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ForumsMetabolic Health & DiabetesGLP-1 and gluconeogenesis — 12 month update Page 2

GLP-1 and gluconeogenesis — 12 month update

amsterdam_pete Wed, Jun 26, 2024 at 6:17 AM 9 replies 1,918 viewsPage 2 of 2
anders_CPH
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Jun 26, 2024 at 7:50 AM#6
amsterdam_pete said:
HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very…

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: 23 → 15 → 7 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.

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josh_phd_bmore
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Jun 26, 2024 at 8:26 AM#7

One thing that is still open after VendorMark’s answer:

Did your prescriber agree with that reading, and if not what was their objection?

20 15Dr.ObesityLA, NurseKim_ATL, paul_denver and 17 others
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BariatricNurseD
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Jun 26, 2024 at 9:02 AM#8
anders_CPH said:
Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction…

My labs after 3 months on glycaemic control: A1C 5.2%, fasting glucose 87 mg/dL, fasting insulin 6 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.9% and fasting glucose was 112 mg/dL. The improvement has been dramatic and consistent.

Last edited: Jun 26, 2024 at 2:02 PM
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amsterdam_pete
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Jun 26, 2024 at 9:38 AM#9
anders_CPH said:
Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction…

Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include:

BiomarkerAssociationEvidence Level
Baseline BMIHigher BMI → greater absolute weight lossStrong
Fasting insulinHigher insulin → better responseModerate
GLP1R gene variantsrs6923761 → variable responsePreliminary
Baseline hsCRPHigher CRP → greater CV benefitModerate
Early weight loss (4 wk)≥3% at 4 wks → strong predictor of ≥10% at 68 wksStrong

The 4-week early responder criterion is the most clinically actionable: if you haven't lost ≥3% by week 4 at a therapeutic dose, discuss optimization strategies with your provider.

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pat_auckland
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Jun 26, 2024 at 12:29 PM#10
BariatricNurseD said:
My labs after 3 months on glycaemic control: A1C 5.2%, fasting glucose 87 mg/dL, fasting insulin 6 uIU/mL.

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

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1241028886
Insulin (fasting)201686
HOMA-IR4.53.51.61.3
Uric Acid8.26.45.55.0

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.

32 7dan_philly, MeganSA_TX, LarryQC_SD and 29 others
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