my own dx A1c was 8.4, same as half these onederland posts, which always makes me read the A1c line before the scale number. so here’s the stuff I get asked when I bring up the T2D side of this, answered the way I actually think about it. does a 5.0 A1c mean the diabetes is “handled”?
A1c is a 3-month average. great number, worth celebrating, but it smooths over the part CGM actually catches. mine sat at 5.6 while my MAGE (glucose variability) was still dropping for weeks after. mean glucose and postprandial swings are two different clocks, and for T2D the swings are their own thing, not a footnote to the average. a 5.0 with big meal spikes reads identical on the lab slip to a 5.0 that’s actually flat. is scale weight the metric that matters?
for how you feel, sure. but scale weight bundles fat and lean mass. my DEXA at month 9 showed ~2.1 lb lean loss while I was lifting the whole time, just not at enough volume. that’s n=1, but the lean mass question for women over 40 is real and under-discussed. protein per meal (not daily total) and volume-load on training are the two things I’d track from day one if I started over. the constipation everyone mentions, is that the GLP-1?
maybe not the part people assume. the motility literature is mostly upper GI, gastric emptying. colonic stuff (stool water, transit) is more likely downstream of bile acid and microbiome shifts, metformin included if you’re on it, than direct receptor activity at the colon. tirz also hits GIP, which modulates gut motility separately from the GLP-1 side. so “it’s the GLP-1” is doing more work than the mechanism supports. fixable for most people either way. when do the glucose numbers actually move?
earlier than the weight, in my logs. my CGM 14-day average went 148 to 102 between weeks 4 and 12, and the hepatic glucose improvement showed up weeks 4-8 before fat mass moved meaningfully. so if the scale is slow but your fasting and post-meal numbers are dropping, the drug is working on the thing it’s actually indicated for. one tracking note: the weekly insight summary in the med tracker I use is the part I actually sit with on Sundays, bc it cross-correlates dose day against the CGM dips, and that’s where the week-to-week pattern shows up, not in any single reading. none of this takes anything away from 95 lbs with an A1c like that, that’s huge. I just think the A1c line deserves as much spotlight as the scale, especially for anyone who came in T2D first. what was your fasting vs post-meal split doing while the weight came off, or were you only watching the scale?