Did you know…

A person can walk into a cardiologist’s office with cardiovascular disease, receive a full standard laboratory panel that returns normal on every axis, and be in advanced hyperinsulinemia that no test in the panel can see. The pathologist who documented this pattern spent forty years reading insulin curves that ordinary medicine has never learned to order.

The claim, in the words of the pathologist who measured 15,000 curves

Joseph R. Kraft was chief of the department of clinical pathology and nuclear medicine at St Joseph’s Hospital in Chicago. Over four decades he performed and interpreted more than 15,000 glucose-tolerance tests with paired insulin curves, and classified the responses into five patterns. Patterns II through V are hyperinsulinemic while glucose remains normal, and are invisible to the standard fasting glucose and HbA1c that ordinary medicine relies on. In his 2008 book Diabetes Epidemic and You, Kraft wrote the sentence that summarizes his career:

“Those with cardiovascular disease not identified with diabetes are simply undiagnosed.”

— Joseph R. Kraft, Diabetes Epidemic and You, 2008

The instrument that would see it, and does not

Fasting insulin is a routine assay in research laboratories. It has been the gold standard for insulin sensitivity assessment since Ralph A. DeFronzo published his hyperinsulinemic-euglycemic clamp in 1979. It costs a few dollars and requires the same blood draw as a glucose test. In 2026, four decades and five researchers of first rank later, the standard laboratory panel in most jurisdictions still does not contain a fasting insulin as a default line.

Why the continuous glucose monitor cannot rescue this

A person can wear a continuous glucose monitor for a month, see a well-behaved glucose trace, and remain in an advanced hyperinsulinemic state. The compensatory phase of insulin resistance is defined by hyperinsulinemic responses that still hold glucose in a normal range. Measuring glucose cannot see what is holding glucose in range. The compass for that is insulin.

This entry is a companion to Right to Insulin Assessment and to John, 68: A Model Case.