Waist measurement and insulin resistance - visceral fat

[LittleGreyCat]

Just had my review, and brought up the issue of insulin resistance (other thread going about testing for this).

BMI is currently 23.1 so in "normal" range.

My DSN said that I wouldn't be insulin resistant because I wasn't over weight.

I mentioned waist measurement, we checked and it is currently 37". This gives me an added risk factor from the rule that your waist measurement shouldn't be more than half your height. I am 72" tall.

This in turn could be an indicator of visceral fat which in turn could cause insulin resistance.

So - has anyone else had a larger than desirable waist measurement when within normal BMI and turned out to be insulin resistant?

I have asked my DSN to check if there are tests available on the NHS for visceral fat.

Also, shouldn't waist measurement be checked at your review? Allegedly it is more important than BMI for diabetes risk.

 

[Art Of Flowers]

Some people are TOFI = Thin Outside, Fat Inside.
Some body composition weight scales show you % body fat, % visceral fat.

 

[ringi]

Given that the NHS will not pay for the blood tests to measure insulin resistance......

Vsceral fat is a good indicator but once again the NHS will to pay for the scans to measure it, unless they need to check for something else.

So we are left with waist measurement, but why do you want to know your level of insulin resistance? Will you go back to high carb if your insulin resistance is low......

 

[Metabolism_Boss]

Just had my review, and brought up the issue of insulin resistance (other thread going about testing for this).

BMI is currently 23.1 so in "normal" range.

My DSN said that I wouldn't be insulin resistant because I wasn't over weight.

I mentioned waist measurement, we checked and it is currently 37". This gives me an added risk factor from the rule that your waist measurement shouldn't be more than half your height. I am 72" tall.

This in turn could be an indicator of visceral fat which in turn could cause insulin resistance.

So - has anyone else had a larger than desirable waist measurement when within normal BMI and turned out to be insulin resistant?

I have asked my DSN to check if there are tests available on the NHS for visceral fat.

Also, shouldn't waist measurement be checked at your review? Allegedly it is more important than BMI for diabetes risk.

It does sound like you might be TOFI like me. I had a 34 inch waist and my diabetic nurse warned me that I might not see much difference if I dieted off the stone or so that I needed to lose. The good news is that losing that stone dropped my BG from 15 to 6.0 on average, although that was combined with an Atkins style diet. If you are TOFI, you may find that small things affect your BG a lot, and you may find you have to keep an strict eye on your weight. I find a 3-4lb increase can send my BG up to 8.0 and beyond. I am currently doing resistance exercise to try to build some muscle, as that gives us TOFI's a bit more leeway. How successful I am remains to be seen. If you find information on TOFI you may end up getting depressed, as many articles say how dangerous it is. In my view, it can be controlled, just like any other form of diabetes, it's just that we have to follow the law of small numbers.
Best wishes to you.

 

[Grateful]

When I was diagnosed nine months ago my BMI was 21.7 but it was a Type 2 diagnosis so insulin resistance is pretty much a given.

I have always been very skinny but my waist had ballooned to 40 inches. A classic "beer belly" and a bizarre body shape. The "waist-to-hip ratio" even classified me as "obese" believe it or not.

I agree with you about the need to check waist. My doctor had never done it, and blithely said I was "not overweight" but I now consider myself to have been, in fact, overweight at the time.

This of course was a "risk factor" for diabetes although it is impossible to say exactly what "caused" the disease, probably a mixture of factors contributed, including sedentary lifestyle, stress, and genetics. Who knows.

As for ongoing control of T2D I do now closely watch my waistline and think that the theories about "visceral fat" being a danger factor make sense.

 

[LittleGreyCat]

<snip>

So we are left with waist measurement, but why do you want to know your level of insulin resistance? Will you go back to high carb if your insulin resistance is low......

That is a very strange question. Why would I want to go back to high carbohydrate? Or was that a lame attempt at humour?

I leave it to you to work out a sensible reason why I might want to know if I was under producing insulin or producing more but not utilising it effectively.

 

[Bluetit1802]

Just had my review, and brought up the issue of insulin resistance (other thread going about testing for this).

BMI is currently 23.1 so in "normal" range.

My DSN said that I wouldn't be insulin resistant because I wasn't over weight.

I mentioned waist measurement, we checked and it is currently 37". This gives me an added risk factor from the rule that your waist measurement shouldn't be more than half your height. I am 72" tall.

