Blood Test, Fasting Insulin, HA1C, TG/HDL

BLOOD TESTS

Important Blood Tests

This one test may in time become the most predictive blood test that you can ever take. It gives important information about total body health, including: cardiovascular health, neurological health, eicosanoid balance and immune system strength. Measuring Omega-3 strength monitors cardiovascular health. Measuring the AA/EPA ratio monitors eicosanoid balance. Measuring EPA levels monitors neurological activity. The lower the AA/EPA ratio, the better the balance of "good" and "bad" eicosanoids in your body. Shown below is how this test relates to the development of chronic disease:

Fasting Insulin

The best test is your fasting insulin levels. Although the normal range is considered 5 to 25 uUnits/ml, I personally feel that any fasting insulin level over 10 uUnits/ml is probably too high, and that anything over 15 uUnits/ml should be considered hyperinsulinemia.

Beta cells in the pancreas produce insulin. Insulin stimulates uptake of glucose (sugar) from the blood to the cells in the body. When the body's cells are resistant to the action of the insulin, it is called insulin resistance (IR). As a result of the insulin resistance, the pancreas produces much more insulin than normal. This is called hyperinsulinemia (Figures 1,2). As an example, in a normal person, 1 unit of insulin might be needed to help 10 mg of glucose go into the cell, but in a hyperinsulinemic person, 10 units of insulin might be needed to get the same 10 mg of glucose into the cell (Figure 2). With hyperinsulinemia and IR come a myriad of problems including the following:

high triglycerides (increased risk of heart and stroke)
high plasminogen activator inhibitor activity (PAI-Fx), causing increased risk of clotting
low HDL cholesterol (increased risk of heart attack and stroke)
high uric acid (gout)
polycystic ovary syndrome (endocrine disorder with oligo-amenorrhea, infertility, hirsutism, obesity, high Leptin levels
type 2 diabetes
obesity (Figures 1,3)
High insulin can also stimulate the kidney to produce angiotension, a substance which increases blood pressure (Figure 1)

Hemoglobin A1C

In the blood, glucose binds irreversibly to hemoglobin molecules within red blood cells. The amount of glucose that is bound to hemoglobin is directly tied to the concentration of glucose in the blood. Since red blood cells have a lifespan of approximately 90 days, measuring the amount of glucose bound to hemoglobin can provide an assessment of average blood sugar control during the 60 to 90 days prior to the test. This is the purpose of the glycated hemoglobin tests, most commonly the hemoglobin A1c (HbA1c) measurement. Since the test results give feedback on the previous two to three months, getting an HbA1c test done every three months will give you good data on your average blood sugars. If you get an HbA1c every six months, you'll miss out on three months worth of information that could help you manage your diabetes. Background

A1C, also known as glycated hemoglobin or glycosylated hemoglobin, indicates a patient's blood sugar control over the last 2-3 months. A1C is formed when glucose in the blood binds irreversibly to hemoglobin to form a stable glycated hemoglobin complex. Since the normal life span of red blood cells is 90-120 days, the A1C will only be eliminated when the red cells are replaced; A1C values are directly proportional to the concentration of glucose in the blood over the full life span of the red blood cells. A1C values are not subject to the fluctuations that are seen with daily blood glucose monitoring.

The A1C value is an index of mean blood glucose over the past 2-3 months but is weighted to the most recent glucose values. Values show the past 30 days as ~50% of the A1C, the preceding 60 days giving ~25% of the value and the preceding 90 days giving ~25% of the value. This bias is due to the body's natural destruction and replacement of red blood cells. Because red cells are constantly being destroyed and replaced, it does not take 120 days to detect a clinically meaningful change in A1C following a significant change in mean blood glucose. (1)

Fasting Triglyceride/HDL Ratio

The ideal fasting triglyceride to HDL cholesterol ratio is less than 1.0. Less than 2 is good, and more than 4 means you are hyperinsulinemic. The average ratio for most Americans is about 3. According the Harvard School of Medicine, the higher the TG/HDL ratio, the greater the likelihood of heart attacks. The best way to increase the TG/HDL ratio is to eat a high-carbohydrate, low-fat diet.

TEST	HEALTHY	CAUTION	DANGER
Fasting Insulin	5	10	15
Hg A₁C	7	7	7
TG/HDL	1.5	>10	>11.7

Where Can I Get More Information?

Ask your physician to order these tests.