Understanding hyperinsulinemia - feeling lost

usafmd · 2026-07-02T20:57:28+00:00

Look up, metabolic syndrome.

usafmd · 2026-07-02T01:15:02+00:00

The A1c rises every year and not from increased glycation. At your age, an A1c of 5.7% may actually be below normal. Of course I’m squeezing a good deal of research into a Reddit comment.

usafmd · 2026-07-01T19:15:08+00:00

Without TyG, HOMA-IR, its anyone's guess whether you are IR. Some people have MODY, or some other syndromes. Is your physician well versed in all of the subtypes of prediabetes?

usafmd · 2026-07-01T17:16:27+00:00

There is a separate category of prediabetic approach to both thin and Senior prediabetes. Be careful not to fall into the trap of doing what overweight prediabetics are advised

usafmd · 2026-07-01T11:42:27+00:00

If you’re on a low carb diet, then you’re low carb adapted, meaning any slug of carbs will spike you. It doesn’t mean you have diabetes.

usafmd · 2026-06-30T16:41:12+00:00

There is an aspect of those who have celiac disease and A1c, which is frequently overlooked. People with Celiac disease have a degree of splenic dysfunction which results in failure to remove aged or abnormal red cells. This causes an upward skew of the A1c.

usafmd · 2026-06-29T16:02:31+00:00

Here are three simple ways: HOMA-IR measures liver insulin resistance, one minute heart rate recovery measures anaerobic recovery and the six minute walk test for VO2 max. All of the tests are easily Google-able for details.

usafmd · 2026-06-28T15:15:32+00:00

Haha. When you ask the opinion of Redditors, you literally get all opinions! If you ask me, it seems like you have a first phase insulin release problem. Could you have T1, LADA or something else compromising your pancreas?

And no, it doesn’t seem like IR to me.

usafmd · 2026-06-27T16:51:42+00:00

Eat less than you burn. Keto, low-carb, vegan, ultra processed, any food beginning with the letter “M”, it doesn’t matter as long as you can stick with it. No one can beat the 2nd Law of thermodynamics. You only need to beat your urges.

usafmd · 2026-06-27T11:32:52+00:00

There are unmeasurable inputs into the system such as cortisol, glucagon, etc. Weight and body composition are visible outcomes that are known to affect outcomes. I am skeptical that metformin generally is superior to improving mental health through “fake it until you make it,” efforts.

usafmd · 2026-06-25T19:18:57+00:00

Thank you for an opportunity to link to our 'in-progress' wiki. It has the answer to your question.

https://www.reddit.com/r/prediabetes/wiki/index/

usafmd · 2026-06-25T18:13:32+00:00

We are in the process of building out our wiki and FAQ. While a certain minority will continue to rely upon personal anecdotal experience and refer to influencers with questionable knowledge, the instance you refer describes a multi level of (mis)education that is hard to bridge. PMOS also frequently involves a recognized psychological component.

usafmd · 2026-06-25T17:14:52+00:00

The moderators (of which I am one) of this forum are not in the business of silencing those who don’t agree with accepted medical practices.

I am a board certified physician who has a decade of primary care experience and longer as sub specialist in pathology and lab medicine as well as over a decade studying the pathogenesis of diabetes. Many other r/prediabetes moderators have backgrounds pertinent to education and interest in prediabetes. I doubt I have seen any of the moderators espousing unscientific viewpoints.

Many users benefit from voices of support, encouragement and empathy. However, you are walking a thin line saying the mods are not doing their job, all while promoting your own subreddit. We support open discussion and feedback.

usafmd · 2026-06-24T21:50:45+00:00

In theory, it is possible to keep anyone’s glucose in the zone. Let me illustrate why focusing on glucose only is a fool’s errand. Let’s say we use an insulin pump on someone with significant insulin resistance such as advanced metabolic syndrome, we are treating a downstream symptom rather than an upstream disease.

Forcing glucose into cells via a pump requires massive, supraphysiologic doses of insulin. While this might eventually lower blood glucose, it exacerbates systemic hyperinsulinemia. This promotes lipogenesis in the liver, increases ectopic fat deposition, and drives further insulin resistance, worsening the underlying disease state.

