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ForumsPharmacology & MechanismsIncretin effect in healthy vs T2DM — 12 month update

Incretin effect in healthy vs T2DM — 12 month update

marco_milano Mon, Oct 20, 2025 at 2:49 AM 28 replies 1,548 viewsPage 1 of 6
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marco_milano
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Milan, IT
Oct 20, 2025 at 2:49 AM#1

Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

So the question, as narrowly as I can put it: why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.

Happy to be told the question itself is wrong.

1 21kevin_tulsa
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RetaRick_CA
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Oct 20, 2025 at 3:06 AM#2
marco_milano said:
Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1121069284
Insulin (fasting)181487
HOMA-IR4.53.32.01.1
Uric Acid8.06.25.94.8

The insulin resistance improvement (HOMA-IR) is what my endo focuses on most. Going from 4.5 to near 1.0 is a metabolic transformation.

50 20AmyNC_wife, SkepticalSean, Dr.CardioMD and 47 others
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roxy_nash
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Nashville, TN
Oct 20, 2025 at 3:23 AM#3
RetaRick_CA said:
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone: Test Baseline Month 3 Month 6 Month 12…

Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking:

HOMA-IR = (fasting insulin × fasting glucose) ÷ 405

My numbers: Baseline HOMA-IR = 4.6 (insulin resistant) → Current = 1.0 (insulin sensitive)

Anything above 2.0 indicates insulin resistance. The goal is below 1.5. GLP-1 agonists address the root metabolic dysfunction, not just the symptoms. This is why they work so much better than calorie restriction alone.

49 19tony_orlando, Dr.NephBHM_UK, kim_atl_prep and 46 others
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dave_SLC
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Salt Lake City, UT
Oct 20, 2025 at 3:40 AM#4
marco_milano said:
Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

Same experience, arrived at from the opposite direction. Posting only so the count is not one.

48 18FranDenver, Dr.BariatricHTX, LindaRN_retired and 45 others
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anna.melb_AU
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Melbourne, AU
Oct 20, 2025 at 5:10 AM#5

Adding the clinical framing, because it changes how the question reads.

Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction than glucose or A1C.

My fasting insulin: 22 → 14 → 5 uIU/mL over 9 months. Target is <7. By the time your fasting glucose is elevated, your insulin has been elevated for YEARS trying to compensate.

Ask your doctor to include fasting insulin in your bloodwork panel. It's cheap (~$20) and incredibly informative.

47 17Dr.LipidDallas, alex_tucson, kevin_tulsa and 44 others
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