Waist measurement and insulin resistance - visceral fat

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

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......

LittleGreyCat said:

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.

Click to expand...

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.

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 said:

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.

Click to expand...

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

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 said:

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?

Click to expand...

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!

LittleGreyCat said:

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.

Click to expand...

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.