Podcast conversation (Dr. Betty Murray) about what it means to be metabolically fit and how to identify pre-diabetes and diabetes risk. Speaker B emphasizes balance over extremes and lists practical biomarkers and target ranges: hemoglobin A1C (<=5.6, ideally <=5.4), fasting blood glucose (70–99 normal, optimal 75–85, <60 likely hypoglycemia), fasting insulin (recommended but underused), and C-peptide (to assess pancreatic function). The episode also notes diagnostic threshold shifts (pre-diabetes defined as A1C 5.7–6.4) and epidemiology (≈95% of diabetes is type 2; increasing pre-diabetes in teens).
Questions this episode answers
5.6 or lower; preferably 5.4 or lower.
5.7 to 6.4.
Ideal: 70–99 mg/dL; Optimal control: 75–85 mg/dL.
In the 50s–60s mg/dL (e.g., 50s–60s).
About 95%.
Chapters
And so let's talk about what does it really mean to be metabolically fit and be at a reduced risk, particularly as we get older, for pre diabetes, diabetes and metabolic disorders? Because I think people know how to, like, parrot the words, but we don't know what does it mean to be truly healthy?
That's a great place to start, right? So to be truly healthy, we want to have balance in these things. We don't want to be extreme. And there's a lot of things culturally that gets rewarded around extreme. Whether it's extreme nutrition, extreme diet, extreme deprivation, extreme indulgence. Like, whatever it is, it's extreme. And so to be metabolically fit, you want to have a hemoglobin A1C in that healthy range, and that's going to be a 5.6 or lower. I would say even a 5.4 or lower, right? 5.6 is okay. Back in the day, 30 years ago, they changed. About 30 years ago, actually, they changed the standards. I remember some of the older doctors I worked with then, as I was going through my own training, they were suspicious because they thought, oh, wait, they're changing it so that the A1C number, now we have a much wider range for what's considered at that point 30 plus years ago to be pre diabetic. And they thought, man, they probably have some drugs coming out to give people for that range. Ah, sure enough, right? So we see these markers that are objective. Sometimes these goalposts are changed in order to fit certain pharmaceutical prescribing guidelines. Now, that's not to say that it's not about health, but I just say, you know, everybody pay attention to what's going on. When the goalposts literally move from here to here, right? So as the numbers became lower for that A1C, so now that pre diabetes range became 5.7 to 6.4, well, metformin is the basic starter drug, and from there they've added other ones. Meanwhile, though, the thing that I've always felt is not right about this is that people are not giving clear information about what they can do. Those five simple steps that will make the difference for their metabolic health. So you want that A1C in a healthy range, you want your fasting blood sugar numbers to be 99 or lower, ideally 70 to 99. I would say optimal control is 75 to 85. Here's why. Once people get a fasting blood sugar number in the 60s or boy, the 50s, that's usually hypoglycemia, they don't feel well, they May feel shaky, they might be sweating, they might feel a little woozy. So we don't want blood sugar too low the same way we don't want it too high. Fasting blood sugar numbers of like 100, 101, 125, 150. Heaven forbid it's in the 203 hundreds, because now we've got an emergency that's a bad situation. These are things that we have to deal with, right? So that's two parameters. Fasting insulin is a lab marker that's rarely looked at. It's not routinely prescribed. And I love the fact that you talk about it. I certainly talk about it. And we have other colleagues that we work with or that we know of who promote it, but we haven't quite yet gotten into the general consciousness, into that zeitgeist that says this is a standard lab test. Fasting insulin lets you know how well your pancreas is doing. The pancreas is making insulin. If you have type 2 diabetes or pre diabetes, right? If you're type 1 diabetic, you're taking insulin as a medicine, as an injectable for the rest of your life until they figure out a cure for that. They're not there yet. They've made some progress, but they're not there yet. I'm praying that that can happen. That would be so freeing for people with type 1. So if you look at it right now, about 95% of the people who have diabetes have type 2. Didn't used to be such a huge pile of people with type 2. When you said diabetes back in the day, you were talking about one. So the whole thing has shifted. So if we want to be metabolically healthy, we want to look at those things, right? So that's your A1C, your fasting blood sugar number, fasting insulin. You want to make sure C peptide's okay, because you don't want C peptide to show either exhaustion of the pancreas or it's working too hard. There is a range in there for C peptide. C peptide is a great marker. So if someone is in, let's say, an emergency room, and the doctors need to decide, hey, has this person become a type 1 diabetic or are they a type 2 who's in a bad spot? Maybe they are newly diagnosed as type 2. Sometimes that happens, right? And your A1C is at A13, and, you know, they had no idea they were even in trouble. That C peptide can help make that decision. And sometimes that gets missed. Mistakes happen. So it's good to be well informed. Metabolic fitness. Hey, can you reasonably walk up a hill and not feel overly stressed by it? What is your blood pressure like? Is it really volatile? Is it pretty stable? Is it too high? Is it too low? I think metabolic fitness means you can meet the demands of your life and still stay in a healthy range for your biomarkers. And I think if the demands of your life mean that your biomarkers go bonkers, that's you're no longer metabolically fit. I just want to make this practical so that people can understand. You know, we got like a third of teenagers now who have pre diabetes. This is crazy.
