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IS IT DANGEROUS TO RELY ON FASTING BLOOD SUGAR VALUES?
Majid Ali, M.D.
(Taken from forthcoming book entitled Darwin's Drones, Oxygen, and Diabetes)
Part I

What does a fasting blood sugar level signify? What does the fasting status reveal? What might it mask? In many cases, I assert that the fasting status reveals nothing and hides much. Indeed, in such cases it is dangerously misleading. If so, why do doctors insist on it?

In health, blood sugar levels are essentially regulated by insulin. Even in obesity, prediabetes, and disease states, other glucose-regulating hormones play only secondary roles. In assessing metabolic status, it should be self-evident that insulin is the primary molecule of concern, not glucose. Then, why do doctors focus on glucose, not insulin?

Insulin, in excess, is a potent toxin. It is inflaming, fattening, pro-stroke, pro-heart attacks, and pro-premature aging. Blood sugar tests do not reveal the true status of insulin. Then, why do doctors not profile insulin to investigate the etabolic status?

I will address the above questions and illustrate my points by presenting revealing cases studies. First, some comments about oxygen, insulin, obesity, and Diabetes.

When I think of health and healing, first I think of oxygen. When I think of cellular metabolic dysfunctions, after oxygen I think of insulin. On November 29, 2009, I planned to discuss the subjects of memory and mentation on my program entitled ďScience, Health, and HealingĒ on WBAI radio (archived online at www.wbai.org for worldwide listening). I intended to Google the words oxygen and memory. Instead, I absent-mindedly entered the words oxygen and insulin. Google offered me 3,070,000 links. To my great surprise, the first two links were my own articles on oxygen and insulin. It was flattering to have received the highest rating on the search engine. Beyond that, I wondered how Google might have tracked me. I made my inquiry in Leesberg, Virginia using our daughterís computer. Later, I had three questions:

First, how can Google be so efficient in tracking my work with oxygen and insulin?
Second, why don't researchers explore the links between the biology of oxygen homeostasis and the diverse metabolic roles of insulin, especially in light of the established high risk of Alzheimer's disease in individuals with obesity, hypertension, prediabetes, and diabetes?
Third, now that oxygen, insulin, and memory have been brought together, what inter-relationships might indeed exist between oxygen and insulin in the context of memory and mentation?

On November 30, I Googled "
insulin toxicity" and found 2,260 links. Happily, I found that the fifth and sixth links were to my own articles on insulin toxicity. None of the first twenty links were to articles published by The New England Journal of Medicine or any other prestigious medical journals. Ironically, most other articles were published by scientists working for drug companies.

Here are the types of cases in which I have found relying on fasting blood sugar to be misleading, even dangerous:

► Normal fasting level followed by delayed hyperglycemia that meets the criteria for diabetes;
► Normal fasting level associated with high fasting blood insulin level, indicating early stages of hyperinsulinism;
► Normal fasting level followed by frank diabetic glucose profile;
► Normal fasting level associated with severe hyperinsulinism accompanied by clinical features of insulin toxicity (delete colon add quote):insulin rash," skin nodules ccaused(delete extra c) by fat necrosis, fatty change of the liver, and others); and
► Normal fasting level associated with early indications of evolving insulin depletion and the development of Type I diabetes.
► Normal fasting level associated with excess insulin allows one to have a high index of suspicion for rising blood creatinine levels (which may still be in the normal range), indicating the beginning of kidney failure.


The Intelligent Insulin Design
Evolution designed pancreas and insulin pathways to "rest" at night. By that I mean the human cellular energetics can be maintained within perfectly normal limits with extremely low amounts of circulating insulin. I illustrate this crucial aspect of insulin homeostasis with two case studies. Table 1 shows data for A 61-year-old woman weighing 170 pounds with a history of hypertension, colitis, and arthritis. There are three notable aspects of the insulin and glucose profiles in this case: (1) the fasting blood insulin level is less than two IU (below the laboratory range of detection and quantification); (2) the peak insulin value at two hours is 34 IU; and (3) the blood glucose values describe a gentle rise with later steady-state values. All glucose values in this and other profiles are given in mg/dL and insulin levels in international units.

Table 2 shows data for a 45-year-old 6'-2" tall athletic man weighing 225 pounds. Note that the blood glucose values are maintained within a healthful range with low blood insulin concentrations in a powerfully built man, such that the peak value at two hours is only 29 IU. There is no roller coaster pattern in both glucose and insulin values.





The Beginning of Insulin Toxicity
Table 3 displays data showing the dangers of relying on a normal fasting blood level. The patient is  a 45-year-old woman with breast cancer, hypothyroidism, and
sleep disorder. During one pregnancy she was diagnosed with gestational diabetes. Notice that her fasting blood sugar level was a perfect 74 and her fasting insulin level was less than two IU. Her peak insulin value of 62 units is more than twice that of a 225 pound man (Table 1). She had been told her glucose metabolism is normal. This is the danger of reliance on fasting blood sugar. She has hyperinsulinism and suffers from insulin toxicity, both conditions would have gone undetected had I not strongly recommended a four-hour insulin profile.

Table 4 shows a more dramatic example of the dangers of relying on a normal blood sugar levels. The patient is a 60-year-old man with GERD (gastroesophageal reflux disorder) and raised blood PSA (prostate-specific antigen) values. Again, the fasting blood sugar level was a perfect 78 and fasting insulin level was less than two IU. His peak insulin value of 103 is more than three times the value of a 225-pound man. He had also been told his glucose metabolism was normal. His severe hyperinsulinism (and insulin toxicity) would have gone undetected had I not insisted on a four-hour insulin profile.



Additional insulin profiles and discussion will be included in Part II.

You may find these DVDs by Majid Ali, M.D. helpful
Diabetes
Hypoglycemia
 

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Ethics-in-Medicine, Inc. was organized to advocate and promote access to compassionate, ethical, and effective health care, with an unrelenting focus on health preservation and disease reversalópreferring, when safely possible, nutritional and nondrug approaches. For those purposes, it is necessary to strongly oppose the pernicious influences of the Medical-Industrial Complex over all aspects of the art and science of healing practices.America's extreme health problems cannot be addressed without a radically new way of thinking about health and the absence of health. The three core problems of American medicine are: The 21st-century health problems caused by poisoned foods, polluted environment, and perverted life circumstances are addressed with 19th-century notions of disease and drugs;

Generations of physicians believe that all nondrug, nonscalpel therapies are unscientific; and
 
Ethics in medicineótruth and integrity in the work of practitionersóhas been endemically and perniciously compromised by the "Medical-Industrial Complex (the "Complex"), which, in 2008, controlled the $2.4 trillion disease- maintenance system in the U.S. There is no end in sight for the deepening health care crisis with the prevailing medical modelóAmericans continue to become sicker as enormous sums are stolen from them by the Complex. Read the entire Mission Statement