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ForumsMetabolic Health & DiabetesBlood sugar used to spike to 200 after meals, now barely hits 120 — need advice

Blood sugar used to spike to 200 after meals, now barely hits 120 — need advice

HealthEcon_DC Thu, Mar 21, 2024 at 11:00 PM 24 replies 2,236 viewsPage 1 of 5
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HealthEcon_DC
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Mar 21, 2024 at 11:00 PM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

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.

Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.

The narrow version of the question is why A1C lags the way it does, and what to look at in the meantime if you want to know sooner. I would rather have one careful answer than five confident ones.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
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Dr.ObesityLA
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Mar 21, 2024 at 11:06 PM#2
HealthEcon_DC 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 41% to 21%. 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.

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JennaRN
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Mar 21, 2024 at 11:12 PM#3
HealthEcon_DC 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…

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

TestBaselineMonth 3Month 6Month 12
Glucose (fasting)1251078985
Insulin (fasting)211595
HOMA-IR5.53.11.71.4
Uric Acid7.86.55.65.1

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.

Last edited: Mar 22, 2024 at 12:12 AM
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EndoResFellow
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Mar 21, 2024 at 11:18 PM#4
JennaRN said:
Complete metabolic panel trending on glycaemic control — sharing because comprehensive data helps everyone: Test Baseline Month 3 Month 6 Month 12…

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 = 5.4 (insulin resistant) → Current = 1.2 (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.

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CanadaChris
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Mar 21, 2024 at 11:47 PM#5
Dr.ObesityLA said:
Glycemic variability as the key metric for glycaemic control success: my coefficient of variation (CV) on CGM dropped from 41% to 21%.

This is my experience too, for whatever a second data point is worth. The detail I would add is minor and it is already implied above.

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