What Your Labs Are Actually Telling You (and What to Ask For)

Welcome to another episode of the Diabetes Digital Podcast presented by Food Heaven.
In today’s episode, we’re going to talk about labs and diabetes test resuts.
And we know that for many of you, labs can feel so overwhelming.
And especially for those who do have a chronic condition like diabetes or even people with pre diabetes, labs can bring up a lot of fear, shame and pressure.
0:23
And in our episode today, we really just want to help you be able to read your labs without spiraling and also give you some tips for how to manage certain labs like cholesterol, triglycerides, blood glucose, and if there’s anything you should be asking your provider for.
0:40
So our goal today is really to help you understand what labs are commonly checked, especially for people with diabetes, pre diabetes, hyperlipidemia, which is high cholesterol.
And also we are going to explain what exactly the labs are, what the ideal values are in your diabetes test results.
0:57
And hopefully you can take in this information and it’ll make you feel more grounded and not spiral into, you know, trying to make a million changes at once that are not sustainable.
Yes, I am so happy that we’re talking about this because labs give you a very accurate picture of your current health.
1:18
Of course, there’s so many other things that we can look at as well, but there’s nothing like some good old lab work to really quantify what is happening in your body.
In the medical system.
Oftentimes weight is what’s prioritized and that’s why I love using labs as an indicator because it’s way more accurate in terms of giving you a picture of what’s going on with your health, then the number on the scale.
1:43
Lab work can predict your risk for certain conditions.
It might tell you where your body might benefit from more support.
It can also be used to guide conversations with different specialists and providers.
When we get lab work, we use that to tailor the recommendations that we provide for nutrition and for our patients.
2:04
We actually order labs because I know sometimes people going to the doctor and there’s a lot of pushback.
This is something that Jess and I have both experienced for.
We go to the the doctor like we’re going to go over some labs today and you might go to your doctor and say, hey, spoke to my dietitian and they recommended these labs and they might be like, oh, well, you don’t need it.
2:20
Oh well, it’s not time for you to get that done.
And so some self advocacy sometimes is really important.
We’re going to be talking about why it’s important to get these and also the time frames that we typically recommend.
But labs will help you get that personalized care because sometimes things get overlooked because you might not fit the picture of whatever it is that you want to investigate further.
2:45
One number for one lab value isn’t going to give you the full picture of what’s going on.
It’s really important to look at trends and also look at the whole picture of what your health is, right?
So stress, sleep, illness, medications, hormones, because these things can drastically affect your labs sometimes.
3:08
And so once you start correcting some of these underlying factors, it’ll help to normalize whatever labs are in question.
So it is really important to not just like get the lab work, but really look at what might be going on.
So you could tell your medical provider and and then they can kind of help you make those connections to see where improvements can be made.
3:29
Welcome to the diabetes digital podcast.
I’m Wendy.
And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.
Through our telehealth platformdiabetesdigital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre.
3:45
Diabetes Visit diabetesdigital.co that’s Co to book your first appointment.
We accept insurance and offer affordable self pay options.
Now let’s get into today’s episode.
So we’re going to just dive right in when it comes to diabetes test results.
4:00
And I’m going to start with labs that are related to diabetes or pre diabetes because obviously we’re diabetes digital.
We got to start there.
So #1 and you probably heard us talk about this on the podcast A1C.
This is our favorite lab to look at for somebody who is wanting to know how well their body is processing blood glucose, whether or not they have diabetes, pre diabetes.
4:22
Is the condition improving?
Is it becoming more challenging for their?
Is the condition improving or not?
So we’re going to start with that now.
A1C is essentially the average blood sugar over two to three months in time.
This is why it’s such a powerful lab to look at because it’s not just looking at your blood glucose from whatever you ate this morning, but it’s looking at an average of two to three months.
4:46
Typical ranges write this down is below 5.7 that’s considered normal.
Anything below 5.7.
So 5.65.45.25.7 to 6.4 is in the pre diabetes range which means you don’t yet have diabetes but your blood sugar is more elevated than quote normal diabetes is when your A1C is 6.5 and above.
