Bloodwork improved, yet insulin sensitivity got worse?

[Neurogroot]

So here is a strange one… I followed the playbook, had a wild pile of bloodwork drawn before touching peptides, and I have just wrapped up the next round of bloodwork along the peptide journey. Some backstory… I golf a lot, and club speed training is my main workout.

Mid golf outing, on a pleasant 65 degree day with no humidity and good hydration, dizziness set in. I tried to play through it. Vision pin-holed, rushing water sounds. Eventually I sat out 45 minutes, pounding water, Gatorade Zero and beef jerky… Went back out, same outcome.

A pile of heart tests followed, plus bloodwork for electrolytes and iron.. all clean. And yet 2-3 days every week these symptoms land on me. Brand new as well: sleep paralysis after night terrors 3-4 nights a month, over the past 2 months.

My doctor did not feel like ordering the blood tests I wanted for the peptide journey (they only know 1/3 of my stack), so I ordered them myself. Results are arriving, and everything reads well. 6 months in, total cholesterol has dropped 22 points, 186 to 164… LDL is down 19 points, 114 to 95. Triglycerides went from 113 to 84. A1C fell from 5.9% to 5.1%. Everything appeared to be in order. Then the strange numbers started landing.

Fructosamine (Like A1C, but shorter time frame) came in at 281 originally, now down to 162 (range is 205-285). My fasting glucose read 105 6 months ago and is 64 today? Fasting insulin was never run before, so this is a first, and it sits at 31.3 uIU/mL (range is 6-25). Most importantly, the HOMA2-IR score was 3.13, when 1.3 is already considered high.

That was a very very long way to reach my question. 6 months into the peptide journey I am down 54 lbs. If ArboLeaf is to be believed, just 11.4 lbs of that was lean mass. Sugar used to be my whole diet. Easily 350g-500g a day, no exaggeration. These days it looks more like 80-120g. So how do I now have more insulin resistance? Could there be a 3+ month lag before insulin production catches up with the new me? I picked up a glucose spot checker, and this morning it read 52. An hour after breakfast, 115. An hour after that, 79.

What would you suggest for getting this insulin resistance sorted out? Currently 9 mg weekly Tirz (Friday) with a tide over of Reta/Cag (3 mg/0.6 mg) on Tuesday. MOTS-c protocol starts tomorrow (Sun/Tues/Fri), 5 mg a dose. Fingers crossed it helps.

The doctor I see is negative supportive on non-GLP peptides. So I struggle bringing it up with them. Hoping your experiences can help me make sense of what is going on. And as ever, thank you all, and sorry for the novel!

 

[CNCCurrency]

Neurogroot said:

So here is a strange one… I followed the playbook, had a wild pile of bloodwork drawn before touching peptides, and I have just wrapped up the next round of bloodwork along the peptide journey. Some backstory… I golf a lot, and club speed training is my main workout.

Mid golf outing, on a pleasant 65 degree day with no humidity and good hydration, dizziness set in. I tried to play through it. Vision pin-holed, rushing water sounds. Eventually I sat out 45 minutes, pounding water, Gatorade Zero and beef jerky… Went back out, same outcome.

A pile of heart tests followed, plus bloodwork for electrolytes and iron.. all clean. And yet 2-3 days every week these symptoms land on me. Brand new as well: sleep paralysis after night terrors 3-4 nights a month, over the past 2 months.

My doctor did not feel like ordering the blood tests I wanted for the peptide journey (they only know 1/3 of my stack), so I ordered them myself. Results are arriving, and everything reads well. 6 months in, total cholesterol has dropped 22 points, 186 to 164… LDL is down 19 points, 114 to 95. Triglycerides went from 113 to 84. A1C fell from 5.9% to 5.1%. Everything appeared to be in order. Then the strange numbers started landing.

