When you are driving into unfamiliar territory you probably use a GPS, right? The first thing the GPS needs to know is your current location. Without knowing your current location, the GPS can’t plot a course for you.

So, before anything else, we do a comprehensive medical and wellness assessment of your current health to get a complete picture of where you are now. This includes Anthropometric Measurements and Advanced Blood Tests to get an accurate picture of your current state of health and to create your individual plan to reverse your diabetes.

It’s important to recognize and diagnose insulin resistance, because it is the root cause of Type 2 Diabetes and most Heart attacks, and Alzheimer’s disease (Type 3 Diabetes). And finally, insulin resistance is associated with increased risk of developing cancers, including breast, prostate, and pancreatic cancer. It’s no surprise that hyperinsulinemia is a risk factor for most, if not all cancers. When a person becomes insulin resistant, it’s not a disease of blood sugar at all, it’s a disease of insulin signaling.  So why focus on lowering blood glucose, which is only the symptom? Isn’t that useless? You need to lower insulin, not glucose, because the disease is about too much insulin.

Obviously, having elevated blood sugars is not healthy.  But how you lower the blood sugars is very important.  If you’re lowering sugar by raising insulin level or by increasing insulin sensitivity artificially, then you’re mimicking the conditions that cause diabetes in the first place.  When cells become insulin resistant, they’re not being stupid.  Cells become very smart because they let less sugar in.

Reversing diabetes is a term that usually refers to significantly reducing insulin resistance in people with type 2 diabetes. So, reversing insulin resistance is a first step towards reversing type 2 diabetes.  Your Blood Panels should reflect better insulin sensitivity. Your HOMA-IR should approach 1.0 and Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. Your HsCRP (marker of inflammation) should be below 1 mg/L and Fatty Liver Index should be < 30.

The Blood Test Panels are designed to be the most effective and cost-efficient way to evaluate your metabolic health and progress.

Waist/Height Ratio

Waist to height ratio is a reasonable proxy for diagnosing insulin resistance. So it is the easiest way to measure your risks for obesity, heart disease, diabetes, stroke, and hypertension. It is obtained by dividing waist size by height. Waist/Height Ratio (WHtR) is a far more accurate way of measuring healthy weight than the traditional Body Mass Index (BMI).

Waist to height ratios over 0.5 are considered to be exceptionally risky when it comes to metabolic health.

Waist Circumference for Asian populations is considered a risk factor for heart disease, irrespective of height and build, in the following cases:
Men: Over 90 cm (approximately 35 inches)
Women: Over 80 cm (approximately 31.5 inches)
Your waist measurements are the most accurate just after you wake up from 7-8 hours of sleep.

HOMA-IR (Fasting Insulin and Fasting Glucose)

8 out of 10 people with heart attacks also have high insulin. High insulin is a hallmark of metabolic syndrome.
Having normal blood glucose levels does not rule out insulin resistance.

Here are some examples:

Patient A                                                                       Patient B
Fasting glucose: 110 mg/dL                                      Fasting glucose: 90 mg/dL
Fasting insulin: 3 μIU/mL                                        Fasting insulin: 14 μIU/mL
HOMA-IR: (110 x 3) / 405 = 0.81                            HOMA-IR: (90 x 14) / 405 = 3.11

Patient A’s fasting glucose is higher than Patient B’s, but Patient A’s insulin is much lower. By taking both glucose and insulin into account, the HOMA-IR scores show us that even with a lower fasting glucose, Patient B is at greater risk for metabolic complications down the road.

Endogenous Hyperinsulinemia Contributes to Pancreatic Cancer Development.

Unless people with diabetes are taking insulin, they waste their time and money when they test their blood sugar.

Lipid profile (Triglycerides to HDL Cholesterol Ratio)

The fasting TG/HDL ratio is highly correlated with 2-hour insulin (insulin levels 2 hours after consuming glucose) and, with a higher cut off, is also predictive of fasting hyperinsulinemia.

People with the highest TG/HDL levels are 5 times more likely to suffer a heart attack. So, calculating this ratio is not only a simple trick to measure insulin resistance but also a more-accurate heart disease risk assessment. 

Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. So, if your triglycerides are 100 mg/dl, your HDL cholesterol should be 50 mg/dl. Some insulin resistance: 2.0–3.0. Significant insulin resistance and heart disease risk is found at ratios >3.0

High Sensitivity C-Reactive Protein (hsCRP)

High-sensitivity C reactive protein (hs-CRP) is a sensitive marker of low-grade systemic inflammation and is a reliable indicator of atherosclerotic cardiovascular diseases (CVD) and is associated with hyperinsulinemia and hyperlipidemia. Elevated serum hs-CRP is associated with insulin resistance and signals an increased risk for practically all degenerative disorders, including cardiovascular disease, cancer, nephropathy progression, diabetes and more.

BEWARE! CRP test is NOT hs-CRP test

The standard CRP test is ordered for people with symptoms of serious bacterial infection or chronic inflammatory disease. It measures CRP in the range from 8 to 1000 mg/L, while hs-CRP test measures CRP in the range from 0.3 to 10 mg/L.

Liver function test (ALT, AST, ALP and GGT)

Observational studies usually show some measures of liver function, such as ALT, ALP and GGT, associated with higher risk of cardiovascular disease (CVD) and Type 2 Diabetes. Among these liver enzymes, GGT is most strongly positively associated with both CVD and T2D, although GGT is a non-specific marker of liver function. ALT is more clearly positively associated with T2D than with CVD while the role of ALP is unclear.

