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ForumsLab Results & BiomarkersInsulin levels — anyone have experience?

Insulin levels — anyone have experience?

SandraNC_45 Fri, Mar 22, 2024 at 5:25 AM 40 replies 2,260 viewsPage 1 of 8
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SandraNC_45
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Mar 22, 2024 at 5:25 AM#1

Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.

Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c becomes informative again, since it reflects about three months of glycaemia. After the first year, and once doses are stable, annual is reasonable unless something specific is being followed.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

What I actually want to know is how often to repeat it, because quarterly seems to be the convention and I cannot find the reasoning. Numbers rather than impressions, if you have them.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
41 11FranDenver, Dr.BariatricHTX, LindaRN_retired and 38 others
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PharmD_Rodriguez
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Mar 22, 2024 at 6:11 AM#2
SandraNC_45 said:
Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c…

No disagreement with SandraNC_45. One condition attached. A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin and B12, and a full blood count. That set catches the things that change, the things that explain symptoms, and the things that alter the prescribing decision. Almost everything else on the long circulating lists is either invariant, uninterpretable without a specific question, or an incidental finding waiting to cause an unnecessary workup.

Last edited: Mar 22, 2024 at 11:11 AM
40 10TinaHashiRN, robert_kc, dan_philly and 37 others
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Dr.KarenChen
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Mar 22, 2024 at 6:57 AM#3
SandraNC_45 said:
Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I would drop the "get everything" instinct further than this thread does. Every extra test is another chance at a false positive, and incidental findings have their own cost in scans, biopsies and worry.

39 9TomFromTexas, mike.trainer_LA, sarah_nash92 and 36 others
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PharmHunterJen
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Mar 22, 2024 at 7:43 AM#4

Taking the question as asked, rather than the general version of it. The single most useful discipline is bringing the whole panel to a clinician rather than one flagged value. One out-of-range result in isolation generates anxiety and unnecessary tests; the same result next to the trend and the rest of the panel usually generates a shrug.

38 8Dr.PainCLE, mike_mealprep, NicoleRaleigh and 35 others
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laura_annarbor
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Mar 22, 2024 at 12:04 PM#5
PharmD_Rodriguez said:
A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin…

Can confirm. Same sequence, different timescale. Posting only so the count is not one.

37 7JenMemphis, pat_auckland, Dr.GastroMayo and 34 others
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