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sadie's avatar

Fasting insulin isn't covered by Medicare unless you have 2 high fasting glucose results. So much for keeping us healthy and saving money🤦🏻‍♀️

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Karen Brennan, PhD's avatar

Oh wow, unfortunate. But getting both biomarkers done via a lab such as quest is pretty affordable. For instance, I just checked on my Fullscript site and both can be ordered for less than $20.

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Valerie's avatar

This is very helpful information! I'm going to get both these tests done and see where I'm at. Thanks for this Karen!

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Karen Brennan, PhD's avatar

You are welcome!

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knightsaberpriss's avatar

Interesting conversation. I didn't realize Dr. Shanahan had a new book to promote. I liked her book "Deep Nutrition". On the topic of insulin resistance, Dr. Benjamin Bikman also has new book to promote entitled "How Not to Get Sick: A Cookbook and Guide to Prevent and Reverse Insulin Resistance, Lose Weight, and Fight Chronic Disease" and has been making the podcast rounds. He was very recently on The Model Health Show to discuss insulin resistance, fat cells, etc. You can read the full transcript here:

https://themodelhealthshow.s3.us-east-2.amazonaws.com/Episode+807.pdf

The part of the conversation I found interesting as someone who isn't white was this part:

"And there's some fascinating differences across ethnicities. I, for example, did my

postdoctoral fellowship. So after a PhD, if you want to become an academic scientist, you

have to do a fellowship period. I did my fellowship with Duke medical school in Singapore, this

beautiful country in Southeast Asia. We love it. It's a second home. One of my kids was born

there. We love Singapore, but Singapore was interested in understanding across their the

populations within Singapore. Why is it that a chubby white guy is perfectly fine? And yet a

chubby Chinese Singaporean already has fatty liver disease. He has hypertension. He has type

two diabetes. And even though they have the exact same amount of fat on their bodies just

as a point of interest, if you want to be really fat, you want to be Caucasian. White people can

handle the most amount of fat on their bodies. On the other end, is Asians and South Asians

or Indian, Asian, Indian. They have the lowest tolerance for body fat. And that's because their

fat cells get very big, very early because they have generally fewer fat cells on the body."

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Karen Brennan, PhD's avatar

This is why body mass index is a useless marker since it doesn't take into consideration different ethnicities.

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knightsaberpriss's avatar

Oh, for sure. BMI, by itself, is really not useful. Also, I honestly have to wonder how many doctors, even Asian doctors, are aware that Asians have a different range for "normal" BMI. Joslin Diabetes actually have an Asian BMI Calculator on their website:

https://aadi.joslin.org/en/am-i-at-risk/asian-bmi-calculator

They even mention waist circumference towards the bottom of the page as something to factor in since "Sometimes even when your BMI is within healthy range, having too much fat around the abdomen (apple-shaped body) will still put you at risk for heart disease and diabetes. Below are the target goals for waist circumference measurements."

For Men:

Equals or less than 90cm (35.5 in)

For Women:

Equals or less than 80cm (31.5 in)

Waist to hip ratio could be another useful method to determine if one might have insulin resistance. In Dr. Robert Lustig's book "Fat Chance", he mentioned that a waist to hip ratio of 0.85 in Asian women is another warning sign of insulin resistance. 0.8 or below is normal.

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Karen Brennan, PhD's avatar

Waist circumference and hip to waist ratio are more accurate markers for determining which weight category someone falls into. BMI is used more often bc it's an easier, quicker tool. But as we've been discussing, at the very least, BMI categories should not be a one size fits all marker.

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