STEP 2: One of the most important questions that a man can ask himself is whether or not he is insulin resistant. This is why I think it should be Step 2 in Any Program to Reverse Prediabetes or Even Diabetes. Insulin resistance is the hallmark sign of prediabetes or Metabolic Syndrome and is a risk factor for erectile dysfunction, type II diabetes and a host of other nasty chronic diseases and medical conditions. Of course, the problem is that we develop insulin resistance sometimes decades before full blown diabetes sets in and some men never even develop diabetes, so the issue can remain “hidden.”
The signs are usually there though, including increased values of triglycerides, A1C, fasting glucose / insulin, blood pressure and liver markers. Alternatively, you may have Low SHBG or Low Prolactin. You want to try to catch all of this at an early a stage as possible, i.e. before it develops into full-fledged erectile dysfunction, NAFLD, NASH or diabetes. Is this possible? Recent research says yes.
One of the simplest ways – and I want to say thanks to Dr. Rocky Patel for alterting me to the the study I am going to mention below- was found simply by looking at a man’s one-hour post-prandial (“post-meal”) blood glucose was greater than 125, he already had insulin resistance and if greater than 150, he was 13 times more likely to develop diabetes in the next 8 years – ouch! Furthermore, Dr. Patel pointed out that the one-hour post-prandial blood glucose test was the best test for insulin resistance – better than fasting glucose for example.
This is beautiful! I check my blood glucose fairly regularly as this is one of the most important tests for a middle-aged guy. But basically Dr. Patel points out that you can just eat a big meal with plenty of refined carbs and then check your blood glucose an hour later and – voila! – you’ve got a great gauge of your insulin resistance, one that will actually quite reliably predict future issues.
Now, to be honest, I could never find verification of the 125 number that Dr. Patel cited, but it occurs at 31:35 on the podcast in reference #1 for those interested. However, I did find that if blood glucose went above 155 in the study Dr. Patel mentioned, that you were at a much greater risk of diabetes and I document that below. I also would like to point out that one recent study found that Low SHBG also did a great job of foreshadowing metabolic issues, and I hope to cover that in a post sometime soon. In the meantime, for those who love to really dig in and understand the study, it is actually available in full text for free here: One-Hour Plasma Glucose Concentration and the Metabolic Syndrome Identify Subjects at High Risk for Future Type 2 Diabetes. 
Again, the beauty of the post-meal test is that you can easily purchase an inexpensive blood glucose monitor, test strips, etc. for dirt cheap at Walmart. The prices have come down to almost nothing. Walmart’s system is called ReliOn and here is an example of their ReliOn Blood Glucose Monitoring System.
Now let’s dig into some of the other key findings of this study:
1. Fasting Glucose Above 95.5 mg/dl Is Not a Bad Predictor: “We previously demonstrated that the 1-h plasma glucose concentration during the OGTT is a good predictor for future type 2 diabetes (9). A plasma glucose cutoff point of 155 mg/dl has the maximal sum of sensitivity and specificity (0.75 and 0.79 for sensitivity and specificity, respectively) and for predicting future type 2 diabetes. Similarly, the ideal cutoff point for fasting plasma glucose concentration in predicting future type 2 diabetes was 94.5 mg/dl.” 
2. Normal Glucose Tolerance But a One Hour Post-Prandial Greatly Increases Risk: “Although, as a whole, subjects with NGT had a low risk for type 2 diabetes (5.0%), normal glucose-tolerant subjects with 1-h plasma glucose >155 mg/dl had significantly increased risk (15.3%) for future type 2 diabetes compared with nor subjects with 1-h plasma glucose <155 mg/dl (2.9%) (P < 0.0001).” 
The bottom line is that one hour post-prandial glucose > 155 is probably the best test but fasting glucose > 95 and low SHBG below about 16-18 should also be considered as markers as well. And Dr. Patel recommends that you use a much lower value of 125 to test for the beginnings of insulin resistance.
Put these all together and you have an excellent early forecaster of insulin and blood glucose issues. You can get your SHBG measure inexpensively and you can also take your fasting glucose first thing in the morning upon rising with the same meter. With these measurements, you can save yourself decades of headaches and declining health potentially. Remember that prediabetes can be very serious for erections: as insulin resistance and often higher blood pressure sets in, arterial plaque and hardening of the arteries often follow quickly – clogging your penile arteries. I call prediabetes Erectile Dysfunction Syndrome, because it is so hard on a guy’s sex life. In addition, 40% of those with prediabetes will go on to develop full blown diabetes. All of these conditions lead to elevated levels of glucose which accelerate aging of many tissues throughout the body.
So get your SHBG measured and then do a fasting and 1 hour post-meal blood glucose test at home. If you can get the doctor to do it with actual glucose, that’s the gold standard. And what do you do if you are insulin resistant? Below are the “big guns:”
1. Exercise! Stay active. Keep moving.
2. Weight loss if appropriate (and it usually is). You’ve got to get rid of that liver fat!
3. Proper Diet. The following books cover two different approaches to (often) reverse diabets and that can help you choose a diet for the same: Using a Low Glycemic, Low Fat Diet to Reverse Diabetes and A Review of Reversing Diabetes by Julain Whitaker. You do have to catch the condition in the earlier stages, but this can be done and many men have now reversed their diabetes. Why not try to treat the condition naturally instead of just grabbing medications?!? (Do not stop any medication with talking to your physician first! Some men MUST be on insulin due to substantial beta cell death in their pancreas and other issues. Not all men can reverse their adult onset diabetes.)
4. Consider with Your Doctor Boosting Your Low Testosterone. If you’re a low T guy, increasing testosterone will do the trick and may lower your A1C by as much as a point. As your testosterone falls, your insulin levels will start to rise. See my page for on Testosterone and Diabetes for more information and studies.
5. There are many supplements that may help as well from chromium to cinnamon to green coffee extract to berberine. You shouldn’t need to use any of these, but I am mentioning them as a possible direction for your personal research. But don’t rely exclusively on supplements: there is no substitute for lifestyle changes in this arena.
It is possible that you have the beginnings of fatty liver as well. If so, then you may want to read this link on How to Cure Your Low SHBG according to one of our senior Peak Testosterone Forum members.
2) Diabetes Care, Aug 2008; 31(8):1650 1655, “One-Hour Plasma Glucose Concentration and the Metabolic Syndrome Identify Subjects at High Risk for Future Type 2 Diabetes”