High A1C and low insulin?

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gpaz
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High A1C and low insulin?

Post by gpaz »

Hi there!

I am finally ready to start tackling some of this APOE4 lifestyle stuff :) My daughter is now 5 years old and I have some breathing room ;) I am 48 years old. My dad's side has bad dementia and I believe they are all APOE 4/4. I have the 3/4 gene.

Question for you: I just had some blood work done and was sadden to see my A1C at 5.6! I never eat sugar and eat a lower carb diet. More work to be done. But, I am confused by my blood markers as my fasting glucose was 80 and more importantly, my insulin number was 2.6.

Have others seen this kind of discrepancy?

Would love to hear how others got down their A1C as well. Guess I really have to slash the few carbs I eat.

I have questions on my high cholesterol but will start a new post at some point on that one.

Thanks,
Genevieve
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Re: High A1C and low insulin?

Post by bigbrainE3/4 »

Hey gpaz - I'm in a similar boat :) My conclusion after speaking with multiple highly respected endocrinologists is that we're in good shape.

HbA1C is very sensitive the residence time of red blood cells in your blood – typically this is 90 days, but this can vary from person to person. I've worn a CGM for ~12 months total and my predicted A1C is much lower than my actual A1C. This likely means my red blood cells live more than 90 days on average.

The fact that your insulin is low is great, given hyperinsulinemia may be as or more destructive than high glucose itself. That said, you might consider doing an OGTT or wearing a CGM to really make sure your post prandial response looks healthy
gpaz
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Re: High A1C and low insulin?

Post by gpaz »

Thanks so much Big Brain! Last year, my insulin was 2 so maybe I need to be a little more cautious :) but this makes me feel better. I'll look into a CGM. Thanks again!
JD2020
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Re: High A1C and low insulin?

Post by JD2020 »

gpaz wrote: Wed May 22, 2024 7:58 am Question for you: I just had some blood work done and was sadden to see my A1C at 5.6! I never eat sugar and eat a lower carb diet. More work to be done. But, I am confused by my blood markers as my fasting glucose was 80 and more importantly, my insulin number was 2.6.
Hi,

My situation is similar. Somewhere around here I posted details. The short story is a1c was about the same, creeping up. I made a bunch of changes, and a1c did not budge. Fasting insulin was finally tested and it was about 1/2 of the low end of normal. Changing my food was not going to make a difference.

I had an appointment with an endocrinologist for another issue, so of course, I brought this to her attention. She said that I have a weak pancreas. Insulin production cannot keep up. It is not just about the glucose that we eat. It is also about the glucose that the body creates. Stress does something also. When uptight at work, the CGM showed the glucose spike. Her words, "My body cannot keep up."

So this situation is not normal and not great. I started on metformin, 1000 mg 2 x per day. I am getting much better glucose control. Everything is being restested next month, and my appointment is in July, so I will have her professional feedback then.

My suggestion is that the low fasting insulin indicates that your body needs some help. Elevated glucose is never good, no matter what the reason.
mike
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Re: High A1C and low insulin?

Post by mike »

gpaz wrote: Wed May 22, 2024 7:58 am Question for you: I just had some blood work done and was sadden to see my A1C at 5.6! I never eat sugar and eat a lower carb diet. More work to be done. But, I am confused by my blood markers as my fasting glucose was 80 and more importantly, my insulin number was 2.6.
Insulin levels are quite variable. Low insulin when fasting is usually good - it usually means your blood glucose levels are low enough that your body does not feel the need to drive it lower. Seeing how your BG responds after a meal with carbs can help get a better picture. Take BG before meal, then 30 min after and then 60 min after and then 2 hours after. You should see a spike in BG at 30 min but it should come down after 60 or at least by 2 hour mark.
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Veero
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Re: High A1C and low insulin?

Post by Veero »

Low iron stores can also make the body take longer to replace the current blood cells so they stick around longer and become glycated more. Maybe worth a test for iron panel including ferritin to double check since it seems as though your A1C is higher than anticipated.
gpaz
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Re: High A1C and low insulin?

Post by gpaz »

It’s interesting you say that as my ferritin was 34 on my most recent test from this month (I did an iron panel along with the A1C and many more markers). I always thought low ferritin was better than high but it may be too low now!

I just ordered a continuous blood glucose test through levels to see what I learn there.
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Re: High A1C and low insulin?

Post by Veero »

Some say that a 30 or lower is indicative of an iron deficiency so if so you are on the edge and your cells are older. I had a ferritin of 10 but normal hemoglobin and had hair loss/palpitations/air hunger /angina with exercise and unable to do much aerobic exercise and now I’m 50 a few months later of taking iron supplements and the hemoglobin went higher in the range and now I can run a bit and have so much more energy. I had donated blood thinking that I had extra to get rid of just by living so long, I hadn’t checked ferritin before and did so for the PreCode list of tests and got surprised.
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Re: High A1C and low insulin?

Post by Tincup »

gpaz wrote: Wed May 22, 2024 7:58 am Question for you: I just had some blood work done and was sadden to see my A1C at 5.6! I never eat sugar and eat a lower carb diet. More work to be done. But, I am confused by my blood markers as my fasting glucose was 80 and more importantly, my insulin number was 2.6.
Here is a response I wrote on insulin a while back, with a link for more info. Here is a paper on the insulin topic. Catherine Crofts, who I mention in my link is the senior author. Here is a quote from a post by the first author, Isabella D. Cooper.
Basal insulin (the blue line in the figure below has a pulsatile rhythmic pattern, approximately every 4 minutes, in addition to circadian and ultradian periodicities. Five-to-fifteen-minute fast oscillations modulate the ultradian periodicity, which has a range of 40 to 180 min.
This does mean that there is a risk of sampling exactly when ones insulin concentration is at the trough of it's cycle, therefore it would be best to take three samples spaced 5 minutes apart and take the highest reading as the most reflective of your basal insulin.
Leptin is also an excellent proxy marker for hyperinsulinaemia, so I would pair this with a fasting insulin and HOMA-IR.
Testing capillary BHB for more than 3 consecutive days, between 4-6 p.m., three hours after any meal, 15 to 30 min before a meal, will indicate whether your insulin levels are hyperinsulinaemic for yourself, although an individual suffering from chronic hyperinsulinaemia, who fasts for a few days beforehand will end up with nutrional levels of ketones (> 0.5 mmol/L) in that situation, which would result in a false negative for chronic hyperinsulinaemia but a true negative for acute hyperinsulinaemia according to this test method, as well as fasting insulin and HOMA-IR.
Image

Here is a Chris Kresser response as to why A1C can be unreliable.
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