Type 1.5 diabetes (LADA) and GLP-1 — anyone have experience?

marcus_mpls 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.

My labs after 3 months on glycaemic control: A1C 5.9%, fasting glucose 79 mg/dL, fasting insulin 4 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 7.3% and fasting glucose was 134 mg/dL. The improvement has been dramatic and consistent.

Dr.RaviCardio said:

My labs after 3 months on glycaemic control: A1C 5.9%, fasting glucose 79 mg/dL, fasting insulin 4 uIU/mL.

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.

marcus_mpls 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.

Second this. I had assumed I was the exception until I read this.

From the other side of the consultation, briefly.

Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include:

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.