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ForumsMetabolic Health & DiabetesMy A1C dropped so fast my doctor thought the lab made an error — my results so far

My A1C dropped so fast my doctor thought the lab made an error — my results so far

JakeSmashed95 Thu, May 16, 2024 at 5:39 PM 18 replies 2,301 viewsPage 1 of 4
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JakeSmashed95
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May 16, 2024 at 5:39 PM#1

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.

The narrow version of the question 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.

14 9Dr.PainCLE, mike_mealprep, NicoleRaleigh and 11 others
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Dr.MetabolicMD
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May 16, 2024 at 5:44 PM#2
JakeSmashed95 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.

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

After 12 months: periods became regular for the first time in ever, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my hormonal symptoms have almost completely resolved.

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.

13 8PedsEndoPhilly, SleepDoc_PDX, RegAffairsDC and 10 others
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MikeFit_NJ
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May 16, 2024 at 5:49 PM#3
Dr.MetabolicMD said:
PCOS success story with glycaemic control: as someone with polycystic ovary syndrome, this medication has been transformative beyond weight loss.

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 7DeniseRN_TPA, SandraNC_45, Dr.EndoIndy and 9 others
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Dr.EndoEP
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May 16, 2024 at 5:54 PM#4
JakeSmashed95 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.

This is my experience too, for whatever a second data point is worth. Nothing to add that would improve it.

Last edited: May 16, 2024 at 7:54 PM
11 6Dr.BariatricHTX, LindaRN_retired, tommy_boulder and 8 others
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Dr.AddMedPHL
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May 16, 2024 at 6:20 PM#5

From the other side of the consultation, briefly.

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 = 5.1 (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.

10 5JessicaM_2024, TomFromTexas, mike.trainer_LA and 7 others
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