Fructosamine (Like A1C, but shorter time frame) came in at 281 originally, now down to 162 (range is 205-285). My fasting glucose read 105 6 months ago and is 64 today? Fasting insulin was never run before, so this is a first, and it sits at 31.3 uIU/mL (range is 6-25). Most importantly, the HOMA2-IR score was 3.13, when 1.3 is already considered high.

That was a very very long way to reach my question. 6 months into the peptide journey I am down 54 lbs. If ArboLeaf is to be believed, just 11.4 lbs of that was lean mass. Sugar used to be my whole diet. Easily 350g-500g a day, no exaggeration. These days it looks more like 80-120g. So how do I now have more insulin resistance? Could there be a 3+ month lag before insulin production catches up with the new me? I picked up a glucose spot checker, and this morning it read 52. An hour after breakfast, 115. An hour after that, 79.

What would you suggest for getting this insulin resistance sorted out? Currently 9 mg weekly Tirz (Friday) with a tide over of Reta/Cag (3 mg/0.6 mg) on Tuesday. MOTS-c protocol starts tomorrow (Sun/Tues/Fri), 5 mg a dose. Fingers crossed it helps.

The doctor I see is negative supportive on non-GLP peptides. So I struggle bringing it up with them. Hoping your experiences can help me make sense of what is going on. And as ever, thank you all, and sorry for the novel!

First step: find yourself a different physician.

 

[Neurogroot]

CNCCurrency said:

Neurogroot said:

So here is a strange one… I followed the playbook, had a wild pile of bloodwork drawn before touching peptides, and I have just wrapped up the next round of bloodwork along the peptide journey. Some backstory… I golf a lot, and club speed training is my main workout.

Mid golf outing, on a pleasant 65 degree day with no humidity and good hydration, dizziness set in. I tried to play through it. Vision pin-holed, rushing water sounds. Eventually I sat out 45 minutes, pounding water, Gatorade Zero and beef jerky… Went back out, same outcome.

A pile of heart tests followed, plus bloodwork for electrolytes and iron.. all clean. And yet 2-3 days every week these symptoms land on me. Brand new as well: sleep paralysis after night terrors 3-4 nights a month, over the past 2 months.

My doctor did not feel like ordering the blood tests I wanted for the peptide journey (they only know 1/3 of my stack), so I ordered them myself. Results are arriving, and everything reads well. 6 months in, total cholesterol has dropped 22 points, 186 to 164… LDL is down 19 points, 114 to 95. Triglycerides went from 113 to 84. A1C fell from 5.9% to 5.1%. Everything appeared to be in order. Then the strange numbers started landing.

Fructosamine (Like A1C, but shorter time frame) came in at 281 originally, now down to 162 (range is 205-285). My fasting glucose read 105 6 months ago and is 64 today? Fasting insulin was never run before, so this is a first, and it sits at 31.3 uIU/mL (range is 6-25). Most importantly, the HOMA2-IR score was 3.13, when 1.3 is already considered high.

That was a very very long way to reach my question. 6 months into the peptide journey I am down 54 lbs. If ArboLeaf is to be believed, just 11.4 lbs of that was lean mass. Sugar used to be my whole diet. Easily 350g-500g a day, no exaggeration. These days it looks more like 80-120g. So how do I now have more insulin resistance? Could there be a 3+ month lag before insulin production catches up with the new me? I picked up a glucose spot checker, and this morning it read 52. An hour after breakfast, 115. An hour after that, 79.

What would you suggest for getting this insulin resistance sorted out? Currently 9 mg weekly Tirz (Friday) with a tide over of Reta/Cag (3 mg/0.6 mg) on Tuesday. MOTS-c protocol starts tomorrow (Sun/Tues/Fri), 5 mg a dose. Fingers crossed it helps.

The doctor I see is negative supportive on non-GLP peptides. So I struggle bringing it up with them. Hoping your experiences can help me make sense of what is going on. And as ever, thank you all, and sorry for the novel!

First step: find yourself a different physician.

