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ForumsMetabolic Health & DiabetesBlood sugar used to spike to 200 after meals, now barely hits 120 — 12 month update

Blood sugar used to spike to 200 after meals, now barely hits 120 — 12 month update

Dr.LipidDallas Thu, Jan 9, 2025 at 11:45 AM 9 replies 1,723 viewsPage 1 of 2
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Dr.LipidDallas
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Jan 9, 2025 at 11:45 AM#1

A reference post rather than a discussion. Corrections are the point; I would rather this be right than mine. It is about glycaemic control, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

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 little. The improvement on this class comes from two directions — direct glucose-dependent insulin secretion and glucagon suppression, plus the indirect effect of weight loss on insulin sensitivity — and the second continues after the first has plateaued.

The condition it depends on

The caveat that HbA1c is unreliable in anaemia, haemoglobinopathies and recent blood loss, all of which are commoner than people assume. If it disagrees with fasting glucose or a CGM, that is worth chasing.

The practical version

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 am not sure about

What I am trying to establish is 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.

— Dr.LipidDallas · corrections welcome and will be edited into this post with credit
35 5pam_stl, wei_SG, cory_ATX and 32 others
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VendorMark
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Jan 9, 2025 at 11:51 AM#2
Dr.LipidDallas 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.

34 4KristenIndy, MarkLI_maint, Dr.PeteFamMed and 31 others
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mike_nyc
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Jan 9, 2025 at 11:57 AM#3
Dr.LipidDallas 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…

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 38% to 22%. Target is <36%, with <30% being ideal.

Why this matters more than average glucose: large glucose swings cause oxidative stress, endothelial damage, and promote advanced glycation end-products (AGEs). A flat glucose line at 95 mg/dL is metabolically healthier than oscillating between 60 and 160, even if the average is the same.

Last edited: Jan 9, 2025 at 3:57 PM
33 3Dr.EM_Chicago, pete_RVA, CarlaRPh_TPA and 30 others
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Dr.MetabolicMD
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Jan 9, 2025 at 12:03 PM#4
mike_nyc said:
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 38% to 22%.

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: 25 → 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.

32 2Dr.ObesityMed, HealthEcon_DC, PedsEndoPhilly and 29 others
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carlos_SATX
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Jan 9, 2025 at 12:31 PM#5
VendorMark said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

Can confirm. Same sequence, different timescale. I had assumed I was the exception until I read this.

31 1tommy_boulder, hyun_seoul, jim_asheville and 28 others
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