my sister called me yesterday after her annual physical. got the exact same speech i did a year ago. A1c was 6.1, doctor said “pre-diabetic, we’ll watch it,” and sent her on her way. that feeling of being handed a problem with the instruction manual ripped out is something i remember really well.
she asked me what i did. and it’s strange trying to compress a year of obsessive tracking into a single phone call. i told her the A1c is a starting point, but it’s a blurry average. it hides a lot of daily variance.
the first thing i told her to do was call the doctor’s office back and ask for her fasting insulin number from that same blood draw. if they didn’t run it, ask them to add it for her next lab order. that’s the number that tells the real story, imo. my A1c was 6.1, but my fasting insulin was 14.
that’s the upstream signal. the high glucose is the downstream effect. most docs don’t seem to focus on it until it’s a crisis, but it’s the number that shows how hard your pancreas is working just to keep you at that 6.1 A1c. i also had her pull up her lipid panel and find her triglycerides and HDL.
told her to divide the trigs by the HDL. that ratio is another proxy for insulin resistance that’s already there in the standard labs most people get. for me, that trig:hdl number moving from 3.2 down was one of the first things to shift, even before the scale or the A1c really budged. sit with those two numbers, i told her.
fasting insulin and trig:hdl. that’s your real baseline. not the blurry A1c and not the number on the scale. sinevitably she asked about the tirzepatide.
i was careful not to recommend anything, just explained my own process. i