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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesHas anyone dealt with got off metformin for the first time in 8 years - crying happy tears?

Has anyone dealt with got off metformin for the first time in 8 years - crying happy tears?

AmyNC_wife Fri, Apr 19, 2024 at 2:18 AM 10 replies 2,066 viewsPage 1 of 2
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AmyNC_wife
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Jun 2024
North Carolina
Apr 19, 2024 at 2:18 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.

Because it is glucose-dependent, this class carries a low intrinsic hypoglycaemia risk on its own — the risk arrives when it is combined with insulin or a sulfonylurea, which usually need reducing.

What I actually want to know is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.

If the honest answer is that nobody knows, that is a useful answer and I would rather have it.

16 11JessicaM_2024, TomFromTexas, mike.trainer_LA and 13 others
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Dr.PeteFamMed
Senior Member
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Jan 2024
Minneapolis, MN
Apr 19, 2024 at 3:20 AM#2
AmyNC_wife said:
Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

After 11 months: periods became regular for the first time in a decade, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my fertility specialist is optimistic about future conception.

GLP-1 agonists address the insulin resistance at the root of PCOS. For PCOS patients, this isn't "just" a weight loss drug — it's treating our underlying metabolic dysfunction.

Last edited: Apr 19, 2024 at 4:20 AM
15 10tommy_boulder, hyun_seoul, jim_asheville and 12 others
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tyler_CSCS
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Jun 2024
Phoenix, AZ
Apr 19, 2024 at 4:22 AM#3
Dr.PeteFamMed said:
PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

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.

14 9Dr.SportsMedIN, amy_econ_NJ, bbq_ray_KC and 11 others
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alex_tucson
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May 2024
Tucson, AZ
Apr 19, 2024 at 5:24 AM#4
AmyNC_wife said:
Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

Adding a me-too, because a thread of one person's experience is not much use. Nothing to add that would improve it.

Last edited: Apr 19, 2024 at 7:24 AM
13 8ricardo_MIA, BrianDallas92, labquiet_amy and 10 others
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Dr.CardioMD
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Dec 2023
Cleveland, OH
Apr 19, 2024 at 11:21 AM#5

Clinical perspective, offered as context rather than as advice.

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.

12 7josh_phd_bmore, roxy_nash, tony_orlando and 9 others
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