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Evidence-based GLP-1 & peptide discussion since 2023
ForumsMetabolic Health & DiabetesPost-prandial glucose control — looking for input Page 2

Post-prandial glucose control — looking for input

Dr.Martinez Mon, Jul 22, 2024 at 3:46 PM 35 replies 2,485 viewsPage 2 of 7
JessicaH_TX
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Jul 22, 2024 at 11:42 PM#6
TrialTracker_MD said:
Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking: HOMA-IR = (fasting…

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.

50 20wendy_avl, jason_paloalto, Dr.LeslieOBGYN and 47 others
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DataDave
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Jul 23, 2024 at 2:49 AM#7
Dr.Martinez said:
A1C went from 7.4 to 5.6 over nine months and my prescriber was more interested in the fasting insulin, which I did not expect.

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: 22 → 14 → 6 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.

Last edited: Jul 23, 2024 at 3:49 AM
49 19mike_nyc, VendorMark, COA_Karl and 46 others
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Dr.EndoIndy
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Jul 23, 2024 at 5:56 AM#8
JessicaH_TX said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

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

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1141089486
Insulin (fasting)2016106
HOMA-IR4.53.52.21.3
Uric Acid8.26.46.15.0

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.

48 18marcus_mpls, DeniseRN_TPA, SandraNC_45 and 45 others
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A1cHero_PHX
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Jul 23, 2024 at 9:03 AM#9

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

How would you tell the difference between that and the alternative explanation?

Last edited: Jul 23, 2024 at 2:03 PM
47 17chris_chi24, tampaLisa73, KarenAZ_mom and 44 others
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Dr.Martinez
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Jul 24, 2024 at 12:00 AM#10
Dr.EndoIndy said:
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone: Test Baseline Month 3 Month 6 Month 12…

My labs after 12 months on glycaemic control: A1C 5.1%, fasting glucose 86 mg/dL, fasting insulin 5 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.7% and fasting glucose was 111 mg/dL. The improvement has been dramatic and consistent.

Last edited: Jul 24, 2024 at 5:00 AM
31 6adam_van, Dr.SurgeonPGH, rachel_ABQ and 28 others
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