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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesPost-prandial glucose control — need advice Page 2

Post-prandial glucose control — need advice

Dr.ObesityMed Wed, Apr 16, 2025 at 10:23 AM 29 replies 1,656 viewsPage 2 of 6
quinn_sf
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San Francisco, CA
Apr 17, 2025 at 3:01 PM#6
Dr.ObesityMed 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…

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.

9 4tane_welly, Dr.PathRoch, mona_PHX and 6 others
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josh_phd_bmore
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Jul 2024
Baltimore, MD
Apr 18, 2025 at 2:26 AM#7

A narrower follow-up, since the general answer is now clear:

What did you change at the same time, and can you separate the two now?

8 3Dr.ObesityLA, NurseKim_ATL, paul_denver and 5 others
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Dr.EM_Chicago
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May 2024
Chicago, IL
Apr 18, 2025 at 1:51 PM#8
quinn_sf said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

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 = 5.7 (insulin resistant) → Current = 1.5 (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.

Last edited: Apr 18, 2025 at 5:51 PM
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Dr.ObesityMed
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Apr 19, 2025 at 1:17 AM#9
quinn_sf said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

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: 27 → 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.

6 1PeptideChemSF, A1cHero_PHX, Dr.RenalNash and 3 others
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LibrarianMeg
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Baltimore, MD
Apr 21, 2025 at 8:09 AM#10
Dr.EM_Chicago said:
Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking: HOMA-IR = (fasting…

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

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1251078985
Insulin (fasting)211595
HOMA-IR5.53.11.71.4
Uric Acid7.86.55.65.1

The insulin resistance improvement (HOMA-IR) is what my endo focuses on most. Going from 5.5 to near 1.0 is a metabolic transformation.

38 11TomFromTexas, mike.trainer_LA, sarah_nash92 and 35 others
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