hojas/insuline_sensitivity_testing/insuline_sensitivity_self_assessment.md

# Home Insulin Sensitivity Self‑Test Protocol

> **Purpose**
> This protocol is designed to evaluate insulin sensitivity, glucose regulation, metabolic flexibility, and physiological robustness using **only finger‑stick blood glucose measurements** and strong adherence to instructions.
> It approximates what a careful clinician could infer from dynamic testing, not just single lab values.

---

## General Rules (Apply to All Days)

* Use the **same glucose meter** throughout
* Wash hands with warm water; dry thoroughly
* Use the **same finger** when possible
* Record sleep quality, stress, illness, alcohol, or poor sleep
* Avoid alcohol for the entire protocol
* Avoid unusual training or dieting

All glucose values below are expressed in **mg/dL**.

---

## Overview of the 5‑Day Structure

* **Day 1:** Baseline + hepatic (fasting) stress test
* **Day 2:** Standard glucose challenge (dynamic insulin response)
* **Day 3:** Exercise‑mediated glucose uptake
* **Day 4:** Clean control day (true baseline)
* **Day 5:** Repeatability / variance check

---

## DAY 1 — Baseline + Hepatic Stress Test

**Physiology tested:**
Basal insulin tone and hepatic glucose output under mild fasting stress.

**Procedure**

1. Wake and measure glucose within 15 minutes (fasted)
2. Consume only water, black coffee, or tea
3. Remain fasted for **3–4 hours**
4. Measure glucose **immediately before lunch**
5. Eat lunch normally
6. Eat an **early dinner** (≥3 hours before bed)
7. Measure glucose **before bed**

---

## DAY 2 — Standard Glucose Challenge

**Physiology tested:**
First‑phase insulin response, peak handling, and glucose clearance.

**Preparation**

* 8–12 hour overnight fast
* No exercise, caffeine, or nicotine beforehand

**Glucose solution**

* Dissolve **75 g table sugar (sucrose)** in 250–300 ml warm water
* Drink completely within **5 minutes**

**Procedure**

1. Measure fasting glucose (T0)
2. Immediately drink glucose solution
3. Measure glucose at:

   * **30 minutes**
   * **60 minutes**
   * **120 minutes**
4. Eat early dinner
5. Measure glucose before bed

---

## DAY 3 — Exercise Uptake Test

**Physiology tested:**
Insulin‑independent muscle glucose uptake vs stress response.

**Procedure**

1. Measure fasting glucose
2. Perform **60 minutes steady jog** (conversational pace, not maximal)
3. Measure glucose **immediately after exercise**
4. Remain fasted
5. Measure glucose **60 minutes post‑exercise**
6. Eat early dinner
7. Measure glucose before bed

---

## DAY 4 — Clean Control Day

**Physiology tested:**
Unstressed baseline glucose regulation.

**Procedure**

1. Measure fasting glucose
2. Eat normally (no fasting extension)
3. No intense exercise
4. Eat early dinner
5. Measure glucose before bed

---

## DAY 5 — Repeatability / Variance Check

**Physiology tested:**
Stability and robustness of glucose regulation.

**Procedure**

1. Measure fasting glucose
2. Normal day
3. Eat early dinner
4. Measure glucose before bed

---

# Interpretation Table

The table below lists **each reading**, the **expected value ranges**, and **their physiological meaning**.

---

## Fasting Glucose (Morning)

| Value   | Category   | Meaning                      |
| ------- | ---------- | ---------------------------- |
| 70–85   | Excellent  | High insulin sensitivity     |
| 86–92   | Good       | Normal metabolic health      |
| 93–99   | Borderline | Early insulin resistance     |
| 100–109 | Poor       | Hepatic insulin resistance   |
| ≥110    | Concerning | Likely chronic dysregulation |

---

## Delayed‑Meal (Day 1, Pre‑Lunch)

| Change vs morning | Category   | Meaning                       |
| ----------------- | ---------- | ----------------------------- |
| Stable or ↓       | Excellent  | Hepatic insulin sensitivity   |
| +1–10             | Acceptable | Normal stress response        |
| +11–20            | Poor       | Hepatic insulin resistance    |
| >20               | Concerning | Stress‑driven glucose dumping |

---

## Glucose Challenge — 30 min (Early Spike)

| Rise from fasting | Category  | Meaning                     |
| ----------------- | --------- | --------------------------- |
| ≤30               | Excellent | Strong first‑phase insulin  |
| 31–50             | Normal    | Adequate response           |
| 51–70             | Weak      | Delayed insulin secretion   |
| >70               | Poor      | Loss of first‑phase insulin |

---

## Glucose Challenge — Peak (30–60 min)

| Peak value | Category  | Meaning                    |
| ---------- | --------- | -------------------------- |
| <130       | Excellent | Strong insulin sensitivity |
| 130–139    | Good      | Normal                     |
| 140–159    | Impaired  | Reduced sensitivity        |
| ≥160       | Poor      | Insulin resistance         |

---

## Glucose Challenge — 120 min (Clearance)

| 120‑min value | Category   | Meaning                 |
| ------------- | ---------- | ----------------------- |
| ≤ fasting +10 | Excellent  | Rapid glucose clearance |
| ≤120          | Acceptable | Normal clearance        |
| 121–139       | Impaired   | Slow clearance          |
| ≥140          | Poor       | Pathologic response     |

---

## Post‑Exercise (Immediate)

| Pattern     | Category   | Meaning                    |
| ----------- | ---------- | -------------------------- |
| ↓ or stable | Excellent  | Strong muscle uptake       |
| Mild ↑      | Acceptable | Balanced response          |
| Large ↑     | Poor       | Stress‑dominant physiology |

---

## Post‑Exercise (+60 min)

| Pattern                 | Category  | Meaning                  |
| ----------------------- | --------- | ------------------------ |
| Lower than pre‑exercise | Excellent | High insulin sensitivity |
| Back to baseline        | Good      | Normal recovery          |
| Elevated                | Poor      | Metabolic inflexibility  |

---

## Evening → Morning Drift

| Morning vs bedtime | Category  | Meaning                   |
| ------------------ | --------- | ------------------------- |
| Same or lower      | Excellent | Stable nocturnal control  |
| +5–10              | Normal    | Mild dawn effect          |
| +11–20             | Impaired  | Nocturnal resistance      |
| >20                | Poor      | Significant dysregulation |

---

## Day‑to‑Day Variance (Fasting)

| Variability | Category  | Meaning                     |
| ----------- | --------- | --------------------------- |
| ≤5          | Excellent | Robust system               |
| 6–10        | Normal    | Mild variability            |
| >10         | Fragile   | Stress‑sensitive metabolism |

---

## Final Integration Rule

* **Mostly Excellent / Good:** Insulin sensitive, metabolically flexible
* **Mixed Results:** Early, reversible insulin resistance
* **Multiple Poor / Concerning:** Established insulin resistance

> **Key principle:** insulin sensitivity is revealed by *behavior across conditions*, not a single number.