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Where can you get a Kraft Test in the UK?

W

wu-lee

Member
I've heard about the Kraft Test, that it is a variant on the glucose tolerance test but which also measures insulin levels as well as glucose levels. I gather it might have detected my T2D trajectory much earlier than it was. I am wondering why it is not used and would like to find out the practical details of getting one for people who tick various risk factors, but are not yet showing abnormally high glucose.

I've hunted around both here in the forum and generally online, can't find the answer:
  • Is the Kraft test available on the NHS? (I live in Scotland)
  • In not on the NHS, where?
  • When private clinics offer it, what does it cost?
I would guess it is not available on the NHS, as none of the GPs or nurses I've asked have even heard of it.

I recall asking at the diabetes clinic on diagnosis: how I would be able to tell if I was insulin resistant, or beta-cell deficient? The answer was something along the lines of, "we'd need to measure your insulin levels - but we're not going to do that." I was a bit taken aback by that and I don't think I got an answer why not.

I've since realised in all the blood tests I've had, I've never had my insulin measured once. So a related question is:
  • Why isn't insulin measured in T2D blood tests?
 
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Looking online, the Kraft test appears to require at least a 3 hour to 5 hours follow up, hence this would be expensive for the NHS to administer - I doubt it's available via any GP route.

The NICE guidelines cover England (& Wales), but not Scotland AFAIK. Under these guidelines
Diagnosis in adults | Diagnosis | Diabetes - type 2 | CKS | NICE,
even an OGTT (Oral Glucose Tolerance Test) is only now offered for Gestational Diabetes, HbA1c is the current standard Diabetes diagnostic tool, and if type 1 is suspected
Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE
then a C-Peptide test or other antibody test may be done, so fasting insulin testing is not done.
Why not? Cost! And being diplomatic, because knowledge / research is evolving and NICE guidelines always lag....., and fasting levels are variable so a one-off test can be misleading,
Scotland NHS may be different.

As to finding a Kraft test privately: couldn't quickly find one in the UK, however you can get a fasting insulin test privately, or HOMA-IR type fasting glucose and insulin, Insulin Resistance Blood Test for Type 2 Diabetes Check (medichecks.com)
There is a v expensive Glucose Tolerance with Insulin Blood Test - Private Blood Tests London that might be like a Kraft test.
 

At a PHC conference I asked a room full of doctors, nurses and other HCP's how many had ever had insulin measured or requested it.
Of those that said they had 2 of us were interested patients who had paid for it privately as had the 1 doctor who had also had his tested privately.
The NHS has zero idea (so far as I am aware) of fasting insulin testing.

Unfortunately the private lab I used now will not accept postal submissions so you have to go to their lab in London to have the blood taken (medichecks) but so far as I know they don't perform the Kraft test.

You could try a c-peptide test as a proxy for endogenous insulin production but again, so far as I know, in the UK it would be a one off sample.
 
BravoKilo said:
Looking online, the Kraft test appears to require at least a 3 hour to 5 hours follow up, hence this would be expensive for the NHS to administer - I doubt it's available via any GP route.
Click to expand...

Thanks. The glucose tolerance test also needs a 3 to 5 hour follow up, and I *did* get one of those a few years ago from the NHS diabetic specialist clinic I was attending (which involved me waiting around, not so much them.) So I think there must be more behind the reason than the duration.

I plan to ask the next time I go back, hopefully they'll have heard of it at the clinic. If it were costly, that would be an acceptable answer for the NHS. Not knowing of it at all seems par for the course, however.
 
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Thanks all. I see now this question has been asked before, for instance:

https://www.diabetes.co.uk/forum/threads/insulin-testing-which-tests-on-the-nhs.128969/

It's a little unclear from that what is what. And there is quite a range of prices! £450 from Blood.London down to £69 from Medichecks, assuming that is in fact the same thing (I wonder).

I've dropped Medichecks a query to see if their insulin test is in fact something like a Kraft test.

In case it help anyone else, this is where I heard about Kraft, from Lucy Burns': "The Hormonal Approach To Treating Obesity"


The take-home from that video: Why wait for chronic diseases when we can detect and treat people early with the Kraft test? I guess the answer is that false economies are sometimes all you can afford.

There's a link to a summary of Kraft's work here: http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf
 
This is the reply from Medicheck about their insulin resistance test. TLDR: it's just a fasting insulin measurement for which you need to physically attend their lab in London.

