Peter Attia, MD is one of the most brilliant physicians I've come across in my online wanderings on the topic of metabolic syndrome and diabetes. Did you know that insulinema, or high insulin levels, precedes pre-diabetes and diabetes by a decade but physicians do not typically check the fasting insulin level in the US? And did you know that there's another marker that precedes pre-diabetes and diabetes? High triglyceride levels. And in the US that is checked annually with the Lipid Panel following a 12-hour fast. Do you know your lab results over the last ten years? Ask your doctor for a copy. This podcast begins with a discussion of subcutaneous and visceral fat. What is it? "Subcutaneous fat refers to the fat stored under the skin. It’s a combination of brown, beige, and white fat cells. The majority of our body fat is subcutaneous. It’s the fat that you can squeeze or pinch on your arms, belly, thighs, and buttocks. Fitness professionals use calipers to measure subcutaneous fat as a way of estimating total body fat percentage. A certain amount of subcutaneous fat is normal and healthy, but too much can lead to imbalanced hormone levels and sensitivity." "Visceral fat, also known as “belly fat,” is the white fat that’s stored in your abdomen and around all of your major organs, such as the liver, kidneys, pancreas, intestines, and heart. High visceral fat levels can increase your risk for diabetes, heart disease, stroke, artery disease, and some cancers." Excerpt from https://www.healthline.com/health/types-of-body-fat#subcutaneous How do I know my level of visceral fat? "Iwasaki et al in a cross-sectional study of 257 Japanese patients, by using more accurate measures of body composition such as by dual-energy X-ray absorptiometry, showed that higher levels of GGT were significantly associated with higher visceral fat whereas no association was observed with subcutaneous fat, proposing that the serum GGT may be useful as a convenient indicator of visceral adiposity (24)." Excerpt from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911166/ Bottom line: Too much visceral fat, the fat you can't see, and this includes those with healthy, even underweight BMI's, puts us a risk for developing or worsening diabetes. The GGT, serum Gamma-glutamyltransferase, lab test gives us an indication of the amount of visceral fat present. Listen to the podcast here... #69 – Ronesh Sinha, M.D.: Insights into the manifestation of metabolic disease in a patient population predisposed to metabolic syndrome, and what it teaches us more broadly https://peterattiamd.com/roneshsinha/ Click on link, scroll down, click on the "play" arrow. On the bar is a 15 second replay icon if you miss something and need to hear it again. (I use that button a lot). [giggle] I'm listening to it now while cleaning around the house.