Yeah, I'm definitely dealing with that. The problem I keep hitting is this: either I go with a PCP who takes insurance and will actually prescribe the specific medication I need, or… I pay cash, it's 50/50 whether they'll write that particular script, and judging by their website at least, they lean toward pushing stuff like LIVV — though they'll happily sell me KPV, 10 mg for $249/month.

What should I be on the lookout for?

 

[eidos]

Stop chasing perfect numbers. Your HbA1c looks fine. After meals, glucose rises then comes down fast enough. What stands out is the low blood sugar spells, and one of those could mean you don't wake up one day...

You should dial back your aGLP-1 dosing now, and possibly keep only 1 in the mix. MOTS-C does a lot of good, yet it pushes hypoglycemia in the wrong direction. Last month I went through 3 of those episodes while on tirz+reta+mots-c.

Add more complex carbs to what you eat. Pick the kind that won't send your blood sugar soaring.

Get a CGM (the Freestyle, for example) so you can track your levels and receive warnings before you pass out.

 

[randompersonrandom]

Worth keeping in mind: a physician's actual duty is to inform you as well as their professional expertise allows, respond to your questions, explain what risks come with a given choice, and then back you up as best they can once you've decided what to do next.

What a physician is NOT there for is handing down orders, assuming you'll comply, and reprimanding you when you don't. I wouldn't tolerate that from ANY physician, and I doubt many would even attempt it if I spelled out what I expected from them.

Last 2 visits, my physician pushed statins and wanted me to stop smoking. I wasn't ready to give up cigarettes, and I wasn't ready to agree that statins were needed. I told him I'd begin a GLP-1, bring my weight down, and then reassess. He replied that even if I quit smoking, he doubted it would change enough. I told him fine, I'd see how it played out. If more than 6 months pass, my weight reaches normal, and LDL remains too high, we'd discuss either quitting smoking or statins; but not both simultaneously. He explained what that does to my cardiac event risk. I thanked him. We left as teammates.

At the following appointment, if my LDL is still elevated, I'm still refusing statins. My cigarette quit date is 8/1. We'll give THAT some time, then retest after a sensible interval. If it's still high, then statins. I get what that means for my risk level right now, because he told me, because that's what my insurance pays him to do. He is NOT an authority over me, and even if he believed he were, he still wouldn't be.

I bring this up because yours isn't an authority over you either. Fine, they're glp-1 negative. That's okay, they can say so, and they can explain why. You chose to go on them. They have to accept that, and they still have to do right by you even if you didn't obey them; and you're entitled to, in a completely cordial manner, hold them to it.

 

[FartfulCodger]

How do your inflammation markers look? Were cytokines part of your panel?

After I dropped 60 pounds quickly, bloodwork showed inflammation was my biggest problem. My glucose was elevated too, sitting at 100. Several AI tools suggested the inflammation probably came from the strain rapid weight loss placed on my body.

From what I gathered, inflammation — even if it's short-lived — may bring on insulin resistance. Those AI tools recommended retesting once my weight had leveled off.

If you haven't done this yet, maybe try opening ChatGPT and sharing your race, gender, starting weight, ending weight, current medications, and how long it took you to lose the weight. After that, paste in your bloodwork results.

 

[lessthanhalf]

Neurogroot said:

So here is a strange one… I followed the playbook, had a wild pile of bloodwork drawn before touching peptides, and I have just wrapped up the next round of bloodwork along the peptide journey. Some backstory… I golf a lot, and club speed training is my main workout.

Mid golf outing, on a pleasant 65 degree day with no humidity and good hydration, dizziness set in. I tried to play through it. Vision pin-holed, rushing water sounds. Eventually I sat out 45 minutes, pounding water, Gatorade Zero and beef jerky… Went back out, same outcome.

A pile of heart tests followed, plus bloodwork for electrolytes and iron.. all clean. And yet 2-3 days every week these symptoms land on me. Brand new as well: sleep paralysis after night terrors 3-4 nights a month, over the past 2 months.

