerides times glucose.
It is also based on a calculation, but this is one that uses common blood measurements, that are pretty standard.
Ln (fasting TG (mg/dl) x fasting glucose (mg/dl)/2)
Here is a sample calculation
Take your fasting triglyceride levels
Take your fasting glucose level and plug it into the formula
Then do the maths to get your TyG index
Alternatively, take your numbers and plug them into this on-line TyG index calculator
NOTE : You must make sure the number is in mg/dl. If your blood work is in mmol/L make the conversion, by multiplying the triglyceride level by 89 and the sugar level, by 18
Interpreting the TyG index
The “magic number’ is 4.68. Below this, you’re considered insulin sensitive, above it, insulin resistant.
The bigger that number…………. the bigger the problem.
New research suggests a TyG index of more than 8.5, strongly suggests you have non-alcoholic fatty liver disease.
TyG will give you a heads up
That you’ve got bad body chemistry.
Of course, it is a stand in measurement, so it is NOT perfect.
When researchers compare the TyG index to the value from the hyperinsulinemic-euglycemic clamp, remember this is considered the gold standard, for measuring insulin resistance, they find that the TyG index would sometimes get it wrong….
- 2 % of the time it would not detect insulin resistance in people with insulin resistance
- 3 % if the time, it would detect insulin resistance in people who were not insulin resistant
Perfect is not required, to take action…….
No drugs for insulin resistance
At this stage, there is no pill you can swallow to “fix” insulin resistance.
For the most part, you have to “wait” until something gives……….. then, a whole host of medical interventions are used, to manage the problem.
Unfortunately, the odds that something GIVES, if you are insulin resistant, is rather high.
It is probably a matter of when, not if.
What gives will depend on your genetic predispositions. The list of health problems associated with insulin resistance is rather long, extending from acne to xanthoma (dry mouth), and everything in between.
Know your status
So do you really want to know if you are insulin resistant ?
The short answer is YES !
Remember it can happen to you even if you are NOT visibly over weight.
The “fix”………….
Hyperinsulinemia is creating the DIS-EASE !
Reining in insulin
Will bring relief. It might not be easy, but there are a multitude of little things you can do, to rein in insulin. Download the Willpower Report for some suggestions. And visit “The Ups & Downs of Insulin Resistance series” to learn more.
Further reading
A bigger insulin response makes for bigger kids – being bigger can be an advantage, but being too big i.e. getting fat, isn’t. Insulin response is the key
It’s time diabetics stop seeing insulin as a knight in shining armour
SUGAR is the enemy and INSULIN is the saviour. The “success” of bariatric surgery, as a treatment for type 2 diabetes, is forcing a re-think
To be healthy, you need MORE fat cells, not less
You can be fat, with lots of fat cells (hyperplasia) or you can be fat with fewer fat cells (hypoplasia). More fat cells is better from a health perspective