Dr. Ben Bikman

Right.

Yeah.

And yet so common.

Right.

I mean, that that adds an extra layer of reason to talk about this because it is it's become the most common problem.

People – much of modern clinical care has what I call a glucose-centric paradigm when it comes to monitoring metabolic health or even cardiometabolic health given how relevant diabetes and metabolic problems are to cardiovascular disease.

But the consequence of the glucose-centric paradigm – and there's reasons for it, so I don't mean to state this in any kind of incriminating way –

They have their own justification for the glucose-centric paradigm, but it's increasingly harder to overlook because of what we know with regards to insulin.

So insulin resistance is the state where insulin levels are higher, the body's having to use more and more insulin in order to keep glucose stable.

in in check but because it is able to keep glucose at that normal range it flies under the clinical radar because of our glucose centric paradigm the conventional clinician is only measuring glucose every time the patient's coming in for an annual visit with no regard

to the patient's insulin levels.

If we were able to broaden the paradigm a little bit and include insulin, then all of a sudden we are measuring the earliest signs of insulin resistance because it is insulin itself that ought to be measured when we're trying to get that view of the patient's not only metabolic health, but insulin resistance.

So to stay all that another way, type 2 diabetes is when both

Insulin is high, but it's starting to really lose the war.

And now glucose rises as well.

Then the conventionally trained clinician says, oh, the glucose is elevated.

So you have diabetes or prediabetes.

But in its earliest stages, the glucose is still normal.

But there's this cold war happening in the body where the insulin levels are still two or three or four times higher than they used to be.

It needs to be that high, and it's working well enough to keep the glucose in check.