My doctor did not feel like ordering the blood tests I wanted for the peptide journey (they only know 1/3 of my stack), so I ordered them myself. Results are arriving, and everything reads well. 6 months in, total cholesterol has dropped 22 points, 186 to 164… LDL is down 19 points, 114 to 95. Triglycerides went from 113 to 84. A1C fell from 5.9% to 5.1%. Everything appeared to be in order. Then the strange numbers started landing.

Fructosamine (Like A1C, but shorter time frame) came in at 281 originally, now down to 162 (range is 205-285). My fasting glucose read 105 6 months ago and is 64 today? Fasting insulin was never run before, so this is a first, and it sits at 31.3 uIU/mL (range is 6-25). Most importantly, the HOMA2-IR score was 3.13, when 1.3 is already considered high.

That was a very very long way to reach my question. 6 months into the peptide journey I am down 54 lbs. If ArboLeaf is to be believed, just 11.4 lbs of that was lean mass. Sugar used to be my whole diet. Easily 350g-500g a day, no exaggeration. These days it looks more like 80-120g. So how do I now have more insulin resistance? Could there be a 3+ month lag before insulin production catches up with the new me? I picked up a glucose spot checker, and this morning it read 52. An hour after breakfast, 115. An hour after that, 79.

What would you suggest for getting this insulin resistance sorted out? Currently 9 mg weekly Tirz (Friday) with a tide over of Reta/Cag (3 mg/0.6 mg) on Tuesday. MOTS-c protocol starts tomorrow (Sun/Tues/Fri), 5 mg a dose. Fingers crossed it helps.

The doctor I see is negative supportive on non-GLP peptides. So I struggle bringing it up with them. Hoping your experiences can help me make sense of what is going on. And as ever, thank you all, and sorry for the novel!

I know this is a long AI response, so apologies for that. It comes from chatgpt running in research/scholar mode with additional prompts, so it ought to be fairly dependable. A helpful feature is that it assigns confidence levels to each of its assessments. I was simply puzzled, and I couldn't find the evidence behind what you said about insulin resistance increasing, so I copied your post and ran it through the model. It does suggest a few possible reasons for the results and the symptoms. Since it's lengthy, I'll split it into 2 parts.



AI answer

Your skepticism makes sense to me. Going by what's written, I don't believe the post makes a convincing case that insulin resistance got worse.

Actually, a number of the findings point the other way.

The main problem is this:

HOMA2-IR is being read without context, and possibly outside the conditions in which it can be trusted.

1. What is HOMA2-IR?

The original HOMA model derives insulin resistance from:

fasting glucose

fasting insulin

HOMA2 is the more refined, nonlinear (calculator-based) version, which accounts for physiology better than the original formula does.

In principle:

more fasting insulin at a given glucose level → greater insulin resistance.

Still, it isn't a direct measurement of insulin sensitivity.

It's a surrogate, and a noisy one at that.

Evidence confidence: high.

2. Why the post looks internally inconsistent

The person reports:

Before

HbA1c 5.9%

fasting glucose 105 mg/dL

fructosamine 281

After 54 lb loss on tirzepatide/retatrutide/cagrilintide

HbA1c 5.1%

fasting glucose 64 mg/dL

fructosamine 162 (below reference range)

fasting insulin 31 μIU/mL

HOMA2-IR 3.13

Those metabolic markers don't line up with each other.

Strong signals of improved glycemia

HbA1c improved substantially (5.9 → 5.1%)

fasting glucose normalized and arguably became low

fructosamine dramatically lower

triglycerides improved

large weight loss.

Taken together, findings like these usually point to:

better insulin sensitivity and better metabolic health

not resistance getting worse.

Confidence: moderate–high.

3. The fasting insulin value is the weird part

The standout abnormality is:

fasting insulin 31 μIU/mL with glucose 64 mg/dL.

That pairing is strange.

If it holds up, it opens up some possibilities.

