Chapters
- 0:00 Meet Sarah, 44, and her normal bloods
- 3:12 What the session covers
- 4:20 How reference ranges are made
- 8:22 Population ranges and decision limits
- 12:14 How the population has changed
- 14:59 Thresholds versus drift
- 17:33 Sarah's HbA1c, glucose and fasting insulin
- 20:00 Why insulin moves before glucose, and HOMA-IR
- 22:33 Reading the metabolic markers as one picture
- 23:44 Liver enzymes: ALT and GGT
- 26:04 Practice targets, hs-CRP and the inflammation index
- 27:19 Vitamin D, and the results that go back to the GP
- 29:44 Putting Sarah's picture together
- 31:26 The Vively Baseline Health Check
- 33:44 Ordering, billing and retesting in the dashboard
- 34:45 Q&A: the GP consult and what it costs
- 36:07 Q&A: when the doctor leaves a test out
- 37:32 Q&A: metabolic markers when fasting insulin is missing
- 41:21 Q&A: how often to retest
This is Part 1 of the Vively Practitioner Masterclass, recorded on 15 October 2026. Dr Michelle Woolhouse, Vively Medical Director, works through one client whose results all sit inside the lab range, and shows what you can still learn from them.
What you will take from this session
- A reference range describes the people sampled to build it. About 1 in 20 healthy people sits outside the range by design, and ranges differ between laboratories.
- Population ranges and decision limits answer different questions. Read each cut-off for the decision it was built for.
- The population has moved. In Australia, 33% of adults live with obesity, up from 19% in 1995, so what is common is not always healthy.
- Chronic disease drifts over years. Direction matters as much as position, so track the same markers on the same laboratory over time.
- Insulin tends to rise years before glucose does. Fasting insulin, HbA1c, triglycerides, HDL, ALT and GGT make more sense read together than one at a time.
- Some results go straight back to the GP, whatever the optimal range says.
Meet Sarah
Sarah is 44. She is tired by mid-afternoon, foggy, and gaining weight around the middle despite eating well. Her periods are still regular. Her GP ran bloods last year and the year before, and she was told they were normal.
Sarah is a synthetic client created for teaching. Her results are not from a real person.
Sarah's results
Every marker below sits inside the laboratory range. The lab's range stays the primary reference. Read against Vively's optimal ranges as well, fasting insulin, HbA1c, ALT and GGT sit outside the optimal range, and most markers are moving in one direction.
| Marker | Earlier results | Latest |
|---|---|---|
| Fasting insulin (mU/L) | 6.8, then 8.1 | 9.6 |
| HOMA-IR | 1.51 two years ago | 2.22 |
| HbA1c (%) | 5.2, then 5.4 | 5.6 |
| Fasting glucose (mmol/L) | 5.1 | 5.2 |
| Triglycerides (mmol/L) | Rising | 1.6 |
| HDL (mmol/L) | Falling slightly | 1.1 |
| ALT (U/L) | 18, then 24 | 31 |
| GGT (U/L) | 14 | 24 |
| hs-CRP (mg/L) | Rising | 2.6 |
Taken one at a time, none of these is remarkable. Together they describe early metabolic dysfunction, and the rising ALT and GGT point towards possible fatty liver. For a 44 year old, Michelle also asks about perimenopause, alcohol, sleep, diet quality, and physical and psychological stress.
Where each topic goes deeper
- How ranges are made, and why optimal is a second reference: Optimal vs reference ranges.
- Metabolic markers: fasting insulin, HOMA-IR, HbA1c, triglycerides and HDL.
- Liver and inflammation: ALT, GGT and hs-CRP.
- Vitamin D: vitamin D. Michelle notes that fatty liver and metabolic dysfunction can make it harder to convert vitamin D to its active form, so a low result is not always about sun exposure.
- Thyroid and iron: Michelle skipped the TSH and ferritin slides in the live session to leave time for questions. See TSH, ferritin and the iron studies guide.
Results that go back to the GP
Michelle was clear that optimal ranges do not replace red flags. She named low haemoglobin, persistently high inflammatory markers, an HbA1c of 6.5% or more and a fasting glucose of 7.0 mmol/L or more as results to refer back to a GP or medical doctor for further investigation. Follow the reporting laboratory and your own scope of practice.
Ordering for your own clients
The Vively Baseline Health Check covers more than 70 markers for a $99 Vively service fee. Where a client is eligible, the pathology is Medicare funded. A GP consult is part of the Medicare pathway and is included in the $99 fee, and a private pay option is available for clients who are not eligible. Collection is available at more than 3,700 locations, and results typically arrive in 3 to 5 days. The consulting doctor confirms the final markers, so some tests, such as fasting insulin and vitamin D, may not be included for every client.
Request practitioner access, or email Jaimee to book a one to one walkthrough of the platform and your first referral.
The next sessions are Beyond the Baseline: hormones and metabolic health on 21 October at 12pm AEDT, and a case clinic on 29 October at 1pm AEDT.
Is the GP consult mandatory, and does it cost extra?
On the Medicare supported pathway, a GP consult is required to order the pathology. It is included in the $99 Vively service fee, so there is no extra charge. Clients who are not eligible for Medicare, or who prefer not to use that pathway, can use a private pay option. You can also build a custom panel if the Baseline is not the right fit.
What if the doctor leaves out vitamin D or fasting insulin?
If either test matters for your client, add it as a private pay item on top of the Baseline.
What can I use for metabolic health if fasting insulin is not available?
Michelle suggested HbA1c, ALT, hs-CRP, triglycerides and the ratio of total cholesterol to HDL. The Baseline also includes iron studies, which help you judge how reliable the HbA1c is. In clinic you can add waist circumference and blood pressure. She also encouraged practitioners to treat metabolic dysfunction as a whole body issue that touches immune, cardiovascular, brain, mood and joint health.
How often should I retest?
It depends on how motivated and busy the client is, how quickly you expect change, and what they can afford. A slow and steady client might retest at 6 to 9 months, while someone borderline for diabetes and highly motivated might retest sooner. Triglycerides and insulin tend to move faster than HbA1c and HDL. Pair the numbers with things clients can feel, such as energy and how their clothes fit, because testing too soon can discourage a client if markers have not changed yet.
- CLSI EP28, on defining and verifying reference intervals.
- Australian Institute of Health and Welfare. Overweight and obesity (2025).
- Australian Bureau of Statistics. Health conditions prevalence, National Health Survey 2022.
- Tabák AG et al. Lancet 2009 (Whitehall II).
- Wallace TM et al. Diabetes Care 2004.