5:13
OK, so if you only remember one thing, know your A1C, look at your lab slip, see if it was tested.
If it was not tested, absolutely asked to get your A1C tested.
It is well within your right to know that number.
Now what I like to look for is the direction over time rather than hitting a perfect number.
5:34
One thing with diabetes digital is we, like Wendy said, we track all these labs.
Even a .3 to .5% shift can be dramatically meaningful for somebody’s health.
Every shift can really help to reduce your risk of complications when it comes to diabetes.
5:55
Also for pre diabetes, one thing that I’d like to tell people is even if you keep your A1C the same over time, that is still a huge win.
It doesn’t even have to necessarily go down.
Yes, it’s always great when things go down, but even maintaining numbers for diabetes, pre diabetes, that can be a win as well.
6:13
One thing I want to have you remember though is A1C is affected by so many different things.
So like Wendy mentioned, stress, illness, when you’re sick, especially if you’re sick over a long period of time, that might affect things, your hormones.
6:29
We talk a lot about this with women.
When you go through perimenopause, menopause, that may affect your A1C.
For many of us, it does sleep and also certain medications.
I know steroids for many people can make their A1C go up.
6:45
So remember, 1 result is not define your health or effort.
And it’s really good to use this number to help guide your care and not judge your behavior.
With all these labs, we’re going to give you like one or two things that you can do to help improve them.
So I’ll start with A1C.
One thing that you can do is pair your carbohydrates with protein or fiber most of the time.
7:06
That will really help to improve A1C and blood sugar spikes and also add short movement after meals whenever possible, like a 10 to 15 minute walk, even after your largest meal of the day.
That’s going to have a really significant impact on how well your body is able to process blood sugar.
7:26
Yes, A1C is 1 of the more popular girls in school.
I would say the second most popular is going to be your fasting glucose and this is routinely done when you go in for your annual visit.
It’s part of like a comprehensive metabolic panel and it measures your blood sugar after fasting.
7:47
So usually they’ll tell you, you know, don’t eat anything after waking up.
In terms of what normal values are, you want to aim for less than 100 to be considered normal.
When it’s over 100, anywhere from 100 to 125 it might be indicative of pre diabetes of and then over 126 might be indicative of diabetes.
8:11
And I say this because usually fasting glucose is used with other tests.
They don’t just use the fasting glucose to diagnose pre diabetes diabetes like they’ll do it with A1 T and possibly other tests as well.
But it is good to look at patterns over time.
If you use like any kind of glucose tracker, you can also see like when you wake up, what are your numbers like and what range do they fall within?
8:35
Also, like how does the fasting glucose align with the A1C, right?
Are you noticing that like your fasting glucose is over 100, but then your A1C is considered normal is less than 5.7?
Because in that case, maybe it had something to do with what you ate in that particular week or something like that.
8:52
So you always want to look at trends.
I will say that if you’re not sleeping well, if you’re very stressed out, if you’re taking certain medications, it could increase you’re fasting glucose, especially if these things are happening acutely, like it’s just like a short time, short time frame thing, it can raise that number.
9:13
So if you’re struggling with these things, like with sleep for example, definitely try to work on that.
And you know, like I said, like always trying to balance out your nutrition because that is going to help tremendously as well.
One thing that often times gets overlooked, but I do want to mention is fasting insulin because that is usually not tested.
9:32
It can suggest insulin resistance even if your glucose is normal.
That happens very often.
And so fasting insulin is going to measure how much insulin your body is making after not eating.
Usually it’s also a fast that you would do.
And lower fasting insulin generally means that you have better sensitivity.
9:53
When the numbers are higher, that means that your body is working harder to manage your blood sugar.
So it could also paint a picture of like are you at a higher risk for pre diabetes or diabetes?
There’s not necessarily like a perfect cut off.
So you would want to talk to your doctor about what ranges like they typically use to be considered like normal or elevated.