A. Non-fasting sample / protocol issue (common)

Probably the most likely base-rate explanation.

Was it genuinely fasting?

GLP drugs + delayed gastric emptying make this complicated.

A person might believe they are fasting while still having:

prolonged nutrient absorption

delayed insulin secretion

residual postprandial physiology.

With tirzepatide/retatrutide in particular, gastric emptying and meal timing matter.

If he ate late or absorption was delayed:

fasting insulin may not truly be “fasting.”

This is likely my leading explanation.

Confidence: moderate.

 

[lessthanhalf]

continued

B. Hyperinsulinemia that trails behind weight reduction

Something people bring up online more than the evidence supports.

The claim:

Even when sensitivity has improved, pancreatic β-cells keep putting out too much insulin.

Biologically, that isn’t crazy.

Insulin release patterns don’t always shift in step with metabolic gains.

However:

a HOMA of 3 measured at a single point doesn’t establish this.

And the unusually low glucose makes the picture harder to read.

Confidence: low–moderate.

C. Reactive hyperinsulinemia / an amplified incretin response

A possibility worth considering.

GLP/GIP agents are able to boost insulin output considerably when nutrients show up.

If some nutrient uptake was still happening (due to slower stomach emptying):

theoretically you might observe:

fairly elevated insulin together with low glucose.

Particularly if the timing of the draw was off.

The home glucose readings that were reported:

fasting 52

1 hr after breakfast 115

1 hr later 79

do not look like insulin resistance.

If anything they point toward:

solid glucose regulation and perhaps overshooting / a tendency toward hypoglycemia.

Confidence: low–moderate.

D. A lab artifact or a problem with interpretation

Can’t be ruled out.

Fructosamine 162 stands out since it sits under the reference range.

That might indicate:

abnormally low blood sugar

changes in protein/albumin turnover

problems with the assay.

Clinically, fructosamine is less commonly used because HbA1c largely replaced it.

It gives a rough picture of:

glycemia over the prior 2–3 weeks

since it captures glycated serum proteins (mainly albumin).

4. Why HOMA2 can be misleading in this situation

HOMA presumes something along the lines of:

fasting physiology at steady state.

Yet this individual has:

substantial recent weight loss

several incretin medications

cagrilintide

slowed gastric emptying

low glucose

possibly reactive physiology.

That isn’t the tidy physiology HOMA was built to describe.

A lone raised HOMA2-IR value here might just amount to:

misapplying the model.

Or at minimum:

reading too much into it.

Confidence: moderate.

5. A drop in HbA1c doesn’t automatically equal better insulin sensitivity — but here it strongly points that way

You asked whether a lower HbA1c means insulin resistance has fallen.

Strictly speaking:

No.

A lower HbA1c might come from:

more insulin secretion

medications

less carbohydrate intake

weight loss

better insulin sensitivity.

Still, in this context:

54 lb loss

lower triglycerides

lower fasting glucose

much lower sugar intake

GLP therapy

the prior probability leans toward:

insulin resistance having improved a great deal.

I would treat:

“my insulin resistance got much worse”

as not supported by what the data show.

6. The real standout red flag in the post is the recurring dizziness plus narrowing vision

That symptom grouping:

dizziness + tunnel/pinhole vision + a rushing-water sound

while exerting yourself

combined with the measured glucose:

52 mg/dL

points me more toward:

hypoglycemia-like physiology, hypotension, dehydration, or autonomic effects

rather than insulin resistance.

Particularly while on:

tirzepatide

retatrutide

cagrilintide

major weight loss

reduced intake.

People on GLP forums sometimes overlook:

lower blood pressure

lower intake

dehydration/electrolyte shifts

not fueling enough for exertion.

“Gatorade Zero + beef jerky” also delivers:

salt/protein but hardly any glucose.

Golf plus calorie restriction plus incretins plus long fasting windows could reasonably produce symptoms.

Not a diagnosis — just what stands out.

My overall read:

The post doesn’t make a convincing case for worsening insulin resistance.

