Triglycerides:HDL - Insulin Resistance

[Roy Batty]

My understanding is that the ratio between triglycerides and HDL is a good proxy/surrogate for insulin resistance. My ratio is 1 (both are 1.4), which suggests I have good sensitivity to insulin.

My fasting glucose morning prick tests are normally in the range 6 to 6.4, perhaps a little on the high side.

My blood pressure is 110/65. My waist to height ratio is <2.

I know from a DEXA scan that my body fat % is 17.8.

I have a ALMI (Appendicular Lean Mass Index) in the 90th per centile when age adjusted.

My HbA1c remains stubbornly in the pre-diabetes range.

I eat low carb, high fat and high protein. Never eat fast food or takeaways, bread, pasta, cakes, biscuits, cookies or any breakfast cereal.

I do a lot of exercise, rucking, resistance and Pilates.

I'm baffled why my HbA1c remains >42 < 48.

 

[MissMuffett]

It sounds like you’re doing everything right, I’d be baffled too. The only thing that comes to mind is that exercise puts the body in stress mode and maybe you’re doing too much? I didn’t think you could do too much but I watched a YouTube video where Dr Elizabeth Bright mentioned certain exercises can cause stress to the body, so raise cortisol and she advised concentrating on muscle building rather than cardio.

 

[IamResistance]

How much coffee do you drink?
Caffeine significantly spikes my BG in mornings and keeps it up throughout all day. After giving it up (and alcohol also) my average BG significantly lowered...

 

[Bcgirl]

I’d be stumped too. Have you had a c peptide test or fasting insulin? I would certainly be asking for those tests if I were you.
i have almost the exact same numbers as you and do the same kind of workouts. I’m very lean and eat, at this time, a carnivore diet because I just cannot lower my glucose. I do have a damaged pancreas though, and therein lies my problem.
good luck!

 

[Roy Batty]

I had my CRP level checked and that's in the basement at 2.1. Ifs a marker for inflammation and elevated in pre-diabetes. Also, if I were exercising too much there would most likely be higher CRP.

Thanks

 

[Roy Batty]

Most days I drink 2 small double shot cappuccinos and that's it. Very occasionally 3. Never after about 3 p.m.

Thanks

 

[Roy Batty]

I haven't seen a doctor in several years. I had a blood test last year at my request, since then I've paid for another HbA1c and the CRP.

I'm 66 and have no health issues, zero stress and I sleep great.

When I got the first HbA1c results I was called by the practice diabetes nurse, who told me I needed to change my lifestyle, lose weight and exercise more. She was using my BMI, when I explained I knew my body mass composition and distribution her reaction was to tell me to lose weight. It was clear that she was not seeing me as an individual.

Thanks

 

[LivingLightly]

Most days I drink 2 small double shot cappuccinos and that's it. Very occasionally 3. Never after about 3 p.m.

Thanks

Evening @Roy Batty.

Milky drinks could certainly be part of your problem. You can pour an awful lot of lactose (milk sugar) into a cappuccino.

Double cream contains less carbohydrate than skimmed, semi-skimmed or whole milk because during the cream-making process, the sugar is consumed by the bacteria that curdle the milk, leaving us with a delicious high-fat, low-carb cream that IMO makes the perfect partner for coffee.

However you brew your coffee, making it with water and then adding double cream allows the coffee flavour to shine through. You would use less cream than your current milk consumption, so that would reduce your daily carb intake further. Most of us find 2-3 teaspoons ample per cup of coffee.

 

[Roy Batty]

I'm drinking small cups, the milk content is very low and full fat. It's far from a milky drink like a latte.

I worked it out, a small cappuccino with 85ml of milk is 4 mg of carbs. So I'm getting 8 mg daily from milk.

 

[LivingLightly]

I'm drinking small cups, the milk content is very low and full fat. It's far from a milky drink like a latte.

I worked it out, a small cappuccino with 85ml of milk is 4 mg of carbs. So I'm getting 8 mg daily from milk.

I can only speak from my own experience; switching from a cappuccino after breakfast, to an espresso with a couple of teaspoons of double cream, worked a treat for me.

Your numbers are none too shabby, so small tweaks in your eating habits may be all that's needed to take your HbA1c results out of prediabetes territory.

 

[LivingLightly]

Evening @Roy Batty

You've quoted some FBG readings, so I take it you have a glucometer and test strips.