This in turn could be an indicator of visceral fat which in turn could cause insulin resistance.

So - has anyone else had a larger than desirable waist measurement when within normal BMI and turned out to be insulin resistant?

I have asked my DSN to check if there are tests available on the NHS for visceral fat.

Also, shouldn't waist measurement be checked at your review? Allegedly it is more important than BMI for diabetes risk.

A good indicator of insulin resistance is:
a fasting insulin test
and/or
an OGGT test done properly.

You can do the OGTT at home with a bottle of Rapilose, and you can order a fasting insulin test on-line.

https://www.gpsupplies.com/rapilose-ogtt-glucose-solution-300ml-pack-of-1
https://www.medichecks.com/fertility-tests/insulin

 

[Guzzler]

TOFI or MONW (Metabolically Obese Normal Weight) is said to be more of a risk than the obvious waistline obesity that some T2s suffer. The main reason being that MONWs are less likely to be diagnosed early and because viseral fat does more harm than that that carried abdominally. I viewed a presentation on youtube about it a few weeks ago but didn't save the link. I distinctly remember diagrams of bodies and slides of fat cells in MONW compared to those of waist obese people then compared to non diabetic people who were also obese. The shape, size and importantly the spaces between the fat cells which should allow microphages to 'hoover up' are different in TOFI.
If I happen to view that presentation again I will post a link here.

 

[LittleGreyCat]

A good indicator of insulin resistance is:
a fasting insulin test
and/or
an OGGT test done properly.

You can do the OGTT at home with a bottle of Rapilose, and you can order a fasting insulin test on-line.

https://www.gpsupplies.com/rapilose-ogtt-glucose-solution-300ml-pack-of-1
https://www.medichecks.com/fertility-tests/insulin

With an OGTT as far as I cas see it measures how effective you body is at both producing and using insulin.
Logically a lot of insulin and high insulin resistance should clear the glucose about as fast as a little insulin and low resistance.
Perhaps the profile of your BG might be different although the time to clear all the glucose is the same?

Thinking logically, a measure of insulin resistance migh be to inject a small amount of insulin after fasting and measure the speed of the BG drop. This would carry a large hypo risk, though, and would need close monitoring. Such a test is likely to be far more expensive than a simple blood test.

 

[Bluetit1802]

With an OGTT as far as I cas see it measures how effective you body is at both producing and using insulin.
Logically a lot of insulin and high insulin resistance should clear the glucose about as fast as a little insulin and low resistance.
Perhaps the profile of your BG might be different although the time to clear all the glucose is the same?

Interesting thought.
What happened with me was I hit my peak at exactly one hour and was back where I started at 2hrs 45minutes then continued to drop and stayed in the low 4s for the rest of the day (including after lunch) until after eating my tea around 10 hours later. The low 4s all day were unusual for me. To be absolutely frank, I have no idea what that tells me!

 

[ringi]

Thinking logically, a measure of insulin resistance migh be to inject a small amount of insulin after fasting and measure the speed of the BG drop.

The gold standard insulin resistance test is to inject insulin into one arm and glucose into the other arm and see how much of each is needed to give a steady BG measured at a third point on the body. This is called a "insulin clamp", and tends to only be done by researchers. There is also a "glucose clamping" when just glucose is injected and the blood insulin and blood glucose are measured in the other arm.

 

[AloeSvea]

An insulin clamp test would be great, but I think my intermediate hyperglycaemia that just won't budge is my big sign post "Insulin Resistance Here!".

As my own insulin resistance is long standing, at least it was intermittently and stubborn - I assume I have IR in my liver, and in my muscles.

I track my health signs (ie my T2D and risk for strokes and CVDs) principally by my waist height ratio, rather than weight. This has a very close connection with my HBA1c, I have found during periods of experimentation, and watching it now. But I do see gaining weight as a sign "Insulin Resistance Warning Warning Warning" - with very loud beeps! Or a siren really. What my tape measure shows, as in my waist size, is 'the golden yardstick' because of the close connection to my HBA1c. (I have had the opportunity to do lots of experiments with lots of blood tests - bless socialised medicine.)

In my own family of origin, IR and health problems, including strokes, seems to follow waist size rather closely. Even in someone who is slim, and always has been, her HBA1c rose to borderline prediabetes when she gained some fat around the waist. I didn't believe her in the waist fat department until she jiggled it, she is that 'TOFI' - Thin on the Outside, Fat no the Inside, if she ever does get fat deposits, it is right there around the middle.