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 trying to establish is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner.
Numbers rather than impressions, if you have them.
MikeKY_noInsulin 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 21%. 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.
DataDave said:Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 40% to 21%.
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 → 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.
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Shop Reference StandardsMikeKY_noInsulin 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.
Can confirm. Same sequence, different timescale. The detail I would add is minor and it is already implied above.
Adding the clinical framing, because it changes how the question reads.
My labs after 12 months on glycaemic control: A1C 5.6%, fasting glucose 86 mg/dL, fasting insulin 7 uIU/mL. My endo says these are "textbook perfect."
For context, my baseline A1C was 6.7% and fasting glucose was 131 mg/dL. The improvement has been dramatic and consistent.