You’ll learn most from blood glucose levels just before you start a meal and then two hours later. The post-meal reading should be no more than 2 mmol/l higher than the first and not higher than 8 mmol/l. If that's the case, your body dealt with the arrival of glucose in your bloodstream and cleared it relatively quickly.

If you can achieve that consistently (by modifying your carbohydate intake where necessary), your HbA1c results should improve.

 

[Lupf]

Hi Roy,
From what I can read, you seem fit and healthy.
Do you have any diabetes symptons?

 

[Roy Batty]

I've never had a post meal reading either above 8 or more than 2 greater than before eating, My body seems to have no problems managing blood sugar. I already eat very few carbs.

 

[Roy Batty]

Hi Roy,
From what I can read, you seem fit and healthy.
Do you have any diabetes symptons?

None, nothing at all. Good BP, height to waist< 2, low CRP, visceral fat low, high muscle mass.

Thanks

 

[HSSS]

Any chance you have anything less than typical about your rbc? An hba1c assumes a normal shape and size and lifespan of the RBC. Anything more or less can squew the numbers. Often it could be something like some forms of anaemia, sickle cell thalassemia etc. In these situations either a fructosamine test (often done in pregnancy as well) or an old school oral glucose tolerance test may be better assessments.

 

[Roy Batty]

Any chance you have anything less than typical about your rbc? An hba1c assumes a normal shape and size and lifespan of the RBC. Anything more or less can squew the numbers. Often it could be something like some forms of anaemia, sickle cell thalassemia etc. In these situations either a fructosamine test (often done in pregnancy as well) or an old school oral glucose tolerance test may be better assessments.

RBC completely normal. I did have an oral glucose test about 2 years ago when I was a volunteer participant in a medical trial. A doctor researching for a PhD recruited a small # of prediabetic men of which I was one. I don't have the numbers but I do recall that she was confounded by my blood sugar and insulin sensitivity. During the trial I was hooked up to a drip that was infusing sugar, while another in the other arm was used to take regular and frequent blood samples. I also drank a large glass of something very sweet beforehand. This took a whole day and there were other trial days that were less intrusive and demanding. I was also in a chamber, a sort of Turkish bath and I think this was to accurately determine my basal metabolic rate. I don't think I can get the data from the trial yet as it hasn't completed.

 

[IncogKeto]

My ratio is 1 (both are 1.4), which suggests I have good sensitivity to insulin.

Could you expand on that a little i.e. provide some website links, units and when and how you got those numbers - I seem to remember that you’ve previously had tests done in America.

 

[Lupf]

None, nothing at all. Good BP, height to waist< 2, low CRP, visceral fat low, high muscle mass.

Thank

Non-diabetic people have on average an HbA1c of 38 mmol/mol, but there is a distribution, see diagram. The standard deviation is +-3 mmol/mol
and looks like a Gaussian or normal distribution. Thus about 2% of the sample have an Hb1Ac above 44 (or below 32) mmol/mol, which is well into the prediabetic range. I tag @KennyA, he has shown such a distribution before. Figure is taken from https://www.semanticscholar.org/pap...nsen/d753c7ba8eef5dc1d63407f5e9e8728cd43a52eb

Maybe then your HbA1c is ok, and you shouldn't worry at all?

 

[AndBreathe]

I haven't seen a doctor in several years. I had a blood test last year at my request, since then I've paid for another HbA1c and the CRP.

I'm 66 and have no health issues, zero stress and I sleep great.

When I got the first HbA1c results I was called by the practice diabetes nurse, who told me I needed to change my lifestyle, lose weight and exercise more. She was using my BMI, when I explained I knew my body mass composition and distribution her reaction was to tell me to lose weight. It was clear that she was not seeing me as an individual.

Thanks

If you had a DEXA scan, where did you score on visceral fat? Where was your DEXA done? I know of. Several dotted around, but have never quite managed to swing one.

 

[Roy Batty]

If you had a DEXA scan, where did you score on visceral fat? Where was your DEXA done? I know of. Several dotted around, but have never quite managed to swing one.

I had the scan in London. I've had to dig around in the report for those data. Android to Gynoid ratio 1. In the 13th centile for visceral fat (low is good). Visceral fat area 95 cm² ( below 1 is good).