10:13
And this is a lab that you want to use also in combination with A1C, fasting glucose, even things like triglycerides to paint a better picture of what might be going on.
Something that some doctors do is the oral glucose tolerance test to see how your body responds to glucose.
10:35
And so for those of you that have had gestational diabetes, you’re probably very familiar with this test where you drank this disgusting, really sweet drink.
I mean, I remember when I was working at the maternity clinic, like so many women would just vomit after, you know, drinking.
10:54
It’s it.
It’s just tasting it.
It’s literally like drinking like syrup and it’s a lot of it.
So yeah, I just feel so terrible.
And then for some of them, it’s like they’re vomiting so much that they have to redo it again.
It’s like, I would feel so bad for them and I’m like, just put them on a glucose.
11:13
Like some women would just be like, I’d rather just check my glucose to see if my numbers are fine.
It’s also like I’ve read that it’s a little controversial because like for some people who aren’t used to having that high of a glucose load, they might have an like an inaccurate response to like having all this glucose in their system and like their insulin might spike more than normal, but it’s because they’re just not used to that load.
11:40
So I don’t know that I’m not crazy about the test, but sometimes doctors do recommend it, especially if you’re pregnant.
And so that can also like be used to assess your insulin response.
Yeah, for sure.
OK.
So moving on from diabetes, pre diabetes related labs, they’re all honestly kind of related, especially when you think of metabolic syndrome, all of these things are metabolic, right, different markers.
12:08
And so they’re intertwined.
That’s why people who have elevated A1C tend to have elevated cholesterol as well.
People who have elevated A1C fasting tend to have elevated triglycerides.
So we’re going to cover all of them today.
12:23
And also we have an article on this that lists everything.
So don’t feel like you have to memorize it all.
But if you do want that recap and you’re not writing everything down, go to our website and just search for this podcast that we’ll put it in the show notes.
12:40
But with this podcast episode, the show notes will have all the labs as well.
OK, so next is total cholesterol.
So this represents a combined number that includes your LDLHDL and other blood fats.
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The typical range is under 200 and that’s what we’re usually aiming for.
And one thing I do want to share because people are often confused about LDL cholesterol, HDL cholesterol and I learned this in school and I always remember it this way and I think it’s so helpful.
13:16
It’s LDL and HDL are transport proteins and what that means is they are proteins that will either transport the cholesterol into the body is how I learned it.
13:32
It’ll like deposit the cholesterol into like the arteries or it’ll help transport it out.
So just think of it as like a garbage can.
So either it’s dumping the cholesterol into your arteries or it’s a garbage can that’s like taking it out and like garbage person is going to get LDL is the transport protein.
13:50
We want to keep low, think LDL low because that’s the one that’s going to dump it into the body versus HDL.
We want that to be high because that’s going to be the trash collector who’s going to take it out of the body.
14:06
So low LDL, high HDL, now total cholesterol, the number alone doesn’t really tell the full story, right?
It’s really better reviewed alongside LDLHDL and triglycerides because they’re different transport proteins and they have, you know, different effects on the body.
14:23
But either way, like what you can do to help your total cholesterol if it is elevated, is focus on regular meals, three meals a day that include fiber rich foods.
So think of your nuts, your seeds, your fruits, your vegetables, your whole grains, protein, and also fats.
14:43
We want to include those healthy fats in the diet, things like olive oil, avocado, walnuts.
We love putting walnuts in our smoothie.
They blend really well and they have a lot of those healthy fats in them and that’s going to help with your total cholesterol.
14:59
Yeah.
And I’ll cover what some of the ideal ranges are.
So for HDL, which is like just mentioned, the healthier cholesterol, optimal levels are going to be over 60.
So what we see with people that have hyperlipidemia, for example, where like their cholesterol, their triglycerides are really high, this number tends to be lower.
15:18
It’ll be like in the 30s perhaps.
And so we actually want to get this number up because it is the more protective type of cholesterol.
Now with LDL, we want that to be lower because it’s associated with cardiovascular risk.
