1/ Thread (with polls!)- Higher Fasting Glucose + Lower Insulin

Here's the setup: Imagine a group of people who go low carb, are fit/healthy, and see their fasting glucose in the 90s to low 100s, yet fasting insulin <5. Are they at a higher risk to develop Type 2 Diabetes (T2D)?

2/ Now imagine we strap all of them with Continuous Glucose Monitors (CGMs) and find they have nearly a flatline throughout the day (see below), with glucose in a tight delta between, say, 90 and 108.

3/ Did this new CGM data affect your answer?

4/ We look for any genetics that might result in higher glucose yet normal-ish insulin levels.

Here's an example: Heterozygous Glucokinase, who often have FBG of 97 to 149 yet no higher T2D complications than general population. https://care.diabetesjournals.org/content/38/7/1383

ht @siobhan_huggins

5/ Did this genetic disease that results in high fasting glucose yet low prevalence of diabetes complications affect your answer?

6/ Lastly, we check into the remarkable work of Dr Joseph R Kraft. He demonstrated higher insulin levels (particularly postprandial -- which is following a meal) are highly correlated with T2D and future development of T2D. https://thefastingmethod.com/understanding-joseph-kraft-diabetes-in-situ-t2d-24/

7/ Unfortunately, we can't do a standard Oral Glucose Tolerance Test (OGTT) with low carbers given they are fat-adapted and likely to fail it -- but it's worth noting that I believe this is for the same reason we see the lower fasting insulin alongside moderately higher glucose.

8/ But we do note that his work demonstrates insulin is far more relevant to diabetes (and heart disease, btw) than glucose levels, as the latter comes in the later stages in large part as a result of impaired insulin regulation.

9/ In other words -- context matters!

In the context of low, but clearly sufficient and consistent insulin where fat-adapted- alongside <fill in the blank> levels of glucose that appear to be regulated to a tight delta... it's hard for me to not to speculate this as homeostasis.

10/ So no, I do not predict this group is at high risk for developing T2D, I'd predict the opposite -- that they are at much *lower* risk. Yes, this is even in spite of regular fasting glucose in the 90s to low 100s.

But as always, this is uncharted territory. #NeedTheData

Of course, one excellent thinker on this specific subject is @BenBikmanPhD. Ben, care to add any thoughts? Would you make the same prediction I am?