1-year semaglutide anniversary — May 2025

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.

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.

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.

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.