So the range for that is going to be less than 100.
15:36
And something that you can do to help support these numbers and improve them is increase your fiber intake, especially your soluble fiber.
So you could think about oats, beans, chia seeds, those are all really great.
And they will help your cardiovascular panel.
15:53
So like your triglycerides, your cholesterol, the HDL, the LDL, all of it.
And also, it’s good to talk about risk factors with your doctor because for some people like myself, you’re at a higher risk because your parents might have hyperlipidemia.
16:10
And so for example, my mom, she’s a very healthy eater, very plant forward.
However, she’s at a higher risk just because of genetics.
And she has to be on a statin, she has to be on a cholesterol medication because otherwise her numbers will spiral, even if she’s doing all of the right things.
16:31
So it is a, you know, just a conversation for you to have with your family if you can, so you can understand your risk and with your healthcare provider.
Yep, absolutely same.
My dad’s not been on statin for decades I feel, and my grandma was also I believe on a statin.
16:48
So sometimes you just got to take the medication and as look as as they say, OK, triglycerides.
This is the one I think people are a little bit more confused about.
I feel like most people kind of know cholesterol.
They have a gist of it, but triglycerides are like, what is that the best way to explain triglycerides?
17:05
They are a type of fat circulating in the blood, so they are very closely connected to how our body processes carbohydrates, insulin, and stored energy.
The typical ranges for triglycerides are under 150.
17:22
That is what’s going to be considered normal. 150 to 199 is mildly elevated and anything 200 and above is higher elevation.
So this is something that we see a lot in our practice, elevated triglycerides because we work with diabetes and what did I mention, they’re very closely related to carbohydrates and insulin.
17:43
That’s why you’ll see if you have elevated A1C, people often have elevated triglycerides.
The nice thing about triglycerides is that they typically improve as your insulin resistance improves and they’re really a good tool for tracking metabolic changes over time.
18:01
We track triglyceride for our patients and this is one of the labs that improves very significantly because as people are making those improvements, like I said, to the carbs or meal distribution as a byproduct going to improve their triglycerides too.
So what can you do to help a distributing your carbs evenly across the day rather than large single meals, trying to aim for more complex carbs.
18:27
That’s going to be helpful.
And really avoiding long gaps between meals because that can make it harder for your body to be able to process the carbohydrates because it’s getting such a big load at once versus spreading it out throughout the day.
Another thing that I will say, and I did a research paper on this in grad school.
18:46
I presented on it ’cause there was a lot of solid evidence.
Fish oils are so good for elevated triglycerides.
And I literally have my fish oils right here that I have to take.
You typically have to take them in larger doses.
19:02
I believe it’s between like 2:00-ish grams, maybe up to 4 grams.
Work with your doctor, dietitian before starting anything but it.
I think that’s like one of the strongest things that can help, and I’ve seen it help with patients as well.
19:18
Have you seen this too, Wendy?
Definitely.
Yeah, yeah.
It’s like my go to whenever I’m like OK let’s get that fish oil going gal.
I recommend that people focus on the EPA and DHA.
They are effective for lowering triglycerides.
19:36
However, EPA is usually better for lowering triglycerides without raising LDL.
So look at your bottle, make sure it has more EPA and get close to that, you know, 2-3 grams a day.
19:51
It can be expensive because it is more of like the pure form versus sometimes Omega threes.
I don’t typically recommend them because you don’t really know what exactly you’re getting.
So that means that EPADHA, it’s going to be more expensive.
So sometimes people can only afford 1g, which is usually like 1 pill.
20:09
But whatever you can do, it’s probably probably going to be helpful in some capacity with your triglycerides.
Yes, yes, those are really great tips.
So those are the main labs.
I will give you some bonus ones as well.
20:26
One is your kidney lab work, and I highly recommend this if you have diabetes type 1, type 2, also recommend this if you’re over 50.
Sometimes they do it routinely when you get your annual check.
They might not do it every year, but sometimes they do it just to make sure that everything is working properly.
