If you’re curious about what it looks like to stop pursuing weight loss, click here for some fabulous freebies that will help guide you in your journey!

Click here to leave me a review on iTunes and subscribe. This type of kindness helps the show continue!

Find FREE food voice resources here.

Thank you for supporting Find Your Food Voice!

Intro music: Bags are packed, are you ready to go?…This time tomorrow we’ll be on the road…riding with you into sunnier days…I wouldn’t want it any other way. 

Julie: It’s time to name the neglect from typical food advice. Welcome to the Find Your Food Voice podcast, hosted by me, Julie Duffy Dillon. I’m a registered dietitian with 20 years of experience partnering with folks just like you on their food peace journey. What have we learned? Well, cookie cutter approaches exclude too many people, and you don’t need to be fixed. It’s not you. It’s not me. It’s all of us. Only together we can start a movement and fix diet culture. And we will. Let’s begin with now.

Transition music: I want to see how the world turns round…Let’s go adventure in the deep blue sea…home is with you wherever that may be…home is with you wherever that may be.

Julie: Welcome to episode 347 of the Find Your Food Voice podcast. I am Julie Duffy Dillon. I am so glad to be here with you today for a listener question episode. So if you’re new to the podcast, welcome. And once a month I pick a question from a listener just like you. And we dive deep into a particular question and I do my best to answer it and it could be a question about some part of your relationship with food repairing or recovering your relationship with food or it could be about certain parts of health care and navigating um doctor, doctor’s office visits or lab work. And today’s question has to do with insulin levels. And I want to read the question for you. And this is a question that I get seriously whatever I do a webinar on PCOS. This is a question I get every single time and it’s one that I get emailed very often. So when I saw this listener question pop up, I was like, yes, I have to answer this. And so here’s the question. “I hear you mention insulin often when talking about PCOS, also known as Polycystic Ovary Syndrome. I don’t have PCOS, but I do have carb cravings and I’m tired all the time. My doctor and I ruled out PCOS a long time ago, but something is definitely going on with my insulin. When I asked my doctor, she said my A1C is normal. So my insulin is fine. How does A1C measure insulin?”

Julie: OK. Thank you. First of all listener for this question, I love it so much because it is so like amazing to see the ripple effect of once someone understands the difference here. Not only does it help you in your own health care and advocating for yourself, but seriously, it helps like the people behind you who are trying to access the same information because doctor Star like understanding the difference between getting an A1C and actually what your insulin is doing. 

Julie: So with that all being said, we are going to do a quick book update. And if again, if you’re new to the podcast, welcome. And I’m writing a book, it’s called Find Your Food Voice. And in the Find Your Food Voice book. I am, let’s see. I am in the middle of chapter five, which there are 10 chapters, I believe there’s going to be 10, possibly 11 because one of my chapters is already very long. So I’m like, I may have to break it up. But with chapter five, I am at actually, I just calculated this morning after I did my writing time. I’m at 28,271  words, I’m estimating this book is going to be between 60- 80,000. So, you know, I feel like a big chunk is, is coming along and I’m like, what other updates should I give you? I feel like I’m at this place where my writing where it’s just a little nugget each day and again, it feels great. So I appreciate, you know, the questions I’ve been getting and the, I don’t know the cheers, the high fives that you’ve been giving me over email about writing this book. So thank you for the support. And it’s sometimes I’m like, maybe I actually will be done with this book before the publisher is requesting it in May. But I don’t know, it’s a long way off. So it may be really just hopeful thinking at that point, but we will see what happens. So that is my book update for you. If you would like to stay engaged with the process with the book, you can go to julieduffydillon.com/book and there is a way to just put your email in and so any book updates that I have outside of the podcast, I will send them right to you. All right. So we’re going to take a very quick commercial break. And then when we get back, I will dive in into this listener question and we’ll be right back. 

Julie: Welcome back. Let’s get to this listener question. So remember this person was wondering how does getting an A1C blood test actually measure insulin levels? And I love this question for so many different reasons. And by you being able to discern the difference, not only is it going to help you to understand what’s going on in your body and to advocate for yourself, but it’s also going to help people after you, especially if you are in the role of educating your doctor on the difference. OK. So insulin, the reason why I like getting a baseline insulin marker is if you have diabetes, prediabetes, PCOS, or just have been told you have insulin resistance, well, having a baseline every year of what’s going on with your insulin along with your own data on like fatigue levels, cravings like this person. And that asked the question, having that data all kind of contained every year just helps you to know is, you know, are things moving towards diabetes or not? Are they kind of stable and are they moving more towards it? And it also helps you to better be able to target what you’re going to do about it. And there’s a few things that are really unfortunate about the insulin, like blood tests. One, not so much anymore, but it used to be very expensive like thousands of dollars, but it is continuing to be very unreliable. So when you get a fasting blood sugar taken, you know, if you get a little finger stick at the doctor just to check your blood sugar or if you’re someone with diabetes and you check your blood sugar, that’s your, that’s your blood sugar in that moment. And a fasting blood sugar is in that moment or if you just do a random blood sugar, it’s in that moment, it tells you what your blood sugar actually is a fasting insulin or an insulin test is not actually that moment. It is an insulin level over the last three weeks. 

