you know i've forgotten about that i'm taking a class uh i'm looking at your hair and
feeling that maybe half of that you can donate me to transplant here
yeah you are beautiful here you are beautiful here anyway
i will i will forget about my baldness and focus on your question yes what's your question
yes in the early stages how do you distinguish if a person has insulin resistance or is it insulin
deficiency so that we can treat appropriately yeah it's very it's yeah of course number one is the
number one reasons even though clinical reasons are there right that usually type 1 diabetes in
younger age and type 2 diabetes is little age but i will go to direct and hit the bullseye
you simply check the c peptide in the blood right c peptide if it is very low
or you check the level of insulin so simply in the blood check the level of insulin or check
the level of c peptide which is co-secreted with insulin you know insulin granules have three types
of important sense number one they are having insulin with pro insulin plus insulin granules
have of course insulin plus they have a myelin and they are having yes c peptide again i will repeat
insulin granules when beta cells are functional when they release insulin they not only release
insulin in equimolar amount right with insulin they release c peptide and they also release
some pro insulin they also release a myelin right and so because insulin levels in the blood can be
checked and c peptide levels can be checked if c peptide levels are very low now result
very carefully if c peptide level is very low it means endogenous production of insulin is very low
now here i want to clear clear one concept that sometimes would happen someone is on exogenous
insulin someone is taking insulin by injection but in their patient who take the exogenous insulin
their blood does not have c-peptide their blood does not have c-peptide if insulin is not being
produced by pancreas so we can say that whenever insulin is present and if it is pancreatic origin
it will be accompanied by the c-peptide which can be measured in the laboratory test in the blood
but if you come across a patient who has insulin in the blood right but c peptide is very less
it means that that insulin he has taken exogenous it is not his own insulin right
now we again come another way to look at it if you feel there's a patient who has insulin level
more than normal now listen very carefully manuel manuel james yes if if you come across a patient
that whose insulin level is normal or above normal and that person is having diabetes and all
clinical features of diabetes and in the blood he has hyperglycemia and hemoglobin a1c is high right
for on different parameter if person is diagnosed and diabetic diabetic but if insulin is normal
that along with the c peptide in equimolar right then it means he's producing insulin very well
then why he has diabetes why he has chronic hyperglycemia why he is having uh why he's having
especially this uh high level of hemoglobin a1c the answer is that this hyperglycemia is
due to resistance resistance peripheral and glucose which is present in the blood
that is number one coming from the food number two when you have low now again it
is very important to understand when insulin does not work on the cells cells perception
is as if insulin is really deficient so what happens glucagon will be produced
right and other counter regulatory hormones will be produced and they will activate lot of gluco
neogenic process and glycogenolytic process and liver will start producing lot of
glucose right so again i will repeat in short if you say i want in one sentence answer answer is
that that if someone has diabetes and you want to be sure that diabetes is due to deficiency
of insulin or not just check the c peptide that's it thank you very much for your question