So I had another patient I wanted to talk about, another interesting case. This one also has to do with blood sugar management, type 2 diabetes, that kind of stuff. So I just posted another one kind of in that genre. I figured I'd stick with the trend and throw another one of these up here.

This is an older gentleman. We've been working with him for a while. He does have a cancer history, and blood sugar is not well managed. We're running fasting blood sugars in the 150s, 140s most of the time, and that's pretty much with diet. Triglycerides tend to run in the 165, kind of 170 range. I like it below 100, so definitely not saying this is good blood sugar management. But we had seen worse on him. Hemoglobin A1C had been running in the upper sevens. Again, not where I'd like to see it, but better than it's been. We didn't have a fasting insulin, partly because I wasn't the one that ran the previous blood work, but that's kind of where we were.

Now, he had gone in for a surgical procedure and as part of the pre-surgery blood work, they checked blood sugar, and his fasting blood sugar came in closer to 350. This was, I don't know, I guess it was probably about eight weeks, maybe 10 weeks after the previous check that I had just mentioned where his fasting blood sugar was in the 150s I think it was, low 150s. So in eight to 10 weeks it went from 150 to 350. That's a significant jump and arguably kind of alarming, and so they said, "We can't do the procedure. Go back to your doctor. Figure this out." Triglycerides had gone up to 196, and his hemoglobin A1C was now 12.5. Crazy bad.

But on our test we followed up with a fasting insulin. So when we did the fasting insulin, it came in at eight. Now, those of you that have heard me talk about fasting insulins in the past, I like it below 10. That generally means that someone is fairly well-managed, or even if they're not managed, they are fairly metabolically healthy. They're not all that insulin resistant if they can get by with an insulin of seven, eight, nine, even 10. So for him to come in with an insulin of eight, that doesn't match his blood sugar of almost 350. With a blood sugar of 350, he should have an insulin that's sky-high if it's just because of insulin resistance. So how do you explain that? Why would he have an optimal fasting insulin level with a blood sugar of 350? And this is on the same sample.

Well, the blood sugar of 350 is probably partly because his insulin is so low. He's not making enough insulin. He's likely still considerably insulin resistant. He's just not making enough insulin, not nearly enough, to manage this kind of blood sugar given his insulin resistance. So why would that be? I mean, it could be a signaling issue, but I doubt that's the case. What's likely happening is the pancreas is losing its ability to make insulin, and he is transitioning from type 2 to type 1, and this will be a different kind of type 1. Type 1 diabetes doesn't have to involve any insulin resistance at all. You could have perfectly normal in insulin signaling, there's just no insulin to send the signal. In his case, he will end up being a type 1 with insulin resistance, where even if he takes insulin, he won't listen to it, he'll have to take very high amounts of insulin. Well, because he is got a cancer history that's kind of risky. Even for anybody, it's risky. There's a big push to control blood sugar but kind of ignore insulin levels once you have a type 2 diabetic.

Honestly, in my opinion, I think several other functional medicine doctors share this opinion, that the insulin can do damage to nerve tissue and blood vessels just like blood sugar can. If you drop the blood sugar but you have this massive amount of insulin, you're still doing damage, and so trying to find a lower blood sugar but requiring as little insulin as possible to get there is probably the sweet spot. It's just a matter of how low can you get both of them.

So anyway, we're starting down that road, but it was an interesting case where all of a sudden there was this significant jump in blood sugar and in A1C, meaning the damage to the red blood cells from having the high blood sugar, but yet his insulin numbers looked ideal for a normal patient. They just didn't match his situation. Now, with an insulin level of eight, could he still stay off of insulin? Well, if he ate a diet that required next to zero insulin, then potentially yes, he could have minimal insulin, if not, maybe no, insulin a fair amount of time. But that involves fixing the insulin resistance and eating a diet that requires almost no insulin. So he's going to have to navigate learning what he eats, what his levels are, how much insulin he can use to keep the blood sugar decent but still not take large amounts of insulin.

Anyway, interesting case, type 2 converting to type 1, kind of an insulin resistant type 1. So we'll see how he does over time. It was just an interesting situation where we got a call from the other doctor saying, "I can't do this procedure. He's out of control." We didn't expect that because recently his blood work had not been that far out of control. He would've qualified for the procedure with no problem.

So anyway, just wanted to throw that out there. Another blood sugar management case that had kind of an interesting twist to it that if we hadn't been doing the fasting insulin, we would not have understood his complete situation. All right, let me know if you have any questions about it. Hope that helps you out if you ever run across one of these or if you are one of these. But another illustration of why getting a full blood sugar panel, fasting blood sugar, triglycerides, A1C, and a fasting insulin, why that is so important to understand all facets of the case. All right, have a good one. See you next time.