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What Do Elevated Insulin Levels With Normal A1c Level Indicate?

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Posted on Fri, 20 Feb 2015
Question: Is this a sign of insulin resistance or diabetes? My A1C is 4.2 (optimal) & random glucose always normal. My doctor said my insulin was slightly elevated from stress & emotion (I was nervous crying during blood draw) ?
doctor
Answered by Dr. Shehzad Topiwala (2 hours later)
Brief Answer:
Possible

Detailed Answer:
Elevated insulin levels, despite a normal A1c and fasting/random glucose can still be indicative of Insulin resistance.

There are, however, 2 caveats to this:

A) We lack simple, convenient and accurate tests to diagnose insulin resistance.

Whatever methods we currently have are restricted to research settings such as laboratories and clinical trials.

So the elevated Insulin test result that you have attached, is possibly suggestive of insulin resistance but we cannot conclude so on the basis of this one test alone.

There are indirect ways of estimating this called HOMA-IR, although even this has it's share of shortcomings.

B) A1c and glucose can very well appear normal in the face of an elevated Insulin

This typically occurs early in the progression from normal to pre diabetes. The essential causes of insulin resistance such as overweight/obesity/physical inactivity lead to a gradual rise in blood glucoses. In response to this, the beta cells of the pancreas start producing more insulin to compensate and keep the glucoses (and this is reflected in the A1c too) in the normal range.
The blood insulin levels therefore are high because they are a consequence of the pancreas being overworked to keep glucoses from rising into abnormally high range.

A time comes when the pancreas' insulin producing capacity is overwhelmed and despite it's efforts, blood glucose eventually rises. At this point the person has either diabetes or pre diabetes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (5 minutes later)
Can chronic stress cause insulin increase?
doctor
Answered by Dr. Shehzad Topiwala (2 hours later)
Brief Answer:
Follow up

Detailed Answer:
There is no published medical literature to the best of my knowledge that has systematically studied this and concluded that chronic stress raises blood insulin levels.
That being said, there is increasing scientific support to the role of stress in causing many chronic conditions in modern life, such as diabetes, blood pressure and weight gain
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (16 hours later)
Darkening of skin
doctor
Answered by Dr. Shehzad Topiwala (2 hours later)
Brief Answer:
Second follow up

Detailed Answer:
I believe your comment of skin darkening is in reference to my first reply.

Yes you are correct in that 'acanthosis nigricans' is a clinical finding on examining a person that is typically associated with Insulin resistance.
However it can other in other conditions also such as some medications like niacin and steroids (like prednisone) cause it. It is likely these also induce it through insulin resistance.

There is another skin condition called acrochordans, or simply skin tags. These are also markers of insulin resistance that can be found on clinical examination.
Again, these too can be present even in the absence of insulin resistance. For example, some individuals may constitutionally, genetically or otherwise have a tendency to develop these skin lesions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (4 minutes later)
I often get lightheaded immediately after eating or during eating. Even if low carb. My blood sugar is always normal. Is this symptom due to insulin kr something else?
doctor
Answered by Dr. Shehzad Topiwala (18 hours later)
Brief Answer:
Third follow up

Detailed Answer:
There is a medical condition called 'Reactive hypoglycemia' that can occur in pre diabetes or early type 2 diabetes. It is essentially a consequence of insulin resistance.
It can be a tricky entity to deal with because often there is no true hypoglycemia ('low blood glucose') and just some vague symptoms like the kind you are experiencing.
The treatment includes frequent small meals, more fibre, less refined carbohydrates, and in severe cases a medication called acarbose helps


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (10 minutes later)
Well my symptoms occur during meal or immediately following, can that still be reactive hypoglycemia? Also when I check my glucose during these episodes it is normal
doctor
Answered by Dr. Shehzad Topiwala (18 hours later)
Brief Answer:
Fourth follow up

Detailed Answer:
Symptoms during and immediately after meals are unlikely due to reactive hypoglycemia.
Glucose levels can well be normal during these episodes, because it is often the speed at which glucoses drop that tends to cause this problem, even if the glucoses remain within the normal range
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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What Do Elevated Insulin Levels With Normal A1c Level Indicate?

Brief Answer: Possible Detailed Answer: Elevated insulin levels, despite a normal A1c and fasting/random glucose can still be indicative of Insulin resistance. There are, however, 2 caveats to this: A) We lack simple, convenient and accurate tests to diagnose insulin resistance. Whatever methods we currently have are restricted to research settings such as laboratories and clinical trials. So the elevated Insulin test result that you have attached, is possibly suggestive of insulin resistance but we cannot conclude so on the basis of this one test alone. There are indirect ways of estimating this called HOMA-IR, although even this has it's share of shortcomings. B) A1c and glucose can very well appear normal in the face of an elevated Insulin This typically occurs early in the progression from normal to pre diabetes. The essential causes of insulin resistance such as overweight/obesity/physical inactivity lead to a gradual rise in blood glucoses. In response to this, the beta cells of the pancreas start producing more insulin to compensate and keep the glucoses (and this is reflected in the A1c too) in the normal range. The blood insulin levels therefore are high because they are a consequence of the pancreas being overworked to keep glucoses from rising into abnormally high range. A time comes when the pancreas' insulin producing capacity is overwhelmed and despite it's efforts, blood glucose eventually rises. At this point the person has either diabetes or pre diabetes.