When a patient has a sudden and continued spike in glucose levels, we often look to check their insulin levels by ordering a C-Peptide test. We know that this test measures in vivo insulin based on the measurement of C-Peptide, which is co-secreted with insulin in equimolar amounts as a consequence of pro-insulin cleavage. However, there are many other factors that affect how in vivo insulin works that we often don’t look at. These factors may explain why our best efforts to manage a patient’s glucose fail.
This week our clinical text delves in to the multiple factors that we need to consider in order help these difficult patients succeed.