She didn't improve. She relocated.
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Hey Reader, Dr Karl here. She didn't improve. She relocated. Her HOMA-IR went from 2.6 to 0.8. The easy way to describe that is "she improved." It is also the wrong way, and the difference matters more than almost anything else I could tell you. She did not get better inside a category. She changed which category she is in. She left the country. She was living in the insulin resistant population, and she is now living in the non insulin resistant population. Different rules, different patterns, different future. That is not a shade of improvement. That is a border crossing. And once you see it that way, the reference range starts to look like what it is: a fence around one number that tells you nothing about which country you are standing in. A fasting insulin of 9.6 is inside the fence. It is also, unambiguously, the wrong country. Where do the plots come from that let me see this? Clients come in, they all run the same panel, which has grown over the years. The results go into one long spreadsheet. Each person is a row. Each lab is a column. Then I plot, and I split by HOMA-IR. Raw data in, pattern out. From individual lab values to meaningful clinical patterns. That phrase is doing real work: meaningful is the opposite of in range. The relocation slide is at about eight minutes. The spreadsheet and where the plots come from is right after it. >> WATCH: To your health, Dr. Goldkamp Links to Our books Or consider becoming a client |
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Hey Reader, Dr Karl here. A1c tracks glucose beautifully, in only one group of people. A1c tracks glucose tightly in insulin resistant people. In everyone else it barely tracks at all. Two groups. One line is steep. The other is almost flat.That is one sentence and it undoes most of what A1c gets used for. Glucose verses Hemoglobin A1c Red line is the insulin resistant group. Steep. As glucose rises, A1c rises with it, more or less the way the textbook promises. Green line is everyone else....
Hey Reader, Dr Karl here. A1c is not a glucose test. It is a protein test. It measures the percentage of your hemoglobin that has glucose stuck to it. Hemoglobin lives inside red blood cells. A1c has two inputs, not one: 1. how much glucose is in your blood, and 2. how long your red cells stay Nobody tells you about the second one. Here is a client. Four years of work. Fasting insulin down 65%, from 9.6 to 3.4. Glucose down 16 points, from 108 to 92. CRP down 87%, from 3.6 to 0.47. Eleven...
Hey Reader, Dr Karl here. Last time: her insulin, glucose, inflammation and weight all improved over four years, her CGM went flat, and her A1c went up to 5.7 and parked at the prediabetes line. Here is what A1c actually is, because almost nobody is told. A1c is not a glucose test. It is the percentage of your hemoglobin that has glucose stuck to it. Hemoglobin lives inside red blood cells. Glucose attaches slowly and it does not come off. So the number depends on two things, not one: how...