I query most of my patients during the initial exam and history as to whether or not they have any diabetes in the family. Often I am told that they do, and that they themselves “have been tested” for diabetes and are fine. This almost always means that they have had a fasting glucose measurement which was normal.
A fasting sugar level that is elevated confirms diabetes. If the level is between 5.7-6.0, it may not be diabetes but rather, pre-diabetes. Still, I never believed that a fasting sugar level was sufficient to assess the relative risk of developing diabetes in the next 3-5 years. I have always used a fasting insulin in combination with fasting sugar to get a better functional idea of how the body is handling sugar. I wrote about sugar, diabetes, and insulin resistance here.
Simplistically, the higher the fasting insulin, the harder your body is trying to lower the blood sugar. The sugar might be normal, but your body may be having trouble keeping it normal. There is evidence that high insulin levels increase cardiovascular risk, cancer risk, and contribute to chronic fatigue issues.
Now, in the journal Lancet, June 2009, another good study has been published confirming this. This study showed that a fasting sugar might show a prediabetic condition 3 years prior to diabetes. However, measuring insulin resistance showed increase resistance 5 whole years prior to the onset of diabetes. That is a lot of time to intervene and avoid drug therapy.
With such a simple inexpensive test, for those who have diabetes in the family, are overweight, or have other risk factors, it is well worth checking in order to quantify risk and to follow with lifestyle changes, nutritional support, and other therapies (such as exercise and oxidative therapies).
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