What the evidence backs more strongly is:

markedly better glycemic control alongside one odd fasting insulin result that could stem from measurement context, lingering postprandial physiology, or a misread HOMA.

I’d be wary of accepting a single HOMA2-IR value at face value in someone using a stack of incretin/amylin drugs after major recent weight loss.

My take on all of it is: don’t get too worried about a few test results that don’t line up perfectly, there are reasons they might differ from expectations, and taken as a whole the evidence points to improved insulin resistance, so repeating tests down the road might resolve the question.

The symptoms, to me as well as to the AI, sound more like blood pressure/hydration/electrolyte problems.

 

[Meritocrat]

Ok, this is something I've seen in our diabetes clinic. It looks like the reverse of insulin resistance. It comes across as hypersensitivity to insulin, yet there also seems to be glucose dysregulation. That's what your low glucose levels point to. From what I can recall, what you're describing sounds closer to hypoglycemia than to the opposite. The massive weight loss may be what's driving it. It sounds like your system got a sudden shock. Then there's the glucagon action, which really does a number on our hormonal profile.

It may take some time for the endocrine signaling to settle at normal levels. For any future emergency episodes, I would keep some glucose powder on hand. HbA1c is the real number. Yours is super.

I don't think Mots-C would be a great choice at this moment. Maybe you could try some weight training? Getting the glucose turned to glycogen might minimize insulin production.

 

[Neurogroot]

FartfulCodger said:

How do your inflammation markers look? Were cytokines part of your panel?

After I dropped 60 pounds quickly, bloodwork showed inflammation was my biggest problem. My glucose was elevated too, sitting at 100. Several AI tools suggested the inflammation probably came from the strain rapid weight loss placed on my body.

From what I gathered, inflammation — even if it's short-lived — may bring on insulin resistance. Those AI tools recommended retesting once my weight had leveled off.

If you haven't done this yet, maybe try opening ChatGPT and sharing your race, gender, starting weight, ending weight, current medications, and how long it took you to lose the weight. After that, paste in your bloodwork results.

Great thing to ask! Before I started tirzepatide, I'd been living with a psoriatic arthritis diagnosis for 3 years, and Otezla was the treatment — though it hardly did the job. Since tirzepatide (and, as far as I can figure, KPV), I haven't needed Otezla anymore. My PsA showed up mildly on my skin, but my joints had it worse. Both hands — thumb, index, middle fingers — plus both wrists, my neck and my ankles. Oddly, it was symmetrical. The pattern comes from 15 years of playing organized baseball, averaging 55 games a season, plus all the practices that came with it, and these days golf just for fun.

Could this be inflammation-linked?

-RF came in at 11 iU/mL

-hs-CRP was 2.8, which I'm counting as a massive win given it hit 7+ at its worst.

-Fibrinogen was 423 mg/dL, a touch above range.

Still no cytokine results. I went through Goodlabs and ended up with a huge batch of panels, then added things à la carte like testosterone, igf-1, and others too.

Using demographics and uploading to AI was the route I took as well, except I used Gemini. Makes me wonder whether ChatGPT and Claude — the big 3 — would have handed me different advice...

After digging deeper, I'm also beginning to suspect that what Gemini actually meant was Hyperinsulinemia, not insulin resistance. The insulin my body makes seems to do its job well, but it opens the tap all the way if I have even 1 carb.

Congrats on hitting 60 lbs down — that is a massive accomplishment!!

 

[Neurogroot]

Meritocrat said:

Ok, this is something I've seen in our diabetes clinic. It looks like the reverse of insulin resistance. It comes across as hypersensitivity to insulin, yet there also seems to be glucose dysregulation. That's what your low glucose levels point to. From what I can recall, what you're describing sounds closer to hypoglycemia than to the opposite. The massive weight loss may be what's driving it. It sounds like your system got a sudden shock. Then there's the glucagon action, which really does a number on our hormonal profile.

