Insulin response test and NMR lipid test will help to determine the level of diabesity. However, as much as these tests are important, other tests which measure cardiovascular risk factors, have the added value of helping complete the ‘severity profile’ of the condition and what should be done to remedy it. The following tests add this value:
inflamation: The Link
High-sensitivity C-reactive protein - level should be less than 1.0mg/L (ideally less than 0.7mg/L). This is the best measure of hidden inflammation in the body. C-reactive protein is significantly elevated in most people with diabesity. As the diabesity gets better the inflammation goes down. In addition liver function test should be carried out to measure liver damage from inflammation, something that is very common with insulin resistance.
Fibrinogen - (less than 350mg/dl is ideal): This is a clotting factor in the blood that increases with inflammation and insulin resistance.
Lipoprotein (a) - is a genetically inherited lipoprotein marker that increases the risk of cardiovascular disease but can be treated. Less than 30nmol/L is ideal.
Uric acid - (less than 7.0 mg/dl is ideal): This is a by-product of protein metabolism that causes gout and an increase in insulin resistance.
Homocysteine - (Between 6.0 and 8.0mol/L is ideal). This is a sensitive marker for folic acid (vitamin B) deficiency.
Ferritin - (less than 200ng/ml is ideal): This is a measure of excess iron stores that increases with inflammation and insulin resistance.
Toxins and fatty liver
A common major complication of diabesity is fatty liver, also known as non-alcoholic steatohepatitis. It affects millions of people and is the number one cause of liver damage in the western world. This means that it is possible to get hepatitis from eating too much sugar and too many processed carbohydrates. The French delicacy fois gras (which means “fat liver” in French) is produced by force-feeding ducks corn (a starchy carbohydrate), which turns to sugar. The sugar turns to fat in the liver, creating problems with detoxification, which lead to a further increased load of toxins in the body, creating more disease in a vicious circle. However, it is possible to treat the liver to reverse this problem.
Liver function tests (elevated AST, ALT, GGT) - These tests identify the death of liver cells, most often caused by elevated insulin resistance because of a fatty liver.
Kidney function: the warning signs
The following test are used to identify early damage to kidneys, which can occur even without full-blown diabetes.
BUN – abnormal > 20 mg/dl
creatinine – abnormal< 1.2 mg/dl)
microalbumin - abnormal > 20 mg/d: to assess protein in urine, an early marker for damage to kidneys.
vitamin d: a key contributor
25 OH vitamin D - 45-60 ng/dl is good but 60–80 ng/ml is ideal. Vitamin D deficiency is an important predisposing factor to diabesity. Vitamin D levels should be monitored until they are in the optimal range. If you are taking high doses (5,000 to 10,000 IU a day), ensure that your doctor checks your calcium, phosphorous, and parathyroid hormone levels regularly (every three months).
Hormonal imbalance: a familiar component of diabesity
Thyroid dysfunction is a common phenomenon amongst diabesity sufferers and often goes undiagnosed.
TSH - ideal range is between 1 and 2. This is a measure of the pituitary hormone that controls the thyroid.
Free T3 and free T4 - These are a measure of the circulating thyroid hormones. The normal level of free T4 is usually between 0.9 and 1.8ng/dl. The normal level of free T3 is considered to be between 240 and 450pg/dl, depending on the laboratory measurements. However, range of reference for laboratory tests are often based on statistical ‘normal’ (which means the average of population, not necessarily the ideal.)
TPO (thyroid peroxidase) and antithyroglobulin antibodies: These are autoimmune antibodies in the thyroid gland that interfere with its function. They should both be less than 20 IU/ml.
Sex hormones: last but not least
Sex hormones (male and female) are often altered by diabesity and are important to monitor and treat.
free and total testosterone - in men is often low in insulin resistance and diabetes. This leads to muscle loss, fatigue, loss of motivation, low sex drive, and impotence.
DHEA-S - measurement of adrenal function
total and free testosterone and estrogen
FSH (follicle stimulating hormone), and LH (luteinizing hormone) - between days 18 and 23 of the menstrual cycle for premenopausal women and anytime for postmenopausal women. These are very helpful in identifying imbalances of hormones, which are common in diabesity. Women often have increased levels of testosterone and DHEA-S and a ratio of LH/FSH (luteinizing hormone to follicle stimulating hormone) of > 3:1.
Optimal Levels of Hormones Men:
Total testosterone: > 500 ng/dl
Free testosterone: > 20 pg/dl
Optimal Levels of Hormones Women:
Free testosterone: < 0.5 to 5 pg/dl
DHEA-S: < 200 mg/dl
LH/FSH ratio: < 3:1
Estradiol (depends on age and time of cycle)
Progesterone (depends on age and time of cycle)
Gluten Antibodies - Testing IgG and IgA anti-gliadin and IgA and IgG tissue transglutaminase antibodies measures immune response to gluten found in grains such as wheat, barley, rye, spelt, and oats and can help you identify this hidden cause of inflammation and heart disease (as well as other health issues). Any level of antibodies indicates you may have a sensitive reaction to gluten. Your body should not make autoimmune antibodies to gluten. There isn’t really is a “normal” level.
Genes or SNPs - Genetic tests may also be useful in assessing your heart disease risk factors. A number of key genes regulate cholesterol and metabolism:
Apo E genes
Cholesterol ester transfer protein gene
MTHFR gene, which regulates homocysteine
High-Speed CT or EBT Scan - This high-speed X-ray of the heart can help ascertain if you have CVD (cardiovascular disease). It may be helpful in assessing overall plaque burden and calcium score and can inform how assertive you need to be in terms of taking preventative measures. A score higher than 100 should turn on a red light, and a score higher than 400 indicates severe risk of CVD.
Carotid Intima-media Thickness (CIMT) – The carotid intima-media thickness test (CIMT) is a measure used to diagnose the extent of carotid atherosclerotic vascular disease. The test measures the thickness of the inner two layers of the carotid artery - the intimal and medial - and alerts doctors to any thickening when patients are still asymptomatic. Early detection may indicate the need for a more aggressive approach to managing diabesity and the risk factors associated with heart disease and stroke.
Aging is a contributing factor to increased carotid intima-media thickness. Other risk factors include high lipoprotein levels, high blood pressure, smoking, diabesity and a sedentary lifestyle.
Physicians use CIMT testing to determine the "age" of the carotid arteries. Being aware that patients may not be experiencing the symptoms of artherosclerosis, there still may be subtle changes in artery thickness. Armed with this information, doctors may develop an aggressive medical approach by prescribing medications such as blood pressure and cholesterol lowering agents and aspirin, and patients may be encouraged to make lifestyle and dietary improvements.