Measurements of Glucose (Sugar) Control

Fasting Glucose

Now, we come to the set of lab measurements that you will need to diagnose yourself with metabolic issues like diabetes and prediabetes.  The first and most straightforward test is your fasting glucose.  When you fast overnight, your blood glucose is supposed to drop to a level below 100 mg/dl.  If it does not do that, this is a very early sign of diabetes or prediabetes.  It is very likely that you have had fasting glucose measured in your physicians office and if you haven’t, it is very reasonable to ask him or her to perform the test.  The American Diabetes Association recommends periodic fasting glucose levels for all people over the age of 35.

Hemoglobin A1c

This very important test is a way of measuring average blood glucose over the 2 or 3 month period before the test as taken.  It is a very common test in primary care practice and it the main way that most physicians screen for the presence of diabetes or prediabetes.  Most primary care doctors include hemoglobin A1c tests as part of an annual physical.  If you have a primary care doctor and visit him or her regularly, then you have likely had this test done.  You may need to repeat it, especially if you have changed your diet or gained weight since your last test.  Like fasting glucose, the American Diabetes association recommends periodic testing with hemoglobin A1c particularly for individuals with risk factors such as a body mass index greater than 25.  So, if you look for a hemoglobin A1c in your medical record and don’t find one there, it is very reasonable to ask your physician to perform the test.  The table below show normal levels and levels at which a diagnosis of prediabetes or diabetes would occur for fasting glucose and hemoglobin A1c.

Glycemic Control Measurements
Fasting Glucose Level	Normal: < 100 mg/dl	Prediabetes: 100-126
		Diabetes: > 126
Hemoglobin A1c	Normal: < 5.7 %	Prediabetes: 5.7-6.4
		Diabetes: > 6.4

Insulin Level

Fasting insulin level is an extremely useful and sensitive test that is underutilized in typical primary care offices.  When your body begins to lose control of glucose levels one thing that can happen is that your pancreas can begin to create more insulin to keep pace with those glucose elevations.  This elevated blood insulin level is one of the major reasons that for weight gain, (especially abdominal weight gain) in people with insulin resistance.  If yours is elevated, then you will want to focus closely on the glycemic control experiment before moving on to the other experiments.  When you use your diet to tightly control your blood glucose, this will lower your insulin level and help you lose weight and break the cycle of insulin resistance.

Insulin level must be measured fasting.  That is important as any food intake at all can elevated the blood insulin level and make the test invalid.  We generally try and get all of our patients below 10 for this value, but standard norms are shown below.

		Fasting Blood Insulin Level
Ideal	Normal	Elevated
< 10 mIU/L	< 25 mIU/L	> 25 mIU/L

Collect values for glycemic control: HbA1c, Fasting Glucose and Insulin Level and record them in your notes of field journal.