1-year semaglutide anniversary — honest review with all data — Progress & Lab Results

mike_nyc

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Jun 7, 2026 at 5:28 PM#1

I'm a numbers person by profession (biostatistician) so I went all-in on labwork. Posting this because I think comprehensive lab panels are underrepresented in the online discourse — everyone focuses on weight and A1C but there's SO much more going on metabolically.

M/44, 6'1". SW: 258, CW: 224 (-34 lbs). Titrated to 2.4mg by month 3.

Marker	Baseline	3 Months	6 Months	Ref Range
A1C	6.4%	5.9%	5.5%	<5.7%
Fasting Glucose	118 mg/dL	102 mg/dL	94 mg/dL	65-99
Fasting Insulin	24.1 µIU/mL	14.8 µIU/mL	9.2 µIU/mL	2.6-24.9
HOMA-IR	7.0	3.7	2.1	<2.5
Total Cholesterol	234 mg/dL	211 mg/dL	192 mg/dL	<200
LDL-C	158 mg/dL	138 mg/dL	118 mg/dL	<100 optimal
HDL-C	38 mg/dL	42 mg/dL	48 mg/dL	>40
Triglycerides	248 mg/dL	168 mg/dL	124 mg/dL	<150
hsCRP	6.8 mg/L	3.2 mg/L	1.4 mg/L	<1.0 low risk
ALT	52 U/L	38 U/L	24 U/L	7-56
AST	44 U/L	31 U/L	22 U/L	10-40
GGT	68 U/L	42 U/L	28 U/L	9-48
Uric Acid	8.2 mg/dL	6.9 mg/dL	5.8 mg/dL	3.5-7.2
BP (avg of 3)	142/92	132/84	124/78	<120/80
RHR	78 bpm	72 bpm	68 bpm	60-100

Key observations:

HOMA-IR normalized — went from solidly insulin resistant (7.0) to normal range (2.1). This is arguably the most important number on the panel.
Liver enzymes all normalized. ALT dropped 54%. Likely had some degree of NAFLD that's resolving.
hsCRP still slightly above optimal (<1.0) but an 80% reduction from a high-risk value is significant.
Triglyceride/HDL ratio went from 6.5 to 2.6 — this ratio is a strong predictor of cardiovascular risk and insulin resistance.

Things that did NOT change much: kidney function (eGFR stayed at 92-94, creatinine stable), thyroid (TSH 2.1 to 2.3), CBC all normal throughout.

I should note I also started walking 45 min/day and reduced alcohol from ~10 drinks/week to 2-3.

30 0maya_sedona, stefan_berlin, Dr.EM_Chicago and 27 others

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EndoResFellow

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Baltimore, MD

Jun 7, 2026 at 5:50 PM#2

This is one of the most thorough panels I've seen shared here. A few comments:

The liver enzyme improvement is really notable. ALT 52→24, AST 44→22, GGT 68→28. The GGT in particular responds to both reduced visceral fat AND reduced alcohol, so your lifestyle changes are clearly complementary. If you had an ultrasound showing hepatic steatosis before, it would be worth repeating — you may have fully resolved NAFLD.

Your LDL is at 118, still above optimal. Given the trajectory, it may continue to drop, but depending on your overall ASCVD risk score, your doc might discuss a statin. The good news is your particle profile is likely improving — the trig/HDL ratio you mentioned is a decent surrogate for LDL particle size, and 2.6 suggests you're shifting toward the less atherogenic pattern A.

29 24TinaHashiRN, robert_kc, dan_philly and 26 others

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PharmacoVig_BOS

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Jun 7, 2026 at 6:12 PM#3

The HOMA-IR normalization is the story here. Going from 7.0 to 2.1 means your cells are actually responding to insulin again. This drives almost everything else on that panel — the lipids, the liver enzymes, the blood pressure, the inflammation.

Question: did you get fasting insulin tested through your regular lab or did you have to request it specifically? My doctor keeps refusing to order it, saying A1C is sufficient.

Last edited: Jun 7, 2026 at 9:12 PM

28 23DataDave, Dr.GutHealth, amsterdam_pete and 25 others

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fiona_VT

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Dec 2024

Vermont

Jun 7, 2026 at 6:34 PM#4

I had to specifically request fasting insulin. My PCP was skeptical but agreed. I also calculated HOMA-IR myself — most standard panels don't include it. The formula is (fasting insulin × fasting glucose) / 405 for anyone who wants to compute their own.

Honestly, if your doctor won't order it, services like Marek Health or OwYourLabs let you order your own fasting insulin for around $30. It's one of the most informative metabolic markers you can get and it's baffling that it's not standard.

27 22chris_chi24, tampaLisa73, KarenAZ_mom and 24 others

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MarkLI_maint

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Jun 2024

Long Island, NY

Jun 7, 2026 at 8:45 PM#5

Saving this post as a template for what to ask my doctor to test. I've only been getting the basic lipid panel and A1C. Adding fasting insulin and hsCRP to my next request for sure.

1-year semaglutide anniversary — honest review with all data

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