Women’s health testing: a guide for you

Blood glucose — could you be on a path to diabetes?

by Marcelle Pick, OB/GYN NP

Glucose is a simple sugar that provides much of the energy our bodies use. In fact, glucose is the primary fuel for all life on planet Earth! Each cell in the body runs on glucose, and when it isn’t metabolized properly, the body suffers. Most practitioners test blood glucose as a part of a normal physical and during pregnancy. You may also need a blood glucose test if you have symptoms of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Diabetics test blood sugar at least once per day.

I have written before in some depth about preventing type 2 diabetes and metabolic syndrome, so I won’t go too far into the details, but here are some basics about glucose and insulin.

Insulin is the hormone released from your pancreas that essentially “opens” your cell doors for glucose. Without insulin, glucose stays in the blood and cannot fuel the cells. When a diet is high in refined carbohydrates and low in micronutrients, the pancreas works overtime to produce enough insulin to let all the sugar into your cells. After a while, your cells see so much insulin that they begin to resist it, so both insulin and glucose are at high levels in your blood. If more time goes by under these circumstances, the pancreas will eventually stop producing insulin. From a functional medicine perspective, once your cells become insulin resistant, you are under the umbrella of metabolic syndrome. And this faulty cell signaling will lead to high triglycerides, high cholesterol, and high blood pressure — and a whole cascade of additional health problems.

The best way to picture type 2 diabetes and insulin resistance is on a continuum, where there are many opportunities to step in and make changes for the better. When I see a woman whose blood sugar test result is 90 mg/dL the first year, 91 the second, 92 the third and so on, we talk about the trend, and where those numbers — though not yet in the diabetic range — are headed. This woman is probably already insulin resistant. Often conventional medicine practitioners will not say a thing to the patient until her numbers are getting closer to 98 or 99, and this is very close to pre-diabetes. My goal is to start making diet and lifestyle changes early on, before the trend takes us to diabetes. This might mean setting a goal for the above patient at 85 mg/dL.

Something to be mindful of is that many practitioners don’t test for insulin, and increased blood insulin (greater than 30-35 McU/mL two hours after a high-sugar meal) is one of the first signs that there’s a problem. If I’m even a little concerned that a woman might be heading toward diabetes, I typically suggest we test her fasting blood glucose and fasting insulin (no food or drink for eight hours beforehand), and then a 2-hour post-prandial glucose and insulin test — meaning this second set is drawn two hours after a high-sugar meal.

If blood glucose is elevated, I’ll do a hemoglobin A1C, which will give me an overall sense of where blood sugar levels have been over the past three months. If the two-hour insulin is high but glucose is still under control, we start with dietary changes because it’s still early enough that we can make a big difference — before glucose ever becomes too high.

Keep in mind that your healthcare provider will not be making decisions based exclusively on your test results but will evaluate your test results in context along with your medical history and family history. Each practitioner is different in her approach, so talk with yours about the best direction for your unique circumstances. If you’re concerned about insulin resistance, don’t be afraid to ask your practitioner for an insulin test. And certainly if your blood glucose levels are going up each year, you can take steps to prevent type 2 diabetes. We have lots of helpful information available in our articles on insulin resistance.

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References on interpreting your medical test results

 

Original Publication Date: 12/29/2008
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP