DANGEROUS TO RELY ON FASTING BLOOD SUGAR
Majid Ali, M.D.
(Taken from forthcoming book entitled
Darwin's Drones, Oxygen, and Diabetes)
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
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
fasting level followed by delayed
hyperglycemia that meets the criteria for
fasting level associated with high fasting
blood insulin level, indicating early stages
fasting level followed by frank diabetic
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
fasting level associated with early
indications of evolving insulin depletion
and the development of Type I diabetes.
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
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
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
Additional insulin profiles and discussion
will be included in Part II.
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Majid Ali, M.D. helpful