What you should expect Dr. Jogi to tell you about your labs.

Labs to interpret your metabolic state:  fasting insulin, lipids, AST and ALT. 

1) Triglyceride to HDL ratio is important

Less than 2.5 Caucasians and Less than 1.5 African Americans is the goal. 

If the ratio is higher then patient has too much small LDL and cardiac risk is high and is a good measure of insulin resistance 

HDL goal is more than 60

2) Fasting insulin is important

Less than 10 is good,  less than 7 best. Above 15 not good  and the patient is eating poorly and needs a dietary intervention ASASP. 

High insulin represents diseased fatty liver because the pancreatic vein drains to liver first. If liver fatty then insulin resistance. High insulin is fat storage and inflammatory throughout body. 

3) High LDL is not always bad and statin not always needed. 

The small dense LDL is the bad actor and can measure directly but costs a lot of money.  

Just use the Trig/HDL ratio 

Triglycerides are the form of cholesterol the the liver produces with the assistance of INSULIN.  Insulin stimulates the liver to CONVERT SUGAR TO TRIGLYCERIDES.  (see Fig 1 below). Triglycerides are not created from fatty food intake. They are Then the triglycerides float in the blood stream in the form of VLDL to distant tissues to drop off the cholesterol. Once the cholesterol is delivered to distant tissues then there are two forms of packaging left over: a) large buoyant LDL and small dense LDL. The small dense LDL causes heart disease. A high Triglyceride to HDL ratio can indicate high small dense LDL levels. 

4) ALT more than 25 indicates you have a fatty liver

Normal ranges have increased to 40 or less because  the population is now unhealthy. The "normal" ranges are based on population averages and keep increasing. "Abnormal" is more than 2 standard deviations above the population mean.  In the 1970s then normal range of ALT was 25 or less. 

ALT more Than 25 is a problem =fatty liver. 

If uric acid concentration in blood is high it is a proxy of fructose metabolism. Less than 5.0 is best. 

AST is minute to minute depends on a recent meal

ALT is a more stable way to understand liver metabolism

5)  Fix fatty liver

• Intermittent fasting and diet changes

• No processed food

• No alcohol 

Labs to evaluate diabetes mellitus type 1: hemoglobin A1c, CBC, lipids and microalbumin to creatinine ratio, and AST and ALT and creatinine, and CGM

1.  See section about metabolism above

If any of the metabolic markers above are off, then a type 1 patient may have developed metabolic syndrome on top of their type 1 lack if endogenous insulin. Diet Diet Diet is the best intervention. Exercise is useful. 

2.  Hemoglobin A1c is a 3 month average of your blood sugars:

A1c should be less than 7.0-% in patients with diabetes less than 10 years who do not have heart disease. Less than 8.0% in patients with CAD and more than 10 years of diabetes or those with advanced age or limitations on the ability to handle hypoglycemia. Also the goal in type 2 diabetes to cured the diabetes with a1c less than 5.5% without medication, using dietary changes alone. The A1c can be wrong in certain patients especially if a patient's hemoglobin is abnormal or if the creatinine is elevated. 

A1c alone is not a great indicator of a patient's health or blood sugar control. 

3. Urine microalbumin to creatinine ratio more than 30 suggests a problem with kidneys

Higher than usual ranges suggests that your blood pressures or blood sugars have been too high, leading to early changes of kidney failure.  Changes in diet and medications, such as adding ACE inhibitors or ARB medications can repair the kidney.

4. Continuous glucose monitoring is the safest way to monitor blood sugars while on insulin.

Dr. Jogi believes a continuous glucose meter is mandatory for all patients on insulin and patients that are afraid of wearing the device need to rethink their priorities. Also once on insulin the only way to change your diet to get off diabetes medication is with a CGM like dexcom or libre. 

5. GAD and fasting c-peptide tell us the future

If your GAD antibody is positive it means a patient is at higher risk to develop an autoimmune reponse to the pancreas leading to a lack of insulin production and resultant type 1 diabetes. A nonfasting cpeptide of less than 0.9 with concurrent blood sugar more than 150 is a sign that you are on the way to having type 1 diabetes. Less than 0.1 means you probably do have type 1 diabetes. 

Labs to evaluate diabetes mellitus type 2: hemoglobin A1c, CBC, lipids and microalbumin to creatinine ratio, and AST and ALT and creatinine, and CGM

1. Metabolic syndrome is probably the root cause. 

If you have type 2 diabetes, even if you are not fat then you really need to pay attention to the section on metabolic syndrome. 

Read everything in section on Type 1 diabetes, it applies

Labs to evaluate all other conditions read here 

List of some lab abnormalities that Dr. Jogi will refer to other doctors

CBC testing abnormalities:

Low MCV levels:

1) Iron Deficiency. The most common cause of low MCV is iron deficiency anemia. Work up by PCP or gastroenterologist

2) Anemia of Chronic Disease. ... work up by PCP or hematologist

3) Thalassemia. ... work up by PCP or hematologist

4) Copper Deficiency. ... Worked up after the Gastro work up is negative, by a hematologist or PCP 

5) Vitamin A Deficiency. ...Worked up after the Gastro work up is negative, by a hematologist or PCP 

6) Lead Poisoning. ...Worked up after the Gastro work up is negative, by a hematologist or PCP 

Causes of high RBC. 

1. Low oxygen levels: 

The body might make more red blood cells as a response to conditions that result in low oxygen levels. These might include:

Congenital heart disease in adults

COPD (chronic obstructive pulmonary disease) - the blanket term for a group of diseases that block airflow from the lungs - including emphysema.

Heart failure

Hemoglobinopathy, a condition present at birth that reduces red blood cells' ability to carry oxygen.

Living at high altitudes.

Pulmonary fibrosis - a disease that happens when lung tissue becomes damaged and scarred.

Sleep apnea - a condition in which breathing stops and starts many times during sleep.

Nicotine dependence (smoking)

2. In some people, cancers or pre-cancers that affect the bone marrow can cause too many red blood cells to form. An example is Polycythemia vera

3. Misuse of drugs to improve athletic performance

Certain drugs boost the making of red blood cells, including:

Anabolic steroids.

Transfusions.

Shots of a protein known as erythropoietin.

4. Higher red blood cell concentration

Dehydration

5. Other diseases

Rarely, in some kidney cancers or after kidney transplant, the kidneys might produce too much of the hormone erythropoietin. This causes the body to make more red blood cells. Red blood cell counts also can be high in nonalcoholic fatty liver disease.