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.
What I actually want to know is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.
I would rather have one careful answer than five confident ones.
carl_compliance 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: 28 → 12 → 5 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.
HPLC_Greg 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…
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:
| Test | Baseline | Month 3 | Month 6 | Month 12 |
|---|---|---|---|---|
| Glucose (fasting) | 123 | 101 | 95 | 85 |
| Insulin (fasting) | 19 | 15 | 11 | 5 |
| HOMA-IR | 5.5 | 3.4 | 2.3 | 1.2 |
| Uric Acid | 8.1 | 6.3 | 6.2 | 4.9 |
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.
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Browse GL Biochemcarl_compliance 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 pattern here, and in the same order. The detail I would add is minor and it is already implied above.
Clinical perspective, offered as context rather than as advice.
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 41% to 19%. 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.