Why I Don’t Use Random Insulin Test,

Majid Ali, M.D.

The shirt answer: Because it is not reliable.


Blood insulin level test done with a randomly drawn blood sample should not be done. It is unreliable at many levels. I refuse to interpret such an insulin test whenever I am asked to do so. Indeed, I do not know of any valid reason why any doctor should order this test. Sadly, I continue to see random insulin test reports.


The shirt.

My Reasons for Not Ordering Nor Interpreting Random Insulin Test

A random insulin level of a healthy individual after a large glass of orange juice and cereal breakfast is likely to be more than ten units, which is more than five times the fasting insulin value in many metabolically fit persons.

A random insulin level of a person with diabetes after an egg, fish, and coffee without sugar is likely to be considered normal.

The random insulin levels of persons with prediabetes vary over such a large range that no valid interpretation is possible.

The random insulin levels of persons with diabetes depend on the stage of the disease, very high in early insulin-excess stages and very low in late insulin-depleted stages.

For the above and other reasons, random insulin test must neber be used for screening for diabetes, nor for assessing the results of diabetes control.

Insulin Profile for Optimal Metabolic Status

An insulin profile indicates optimal metabolic status (Table 1) when:

* The fasting insulin value is three or less, ideally less than two;

* The three-hour insulin value is three or less, ideally less than two;

* The peak insulin level is 25 or less;

* The blood peak glucose level is below 120

* The lowest blood sugar level is above 50 and unaccompanied by any negative senses.

Case Study

A 75- yr-old 5′ 7″ man weighing 142 lbs. presenting with a history of undue tiredness, gastritis and GERD (gastroesophageal reflux disorder), inhalant allergy, visual loss, and a history of prostate cancer. His doctor never suspected the presence of diabetes and had not considered ordering insulin and glucose profiles. His glucose and insulin profiles were abnormal (Table 1). Diabetes Type 2 was diagnosed (to his surprise) by his glucose profile and insulin toxicity (hyperinsulinemia) by insulin profile.

Table 1. Insulin and Glucose Profiles of a 75- yr-old 5′ 7″ Man Weighing 142lbs. And Presenting With GERD/gastritis, Allergy, and Visual Loss.

6.11.2013

Fasting

1/2 Hr

1 Hr

2 Hr

Insulin

2.59

14.4

30.2

47.2

Glucose

134

189

237

233

Note that both insulin and glucose profiles fail all of the above-listed criteria for insulin and glucose profiles for optimal metabolic. The insulin peak is usually seen in one-half or one-hour samples. An unusual aspect of this insulin profile is that the insulin peak is seen in the two-hour sample. A three-hour insulin value could have been even higher.

Two Examples of Insulin Profile for Optimal Metabolic Status

It is important to learn about what a healthful insulin profile should be. For this purpose, Tables 2 and 3 present the insulin profiles two of my patients which reflects the optimal metabolic status.

Table 2. Insulin and Glucose Profiles of a Metabolically Fit 47- Yr-Old 5′ 5 1/2″ Woman Weighing 170 lbs. With Fatigue, Allergy, Sinusitis, and Joint Stiffness

3.7. 2010

Fasting

1 Hr

2 Hr

3 Hr

4 Hr

Insulin

3

23

22

8

<2

Glucose

72

44

63

58

65

Table 3. Insulin and Glucose Profiles of a 40-yr-old 140 lb. 5′ 6″ Woman Presented With Allergy.

6.23.2008

Fasting

1 Hr

2 Hr

3 Hr

4 Hr

Insulin

<2

20

<2

<2

<2

Glucose

85

95

59

73

78

Table 4. Insulin and Glucose Profiles of a Metabolically- Compromised 68-Yr-Old 5’4″ Woman Weighing 134 lbs. With Overactive Thyroid (Hyperthyroidism), Headache, Low Blood Sugar (Hypoglycemia, Stress. and a very Low Vitamin D Level of Less Than Seven.

6.2. 2010

Fasting

1 Hr

2 Hr

3 Hr

4 Hr

Insulin

2

55

16

4

Glucose

87

55

57

63

75

Table 5. Insulin and Glucose Profiles of a Metabolically- Compromised 55-Yr-Old Man Weighing 149 lbs. With Kidney Failure, Hypertension, Chronic Fatigue, and Prostate Enlargement.

5.17. 2010

Fasting

1 Hr

2 Hr

3 Hr

4 Hr

Insulin

12

52

52

23

11

Glucose

86

93

108

63

62

Table 6. Insulin and Glucose Profiles of a Severely Metabolically Unfit of a 5′ 5″Man Weighing 214 lbs. With Fatty Change of the Liver, Irritable Bowel Syndrome, and Chronic fatigue.

3.17..2010

Fasting

1 Hr

2 Hr

3 Hr

4 Hr

Insulin

25

274

241

132

19

Glucose

110

171/152

98

66

84

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