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Evidence-based GLP-1 & peptide discussion since 2023
ForumsLab Results & BiomarkersInsulin levels — anyone have experience?

Insulin levels — anyone have experience?

SandraNC_45 Fri, Mar 22, 2024 at 5:25 AM 40 replies 2,260 viewsPage 1 of 8
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SandraNC_45
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Mar 22, 2024 at 5:25 AM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin and B12, and a full blood count. That set catches the things that change, the things that explain symptoms, and the things that alter the prescribing decision. Almost everything else on the long circulating lists is either invariant, uninterpretable without a specific question, or an incidental finding waiting to cause an unnecessary workup.

Where I think it is weakest: the subgroup findings are the part I trust least — with enough subgroups something is always significant, and these were not all pre-registered.

What I actually want to know is how often to repeat it, because quarterly seems to be the convention and I cannot find the reasoning. Practical detail welcome, however dull — the duller the better.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
41 11FranDenver, Dr.BariatricHTX, LindaRN_retired and 38 others
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Dr.NateNeph
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Mar 22, 2024 at 6:11 AM#2
SandraNC_45 said:
A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin…

That is correct as far as it goes, and here is where it stops going. The single most useful discipline is bringing the whole panel to a clinician rather than one flagged value. One out-of-range result in isolation generates anxiety and unnecessary tests; the same result next to the trend and the rest of the panel usually generates a shrug.

I would rather be corrected than agreed with, if it comes to it.

40 10NauseaFreeNow, SteveThurs, B12Beth and 37 others
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Dr.ReproEndo
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Mar 22, 2024 at 6:57 AM#3
SandraNC_45 said:
A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin…

Pushing back on SandraNC_45 here. I would drop the "get everything" instinct further than this thread does. Every extra test is another chance at a false positive, and incidental findings have their own cost in scans, biopsies and worry.

39 9Dr.EndoEP, GraceAZ_72, carl_compliance and 36 others
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rachel_ABQ
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Mar 22, 2024 at 7:43 AM#4

Taking the question as asked, rather than the general version of it. Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c becomes informative again, since it reflects about three months of glycaemia. After the first year, and once doses are stable, annual is reasonable unless something specific is being followed.

Last edited: Mar 22, 2024 at 12:43 PM
38 8SkepticalSean, Dr.CardioMD, EndoResFellow and 35 others
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tony_orlando
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Mar 22, 2024 at 12:04 PM#5
Dr.NateNeph said:
The single most useful discipline is bringing the whole panel to a clinician rather than one flagged value.

Same pattern here, and in the same order. The detail I would add is minor and it is already implied above.

Last edited: Mar 22, 2024 at 1:04 PM
37 7KetoKyle, CanadaChris, ZaraB_AL and 34 others
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