Fasting Insulin and A1C question

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Robin2038
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Fasting Insulin and A1C question

Post by Robin2038 »

Hi!!
I’m Confused about my 88 YO mom’s lab test results. She is overweight (160 lbs and 5’5) eats lots of carbs and her A1C is 5.7, with fasting insulin at 3.6. I am almost certain she is insulin resistant (also triglycerides are 180, HDL 40 and LDL 100 but she had been on a statin for a long time until i asked the doc to take her off a few months ago). She has significant cognitive issues but has not been diagnosed with Alzheimer’s. Yet.. I assume she is Apoe 3/4 or 4/4 but not sure. I am 3/4. Her sister who is 92 has severe Alzheimer’s and has for a few years. I gave my mom exogenous ketones a few times (high level of BHB salts) and she responded very well. Long story but she’s on some ketone tablets now but I don’t think they are strong enough. She is in assisted living and will refuse any ketone drink they give her when I’m not there. And they won’t give her more tablets than the bottle says.
Any thoughts on her labs? She didn’t have the ketones the day she was tested but has been on them
For several months. Could that have affected her fasting insulin? Also the reference range says low is under 9 UIU. Isnt a 3.6 good?? I’m just wondering what her “low” insulin and pre-diabetic A1C means considering her other biomarkers and presentation (cognition, weight, etc). She’s had higher A1C in the past but never over 6.
Thanks in advance
Robin
Tiramisu1984
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Re: Fasting Insulin and A1C question

Post by Tiramisu1984 »

Why do you think she is Insulin Resistant? Those scores seem very normal to me.
Robin2038
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Re: Fasting Insulin and A1C question

Post by Robin2038 »

I was expecting her fasting insulin to be higher honestly. I’m glad it isn’t. Her weight, waist, A1C, and triglycerides to HDL ratio—from what i understood—seemed to indicate possible metabolic syndrome. And she responded significantly to ketone supplements. And I didn’t understand why the lab indicated her insulin was LOW when I understood 3.6 be good. The lab indicated under 9 was LOW so I thought perhaps i was missing something.

Thanks for your response!
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Re: Fasting Insulin and A1C question

Post by NF52 »

Robin2038 wrote: Sat Jan 08, 2022 12:25 pm Hi!!
I’m Confused about my 88 YO mom’s lab test results. She is overweight (160 lbs and 5’5) eats lots of carbs and her A1C is 5.7, with fasting insulin at 3.6. I am almost certain she is insulin resistant (also triglycerides are 180, HDL 40 and LDL 100 but she had been on a statin for a long time until i asked the doc to take her off a few months ago). She has significant cognitive issues but has not been diagnosed with Alzheimer’s. Yet.. I assume she is Apoe 3/4 or 4/4 but not sure. I am 3/4. Her sister who is 92 has severe Alzheimer’s and has for a few years. I gave my mom exogenous ketones a few times (high level of BHB salts) and she responded very well. Long story but she’s on some ketone tablets now but I don’t think they are strong enough. She is in assisted living and will refuse any ketone drink they give her when I’m not there. And they won’t give her more tablets than the bottle says.
Any thoughts on her labs? She didn’t have the ketones the day she was tested but has been on them
For several months. Could that have affected her fasting insulin? Also the reference range says low is under 9 UIU. Isnt a 3.6 good?? I’m just wondering what her “low” insulin and pre-diabetic A1C means considering her other biomarkers and presentation (cognition, weight, etc). She’s had higher A1C in the past but never over 6.
Thanks in advance
Robin
Hi Robin,
Warm wishes for good health in 2022 to you and your mother!

First, full disclosure: I am not a nutritionist, dietician, geriatrician or other scientific expert on the metabolic needs of 88 year old women. I do have opportunities to virtually "attend" multiple conferences on Alzheimer's and other adult-onset cognitive impairments and have had personal experience with a mother and mother-in-law who both lived to their mid-80's, with significant changes in their muscle mass and their gait and strength, as well as mild to moderate Alzheimer's and vascular-related cognitive impairments.

