From the Guidelines
A normal Hemoglobin A1C (HbA1C) level with an elevated insulin level is indicative of insulin resistance, a precursor to type 2 diabetes, and requires immediate lifestyle interventions to prevent disease progression. This condition, often referred to as hyperinsulinemia, signifies that the body is producing extra insulin to maintain normal blood sugar levels, which can eventually lead to metabolic dysfunction and type 2 diabetes if left unaddressed 1. The significance of this combination lies in its ability to identify individuals at high risk of developing diabetes, even when their blood glucose levels are within the normal range.
Key Considerations
- Insulin resistance is a critical early warning sign of metabolic dysfunction, and its identification through elevated insulin levels, despite normal HbA1C, warrants prompt intervention.
- Lifestyle modifications are the cornerstone of management, including weight loss of 5-10% if overweight, regular physical activity aiming for 150 minutes of moderate exercise weekly, and dietary adjustments to reduce refined carbohydrates and increase fiber intake 1.
- The use of metformin, starting at a dose of 500mg daily and potentially increasing to 1000mg twice daily, may be considered in some cases to enhance insulin sensitivity, especially in individuals with additional risk factors for diabetes.
- Intermittent fasting regimens, such as the 16:8 method, can also be beneficial in reducing insulin levels and improving insulin sensitivity.
Monitoring and Follow-Up
Regular monitoring of both insulin and glucose levels is crucial to assess the effectiveness of interventions and to make necessary adjustments. This approach allows for the early detection of changes in glucose metabolism and the implementation of preventive measures to reduce the risk of progressing to type 2 diabetes. Given the continuum of risk associated with glycemic measures, as noted in the Diabetes Care report 1, a proactive and multifaceted approach is essential for individuals with insulin resistance and normal HbA1C levels.