Simple Test to Predict Risk of Diabetes and Heart Attacks

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Two blood tests that are done during routine physical exams can be used to predict whether you are at increased risk for diabetes (Front Endocrinol (Lausanne), Feb 24, 2022;13:828581) and heart attacks (J of Clin Hypertension, Jan 13, 2016). It’s called the triglyceride/HDL ratio, calculated by dividing your triglycerides number by your HDL number.
• Your triglycerides should be below 150 mg/dL (in Canada less than 1.7 mmol/L)
• Your HDL cholesterol should be above 40 (in Canada, greater than 1.00 mmol/L)
• Thus your triglyceride/HDL ratio should be under 3.75
The triglyceride/HDL ratio can also be used to measure blood sugar control in people who are already diabetic (Med Arch, Jun 2019;73(3):163–168).

More than 40 percent of all North Americans will develop type II diabetes in their lifetime (Lancet Diab and Endo, Nov 1, 2014;2(11):867-874) and if you include prediabetes, that number goes up to 70 percent. These diseases can damage every cell in your body to cause heart attacks, strokes, dementia, impotence, many cancers, blindness, deafness, and premature death. If your triglyceride/HDL ratio is above 3.75, you are at increased risk for pre-diabetes or diabetes. Check with your doctor. Since the majority of cases of type II diabetes are caused by a faulty lifestyle, not just by genetics, type II diabetes is both preventable (Am J Lifestyle Med, Jan-Feb, 2018;12(1):4–20) and curable (Lancet, Diabetes and Endpcrinology, June 1, 2020;8(6):477-489) with lifestyle changes. Many people with pre-diabetes and early diabetes can return to normal by changing their lifestyle, long before they develop any symptoms of the disease (Glob J Health Sci, 2012 Oct 10;4(6):185-90).

Why Triglyceride/HDL Ratio Predicts Diabetes
Doctors often screen for diabetes by ordering a fasting blood sugar. However, some people with pre-diabetes have normal fasting blood sugar levels. The first thing that happens when you start to become diabetic is that your blood sugar rises too high after you eat, even if your fasting blood sugar is normal. If your blood sugar is greater than 140 two hours after you eat, you are at least pre-diabetic, even if all of your other tests are normal (Diabetes Care, October 2011;34(10):2237-2243).

High Triglycerides: When your blood sugar rises too high, your liver converts the extra sugar into a fat called triglycerides, so an early sign of diabetes is a triglyceride level above 150 mg/dL (above 1.7 mmol/L in Canada).

Low HDL Cholesterol: High blood fat levels can cause clots and heart attacks, so you use up your good HDL cholesterol to carry triglycerides from your bloodstream to your liver. A low HDL cholesterol is another early sign of diabetes.

Fatty Liver: Your HDL cholesterol carries extra fat from your bloodstream to your liver. Too much fat stored in your liver is called a fatty liver. Your liver is supposed to prevent blood sugar levels from rising too high. When blood sugar levels rise, the pancreas releases insulin which lowers high blood sugar levels by driving sugar from the bloodstream into the liver. However, if you have a fatty liver, it does not accept the sugar, so blood sugar levels remain high to cause diabetes.

My Recommendations
You can check your own triglyceride/HDL ratio. Look at your most recent blood tests for your triglycerides and HDL cholesterol numbers, and divide the triglycerides number by the HDL number. If your triglyceride/HDL ratio is greater than 3.75, you are likely to be at least pre-diabetic. If you can also pinch more than three inches of fat under the skin on your belly, you may already be diabetic. Check with your doctor. Realize that you cannot cure diabetes with drugs alone; you must change your lifestyle to prevent or cure diabetes and to reduce your risk for a heart attack:
• exercise
• lose weight if overweight
• restrict foods and drinks with added sugars, fried foods, red meat and processed meats
• eat more fruits and vegetables
• keep blood levels of hydroxy vitamin D above 30 ng/mL

Note: Pre-diabetics and diabetics can have triglyceride/HDL ratios under 3.75. Your doctor will probably do additional tests for your diagnosis and treatment. A more dependable test is blood sugar taken two hours after you eat. If this is above 140, you probably are at least pre-diabetic.