BLOOD TESTS
In addition to the GTT,Dr.Atkins would typically order:
a lipid panel consisting of total cholesterol, triglycerides, HDL, and LDL;
routine chemistry tests (also known as a comprehensive chemistry panel ), including those for liver function, kidney function, uric acid, and electrolytes;
CBC (complete blood count);
thyroid function, including TSH, free T3, and free T4.
As a cardiologist, he also screened for markers of cardiovascular risk, such as C-reactive protein (hs-CRP), homocysteine, lipoprotein(a), and fibrinogen. These tests are crucial for patients who have elevated lipids, hypertension, known heart disease, diabetes, or a strong family history of heart disease.We’ll discuss these risk factors in more detail in Chapter 9, The Cardiac Connection.
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ARE YOU MAKING INSULIN?
If you have been newly diagnosed with diabetes, stressing the system with a glucose tolerance test may not be appropriate.The key question is discovering how much insulin your pancreas is still producing. Does your pancreas produce high, normal, or low amounts of insulin? The answer is extremely important, as it can influence the kind of treatment you are given.
Instead of the GTT, Dr. Atkins would have these patients do a two-hour postprandial (after a meal) test.This is a way of determining how high your insulin and blood sugar go two hours after you eat a high-carb meal. To do the two-hour postprandial test, you fast for 12 hours (water is allowed) before the test. A blood sample is drawn for blood sugar and insulin. You then eat a standard high-carb breakfast as recommended by the American Diabetes Association: six ounces of orange juice, a bowl of plain oatmeal, two slices of toast, decaf coffee or tea sweetened with a teaspoon of sugar. Two hours after you finish the meal, blood is drawn again to measure sugar and insulin.
If the two-hour insulin level has at least doubled from the baseline level, your pancreas is still clearly producing insulin. That’s excellent news, because it means the ABSCP alone should be effective for managing your blood sugar. If the two-hour insulin level hasn’t doubled, this suggests that your insulin production is low. Don’t despair. You may well need medication or even supplemental insulin at this point, but the ABSCP will still be extremely helpful to you. Many of Dr. Atkins’ patients started the program needing diabetes medications and were able to reduce the doses or even stop taking the drugs completely. (We’ll discuss drug treatment for Type 2 diabetes in detail in the next chapter.)
THE C-PEPTIDE TEST
Another, somewhat indirect way to check your insulin production is a blood test for c-peptide. This protein is a normal by-product of insulin production, so your level of c-peptide is an indication of how much insulin your pancreas is making. Because the normal ranges may vary among laboratories, you should compare your results with the normal results reported by the lab you use. The higher above the norm your c-peptide level goes, the more hyperinsulinemic you are.
Krystal M. was only 19 years old when she first came to see me, but she already had a well-advanced case of the metabolic syndrome. At 5 feet 8 ¾ inches tall, she weighed 288 pounds. Her c-peptide blood level was 9.8 ng/mL (more than twice the normal range), her triglycerides were 180, her total cholesterol was 182, her HDL was 33, her fasting blood sugar was 95, and her A1C was 5.6. In addition, she required two medications that made it difficult to manage her weight. Nine months after beginning her controlled-carb program, Krystal had lost 40 pounds and 5 ¼ inches from her waist. Her lab values improved: her c-peptide was normal at 3.6 ng/mL, her triglycerides were 161, her total cholesterol had dropped to 161, her HDL was 35, her LDL was 113, her fasting blood sugar had dropped to 78, and her A1C was 4.6. At the two-year point, Krystal weighed 186, and she had lost 15 ¼ inches at her waist. Her lipid lab
In addition to the GTT,Dr.Atkins would typically order:
a lipid panel consisting of total cholesterol, triglycerides, HDL, and LDL;
routine chemistry tests (also known as a comprehensive chemistry panel ), including those for liver function, kidney function, uric acid, and electrolytes;
CBC (complete blood count);
thyroid function, including TSH, free T3, and free T4.
As a cardiologist, he also screened for markers of cardiovascular risk, such as C-reactive protein (hs-CRP), homocysteine, lipoprotein(a), and fibrinogen. These tests are crucial for patients who have elevated lipids, hypertension, known heart disease, diabetes, or a strong family history of heart disease.We’ll discuss these risk factors in more detail in Chapter 9, The Cardiac Connection.
----
ARE YOU MAKING INSULIN?
If you have been newly diagnosed with diabetes, stressing the system with a glucose tolerance test may not be appropriate.The key question is discovering how much insulin your pancreas is still producing. Does your pancreas produce high, normal, or low amounts of insulin? The answer is extremely important, as it can influence the kind of treatment you are given.
Instead of the GTT, Dr. Atkins would have these patients do a two-hour postprandial (after a meal) test.This is a way of determining how high your insulin and blood sugar go two hours after you eat a high-carb meal. To do the two-hour postprandial test, you fast for 12 hours (water is allowed) before the test. A blood sample is drawn for blood sugar and insulin. You then eat a standard high-carb breakfast as recommended by the American Diabetes Association: six ounces of orange juice, a bowl of plain oatmeal, two slices of toast, decaf coffee or tea sweetened with a teaspoon of sugar. Two hours after you finish the meal, blood is drawn again to measure sugar and insulin.
If the two-hour insulin level has at least doubled from the baseline level, your pancreas is still clearly producing insulin. That’s excellent news, because it means the ABSCP alone should be effective for managing your blood sugar. If the two-hour insulin level hasn’t doubled, this suggests that your insulin production is low. Don’t despair. You may well need medication or even supplemental insulin at this point, but the ABSCP will still be extremely helpful to you. Many of Dr. Atkins’ patients started the program needing diabetes medications and were able to reduce the doses or even stop taking the drugs completely. (We’ll discuss drug treatment for Type 2 diabetes in detail in the next chapter.)
THE C-PEPTIDE TEST
Another, somewhat indirect way to check your insulin production is a blood test for c-peptide. This protein is a normal by-product of insulin production, so your level of c-peptide is an indication of how much insulin your pancreas is making. Because the normal ranges may vary among laboratories, you should compare your results with the normal results reported by the lab you use. The higher above the norm your c-peptide level goes, the more hyperinsulinemic you are.
Krystal M. was only 19 years old when she first came to see me, but she already had a well-advanced case of the metabolic syndrome. At 5 feet 8 ¾ inches tall, she weighed 288 pounds. Her c-peptide blood level was 9.8 ng/mL (more than twice the normal range), her triglycerides were 180, her total cholesterol was 182, her HDL was 33, her fasting blood sugar was 95, and her A1C was 5.6. In addition, she required two medications that made it difficult to manage her weight. Nine months after beginning her controlled-carb program, Krystal had lost 40 pounds and 5 ¼ inches from her waist. Her lab values improved: her c-peptide was normal at 3.6 ng/mL, her triglycerides were 161, her total cholesterol had dropped to 161, her HDL was 35, her LDL was 113, her fasting blood sugar had dropped to 78, and her A1C was 4.6. At the two-year point, Krystal weighed 186, and she had lost 15 ¼ inches at her waist. Her lipid lab
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