High insulin in teen who eats healthy? Sleep apnea maybe?

[Ann.without.an.e]

I'm still waiting on all of DS's labs to return (as we talked about in an earlier post) but I have most of them back.

Help me think through this a little. His insulin is high, his A1C was normal but on the high end of normal, glucose was fine when tested in the afternoon. I'm not sure why this was not tested again. 

He eats really healthy and doesn't typically overeat. He is gf and df and doesn't even like to eat a lot of sugar. He doesn't drink soda or eat fast food (this kiddo has never even eaten at a restaurant like McDonalds in his life and as far as I know has never even had a standard soda like coke or Pepsi). He is very health conscious. As I said in the other post, he is a bit frustrated that he is holding weight in his middle even though he eats good and exercises. 

so what would cause this?

As tired as he's been, I'm wondering if I should have a sleep study done to evaluate him for sleep apnea? It seems that can cause high insulin, weight gain in the middle, etc. I have noticed that he sleeps with his mouth open and he cannot seem to stop this. I know nothing about sleep apnea, I just know it keeps popping up as suspicious. 

Should I start with an ENT? Any other thoughts. 

Of course, I had him stop taking B just to see if it helped and in just the 10 days he hadn't taken it, the B and the ferritin tanked and MCHC tanked and MPV was high, such a change in that little of time definitely leads me to believe the kiddo has pernicious anemia, which we have suspected for some time. 

Thanks 🙂 

Edited to change the title some 

Edited July 24 by Ann.without.an.e

[QueenCat]

I would ask the family doctor/ped or whoever ordered the tests where to go next and what to do. 

[Katy]

GF/DF processed foods are almost pure starch and saturated fat IME. If he’s not eating any processed foods there’s a myriad of potentials, but that’s really something that needs to be determined by a doctor. 

[prairiewindmomma]

So here, sleep medicine for minors is run through a sleep clinic at the children’s hospital, and the primary can write for the study. Honestly, I’d fix the pernicious anemia first—if he isnt a loud snorer and you dont hear him gasping and choking himself awake or doing other scary sleeping, apnea wouldnt be my first pick.

I’d dig around blood sugars more. What happens if you put him on a lower carb diet? What does “eating good” look like? I ask because dh cant tolerate rice or beans at all with his blood sugars….he’s totally fit, exercises a lot, but if you look at his blood sugars on and off carbs, you totally see the disposition towards type 2 diabetes he inherited genetically.

[Katy]

OTOH, I can handle some carbs, but saturated fat will send my blood sugar through the roof. It’s different for everyone & it’s genetic. 

[Ann.without.an.e]

18 minutes ago, Katy said:

GF/DF processed foods are almost pure starch and saturated fat IME. If he’s not eating any processed foods there’s a myriad of potentials, but that’s really something that needs to be determined by a doctor. 

 

18 minutes ago, prairiewindmomma said:

So here, sleep medicine for minors is run through a sleep clinic at the children’s hospital, and the primary can write for the study. Honestly, I’d fix the pernicious anemia first—if he isnt a loud snorer and you dont hear him gasping and choking himself awake or doing other scary sleeping, apnea wouldnt be my first pick.

I’d dig around blood sugars more. What happens if you put him on a lower carb diet? What does “eating good” look like? I ask because dh cant tolerate rice or beans at all with his blood sugars….he’s totally fit, exercises a lot, but if you look at his blood sugars on and off carbs, you totally see the disposition towards type 2 diabetes he inherited genetically.

 

 

We don't eat many processed foods, even GF/DF ones. I cook mainly from scratch, eating rice and potatoes for our carbs. I do sometimes make wraps or pizza dough with a flour that has sorghum as its first ingredient. 

 

[prairiewindmomma]

Track his macros. We see dh’s numbers change right around the 25-30g/day of carbs threshhold…basically he has to eat keto. 

[BeachGal]

Did his doctor have anything to say about the results?

Yes, not getting enough quality sleep can cause insulin resistance. A sleep study might shed some light. See what his doctor thinks.

You can use an app to check for episodes of snoring during sleep. SnoreLab is one. It records throughout the night and allows you to check the results the following day.

Some mouth breathers tape their mouth at night. If he were to try this, he could use a mouth tape and apply it vertically so that the sides of his mouth can still open and draw in air. Sleeping on his side might help, too.

A1c and blood glucose can be normal when insulin is high, especially initially. That’s not unusual.