 
You can do your own version of a Kraft test using blood glucose and ketone test strips. Do a fasting test on waking, a pre meal check then after you have eaten wait 30 mins and the take a reading every 30 mins until 5 hours is up or you get a sugar crash at 3.9mmol. You have to keep testing after 5 hours unless you have a higher blood glucose reading than the one before. I had to go 6.5 hours when i have done the test 2 x. Once I crashed and once my BG went above the previous reading both at the 6.5 hour mark. You also have to be 10 to 12 hour fasted before you start the test. I have done this as I am tying to manage migraine through blood sugar control and it has got much better. The Angela A Stanton Facebook Group for migraine without medicine gives details how to run this test for yourself and the ketones are used as a proxy for the insulin measurements. It a long day and lots of finger pricks but it gives good information.
 

Thanks for this - another avenue for investigation! I'd never heard of this. Is there any source you know of explaining why ketones would serve as a proxy for insulin?

Searching for Angela Stanton and the Kraft test I find this, which explains the process somewhat, but not why it works.

https://keto-mojo.com/article/meet-migraine-expert-angela-stanton-phd/

Searching elsewhere finds a mentions of Benjamin Bikman, but I've not been able to find any actual answers to this on a quick look.

I do find a PhD from 2015 on "Understanding and Diagnosing Hyperinsulinemia", which looks relevant but fairly chewy. Lots about Kraft tests, but nothing in there about ketone proxies.

https://core.ac.uk/download/pdf/56365678.pdf
 
Goonergal said:
I believe you can get one from these guys. They were at a recent PHC conference. I know of someone who has had the test and been impressed with the service:

https://meterbolic.com/what-is-a-kraft-test
Click to expand...
Thanks I had remembered them from the conference (Food Addiction day). They are connected to Ivor Cummins (who has done great videos on the Kraft test) and Donal O'Neill (of Cereal Killers/Pioppi diet fame).
Isn't the trig/hdl a good cheap man's proxy for IR according to Ben Bikman anyway?
 
Just looking at this thread as I was wondering about taking a test to check how insulin resistant I am. My blood sugar has been relatively stable for over a year through dietary control but I have never had any tests to indicate levels of insulin resistance or indeed just levels of insulin.

Then I wondered what I would do, if say, I took the medichecks insulin resistance test and got the result.....i.e. what action I'd take based on the reading. Although I am curious to know to what extent I am insulin resistant it is a cost and I'm not sure what action I might take different to that which I already do based getting a reading.

If anyone has taken the test and can share what course(s) of action they then took, it'd be interesting to know. Thanks in advance.
 
The only update I have is that I got an appointment to see the endocrinologist at the diabetic clinic at the Edinburgh Royal Infirmary, and amongst other things, asked him why I'd never had my insulin measured, despite having a glucose tolerance test. I also asked whether he knew about the Kraft test (I showed him a print out of this).

The answers were, an insulin measurement wasn't taken because it wouldn't have any clinical outcome, and no, he'd never heard of Kraft. So I infer Kraft's work is not even rejected as incorrect, it's just not included in the NHS worldview at all, as this was a senior medic. I asked if they have any way of screening for prediabetes, and effectively the answer was no.

I don't really know what I am, as I have a diagnosis of T2, but only because they ruled out everything else they could think of. My HbA1c is quite stable at ~41-43 (~6%), but my fasting blood sugar is quite high, and my response to any carbs in my food is a fairly big spike up to 13-15 mmol/L. I don't currently exhibit any other symptoms besides that. I'd hoped my insulin sensitivity would improve over time, and fall below over 31 (5%), but so far it has not, and I am wondering if I should play safe (as per Jenny Ruhl's advice) and ask to take metformin as well as managing my diet.

Having read your story linked in your signature, I think you're doing all the right things - and congratulations, sounds you've achieved a fantastic result already. My symptoms were never as bad as yours.

Therefore my advice, as just someone who's read around a bit, would be based on Jenny Ruhl's - play it safe and keep your glucose levels low. Unless you have the cash to spare to get a private test, you will have to guess your insulin resistance based on guesswork from your own observations of glucose tolerance.

I recommend reading Jenny Ruhl's website (and maybe her book), as it seems to me to be one of the best sources of information around, and is packed with scientific references. (I can't claim to have reviewed them all, of course.) Don't expect the NHS to be very much help, at the best of times they're saturated with truly ill diabetics, and like you I don't find them to be very interested in investigating success stories, they just move on to the next patient and apply the NICE guidelines. They don't expect most people to be able to muster what it takes to improve their condition, and may not have heard of the kind of information people on this forum dig up. GPs even more so.

