GLP-1 and gluconeogenesis — May 2025

pete_manc_UK said:

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

My labs after 3 months on glycaemic control: A1C 6.4%, fasting glucose 79 mg/dL, fasting insulin 6 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 7.3% and fasting glucose was 124 mg/dL. The improvement has been dramatic and consistent.

sarah_nash92 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.

Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone:

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.

VendorMark said:

My labs after 3 months on glycaemic control: A1C 6.4%, fasting glucose 79 mg/dL, fasting insulin 6 uIU/mL.

Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking:

HOMA-IR = (fasting insulin × fasting glucose) ÷ 405

My numbers: Baseline HOMA-IR = 4.9 (insulin resistant) → Current = 1.5 (insulin sensitive)

Anything above 2.0 indicates insulin resistance. The goal is below 1.5. GLP-1 agonists address the root metabolic dysfunction, not just the symptoms. This is why they work so much better than calorie restriction alone.

One thing that is still open after tommy_boulder’s answer:

Was that from a primary source or from a summary of one?

Dr.NutriCornell said:

Insulin sensitivity test (HOMA-IR) on glycaemic control — arguably the most important metabolic marker most people aren't tracking: HOMA-IR = (fasting…

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: 23 → 15 → 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.