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Journalism of Courage
A 35-year-old patient came to me with dark lines on his skin folds, wondering if it was indicative of prediabetes — a condition when blood sugar levels are higher than normal but not high enough to be declared diabetes. He had also read up online and found that a fasting insulin test would help him prevent the onset of diabetes by understanding his insulin patterns. “Should I take the test?” he asked me.
The truth is that a fasting insulin test is neither a new test, not meant for everybody, no matter what you read online. In fact, we introduced it in India around 40 years ago. It is a blood test that measures the level of insulin in your blood after an 8-12 hour fast, providing insight into how well your pancreas produces insulin to regulate blood sugar. It helps detect insulin resistance, a condition where cells don’t respond well to insulin. There are two indices — one of them is called Homa IR, which measures insulin resistance, and the other is Homa Beta, which measures insulin secretion. But both are overemphasised and are of some use in detecting hypoglycaemia and researching on groups of people. Besides, kidney function, age and other medical conditions may impact these tests, which are costly too.
Markers like body mass index, abdominal obesity and darkened skin folds are indicators enough that readings are off. Apart from the fasting glucose test (less than 100 mg/dL is normal, anything between 100 and 120 mg/dL is prediabetes). There’s another simpler test called the Oral Glucose Tolerance Test (OGTT), which is crucial to catch intermediate spikes in blood sugar that’s indicative of blood sugar metabolism even when your fasting and post-prandial readings aren’t high enough to indicate diabetes.
If a person does not have diabetes, their blood glucose level will rise after they eat sugary foods and return to normal after their body absorbs the glucose. In a person with diabetes, blood sugar levels may remain high. This gold standard test measures this response and determines the stage of your diabetes. It’s rather simple. Your blood sample is taken when you wake up after fasting for at least eight hours. Then you are given a solution of glucose (usually 75 gm of it), which you have to drink in five minutes or less. The one-hour test means your blood must be drawn exactly one hour from the time you started drinking the glucose drink. You cannot eat or drink anything in the hour between when you drank the glucose solution and got your blood drawn.
Abnormal glucose tolerance (blood sugar goes too high during the one-hour challenge) is an earlier sign of diabetes than an abnormal fasting glucose. An elevated one-hour value of more than 155 mg/dL means that these individuals will progress to prediabetes in the near future. The advantage is that you can identify cases even before prediabetes and reversal to normal is much easier.
Why wait for a test? Just make preventive lifestyle corrections like diet, exercise and weight loss now to prevent progression. Set aside no less than 30 to 45 minutes of moderate intensity exercise daily, reduce carbs, include more protein and fibre for satiety and slowing glucose breakdown and avoid bad fats and processed foods. Studies show by exercising just 150 minutes a week, people with prediabetes can prevent their condition from progressing and even bring their blood glucose back to healthy levels.
(Dr Mohan is Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
