The development and progression of diabetes is slow and insidious. However, as Dr. Robert Atkins observed through decades of evaluating patients with blood glucose abnormalities, it can be divided into six distinct stages. His observations are similar to those of researchers published in the March 1992 issue of Diabetes Care.

The first four stages are milestones on the road to diabetes. The fifth and sixth stages are diabetes itself:

1. Insulin resistance of cells
2. Insulin resistance with hyperinsulinism (the production of large amounts of insulin)
3. Insulin resistance with hyperinsulinism and reactive hypoglycemia (low blood glucose)
4. Insulin resistance and hyperinsulinism with impaired glucose tolerance (now called pre-diabetes)
5. Type 2 diabetes with insulin resistance and high insulin production
6. Type 2 diabetes with low or virtually no insulin production

Screening: Too Little Too Late

Dr. Atkins knew from observing numerous patients that the standard blood glucose tests do not detect the presence of insulin and glucose changes early enough. It is recognized that damage can begin well before standard test results are abnormal. This makes it a priority to recognize and evaluate people at risk even before the metabolic syndrome is well advanced.

To find out which patients would benefit most from more intensive testing, a review of the information obtained on questionnaires along with the number of blood glucose-related symptoms can be of help (see below).

What Is the Glucose Tolerance Test?

The glucose tolerance test, with insulin levels, or GTT, as performed by Dr. Atkins, can identify people who are already experiencing elevated insulin levels (stage 2) even before the blood glucose level is abnormal enough to cause symptoms. There is strong evidence that high insulin levels themselves cause inflammation in the blood vessels as well as in the brain. Researchers from the University of Washington theorize that high levels of insulin may also contribute to Alzheimer’s disease. And high insulin levels can increase cancer risk as well increasing fat storage.

Many practitioners are often frustrated when trying to impress upon their patients the need for a change in lifestyle. Demonstrating an abnormal blood-test result can make a more significant impact on your patient than a theoretical discussion. When confronted with abnormal results, the patient may more easily understand why permanent lifestyle change is necessary if he or she is to avoid diabetes, heart disease and perhaps other devastating illnesses.

It is especially helpful to instruct patients to record the time and symptoms experienced during the GTT to later correlate with changes in blood glucose and insulin. This can help patients better understand that a number of frequent symptoms they are experiencing are diet-related and can be managed simply by making better food choices.

Common Low Blood Glucose Symptoms

• Feeling hungry between meals
• Craving sweets
• Craving starchy foods
• Waking with a headache
• Thirsty all the time
• Irritable before meals
• Feeling shaky, especially when hungry
• Constant tiredness
• Daytime sleepiness
• Sleepiness after meals
• Difficulty concentrating