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ForumsMetabolic Health & DiabetesIs it possible to reverse type 2 or am I dreaming — 12 month update

Is it possible to reverse type 2 or am I dreaming — 12 month update

tane_welly Tue, Sep 2, 2025 at 2:37 PM 7 replies 1,221 viewsPage 1 of 2
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tane_welly
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Sep 2024
Wellington, NZ
Sep 2, 2025 at 2:37 PM#1

Collecting this in one place because it comes up every few weeks and the answer is always assembled from scratch. It is about glycaemic control, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very little. The improvement on this class comes from two directions — direct glucose-dependent insulin secretion and glucagon suppression, plus the indirect effect of weight loss on insulin sensitivity — and the second continues after the first has plateaued.

The condition it depends on

The caveat that HbA1c is unreliable in anaemia, haemoglobinopathies and recent blood loss, all of which are commoner than people assume. If it disagrees with fasting glucose or a CGM, that is worth chasing.

The practical version

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 not sure about

What would genuinely help is knowing why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. Happy to be told the question itself is wrong.

— tane_welly · corrections welcome and will be edited into this post with credit
40 10GraceAZ_72, carl_compliance, DanielChem_CHI and 37 others
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LabKate
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Oregon
Sep 2, 2025 at 3:19 PM#2
tane_welly said:
HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very…

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

BiomarkerAssociationEvidence Level
Baseline BMIHigher BMI → greater absolute weight lossStrong
Fasting insulinHigher insulin → better responseModerate
GLP1R gene variantsrs6923761 → variable responsePreliminary
Baseline hsCRPHigher CRP → greater CV benefitModerate
Early weight loss (4 wk)≥3% at 4 wks → strong predictor of ≥10% at 68 wksStrong

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.

Last edited: Sep 2, 2025 at 6:19 PM
39 9laura_annarbor, JenMemphis, pat_auckland and 36 others
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PharmD_Rodriguez
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Miami, FL
Sep 2, 2025 at 4:01 PM#3
tane_welly said:
HbA1c reflects roughly three months of average glycaemia weighted toward the most recent weeks, which is why repeating it at six weeks tells you very…

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: 25 → 13 → 7 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.

38 8robert_kc, dan_philly, MeganSA_TX and 35 others
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Dr.DermMIA
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Sep 2, 2025 at 4:43 PM#4
PharmD_Rodriguez 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 12 months: periods became regular for the first time in ever, testosterone levels normalized, acne cleared significantly, and — unexpectedly — my hormonal symptoms have almost completely resolved.

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.

37 7PeptideChemSF, A1cHero_PHX, Dr.RenalNash and 34 others
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MaxMetOK
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Dec 2024
Oklahoma
Sep 2, 2025 at 8:40 PM#5
LabKate said:
Patient selection optimization for glycaemic control: emerging predictive biomarkers for GLP-1 agonist response include: Biomarker Association…

Same pattern here, and in the same order. The detail I would add is minor and it is already implied above.

36 6PurityPaulOR, MaxMetOK, MounjBrad and 33 others
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