Is Your Insulin Sensitivity More Important Than Your HbA1c?Mar 19, 2022
Is your insulin sensitivity more important than your HbA1c?
Hi, my name's Paul Coker. I've been living with Type 1 Diabetes for 45 years, and I love the science of Diabetes, especially when it translates to real actions that I can take to make my Diabetes easier to live with, actually I love the science so much that I went back to university and picked up a Masters degree in Diabetes Practice.
So What? Why Should You Care?
I want use my experience and knowledge to help you with build more strategies that for your Diabetes Management Toolkit to make your Diabetes a little bit easier to live with, and I want to do that without ever restricting the amount of carbohydrates that you eat. To do that first we need to talk about your insulin sensitivity.
Here's what we're going to cover.
Why your insulin sensitivity is so important to your Diabetes management, your overall health and your quality of life.
If you read to the end I will share a tool with you that you can use to calculate your insulin sensitivity is.
This is for adults with Type 1 Diabetes, although it is also valid if you have Type 2 Diabetes.
First a couple of disclaimers: I'm not a healthcare professional. I can't advise you on your insulin needs and your insulin requirements or any other medical needs. In other words you must always seek qualified medical help when it is appropriate for you to do so.
Second: I am going to switch between using the terms insulin sensitivity and insulin resistance. How are they different? They are two sides of the same coin, we measure your sensitivity to insulin but when we report your results we talk about them in terms of insulin resistance; essentially they are the same thing.
If you're like most people live with Diabetes, you want to make your Diabetes easier to live with.
This probably won't be the first presentation you've ever seen about Diabetes, and if you're like most people you found most of what you've seen about Diabetes disappointing, especially when there's a sales pitch for cinnamon or okra at the end.
This will be different, and here's how:
First this is based upon peer reviewed studies that include 19,201 adults living with type one diabetes.
Second, the evidence measured insulin resistance and Diabetes outcomes for up to seven years. That means that those studies had large populations and they were of long duration. Generally speaking that suggests the data from them is good.
Third, the only sales pitch you will find here is an invitation to calculate your insulin sensitivity
Why is insulin sensitivity important in Type 1 Diabetes ?
There are many reasons but the one you are going to notice first is that more sensitive to insulin you are the more predictable your insulin will be, more of the time. In simple terms that means you are likely to have fewer of those occasions where you insulin seems like it has turned to water; you know the ones where you give massive doses of insulin that seems to do nothing for hours and hours and all of sudden it starts working again giving you a hypo.
When your insulin seems like it has turned to water this is often a sign that you have some temporary insulin resistance. However, you may also be experiencing a long term form of insulin resistance.
Wait a minute insulin resistance is a Type 2 Diabetes thing and lack of insulin production is Type 1 thing isn’t it?
Let's go back to the evidence. A study was performed in Sweden that included 17,050 adults with Type 1 Diabetes and it followed them for 7 years.
The researchers concluded that 51.1% of adults with Type 1 diabetes had significant insulin resistance: Yes, 1 in 2 adults living with Type 1 Diabetes were insulin resistant.
So what, why should you care, let’s be honest you have enough to worry about in managing your diabetes?
The Swedish research team concluded that there was a strong association between insulin resistance and cardio-vascular diseases seems to be an independent risk factor for cardio vascular disease and all causes of death in adults with Type 1 Diabetes.
Can you reduce the risks associated with insulin resistance by having a great HbA1c?
In 2021 a study in the UK looked at the relationship between insulin resistance, HbA1c and complications in 2151 adults were Type 1 Diabetes by calculating estimated Glucose Disposal Rates. The higher your estimated Glucose Disposal Rate level the more sensitive to insulin you are. The researchers found that
“Individuals with the highest estimated Glucose Disposal Rate category (≥8 mg kg−1 min−1) had the lowest complication rates regardless of HbA1c levels (Figure 4), indicating that HbA1c is not the sole predictor of microvascular and macrovascular complications in people with type 1 diabetes. The highest complication rate was demonstrated in those with low estimated Glucose Disposal Rate and high HbA1c. We also analysed the association between components of estimated Glucose Disposal Rate and complications with results demonstrating that estimated Glucose Disposal Rate as a whole shows the strongest association with complications”
In other words managing your HbA1c is important but on it’s own it does not appear to be enough to reduce your risks of diabetes complications.
Can improving your insulin sensitivity improve your overall health AND your Quality of Life?
The people that I work with typically improve their insulin sensitivity and their HbA1c, blood pressure and cholesterol; but even more importantly than this as their insulin sensitivity improves their insulin becomes more predictable, meaning fewer rage shots of insulin (or rage boluses) when you have those stubbornly high blood glucose levels and that means fewer low blood glucose levels when your insulin randomly and suddenly starts working again and that may result in improved HbA1c and/or more time in range?
I have no way of knowing what your insulin sensitivity is, what your HbA1c is, what your lipid levels are or what your time in range is right now; so I can’t make any promises about the exact results you will get. And there is a really important saying in Diabetes, if it is not broken, don’t fix it. But if it is broken then maybe, it is time to fix it.
Would It Be OK With You If I Am Brutally Honest?
We both know that fear of complications, or avoidance of complications of your Diabetes is not likely to motivate you. What really matters to you in a day-to-day sense is making your Diabetes a little easier to manage and improving your quality of life, if that also results in a reduction in your risk of complications that is a win-win scenario.
In the next video we will talk about how you can improve your insulin sensitivity, but I am getting ahead of myself.
The big question is how do you measure your insulin sensitivity?
The best tool for measuring insulin sensitivity is called the euglycaemic insulin clamp test. This is difficult test to perform, it is time consuming for you and very expensive, meaning that it is not practical to use it in a normal clinical setting.
The good news is that there is a calculation called the estimated Glucose Disposal Rate that researchers in Sweden and the UK used appears to give similar results. The even better news is that in a few moments, I'm going to give you a spreadsheet that you could use to calculate your estimated Glucose Disposal Rate, using exactly the formula that the Swedish research team used.
To get your copy of this spreadsheet click on the link below this video, fill in the simple form telling me your e-mail address (I promise not to spam you, or share your details with anybody else) and I will email you a copy of the spreadsheet for free.
This will be your spreadsheet, your results will not be shared with me, or anybody else. It is yours to keep.
You may be wondering what you can you do to improve your insulin sensitivity?
That is a great question, I will be covering this topic in the next video. In case you are wondering, it does not mean that you have to restrict the amount of carbohydrates that you are eating. Honestly, this is all based on the science and evidence too.
Click on the Link Below This Video To Get Your FREE spreadsheet NOW.
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