I also found the "Low Carb Down Under" you tube channel to be a useful source of information - although I am still a bit wary about biases there. Things I discovered which I think are relevant and useful for diabetics are:
- The Kraft test! (see link above)
- The cholesterol hypothesis (high cholesterol *causes* cardiovascular disease) may be wrong, the cause is damage through glycolisation of the marker protein on LDL particles (see for example Ken Sikaris and Robert Lustig).
- Therefore statins may be ineffective as a treatment.
- The calcium scoring test. This a NMRI scan which I gather can measure your arterial health more accurately than your cholesterol levels, not available on the NHS but you can get one privately, or if if (like me) you can find your way onto a medical study.

I'd liked to have asked an endocrinologist about these, but after learning he'd not heard of the Kraft test, and considering the time it might have taken to do it, I didn't. I regret it, because I waited 8 months for the appointment, and several hours in the waiting room.

I'd be interested to know if anyone else has asked...
 
@wu-lee Thank you for sharing your update, detailed response and suggestions. I’ve come across some of the information sources you mention, but others are new to me. Given what you describe of your BG behaviour I can see why and how a Kraft test could be insightful for you.

I wouldn’t expect to get any further than you with raising the topic of insulin resistance or insulin levels through the system for the reasons you have cited.

While I’m grateful to have reasonable BG control now, I know if I exceed the levels of carbs I adhere to my BG will rise. My quandary is to what extent is this down to :

(a) insulin resistance; and/or
(b) my lack of ability to produce sufficient insulin.

Using the triglyceride/hdl approximation as a rough guide to insulin resistance, it suggests I’m hardly insulin resistant at all now, but I know this is a very rough guide not to be taken as definitive. My suspicion is that my pancreas may have suffered exhaustion given how high my BG was at diagnosis and is perhaps now unable to produce sufficient insulin to deal with anything more than my limited carb intake. If this is the case, the prevailing view from what I have researched seems to be that the exhaustion is likely permanent.
 
That's exactly the question I asked when I was diagnosed.

As I mentioned, the earlier answer to "Which is it, a) or b)?" was "Well, we could measure your insulin, but we're not going to do that", and to my later question "Why not?" amounts to "Because it doesn't make any difference."

I disagree. Early diagnosis would have made all the difference, as it would for so many other people. Knowing post-diagnosis has missed that opportunity, but could still help to inform my choices - drugs or otherwise.

I still don't have any good answers. The NHS seem not to recognise the question as useful, yet alone answer it. Commercial tests (like a Kraft test) are inaccessible to me. I'll continue to look. In the mean time all I can do is to play safe, and hope I go in the right direction.
 
The test is more commonly known as an Insulin clamp test or the glucose clamp test.
It has only recently been called a Kraft test because it was Kraft who brought it to public awareness.
So you may find that some organisations have no idea what you are asking for if you call it a Kraft Test.

Glucose clamp technique - Wikipedia

en.wikipedia.org

and

Postprandial insulin assay as the earliest biomarker for diagnosing pre-diabetes, type 2 diabetes and increased cardiovascular risk

www.ncbi.nlm.nih.gov
 
Brunneria said:
The [Kraft] test is more commonly known as an Insulin clamp test or the glucose clamp test.
Click to expand...

As I understand it these are two different things?
- Glucose clamp: fix the blood glucose using a computer controlled drip feed, measure insulin
- Kraft test: following fasting, administer a fixed oral dose of glucose, then periodically measure blood insulin and glucose over several hours

So the Kraft test is essentially an oral glucose tolerance test, with added insulin perspective. It might use some sort of proxy for insulin, like c-peptide. But the Kraft test presumably *can't* involve a glucose clamp unless it's brief, as the point is to watch the glucose rather than interfere with it.

[Techncal article, not-so-technical article, also see links above]
 

Have you had a look at Kraft's own work?
He was using a clamp to measure insulin following oral glucose ingestion.
So that is the original 'Kraft Test'.

If people now consider a 'Kraft Test' to not involve a clamp, then there is definitely scope for confusion. Pity they couldn't come up with a name that would avoid such misunderstandings...
 


wu-lee said:
You may have to look for private blood tests online that will give you a Fasting insulin.
Click to expand...


 
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