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ForumsMetabolic Health & DiabetesInsulin sensitivity vs insulin secretion — my results so far

Insulin sensitivity vs insulin secretion — my results so far

mel_PDX Fri, Aug 30, 2024 at 7:37 AM 15 replies 1,850 viewsPage 1 of 3
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mel_PDX
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Dec 2024
Portland, OR
Aug 30, 2024 at 7:37 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.

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

I have searched first, so if this is covered somewhere point me at it and I will read it.

28 23Dr.NateNeph, PharmD_Rodriguez, julia.endo and 25 others
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NurseKim_ATL
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Feb 2024
Atlanta, GA
Aug 30, 2024 at 8:45 AM#2
mel_PDX said:
Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

My labs after 6 months on glycaemic control: A1C 5.5%, fasting glucose 80 mg/dL, fasting insulin 9 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 7.5% and fasting glucose was 115 mg/dL. The improvement has been dramatic and consistent.

27 22raj_cambridge, ingrid_STO, pete_nash and 24 others
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HealthEcon_DC
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Apr 2024
Washington, DC
Aug 30, 2024 at 9:53 AM#3
NurseKim_ATL said:
My labs after 6 months on glycaemic control: A1C 5.5%, fasting glucose 80 mg/dL, fasting insulin 9 uIU/mL.

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.

26 21KevinCompounds, TirzTom, TrialTracker_MD and 23 others
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MarkLI_maint
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Jun 2024
Long Island, NY
Aug 30, 2024 at 11:01 AM#4
mel_PDX 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.

Last edited: Aug 30, 2024 at 4:01 PM
25 20LibrarianMeg, bri_stats, pete_manc_UK and 22 others
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james_edin
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Sep 2024
Edinburgh, UK
Aug 30, 2024 at 5:33 PM#5

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

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.

24 19bbq_ray_KC, oliver_london, tane_welly and 21 others
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