EP27: Blood Sugar And Testing

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. EP27: Blood Sugar And Testing - Summary Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health and cardiovascular care. In this episode, he discusses a patient case involving blood sugar assessment and explores the limitations of standard glucose tolerance testing. Dr. Bishop explains why measuring insulin resistance through the HOMA index may be a more effective diagnostic approach for identifying cardiovascular risk factors in certain patients. Key Takeaways: Standard glucose tolerance tests may miss insulin resistance because they only measure blood sugar at fasting and two hours post-glucose load, missing the metabolic activity that occurs in between. A patient can have a "normal" glucose tolerance test result while still showing signs of insulin resistance, including elevated fasting glucose, elevated triglycerides, low HDL cholesterol, and central weight gain. The HOMA (Homeostatic Metabolic Assessment) index uses simultaneous fasting blood sugar and insulin measurements to calculate an index that indicates whether a patient is insulin resistant. High HOMA index values (elevated insulin with slightly elevated or normal blood sugar) indicate insulin resistance, meaning the body requires excessive insulin to control blood sugar levels. Insulin resistance is strongly linked to cardiovascular risk factors including elevated triglycerides, reduced HDL cholesterol, and central obesity. Patients with insulin resistance benefit significantly from reducing carbohydrate consumption, which can lower insulin response, promote weight loss, reduce triglycerides, and improve HDL levels. HOMA testing may be a more appropriate initial assessment than glucose tolerance testing for patients showing metabolic syndrome characteristics, even if their fasting glucose isn't high enough to indicate diabetes.