Julie: It’s kind of reminds me of A1C in that way and that it’s not just grabbing it in that moment. It is an average over the last three weeks. So that doesn’t really tell you everything you want to know because a fasting insulin, if we could actually get a picture of what your fasting insulin would be. We’d have a better idea of what kind of the baseline is. So, for many people, when they have these intense carb cravings or they’re really tired all the time, that is a kind of a message to me that gives me some clinical insight that insulin levels may be lagging um or just not working in the way that they were designed to work and getting a number and like a lab value I think can be super helpful. One reason is if you’re trying to move away from dieting and using weight as a measure of progress, having something else, maybe kind of comforting. You can always not use a lab value, you know, using your own kind of uh body’s way of experiencing things like energy levels and cravings is just fine, but I can appreciate, especially in the beginning, you want to maybe have something concrete as you’re trying to like re trusts your body again. So what has happened over time is that because a fasting insulin is not really something we have access to with our current technology and A1C has become kind of this overall umbrella to let you know how your body is working towards diabetes or not. 

Julie: And just in case you’re not really sure about an A1C, an A1C 20 years ago used to be called a hemoglobin A1C that’s not very helpful. But what an A1C measures is your graduated average of your blood sugar over the last three months, graduated means, well, it’s not like an equal amount for over the last three months. It’s mostly the last month and then a little bit more, uh, a little bit less of the two months ago and even less of three months ago. But it’s this average and it gives you kind of a snapshot, a bird’s eye view of what your blood sugar has been doing. And if you’ve had lots of higher blood sugars and your body is taking a longer time to bring them down, well, your A1C will be higher compared to controls. If you’ve had more lower blood sugars or your blood sugar is able to come down pretty quickly after meals because your insulin is working in the way it’s supposed to. Well, then your A1C will be in the normal range or in the controlled range. And so that’s why doctors are like, well, if your A1C is normal, that must mean that everything is functioning just fine and dandy, but that’s actually not correct. It is one way to kind of have a snapshot. But there is something that’s really interesting that researchers have taught us about those of you with insulin resistance. So insulin resistance is this condition that people with Polycystic Ovary Syndrome have. But also people with type two diabetes, prediabetes, sometimes just depending on your kind of pathway to diabetes. And then just folks who don’t have diabetes or prediabetes, sometimes people have this condition called insulin resistance. 

Julie: And it basically, you know, if you think about insulin as like a knife that helps cut up food, it really doesn’t do that. It really helps to message the cell of the body to allow, to allow glucose rather into the cell for energy. But um, if you think of insulin like a knife over time, it can become dull, it still works, but it just takes more knives to kind of move things along. And what we know with insulin resistance is there are certain stages of it where the body is not getting the energy it needs in the cell like insulin is like coming out, but it’s not actually um helping the glucose in the blood sugar to move into the cell to bring an energy. And so the body is like, hey, we need energy, right? And so the body is then when we just basically makes more insulin sends more out, your pancreas makes more and it sends more of this kind of dollar kind of insulin out. What is kind of cool is that eventually the body then makes so much insulin when insulin is kind of duller that it does bring down blood sugar and it does it at the same kind of speed. Um sometimes in the beginning um to bring down blood sugar that if it did if it had um, insulin that was fully functioning. It’s something that the body over time just figures out a way to compensate the kind of stages for folks who are in the zone of insulin resistance, eventually can become prediabetes. It doesn’t for everyone, but it can become prediabetes. Then diabetes when the body just, um, namely the pancreas starts to have fatigue and it just can’t keep up with that tremendous amount of insulin production and it slowly starts to make less insulin. And so blood sugar eventually starts to go up and that is caught in A1C but that takes years to happen. And so if you have a connection with your body where you can notice these intense carb cravings or you notice you’re fatigued all the time. That is a sign that insulin is becoming duller for many people. Your body in the beginning will make more insulin. So it’ll bring down the blood sugar years later though, it will start to become fatigued and make less insulin and then, then blood sugar will go up and be caught in the A1C. So I say all that because I want you to appreciate that. There’s this like span of time for many people. It’s years and years where insulin levels are high before blood sugar goes high. 

