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I have an eerily similar case right now. Woman is 56 and non-Hispanic Caucasian but similar biometrics and markers: BMI 23, normotensive, HbA1c 5.6%, FBG 106 mg/dL, hsCRP 1.1 mg/dL, HDL 60 mg/dL, Trigs ~90 mg/dL, LDL ~200 mg/dL. Interestingly insulin 3.3 uIU/L. No known family history because adopted . This was at baseline, pre-keto, but she’s now been keto three weeks. As a PhD and MHP, it would not be responsible for me to counsel the patient alone, but I’ve suggested to her PCP a CAC/CTA, OGTT, lipoprotein, NMR, and Lp(a). Also a cGM. I’d be curious to know what your patient’s insulin runs, as I found it interesting that mine ran a low insulin (again pre-lowcarb) despite borderline HbA1c and high FBG. I’d expect elevation in the fasting insulin if the HbA1c 5.6% and high FBG was marking insulin resistance and am also encouraged by the HDL and trig levels. Lastly, the individual I described had previously tried a statin and was intolerant. Bad muscle cramps and fatigue. Depending on the CAC/CTA, NMR, and Lp(a) results, I’d like to have a discussion with her PCP about Zetia. It may not be necessary but it would be conservative. Caveat to all of this is my qualifications are as a PhD (ketogenic and neurometabolism) and MHP. I’m a rising medical student at Harvard with interest in this area and work as a nutritional consultant but absolutely am not qualified or capable to give patients medical directives and am careful in this respect. Still, you case intrigued me because it was so similar so I figured I’d share. Keep us posted
May 10, 2021