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ForumsMetabolic Health & DiabetesBlood sugar used to spike to 200 after meals, now barely hits 120 — 12 month update

Blood sugar used to spike to 200 after meals, now barely hits 120 — 12 month update

Dr.LipidDallas Thu, Jan 9, 2025 at 11:45 AM 9 replies 1,723 viewsPage 1 of 2
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Dr.LipidDallas
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Jan 9, 2025 at 11:45 AM#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 I actually want to know is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. Numbers rather than impressions, if you have them.

— Dr.LipidDallas · corrections welcome and will be edited into this post with credit
35 5pam_stl, wei_SG, cory_ATX and 32 others
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Dr.ReproEndo
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Jan 9, 2025 at 11:51 AM#2
Dr.LipidDallas 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…

Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 37% to 19%. 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.

34 4andrew_nyc, Dr.EndoEP, GraceAZ_72 and 31 others
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Dr.KarenChen
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Jan 9, 2025 at 11:57 AM#3
Dr.LipidDallas 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…

My labs after 3 months on glycaemic control: A1C 6.0%, fasting glucose 75 mg/dL, fasting insulin 8 uIU/mL. My endo says these are "textbook perfect."

For context, my baseline A1C was 6.5% and fasting glucose was 120 mg/dL. The improvement has been dramatic and consistent.

33 3TomFromTexas, mike.trainer_LA, sarah_nash92 and 30 others
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Dr.EndoEP
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Jan 9, 2025 at 12:03 PM#4
Dr.KarenChen said:
My labs after 3 months on glycaemic control: A1C 6.0%, fasting glucose 75 mg/dL, fasting insulin 8 uIU/mL.

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: Jan 9, 2025 at 2:03 PM
32 2Dr.BariatricHTX, LindaRN_retired, tommy_boulder and 29 others
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andrew_nyc
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Jan 9, 2025 at 12:31 PM#5
Dr.ReproEndo said:
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 37% to 19%.

Mine went the same way, slower.

31 1JessicaM_2024, TomFromTexas, mike.trainer_LA and 28 others
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