sarah.morrison said:Fasting insulin is the lab my functional medicine doctor cares about most for glycaemic control: it's a much earlier marker of metabolic dysfunction…
My labs after 3 months on glycaemic control: A1C 5.7%, fasting glucose 87 mg/dL, fasting insulin 8 uIU/mL. My endo says these are "textbook perfect."
For context, my baseline A1C was 6.9% and fasting glucose was 132 mg/dL. The improvement has been dramatic and consistent.
marcus_mpls said:Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.
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 = 5.2 (insulin resistant) → Current = 1.0 (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.
BethLabQueen said:My labs after 3 months on glycaemic control: A1C 5.7%, fasting glucose 87 mg/dL, fasting insulin 8 uIU/mL.
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include:
| Biomarker | Association | Evidence Level |
|---|---|---|
| Baseline BMI | Higher BMI → greater absolute weight loss | Strong |
| Fasting insulin | Higher insulin → better response | Moderate |
| GLP1R gene variants | rs6923761 → variable response | Preliminary |
| Baseline hsCRP | Higher CRP → greater CV benefit | Moderate |
| Early weight loss (4 wk) | ≥3% at 4 wks → strong predictor of ≥10% at 68 wks | Strong |
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.
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Shop Reference StandardsOne thing that is still open after JennaRN’s answer:
What did you change at the same time, and can you separate the two now?
Dr.SurgeonPGH 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:
| Test | Baseline | Month 3 | Month 6 | Month 12 |
|---|---|---|---|---|
| Glucose (fasting) | 131 | 101 | 95 | 85 |
| Insulin (fasting) | 27 | 15 | 11 | 5 |
| HOMA-IR | 5.5 | 3.7 | 2.3 | 1.5 |
| Uric Acid | 8.4 | 7.1 | 6.2 | 5.2 |
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.