Being in a state of optimal metabolic health is immensely important for both quality of life and avoidance of disease. Nevertheless, over 49.6% percent of Americans are in poor metabolic health as indicated by the presence of diabetes or pre-diabetes. Even worse, there are millions more who are headed in this direction and have no idea. The early stages of metabolic dysfunction are asymptomatic, therefore it’s essential to check for signs early and often. Standard lab tests (blood glucose, A1c) will only tell you if you’ve already progressed to the point of diabetes — they won’t provide any warning signs that you’re heading in that direction and need to change course. This is why we rely on different methods to keep tabs on our metabolic health, and specifically our ability to regulate glucose.
The first option for taking a snapshot of your metabolic health is an oral glucose tolerance test (OGTT). This is where you drink a substantial amount of sugar (usually 50 to 100 grams) and blood samples are collected at various time points. Many labs and doctor’s offices will offer some variation of this test, but it’s rare to find one that includes both glucose and insulin measurements, which is absolutely critical. Our protocol is to measure these values every half-hour for 2-4 hours. If performed and interpreted correctly, an OGTT can reveal signs of insulin resistance years before abnormalities appear on standard lab tests.
Another option for understanding your metabolic health would be continuous glucose monitoring (CGM). This technology was initially created for individuals with diabetes, but is also gaining popularity as a diagnostic and preventive tool. There are many companies who offer CGM, with the most reputable being Dexcom, Abbott, and Medtronic. The devices are placed on your skin, usually on the arm or abdomen, and a small filament sits just below the skin which allows for glucose measurements around the clock. In some ways, this is preferable to an OGTT. A single sensor will allow you to see blood sugar measurements over a period of 7-14 days with virtually no effort required. It’s also nice to see how your body responds to the foods and drinks you consume on a regular basis — the sugar bomb used in an OGTT, while informative, is not very realistic. The main drawback of CGM is that you're unable to measure insulin levels, so you may miss that first warning sign of metabolic dysfunction. It’s still far superior to a spot glucose measurement or hemoglobin A1c, however.
While these are our two preferred methods, the reality is that they’re fairly difficult to access. An OGTT, even done our way, should be simple and affordable. In practice, however, they’re hard to obtain and expensive. The same can be said for CGM. A 3-pack of Dexcom G7 sensors, which we’re fortunate to have access to, retails for around $180 even with the largest discounts from GoodRx. Until we convince healthcare payers (insurance companies and the government) to place an emphasis on preventive measures, it will remain difficult to get an accurate glimpse of your metabolic health. This doesn’t make it any less important, however, so if you have the means we would highly recommend pursuing one, if not both, of these metabolic health assessments at least once annually.
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