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.
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 after is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.
Not looking for reassurance. Looking for the part I have got wrong.
CarlaRPh_TPA 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.
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% 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.
JennaRN said:Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 22%.
My labs after 12 months on glycaemic control: A1C 6.0%, fasting glucose 90 mg/dL, fasting insulin 5 uIU/mL. My endo says these are "textbook perfect."
For context, my baseline A1C was 7.5% and fasting glucose was 135 mg/dL. The improvement has been dramatic and consistent.
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Browse GL BiochemCarlaRPh_TPA 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.
Same experience, arrived at from the opposite direction.
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 = 4.5 (insulin resistant) → Current = 1.3 (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.