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Fasting Insulin and CGMs Catch Metabolic Trouble Years Early
basic-science diet-nutrition hormone-health medical-innovation
Your A1C can look fine for a decade while metabolic damage is already underway. The Whitehall 2 study of British civil servants found that elevated fasting insulin predicted type 2 diabetes up to 15 years before diagnosis, and a separate NHANES analysis found fewer than a third of lean people are metabolically healthy by standard measures, so normal weight tells you almost nothing. A fasting insulin test and a month on a continuous glucose monitor are cheap enough to be unremarkable, and together they can catch the pattern Thompson describes: chronically high insulin, ectopic fat accumulating in organs, insulin resistance building, all while your glucose numbers still look clean. If you want a rough number, HOMA-IR (fasting glucose multiplied by fasting insulin, divided by a constant) above 2 is worth a conversation with your doctor.
Full analysis
Dr. Chris Thompson outlines a predictable sequence of metabolic deterioration — excess glucose, chronically elevated insulin, accumulation of fat in organs (ectopic fat, including fatty liver), insulin resistance, and finally loss of metabolic flexibility — that can begin a decade or more before a hemoglobin A1C (a standard blood test for diabetes control) ever turns abnormal. He cites the Whitehall 2 study of British civil servants, which found that elevated fasting insulin predicted type 2 diabetes up to 15 years in advance. A separate NHANES analysis found that fewer than a third of lean people are metabolically healthy by standard measures, meaning normal weight is not a reliable indicator of metabolic health. Thompson recommends two low-cost, non-invasive tools: a continuous glucose monitor (CGM) worn for a month or two to identify which foods cause large glucose spikes, and a fasting insulin blood test to detect chronically elevated insulin before glucose or A1C become abnormal. The formula HOMA-IR — fasting glucose multiplied by fasting insulin divided by a constant — gives a rough measure of insulin resistance; a value above 2 suggests a problem.
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