Building more muscle can help because muscle cells can take in glucose directly.

Starches might be causing insulin spikes.

Benjamin Bikman. who researches insulin, might be worth following on social media for awhile. He has also written a book.

Virta Health could be worth trying also. The patient wears a continuous glucose monitor (cgm) that records blood glucose periodically throughout the day. Results are then discussed the next morning with a healthcare provider who would make suggestions. Virta was started by Sami Inkinen, a world-class athlete who was diagnosed with insulin resistance and studied by Stanford researchers. His story is interesting.

Your son’s desire to be healthy will help him immensely. Just has to figure out what’s going on.

Edited July 24 by BeachGal

[Toocrazy!!]

A high fasting insulin number is a precursor to glucose issues by several years. As I’ve heard it explained, your body does everything it can to keep glucose levels steady, so it secretes the insulin to do that. The more it needs to regulate the glucose the higher the fasting insulin gets while glucose and A1c are still in normal range. 
even healthy carbs cause spikes- oatmeal, gf bread, and rice are big culprits. You could try to add more protein and healthy fats like nuts and seeds to each meal and see if a steadier blood sugar throughout the day makes him less tired. 
but pernicious anemia is exhausting from what I hear, so that would definitely be a focus point. 

[kbutton]

Pernicious anemia and type 1 can go together, IIRC. They are both autoimmune. 

[Toocrazy!!]

What was his fasting insulin number? 

[Ann.without.an.e]

11 hours ago, BeachGal said:

Did his doctor have anything to say about the results?

Virta Health could be worth trying also. The patient wears a continuous glucose monitor (cgm) that records blood glucose periodically throughout the day. Results are then discussed the next morning with a healthcare provider who would make suggestions. Virta was started by Sami Inkinen, a world-class athlete who was diagnosed with insulin resistance and studied by Stanford researchers. His story is interesting.

Your son’s desire to be healthy will help him immensely. Just has to figure out what’s going on.

 

We haven't had the follow up appt yet so we will definitely be talking to her about this but not yet. 

 

Yes, I'm very glad it is not my older son because his diet is awful and he has no desire to eat right and, at 23, there's nothing I can do about that. This kiddo wants to eat and be healthy. 

 

 

10 hours ago, Toocrazy!! said:

A high fasting insulin number is a precursor to glucose issues by several years. As I’ve heard it explained, your body does everything it can to keep glucose levels steady, so it secretes the insulin to do that. The more it needs to regulate the glucose the higher the fasting insulin gets while glucose and A1c are still in normal range. 
even healthy carbs cause spikes- oatmeal, gf bread, and rice are big culprits. You could try to add more protein and healthy fats like nuts and seeds to each meal and see if a steadier blood sugar throughout the day makes him less tired. 
but pernicious anemia is exhausting from what I hear, so that would definitely be a focus point. 

 

 

What do you do about pernicious anemia other than take B and iron in hefty doses?

 

 

8 hours ago, Toocrazy!! said:

What was his fasting insulin number? 

 

8 hours ago, kbutton said:

Pernicious anemia and type 1 can go together, IIRC. They are both autoimmune. 

 

 

High insulin would be a precursor to type 2 right? Not type 1? I don't know much about diabetes but I thought type 1 was basically a lack of insulin rather than high insulin?

 

The thirst and frequent urination and tiredness are signs of diabetes but his glucose in his CMP in May was fine. That blood draw was not morning or fasting though. 

 

She took an insulin total, it was done morning and fasting. It was 32 and I think it should be 24 or lower, if I remember correctly? I have no idea if this is considered slightly high or more elevated than that. 

 

ETA another question

Edited July 25 by Ann.without.an.e

[Katy]

High insulin could come before any kind of diabetes, even rare ones like MODY or LADA. You can also get one type first and another type later (double diabetes). 

There are other causes of high insulin, but they are much less likely than eating too many carbs or saturated fat for the person. At this point lab work is more important than strangers opinions though. Some of those rare reasons are very serious. 

[Ann.without.an.e]

I have an inexpensive glucose monitor and I tested his morning glucose and it was 108. Google says this is prediabetic. He had salad for supper with some chicken. No bread or carbs with it and not snacks or dessert. 

I had crossed glucose concerns off the list since I tested him about 6 months ago and he was 80 in the morning. 

