[Discussion] the glycaemic control advice in here is 2 years out of date
The title is the argument: the glycaemic control advice in here is 2 years out of date. Here is the rest of it.
Figures up front so nobody has to dig: 2 years.
On hypoglycaemia, because the risk gets attributed to the wrong thing constantly.
Incretin-based agents stimulate insulin secretion in a glucose-dependent way: the effect scales with glycaemia rather than acting unconditionally. That is why monotherapy risk is low. Where risk rises substantially is in combination with agents that lower glucose independently of the current level.
Which means the question "does this cause hypos" is not answerable without knowing the rest of the regimen — and that the person who can answer it is the one who wrote the regimen. Nothing on this board is a substitute for that conversation, and the good threads here end by saying so.
The order things move in, since nobody explains it and it worries people.
Postprandial excursions generally respond earliest. Variability tends to narrow before the average does, which is visible on a sensor and invisible on a lab result. Fasting glucose is often the laggard, and A1c — being a three-month average — is the last thing to reflect anything.
So a month in which the sensor looks better and the fasting number has not moved is the ordinary sequence, not a contradiction. Knowing that in advance would have saved me a quarter of unnecessary worry, which is why it is worth writing down.
Not medical advice, obviously, and nothing here is approved for human use. One person with a spreadsheet.
best — the order this archive was captured in
The diabetes and obesity programmes are separate, with different populations and different primary endpoints. Reading a result across from one to the other is not a comparison.
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Yes — the person managing your diabetes is the one to talk to, and this board is explicit about that.
Postprandial excursions typically respond earlier than fasting glucose, so the sequence people observe is not a sign that something is not working.
Identifying details redacted from the exported report above.
postprandial excursions are where most of the improvement shows up first
I would not compare your numbers to that population. Different baseline, different regimen, different trial.
Identifying details redacted from the exported report above.
This is the distinction that resolves most of the confusion here — average versus shape.
This. Hypoglycaemia risk in this class is driven mostly by the other agents in the regimen.
the diabetes trials report different endpoints from the obesity ones
The three numbers, and what each one can and cannot tell you.
A1c is an average over about three months, weighted to the recent weeks. It cannot show variability and it lags change. Continuous monitoring shows the shape — excursions, overnight, time in range — and is where improvement usually becomes visible first. Fingersticks are point measurements, useful for sanity-checking a sensor and for specific questions.
Most of the frustrated posts here come from expecting one of the three to answer a question that belongs to another. And all three are inputs to a conversation with whoever manages your care, which is not this board.
The three numbers, and what each one can and cannot tell you.
Agreed, and the glucose-dependence point is the reason the risk profile reads the way it does.
Agreed, and the glucose-dependence point is the reason the risk profile reads the way it does.
bianca_dziedzic is right that the fasting number moves last. Knowing that in advance saves months of worry.
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