20:47
But usually kidney function declines as you age.
So that’s why I said over 50.
It’s good to get it done annually to make sure everything is working properly.
And what that would look like is your EGFR, which is your filtration rate, so how quickly your kidneys are clearing waste.
21:07
Creatinine is another lab used to assess kidney function, urea nitrogen.
So these are all things that can be looked at to see if your kidneys are not filtering properly, if you have protein or glucose accumulating in the blood because of impaired kidney clearance.
21:30
In terms of GFR, you want to aim for over 60.
That’s considered normal, especially if you’re younger than 50 years old.
You should definitely have it above 60.
And you want to test negative for having proteins in your blood or your urine, especially like higher levels.
21:49
This is, I think, one of the most important labs aside aside from everything else, but one of the most important to look at if you have diabetes.
Because if you do get any kind of kidney disease, if you’re not taking care of it, it can progress very quickly.
22:06
And I’ve had patients come in where, like, there’s different stages of kidney disease, but they come in at a very advanced stage, not even knowing that they have kidney disease.
Patients where it’s like so advanced that they might have to go into dialysis in the near future.
22:23
Yeah, I saw that a few times when I was working at the hospital.
So it’s really important to get this tested, see where you are, because then you could do preventative work.
And there’s medications and things that can also help to delay it if you do have kidney disease, because once it comes, I will say like with kidney disease failure, it’s one of the most restrictive ways to eat.
22:45
It’s like my mind would be spinning when people would tell me that they had CKD because it’s like the potassium, the protein, the calcium.
It’s like so many restrictions and it’s, it could be very stressful for patients.
23:03
So definitely make sure that you check that out.
The next lab that often also goes underlooked, but I would say when I was working at my clinic in East Oakland, almost everyone had this elevated probably 90% of the patients.
That is the liver enzymes.
23:20
And it’s something too that I feel providers didn’t always talk with them about or it wasn’t really a big focus, but it’s still very important.
And those are going to be ALT and AST, OK.
And the typical ranges are often under 35 to 40, depending upon the lab.
23:40
Again, mild elevations are very common with insulin resistance.
And that’s the reason why people who have elevated A1C might also have elevated liver enzymes.
It is important to note, like with everything, trends matter more than single values.
So often times when something looks off, providers might check it a second time just to confirm that it wasn’t like a one off fluke that was going to be influenced by other things.
24:03
So that can always be a helpful strategy.
And the ways to support are similar to everything we’ve been saying, supporting insulin sensitivity, regular meals movement, not restricting.
And the only thing I’ll add for this, and it applies to all, but especially liver enzymes, is the alcohol.
24:19
Looking at your alcohol intake, is there room to drink less?
If that is affecting your liver enzymes, which it can, you know, especially folks who are maybe been shrinking on the weekends or having drinks every single day.
24:35
It’s just something to consider and ask your doctor, dietitian.
Like hey, do you think this might be affecting my liver enzymes?
OK.
I know we have gone through a lot of labs, so I’ll give you 2 more that could be helpful before wrapping. 1 is B12 and I say that because sometimes for people that take metformin, which is very commonly used for people that have pre diabetes and type 2, it might deplete your B12 levels.
25:02
So we typically recommend anywhere between 200 to 900 or higher for your B12 levels.
And then the last one that I’ll say is vitamin D, which so many people are deficient and I think it’s like one of those vitamins that is like the most common for deficiencies, especially for those of us that live in cooler climates.
25:24
Experts recommend between 40 to 60 nanograms as optimal for immune support, musculoskeletal support.
Some labs that can help add context to your vitamin D levels is also calcium, your PTH, your parathyroid hormone.
25:40
And some things that you can do is, you know, go outside if you can.
Even if it’s not super sunny, you can still get those UV rays.
So try to go out and get some skin exposure.
You can take supplements if you need to.
25:56
Speak with your dietitian if you’re unsure of what amount to take and they can help guide you.
OK, I have to add one more lab that I feel is so important, especially for women and especially for black women.
