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