Insulin production or insulin resistance or inefficient B-cells

by Varun

Dr. Alba, As I understand, high sugar level (or diabetes) is only an exhibition of the underlying problem in your body.

This could be less insulin production or insulin resistance or inefficient B-cells, poor health of pancreas/liver etc etc.

Can you please explain as to how a patient can home on to the exact diagnosis of his high sugar level?



I read your message and understood your medical problem.

Diabetes is a very common disease in the modern world nowadays. It expresses an underlying problem in the organism and this is what differs one type of diabetes from the other types.

Type 1 diabetes is as a result of an improper immune system which destroys the cells in the pancreas that produce insulin.

Thus less insulin is produced and glucose can not enter the cells properly.

This is said to be an autoimmune reaction or autoimmune cause as the body is attacking itself.

Specific causes are not found yet but some triggers are well known such as infections, toxins in food or other unidentified components that have the potential to cause an autoimmune reaction. Genetics is also important.

Type 2 diabetes is a result of many factors acting at the same time thus it is a multifactorial disease.

The most important factor is the family history of diabetes. Important risk factors include sedentary life, obesity, bad eating habits, aging etc.

Some diseases and pregnancy may play a role in the developing process of this type of diabetes.

Another type of diabetes is known as gestational diabetes which is diabetes in pregnancy.

The exact causes remain unknown but risk factors like family history, overweight, polycystic ovary syndrome and some articles mention the ethnicity as well among the risk factors.

Cushing syndrome can be an underlying cause of diabetes as the increased levels of cortisol raise the blood glucose levels.

Glucagonoma is a tumor of the pancreas which produces more glucagon hormone and disbalances the glucagon-insulin equilibrium.

Pancreatitis and pancreatectomy can cause diabetes as less hormone is produced.

The prolonged use of steroids can induce diabetes but this is quite a rare form of diabetes.

Diabetes no matter the cause is identified by the standard test which distinguishes the blood glucose levels and more.

The most important tests that must be done are A1c, random glucose test, fasting glucose test, oral glucose tolerance test.

You may repeat these tests and do other tests as well to identify the exact underlying cause of diabetes.

For example, measuring the hormones in blood, specific tests of the disease that are known to cause diabetes etc.

Personal and family history is very important in planning the treatment and identifying all the risk factor present.

The symptoms vary on the type of diabetes but symptoms of hyperglycemia are universally present in all types.

If you have specific question feel free to ask again.

Hope this was helpful for you.

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Apr 15, 2017
Tests to determine underlying cause
by: Varun

Dr. Alba, you still haven't answered the basic question, I am afraid. The tests (Fasting, PP, HbA1C etc) are only indicators of the severity. Which are the tests which can help me find the underlying cause so that I can target that.


Apr 18, 2017
Insulin testing explained
by: Dr.Albana

Hi back Varun,

Thank you for your further clarifications.

I now understand what exactly you are looking for.

Ok, the part of monitoring blood sugar levels will help us determine if diabetes and how well we are managing it.

Now, you are interested in understanding what is lacking in your body that has caused this glucose impairment.

You are right: everything starts with insulin produced by pancreas.

In diabetics, this insulin lacks partially or totally, but sometimes, it is normally produced but not totally effective.

To understand if your pancreas is producing enough insulin or not we ask to run a specific test called insulin C-peptide test.

Please take note that C-peptide is a byproduct created when insulin is produced. By measuring this byproduct, we can determine how much insulin is really produced by pancreas.
The higher the C-peptide, the higher insulin produced and vice-versa.

Next, can ask your doctor to run 2 hour insulin glucose tolerance test. During this test, glucose level is measured along with insulin levels. In this way, we can understand what is really happening and causing your glucose impairment.

Hope this answers your query.
Please write me back if you have further questions. I'll try my best to help you further.

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