Edited July 25 by Ann.without.an.e

[Kanin]

It sounds like the doc needs to do the glucose tolerance test with him. I'm wondering if what you're seeing is something that will eventually turn into type 1 diabetes. Hoping not, though!! Lots of people do get diagnosed in their 20s and 30s though. 

[Katy]

Does he drink energy drinks in the morning? High fasted glucose is sometimes in response to high cortisol levels the day before. That can be caused from a single can of Monster Ultra (without sugar). 

[prairiewindmomma]

I wonder if it’s Somogyi effect (body pushed out too much insulin so body pushes out more glucose) or Dawn phenomenon—cortisol and/of growth hormone both can push your morning fasting numbers up.  I’d keep testing to see if you see some patterns—cgm would be best but it’s hard to get insurance to cover it. I think there is something here, it’s just subtle still….probably because he does eat well and exercise.

[Ann.without.an.e]

25 minutes ago, Katy said:

Does he drink energy drinks in the morning? High fasted glucose is sometimes in response to high cortisol levels the day before. That can be caused from a single can of Monster Ultra (without sugar). 

 

Nope, he wouldn't drink anything from a can haha. This kid is a serious health nut. He only has caffeine sometimes as black tea, he loves tea, but he doesn't even drink that every morning, much less excessively. 

[Ann.without.an.e]

So, I calculated the carbs in his breakfast. 

2 eggs with peppers and onions, scrambled in a small drizzle of e.v.o.o

3/4 cup of vegan yogurt - unsweetened plain. this has 9 carbs, 13 fat, 1 sugar, 5 protein

1/2 cup strawberries, 5.5 g carbs

1/2 T of enjoy life mini chocolate chips, 4.5 grams of carbs

 

this comes to 19 grams of carbs

Edited July 25 by Ann.without.an.e

[Ann.without.an.e]

14 minutes ago, prairiewindmomma said:

I wonder if it’s Somogyi effect (body pushed out too much insulin so body pushes out more glucose) or Dawn phenomenon—cortisol and/of growth hormone both can push your morning fasting numbers up.  I’d keep testing to see if you see some patterns—cgm would be best but it’s hard to get insurance to cover it. I think there is something here, it’s just subtle still….probably because he does eat well and exercise.

 

I wonder how expensive a CGM is without insurance? 

[prairiewindmomma]

2 minutes ago, Ann.without.an.e said:

 

I wonder how expensive a CGM is without insurance? 

It all depends on what you get—a Dexcom runs SIL about $1500 every 3 months pre-insurance. I hear the FreeStyle Libre is much cheaper.

[City Mouse]

Have he gotten the same Results on multiple tests? I wouldn’t worry about treating or changing anything until you have more data over time. One time results could be caused by all kinds of things. 
 

[gardenmom5]

How's the fiber intake? increasing that can decrease insulin.

[JennyD]

I have no medical expertise to share, but having read both of your posts (and having teenage sons myself) I think that you are doing absolutely the right thing in really trying to figure out what is going on. 

In your shoes,  I would be very aggressively trying to get an appointment on the calendar with the best endocrinologist I could find.  IME, this can take months (although we have had pretty good luck with cancellation lists) so I'd start immediately.  

Best wishes to you and your boy.  I hope that you can get to the bottom of this soon.  

[Ann.without.an.e]

So we tested after breakfast and his glucose was 100, lower than fasting.

We tested after lunch and it was 102, even though he had a little more carbs with lunch (not a lot, just a pita wrap with veggies as a side). 

So even though it was technically pre-diabetic fasting, these numbers are pretty low for after eating?

 

[BeachGal]

I still wonder if your son might be dealing with a type of long Covid or some kind of damage post Covid. If you search for “long Covid” or “Covid” and “insulin resistance” you’ll get a number of articles.

I follow a lot of Bikman’s research and see if he has anything to say.

Your son’s glucose numbers after eating seem okay and diet as well. If you want to check surges in insulin, Bikman suggests taking blood pressure readings. You’d do these throughout the day to gauge how he tends to be.

[kbutton]

13 hours ago, Ann.without.an.e said:

High insulin would be a precursor to type 2 right? Not type 1? I don't know much about diabetes but I thought type 1 was basically a lack of insulin rather than high insulin?

 

The thirst and frequent urination and tiredness are signs of diabetes but his glucose in his CMP in May was fine. That blood draw was not morning or fasting though. 

There aren’t just Types 1 and 2. There is LADA/Type 1.5, maybe other patterns.