Both ALT and GGT have been shown in cross sectional studies to be modestly associated with the presence of fatty liver, whereas AST is not related.

Recent 2017 study on hepatic Involvement in Nepalese Subjects with Type 2 Diabetes Mellitus observed marginal, yet statistically significant increase of serum ALT (26.6±0.84 (diabetic) vs 20.0±0.69 (control), p=0.003) and GGT (40.4±1.51(diabetic) vs 21.2±1.1(control), p<0.001) in the diabetic patients compared to healthy controls. Because of marginal elevation of liver enzymes within normal range in diabetic patients, estimation of liver enzymes is highly recommended for patients with T2DM for early detection of liver dysfunctions.

Elevated gamma-glutamyl transferase (GGT) is strongly associated with obesity and excess deposition of fat in the liver, which is thought to cause hepatic insulin resistance and to contribute to the development of systemic insulin resistance and hyperinsulinemia and increases the risk of diabetes in normal weight people by 3 fold.

Elevated serum GGT level remains the most widely used marker of alcohol abuse. Levels typically rise after heavy alcohol intake that has continued for several weeks (Allen et al. 1994). With 2–6 weeks of abstinence, levels generally decrease to within the normal reference range, with the half–life of GGT being 14–26 days. 

Diabetes and elevated GGT activity are associated with increased oxidative stress, poor metabolic profile, high prevalence of non-alcoholic fatty liver disease and heightened inflammatory burden. elevated GGT activity predicts the risk for all-cause mortality in diabetic patients.

The GGTP level is too sensitive, frequently elevated when no liver disease is apparent. A GGTP test is useful in only two instances: (1) It confers liver specificity to an elevated alkaline phosphatase level; (2) In aminotransferase level elevations with AST/ALT ratio greater than 2, elevation of GGTP further supports alcoholic liver disease. In addition, it can be used to monitor abstinence from alcohol.

GGT contributes in maintaining the physiological concentrations of glutathione in cytoplasm and cellular defense against oxidative stress. So, Elevated GGT may be a marker of antioxidant inadequacy and of increased oxidative stress. Circulating GGT levels are also closely correlated with the markers of inflammation and thus its elevated activity may signify a heightened inflammatory state.

Outside the clinical use as a test for hepatobiliary disease and alcohol abuse, GGT has garnered large interest for its association with cardiovascular disease (CVD), diabetes, metabolic syndrome and cancer. The risk for CVD or CVD-related mortality mediated by GGT may be explained by the close correlation of GGT with conventional CVD risk factors and various comorbidities, particularly non-alcoholic fatty liver disease, alcohol consumption, oxidative stress, metabolic syndrome, insulin resistance and systemic inflammation.

Three large Austrian studies have showed the association of GGT with cardiovascular risk factors, CVD or mortality.
Two prospective studies in Finnish population showed that serum GGT activity was associated with the risk of total and ischemic stroke in men and women.
The EUROSTROKE nested case-control study showed a significant increase in the age- and sex-adjusted risk for stroke of 26% per SD (28.7 IU/mL) higher GGT.
Two studies in Asian population (Japan) have suggested a stronger association between GGT and CVD-related mortality and stroke in women than in men. First, epidemiological evidence strongly supports an association between elevated GGT and incident CVD, stroke or all-cause and CVD-related mortality which appears to be stronger in subjects of younger age. Second, there seems to be a strong correlation between elevated GGT and cardiometabolic risk factors which tend to cluster in subjects with higher GGT levels.

The serum aminotransferases, aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT), are also often considered as screens for heavy drinking.

The normal range of ALT is 0-45 U/L. Average level, above which risk for NAFLD increase significantly: 20 U/L
The normal range of GGT is 0-45 U/L. Average level, above which risk for chronic disease increase significantly: 20 U/L

Uric acid (UA)

Uric acid, despite being a major antioxidant in the human plasma, both correlates and predicts development of obesity, hypertension, insulin resistance and cardiovascular disease, conditions associated with oxidative stress. Uric acid serves as a marker for fructose toxicity.

Several mechanisms could be responsible for elevated uric acid, including the following: 1) increased intake of dietary purines, alcohol, and fructose, which produce UA; 2) impaired renal function and renal microvascular disease, which can increase UA production and/or decrease UA clearance; and 3) hyperinsulinemia, which increases renal UA reabsorption. It is possible that an increase in UA concentration is a protective mechanism to attenuate the adverse effects of an increase in oxidative stress.

The safest range for uric acid is between 3 and 5 mg/dl, and there appears to be a steady relationship between uric acid levels and blood pressure and cardiovascular risk.

Kidney function test (Glomerular filtration rate)

High blood pressure (hypertension) is a known risk factor for kidney disease and people with diabetes are prone to hypertension. On the other hand, despite the contraindication for metformin use in diabetic patients with moderate to severe renal impairment (eGFR < 60 mL/min/1.73 m2), metformin is often used off-label in patients with moderate renal impairment. An estimate of the normal value for your GFR can be obtained by using the equation: GFR = 140 – [your age]. For example, if you are a fit, healthy 30 yr old, your GFR should be approximately 110mls/min.

Hemoglobin A1c (HbA1c)

Criteria for diabetes remission is that Glycated hemoglobin (HbA1c) should be less than 6.5% and maintained for at least 6 months in the absence of pharmacologic therapy.