Incretin effect in healthy vs T2DM — May 2025

CryptoCarl said:

Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

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: 22 → 12 → 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.

Dr.KarenChen 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…

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

After 7 months: periods became regular for the first time in years, testosterone levels normalized, acne cleared significantly, and — unexpectedly — I got pregnant naturally after 4 years of trying.

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.

CryptoCarl said:

Fasting glucose improved within weeks and my HbA1c barely moved for three months, which I now understand and did not at the time.

Same pattern here, and in the same order.

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 38% 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.