One of the take-aways I would suggest is that your mother is, first of all, a survivor for having lived past the expected lifespan of about 85 for women of her generation who lived into adulthood. Whether she has one or two copies of ApoE 4, she showed enough cognitive reserve (brain power) and cognitive resilience (ability to fend off and live with the effects of ApoE4) to be one of the 50% or so of people with ApoE 4 who do not have a diagnosis of AD by the age of 85. You should celebrate with her that she has done many things well with her life, as shown by her ability to live with a little help in assisted living, and hopefully to still engage in many activities in that setting.

At her current height and weight, her BMI is 26.6, and she is only 10 lbs over what the CDC considers "within normal range" for her height. That is markedly different than people who have BMIs over 40, are morbidly obese and have clear metabolic disorders. At 88, her waist circumference, for example, may be of limited use in judging her metabolic health, since it's likely she has had significant loss of abdominal muscles without necessarily having a lot more fat around her organs. (My mother weighed 108 at 5'5" at age 86, but her tummy was round even at she showed marked osteoporosis and a severe loss of muscle from when she weighed 20 lbs more.)

The assisted living center is bound by clear regulations to only use the prescribed or indicated dosages on medications and supplements, so I assume they are not trying to frustrate you--although it may feel that way!
One of the areas where you may be able to partner with them to help your mom is to focus less on ketones and more on protein, given a multitude of recent studies suggesting the "oldest old" (those over 85) may need more protein at every meal than those 65-80, as well as access to some gentle, supervised weight resistance and aerobic exercise (chair yoga can do this, if available).

Here's an excerpt from 2018 article focused on people just like your mom: Dietary Protein, Muscle and Physical Function in the Very Old Note that given the references to kilograms (kg) per body weight( kg/BW), your mom's 160 lb weight would translate to 72.6 kg., so you can multiply recommended grams of protein per meal or day by roughly 73.
The numbers of elderly and exceptionally long-lived people is steadily increasing. Based on a raising body of evidence from both epidemiological and experimental data, several expert groups have argued that higher protein intake of at least 1.0 g to 1.5 g/kg BW/day may be optimal for skeletal muscle and overall health in older adults [19,38]. Importantly, the age range of older participants in these physiological intervention studies was ~65 to 80 years [37]. There is a lack of data to conclude, whether for example the dose-dependent relationship between protein ingestion and MPS rates in very old differ from those observed in younger groups of older adults. More studies that include study participants aged ≥85 years are warranted to investigate and determine protein requirements in this population group....
The metabolic and functional adaptability of skeletal muscle of older individuals aged between 65 and 75 years is different to individuals over 75 years [58]... Regular exercise training may therefore also preserve the responsiveness of ageing skeletal muscle to protein intake, possibly up to a very advanced age. ...
It is also important to note that many elderly could have difficulties in optimizing/increasing dietary protein intake and physical exercise. Dietary adherence might be negatively influenced by oral health problems, altered sensory function, reduced thirst sensation, as well as gastrointestinal malfunction [76]....
The assertions about possible detrimental health effects of a diet high(er) in protein—for example, development of kidney dysfunction, impaired bone health—are, however, not supported by clinical data in humans [78]. Only in patients with pre-existing kidney dysfunction a high protein intake is associated with accelerated deterioration in renal health [19]. Moreover, an increased protein intake is positively associated with bone health [78], which is also supported by the guidelines of the ESCEO suggesting at least 1.0–1–2 g/kg BW/day to prevent osteopenia and osteoporosis [29]. A protein consumption of up to 2 g/kg BW/day and even higher seems to be safe for healthy adults and elderly [79]. Still there is a lack of data in very old humans.
Taken together, the data reviewed for this article support the notion that there is a close interaction of physical activity, diet, function and human ageing. Optimizing the timing and distribution of protein ingestion, with an intake of at least ~25–30 g protein per meal and in close temporal proximity to exercise/physical activity, appears to be a promising strategy for promoting healthy ageing of skeletal muscle in the elderly and likely also in the oldest old, aged 85 years and older.
If may be that your mother, like the moms of others who have posted on this forum, would welcome some protein rich smoothies and would enjoy having the choice of how and when she drinks them. At any age, our preferences and values are important to our joy in living, especially when so much seems no longer to be open to those in assisted living. Keep us posted on how she seems to be doing!
4/4 and still an optimist!
Robin2038
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Re: Fasting Insulin and A1C question