I don’t know why everyone in my life is low in this lab, including myself.
26:13
The common things I see for people who are low in this is like low energy hair loss.
Those are the the main 2 that I’m thinking of.
There’s so many things it affects but those are like 2 big ones where you notice something just is not quite right and that is ferritin.
26:30
Ferritin reflects iron stores, and it often drops before your hemoglobin changes.
And This is why it’s so important to work with a dietitian because doctors typically only look at your hemoglobin and hematocrit, like your red blood cell count, things like that.
26:45
But that’s kind of showing when things have progressed pretty badly versus ferritin shows you before it’s gotten so bad.
And low ferritin can cause fatigue and issues with hair even with a normal CBC which is a complete blood count.
27:01
Definitely please get this checked especially if you’re like my hair just I feel like it’s thinning or it’s coming out in clumps similar to vitamin D.
They all affect hair too.
The thing that’s interesting is that sometimes, like what is considered normal, especially with ferritin is not actually adequate for many adults.
27:20
So typically 30 and above is considered normal, but many people still have symptoms even with 30, right?
So often times in functional medicine, like Nikki’s one of our functional dietitians, she likes to see ferritin over 50.
27:35
Same thing with me.
I met with a functional dietitian for some of my issues and she’s like, yeah, you, we want want to get it over 50.
And I will say that I just had an iron transfusion because of the ferritin and it’s only been like not even that long and I’m already starting to feel so much better, more energy, like better with workouts.
27:56
And the nice thing about ferritin is it’s just going to get better because it takes time.
Usually it takes about like up to three months for your body really to make any changes for your ferritin to go up.
So definitely if you are black and brown or anybody, but especially black and brown, I don’t know why we always have low this number like get a checked.
28:17
Yes, yeah, Jess told me about it and I was like, let me go get my ferritin check and I was low, so I was like.
Oh, you were.
Yeah, it wasn’t super low, but it was like kind of borderline.
And I spoke with dietitian about it and she was like, oh, you know, she was just saying like try to increase your iron intake with foods and things like different strategies because it wasn’t like super low.
28:38
And I was like, yeah, I have to be more mindful of like using my cast iron skillet and all those other things.
The thing with ferritin is if you are taking supplements or let’s say you’re making all these changes and it’s still not getting, it’s not moving, it might be an absorption issue.
28:54
That’s why some of us you go to the infusions because I was supplementing for a year and a half and the levels were kind of staying the same.
That’s probably not the case for most people.
But the other thing is if you’re vegetarian, you’re probably going to need to look closer at these levels.
29:10
So I don’t eat red meat.
So that’s another reason why it’s like I’m not getting a ton from the diet and the the iron you’re getting from animal foods is going to be better absorbed than the iron you’re getting from plant foods.
So just a couple things to think about and if you have questions, work with one of our dietitians.
29:28
Yeah, So we’re going to wrap up this episode.
Hopefully it was helpful for you.
We will create a whole post so that you don’t have to write everything down.
It’ll all be there so that you can go through it.
And when you go to your doctor, try to review these labs with them so they can order it for you.
29:43
If you work with us, we can also order for you.
It does not cost much, so definitely check out our website diabetesdigital.co to get started slash quiz if you want to just go right into the intake form.
But to recap what we said labs, they help us understand risk.
30:01
They don’t necessarily predict your future, but they help you understand your health status and they allow your provider, your dietitian, to personalize care based on what those labs say.
So all those numbers are important for support.
30:16
They help us create tools to help you improve your health.
We know it can be overwhelming.
So again, you can always work one of our dietitians to help guide you through the process.
And thank you so much for tuning in.
So yeah, we will see you guys next week.
30:32
Bye bye.
Thanks for joining us for today’s episode.
If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co. We can help you understand your diabetes test results and any labs you do.
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.
30:56
You can also connect with us on Instagram at Diabetes Digital.
Dot Co and TuneIn every Wednesday for practical, inclusive, and culturally humble diabetes insights.
We’ll catch you later.
Bye.