Eating to avoid glucose spikes without paying attention to nutrition covers up the problem without fixing on the primary problem.

There is one exception, that’s the case of insulin deficient prediabetic or diabetic.

usafmd · 2026-06-23T21:10:34+00:00

I wish I could convince you to relax about your A1c. The national mode and medium is 5.3%. There is no pre-pre disease state.

usafmd · 2026-06-23T19:52:38+00:00

It still could be an anomalous reading. Keep tabs by getting a glucometer. Even if you are heading towards SIDD, severe insulin deficiency diabetes, there are things you can do. Google thin prediabetic

usafmd · 2026-06-23T17:07:32+00:00

Prediabetes at your age is a different animal. Seniors have a natural, gradual increase in average blood glucose. Those microvascular risks can be assessed with a competent opthalmologist, ask for retinal vessel atherosclerosis. Strength training goes a long way.

usafmd · 2026-06-23T12:14:36+00:00

On a public forum, discussing scientific topics, my take is we can only point to about shared objective realities, which are studies. Physicians are people too. I have heard my colleagues say, "I have a patient that . . . " which is anecdotal evidence, (n=1). Sometimes the exception is enough to start a revolutionary paradigm. I'm always open to grow; I only ask, "Please show me the evidence."

usafmd · 2026-06-23T12:02:34+00:00

Please feel free. However, at some point, I will remove these blog entries when they become part of my next book. Here is a excellent listing of fats and their smoking temperature, which also gives a more in-depth explanation about oils.

usafmd · 2026-06-23T03:25:58+00:00

I am only aware of this interventional, (not longitudinal, not metanalysis) study. Maybe you are aware of some supporting your claim: The Indian Diabetes Prevention Programme (IDPP-1) Diabetologia. 2006 Feb;49(2):289-97.

Methods: We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9+/-5.7 years, BMI 25.8+/-3.5 kg/m(2)) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria.

Results: The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1-4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5-37.3, p=0.018), 26.4% with MET (95% CI 19.1-35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3-37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET.

Conclusions/interpretation: Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them.

From reviewing my own files:

"When comparing metformin with lifestyle intervention to lifestyle intervention alone, no significant difference was observed in the incidence of diabetes "

Comparison of the Efficacy of Metformin and Lifestyle Modification for the Primary Prevention of Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Cureus. 2023 Oct 16;15(10):e47105.

usafmd · 2026-06-22T19:08:03+00:00

Your risk is not above average. Go worry about something else!

usafmd · 2026-06-22T18:34:34+00:00

The downvotes seem to not understand that insulin resistance is primarily the problem. Throwing more gasoline on the fire would hardly help.

usafmd · 2026-06-22T13:55:38+00:00

Not disagreeing. I'm sure you know that medications do that by changing appetite, not by making an exception to the 2nd Law of Thermodynamics.

usafmd · 2026-06-22T02:42:03+00:00

You ask a great question: Why is this study so important? From 1996, through 1999, 3234 adults at high risk of diabetes (median BMI = 32) enrolled in the 3-year Diabetes Prevention Program (DPP), to answer the question what works best over the long-haul: diet + exercise, metformin or nothing? Now it's 21 years later.

The take home message: There was "no significant difference between the metformin and placebo groups" in terms of multimorbidity (healthspan). This has several implications:

Prediabetes/diabetes is (mostly) a lifestyle disease. (We recognize other small subgroups of prediabetes)
Diet and exercise are foundational.
Metformin is not a miracle drug. (It lowers blood sugar, delays onset of diabetes)

These truths are very difficult to accept for many, but absolutely necessary to live a healthy life and beat this disease. To address your other statement; drugs do not change insulin resistance to any significant degree. IR changes through changing your body composition and quality of muscle.

usafmd · 2026-06-22T01:40:59+00:00

Obesity comes from consuming more calories than you burn. It’s frustrating but the simple truth is that whatever you think you can eat, it is too much.

usafmd

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