Post by Robin2038 »

Thanks so much! Thats very helpful. She is happy in the moment and fairly healthy for 88. I am
Hoping to prevent the severe Alzheimer’s her sister is experiencing, as she doesn’t recognize her family. In assisted living its so hard to change their dietary choices. I can try offering her protein smoothies. when i visit.
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Re: Fasting Insulin and A1C question

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Robin2038 wrote: Sun Jan 09, 2022 5:50 pm I am hoping to prevent the severe Alzheimer’s her sister is experiencing, as she doesn’t recognize her family. In assisted living its so hard to change their dietary choices. I can try offering her protein smoothies. when i visit.
Hi Robin, Again, I have no professional certifications, but will offer thoughts. My mom died with dementia 9 years ago. I was her only child, so I organized her care the last 10 or so years of her life. She did spend the last few years in a memory care group home. As to ketone supplements, at my mom's place in Colorado, everything they gave her, even magnesium, required a doctor's order. Her doc was my friend and would write these orders. Part of those orders were ones for an MCT oil/Coconut oil mix, so many tablespoons (I don't recall how many) at each meal. I made up the liquid mix and they'd give it to her. Hence, if you could get a doc on your side to write an order, perhaps that would work?

As to insulin resistance, there is a theory called "Personal Fat Threshold (PFT)." It is explained here. Basically, when someone is under their threshold, they are essentially metabolically healthy. I was listening to a podcast the other day where the coach said he had a client who was ~730 #'s, but had an A1c of 5.6%. Basically his fat cells would grow in an unlimited fashion. This, of course led to many problems, but he was metabolically healthy. As of the interview date, he'd lost ~130#s. I think I've seen who I think is this person on social media and he was bedridden and now can walk. In any case, according to the theory, your mom could be overweight and still healthy. As an example at the other end of the spectrum, an issue with people with S. Asian genetics is their PFT is really low. They need to be 22 BMI or less because of this to be healthy. There are things I'd would work to change in her lipid values Tg's down and HDL up, but, from experience, know how hard that is in an institutional setting.
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Re: Fasting Insulin and A1C question

Post by circular »

Robin2038 wrote: Sun Jan 09, 2022 5:50 pm Thanks so much! Thats very helpful. She is happy in the moment and fairly healthy for 88. I am
Hoping to prevent the severe Alzheimer’s her sister is experiencing, as she doesn’t recognize her family. In assisted living its so hard to change their dietary choices. I can try offering her protein smoothies. when i visit.
Hi Robin, I admire your committment to your mother and wanting to optimize things for her! It is indeed difficult to implement much that's on the cutting edge in assisted living facilities, where conventional protocols usually reign supreme. As an alternative if they won't make her protein smoothies in the kitchen, her doctor also might be willing to prescribe high protein drinks so that that staff has to give them to her once or twice a day, but they'll usually use Ensure or Boost. It might not be your cup of tea, but at least it has protein and nutrients. Whether prescribed or not, they might let you bring in some store bought protein smoothies that are healthier than Ensure or Boost. I was able to leave these in my mother's room, but she never really had them except when I offered them to her. A prescription will likely get her more protein, I just don't know whether they would use the store bought kind for the prescription if you brought it in.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
Tiramisu1984
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Re: Fasting Insulin and A1C question

Post by Tiramisu1984 »

After reading the responses, I would get your doctor to write an RX for ketones and MCT oil.
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