Julie: And there are some interventions you can do. Um if you listen to the podcast for a while, you know, I’ve worked with lots of people with PCOS or Polycystic Ovary Syndrome. And some of the things that we know with PCOS is making sure you eat enough, helping with stress, getting enough rest. And using some supplements like an Ovositol and Omega-3s, increase increasing protein intake while also eating enough carbs and fat also can help manage these insulin levels to help them just to be able to work while they’re duller a little bit better. So then the body doesn’t have to go through that pure exhaustion from making all this insulin. But there’s this like conundrum because A1C is not catching it. And insulin as a lab, whether it’s fasting or just a random insulin is not a really reliable test because it doesn’t give you a snapshot of the here and now it’s really just an average over the last three weeks. 

Julie: So, what can you do instead? Well, there is a test that you can actually do that tests your insulin level and gives you a better way of just measuring how much insulin your body needs to bring down blood sugar. And so this is a wonderful test, uh, blood test that you can get taken that if you do have signs like the intense carb cravings or exhaustion all the time or if you have PCOS or you have prediabetes getting this test and I’m going to tell you in a second what it is will give you a baseline and I encourage you to get it every single year. So the name of this test, there are initials and then I’ll give you the actual name for the test and it’s like science uh word. So if it doesn’t come through very well over a podcast, um you can see it in the transcripts in the show notes, but the test name is HOMA-IR and HOMA stands for Homeostatic Model Assessment for Insulin Resistance. And it basically gives you a window into how much insulin resistance you have. How dull has your insulin become? It takes a fasting insulin, remember, not the best test and a fasting blood sugar and puts it through a calculation that helps us to see how much insulin your body needs to make to bring down your blood sugar into a normal range. The HOMA-IR hasn’t been around forever. I started noticing it about 10 years ago and some doctors still aren’t aware that it’s around and you know, no shame on them because like there’s a what a bazillion blood tests for things that they probably have to keep their fingers on. And um what I’ve noticed is the HOMA-IR in many places is now just being referenced as IR which stands for insulin resistance. So if you are wanting to get this test done, you can ask for it. You can also, you know, if you have access to just go to a lab, you know, there’s in the United States, at least there’s lots of labs that you can go to and just say, hey, I want to get this lab test done and the HOMA-IR or IR, depending on how they, what they call it um is a more affordable test. I see it usually for less than $50. Um, still a fee, of course, but it is one that can be more accessible and it’s something that if you do have access to getting it done every year, I find it to be just as important, if not more than an A1C if you have PCOS insulin resistance or prediabetes, because it will help you to know like, hey, am I um using our tools to help my insulin work as best as it can. You may be using all the tools that we have access to at this point and it still may not be helping, but that doesn’t mean necessarily you’re doing anything wrong. But if you haven’t tried any interventions or there are some that you haven’t experimented with yet, that can be a sign of like, oh maybe it’s time for me to experiment with um eating more protein at the first meal of the day, something like that. 

So I hope this helps and letter writer. First of all, thank you so much for your question. And I hope this answers your question. And again, if you are listening and you’re like, oh, I have a question for Julie, maybe a follow up question um or a completely different one about maybe um helping your complicated relationship with food, how to repair it, or maybe how to apply some parts of helping your relationship with food and health. At the same time, I would love to see this question so you can send it over at info@juliedillonrd.com. All right. So that is our episode for today. I hope you enjoyed it. And thank you for joining me. You know, this is one of the last episodes we’re going to have for the year. We’re going to have a couple of mini episodes throughout December and one more diet culture IRL before the end of 2023. But I wanted to communicate to you. Thank you so much for being on this ride with us. Thank you so much for supporting the show and listening. Thank you for sharing the show with anyone who may find this episode in particular helpful or maybe they have a complicated relationship with food too and they just need to have some more tools available to them. We um everyone on the Find your food voice team and I, we are so grateful for you. All right. So until next time, take care and I look forward to being in your ears next week with another episode of Find Your Food Boy. Bye for now. 

Julie: Thank you for listening. I am Julie Duffy Dylan and this is the Find Your Food Voice podcast. Ready to join the Anti Diet Movement and take the Food Voice pledge? Go to julieduffydillon.com and sign your name to the growing list of people saying no to diets and yes to their own food voice. The Find Your Food Voice podcast is produced by me, Julie Duffy Dylan and my team of kick ass folks. I couldn’t make the show without Yeli Cruz, assistant producer and resident book lover and Coleen Bremner, customer service coordinator and professional hype master. Audio editing is from Toby Lyles at 24 sound. Music is Fly Free by Hartley. Are you looking for episode transcripts? Get them at julieduffydillon.com where you can also submit letters for the podcast, give us feedback and sign the food voice pledge. We need your voice to end diet culture. We literally can’t do this without you. Subscribe to the Find Your Food Voice podcast to get weekly inspiration and education on how we can defeat diet culture and reclaim our own food voice. I look forward to seeing you here next week for another episode of the Find Your Food Voice podcast. Take care.