It may take some time for the endocrine signaling to settle at normal levels. For any future emergency episodes, I would keep some glucose powder on hand. HbA1c is the real number. Yours is super.

I don't think Mots-C would be a great choice at this moment. Maybe you could try some weight training? Getting the glucose turned to glycogen might minimize insulin production.

The more I dig into it, the more I believe you're 100% correct... My insulin does appear to be doing its job, so increasing it doesn't seem like the right move. Once I stopped letting AI freak me out and thought it through on my own, I can see this may be Hyperinsulinemia rather than insulin resistance. That explanation fits better. There's a huge amount of insulin being released, and it's very effective at lowering those sugars, but way more is being made than what's actually required. Does that sound like a more sensible conclusion?

 

[Meritocrat]

Neurogroot said:

Meritocrat said:

Ok, this is something I've seen in our diabetes clinic. It looks like the reverse of insulin resistance. It comes across as hypersensitivity to insulin, yet there also seems to be glucose dysregulation. That's what your low glucose levels point to. From what I can recall, what you're describing sounds closer to hypoglycemia than to the opposite. The massive weight loss may be what's driving it. It sounds like your system got a sudden shock. Then there's the glucagon action, which really does a number on our hormonal profile.

It may take some time for the endocrine signaling to settle at normal levels. For any future emergency episodes, I would keep some glucose powder on hand. HbA1c is the real number. Yours is super.

I don't think Mots-C would be a great choice at this moment. Maybe you could try some weight training? Getting the glucose turned to glycogen might minimize insulin production.

The more I dig into it, the more I believe you're 100% correct... My insulin does appear to be doing its job, so increasing it doesn't seem like the right move. Once I stopped letting AI freak me out and thought it through on my own, I can see this may be Hyperinsulinemia rather than insulin resistance. That explanation fits better. There's a huge amount of insulin being released, and it's very effective at lowering those sugars, but way more is being made than what's actually required. Does that sound like a more sensible conclusion?

Honestly, I can't say for certain. Hyperinsulinemia strikes me as something acute, or possibly chronic. You dropped around 25kilos, if I remember what you said? My guess is you were obese or overweight previously. That nearly always brings some kind of glucose malfunction along with it.

In my diabetes, the explanation I've been given is that as we shed weight, glucose control or sensitivity improves at the peripheral tissues first, before those effects get to the viscera. With you, no one can be sure, but it does look like a temporary situation with elevated insulin and extremely reduced glucose.

My way of looking at it is this. No external insulin is going in. Your glucose is too low. That's the opposite of diabetes, so your insulin sensitivity is enhanced. Yet your body is producing more insulin than is needed. To me that's an example of glucose dysregulation. So if it were me, I'd be thinking about how to reduce insulin production.

Plenty of ways exist for that. Keto diet, fasting, protein-rich meals, all are valid measures. Whether I could keep that up pragmatically, I don't know. But I do know that with more muscle-making, the glucose would not have to be converted to fat. Isn't that what insulin does?

Then, if the body needs glucose turned into glycogen, why would insulin be needed? That is my thinking anyway. You taking cagri too, yes? That may also worsen the scenario, me thinks. I guess, reduced food intake, lower glucose, higher insulin, yea I think it is a compounding issue. I think you may have to hit the weights sooner than after.

 

[Neurogroot]

Meritocrat said:


I'm not sure, tbh. hyperinsulinemia feels like an acute, if not chronic condition. You lost some 25kilos, or so you said? I guess you were overweight or obese before. That almost always leads to some form of glucose malfunction.

With my diabetes, they say that when we lost weight, the glucose control or sensitivity improves first at our peripheral tissues before the effects reach the viscera. In your case, one cant be certain, but, it does look like a temporary situation with elevated insulin and extremely reduced glucose.

I look at it like this. You are not taking external insulin. Your glucose is too low. It is the opposite of diabetes so you have enhanced insulin sensitivity. But your body is making more insulin than is needed. That is a glucose dysregulation example, I think. As such, if it were me, I would think about how to reduce insulin production.

