What is the significance of an insulin level of 39.8, indicating hyperinsulinemia?

From the Guidelines

Insulin 39.8 units is a high dose that necessitates careful administration and monitoring to prevent overbasalization and hypoglycemia, as indicated by the latest standards of care in diabetes-2024 1. For a patient prescribed this dose, I recommend administering it exactly as prescribed, using proper insulin injection technique.

• Draw up the precise amount using an insulin syringe with clear markings,
• Injecting into rotating sites such as the abdomen, thighs, or upper arms to prevent lipohypertrophy. This high dose suggests significant insulin resistance or advanced diabetes requiring substantial supplementation.
• Monitor blood glucose levels before and after administration, watching for hypoglycemia symptoms like shakiness, confusion, or sweating.
• Keep fast-acting carbohydrates nearby (15-20g such as juice or glucose tablets) to treat potential low blood sugar. According to the latest guidelines, monitoring for signs of overbasalization during insulin therapy is crucial, especially when the basal dose exceeds 0.5 units/kg/day 1. The patient's individual needs, including body weight, insulin sensitivity, carbohydrate intake, and overall metabolic health, should be taken into account to tailor therapy and prevent complications. As the American Diabetes Association and the European Association for the Study of Diabetes suggest, abnormal islet cell function is a key feature of type 2 diabetes, and enhancing insulin action can relieve β-cell secretory burden 1. However, the most recent guidelines from 2024 should be prioritized when making clinical decisions regarding insulin therapy 1.

From the Research

Insulin Levels and Diabetes

• The provided value of 39.8 is likely related to insulin levels, but without context, it's difficult to determine its significance.
• However, according to the study 2, the optimal A1C cut-off for diabetes defined by OGTT was 6.1%, and using current criteria of fasting plasma glucose (FPG) < 5.56 mmol/L to exclude and ≥ 7 mmol/L to diagnose diabetes, the sensitivity, specificity, and OGTT required were 77.2,100, and 13.5%, respectively.

Relationship Between Insulin Resistance and Glycosylated Haemoglobin (HbA1c)

• The study 3 found that HbA1c was more strongly associated with insulin sensitivity in subjects with normal glucose tolerance (NGT) than in those with impaired fasting glucose (IFG).
• The study 4 investigated the feasibility of using the estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to estimate insulin resistance in young adult diabetes and found that the homeostasis model assessment of insulin resistance level was significantly associated with the eAG/fPG ratio.

Treatment of Type 2 Diabetes and Insulin Resistance

• The study 5 discussed novel targets and mechanisms for the treatment of type 2 diabetes, including glucose-lowering effects and the potential clinical use of the salutary adipokine adiponectin and the hepatokine fibroblast growth factor (FGF) 21.
• The study 6 found that updated mean HbA1c, 1-hour glucose, and 2-hour glucose after an oral glucose tolerance test were associated with cardiovascular disease in individuals with elevated risk for diabetes.

Insulin Resistance and Cardiovascular Disease

• The study 6 found that current 2-hour glucose level in people with impaired glucose tolerance is associated with increased risk of cardiovascular disease, supporting its use in screening for prediabetes and monitoring glycaemic levels of people with prediabetes.