by Dr. Spencer Nadolsky
As you probably already know, I counsel MANY obese individuals in my clinic. As you also know, I am mildly obsessed with blood sugar and insulin sensitivity / resistance. So when obese folks or those with increased belly fat (waist circumference over 35 in for females and 40 in for males) come to me I look in their record to check their recent glucose labs. I do this because I assume they at least have pre-diabetes / insulin resistance and probably have an impaired fasting blood glucose, which can be fixed with proper diet, exercise, sleep, and most importantly berberine. (haha okay the last thing was just a shameless plug).
Interestingly enough these patients ALMOST always have normal fasting sugars. So how can I confirm my suspicion that these patients are in fact insulin resistant despite their normal blood sugars? If I had a deal with the insurance companies that would allow me to order fasting insulins, c-peptides, oral glucose tolerance tests, and hemoglobin A1c’s off the bat then I would be fine. The problem is they won’t get paid for and my patient population is too poor to pay cash. There has to be another way!
This is where a good physical exam and documentation comes into play. With a lot of these same patients with NORMAL fasting blood sugars, I notice that the skin around their neck is slightly darkened. For you fitness professionals that take care of obese individuals take note! This darkening around the neck is called acanthosis nigricans.
One of my patients
Acanthosis nigricans occurs mostly in people who have hyperinsulinemia (high levels of insulin secondary to insulin resistance). It can also be caused VERY RARELY by cancer and genetic issues but mostly by high insulin levels. The theory is that high levels of insulin activate growth factor receptors in the skin especially in the neck and axilla (arm pit) regions.
So who cares right? Well diagnosing someone with this gives me ammunition to order hemoglobin A1c (shows an average of blood sugar over 3 months) and/or also an oral glucose tolerance test. These tests allow me to get a picture of what someone’s blood sugar does when they eat, which can be completely different than when they are fasting (you can read more about how diabetes works in my video series part 1 and part 2 and part 3). In fact, in all of the patients that I have had normal fasting blood sugars on and then found acanthosis nigricans and ordered a hemoglobin A1c and/or oral glucose tolerance test, I have found them to be either pre-diabetic or diabetic. So much for the use of the fasting blood sugar!
Okay so what is the take home message here?
1. If you are obese (over 30 BMI) and/or have abdominal obesity (a lot of belly fat, over 35 in waist circumference for women, over 40 for males) – you are not out of the woods with a normal fasting blood sugar.
2. If you work with someone or help someone with a darkened neck / armpit area, you may want to send them to the doc for various blood sugar testing.
3. If you have insulin resistance you may want to check out berberine. You won’t be sorry.
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