There are many ways to do this. Keto diet, fasting, protein-rich meals, are all valid measures. But I dont know if I could continue that pragmatically. But I know that with more muscle-making, the glucose would not have to be converted to fat. This is what insulin does, right?

Then, if the body needs glucose turned into glycogen, why would there be need for insulin? That is my thinking anyway. You taking cagri too, yes? That may also worsen the scenario, me thinks. I guess, reduced food intake, lower glucose, higher insulin, yea I think it is a compounding issue. I think you may have to hit the weights sooner than after.

Click to expand...

Yep, that matches what I’ve been thinking. The schedule works out nicely—I’m leaving the country for just over 2 weeks, and Tirz is the only thing I’m bringing along. My plan is to keep splitting Tirz as a Friday primary dose plus a Tuesday booster until I hit my first goal weight. After that, I’ll switch gradually to Reta alone, drop a last 10-12 lbs very slowly, and focus harder on building muscle.

On the training side, I realize it’s nowhere near the same thing, but look into speed training for a golf swing. It delivers a serious strength stimulus along with a solid amount of cardio. My average ball speed off the tee went from a pitiful 132 mph to a middling 141. Because my ball flight isn’t great, that’s only about 15 extra yards of carry, yet my average drive is +22 yards versus late last year. It’s helped—at least until the next shots come, haha.

 

[Meritocrat]

Neurogroot said:


you should check out golf club swing speed training. It’s a crazy strength blast with a good deal of cardio attached to it. Went from a sad 132 mph ball speed off the tee on average, to a mediocre 141

Click to expand...

I could be mistaken, but isn't that power training rather than strength training? It sounds like the maximum force produced per unit of time, not the total force produced. I train a little mma, tug of war and grip strength, and this resembles the power work that makes up my tug of war and striking training.

 

[Neurogroot]

Meritocrat said:


I may be wrong, but rather than strength, isnt that power training? Instead of total force generated, it sounds like maximum force generated per unit time. I do a bit of mma, tug of war, grip strength, and this sounds similar to the power training my tug of war and striking training regimen consists of.

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Plenty of approaches exist for this. A big chunk of them center on building up fast twitch fibers — and from what I can tell, I've got none of those. One option: go lighter on squats and add a little jump off the floor. Another: take the same kind of machine used for triceps pulldowns, hook ropes onto it, drop into the back swing position at full stretch, then alternate between lighter resistance done as fast swings downward and heavier resistance done as slow, controlled, smooth swings.

Beyond that, there's simply… swinging weighted clubs. Or drills that involve lining up a dozen balls on tees, each about a foot apart, then stepping up and taking a max swing where direction matters less than raw ball speed. Right after that swing, you step forward and launch another full one. That's 12 all-out max drives within a minute.

The surprising part is where the soreness actually lands: my hamstrings, quads, and obliques take the worst of it. My arms almost never get sore, even though you'd expect them to be the ones getting destroyed.

 

[Meritocrat]

Neurogroot said:


There’s a lot of different methods. A lot of it involves increasing fast twitch muscles, which apparently I have zero of. Talking lighter weights with squats where you hop off the ground a bit. Or, using a similar machine for triceps pulldowns, but attaching a set of ropes to it, getting into the back swing position, full stretch, and alternating sets of lighter resistance fast swings down, to heavier, slow/controlled smooth swings.

Then, there’s just… Swinging the weighted clubs, or drills where you have a dozen balls tee’d up a foot apart, and step up, max swing without caring about direction so much, just ball speed. Immediately after swinging, step forward, full launch again. 12 full max drives in a minute.

Shockingly, the parts that end up with the most soreness would be my hamstrings, quads, and obliques. Never really the arms, which you’d think would get hammered.

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Right — that's what people call power training, or plyometrics.

 

[Neurogroot]

eidos said:

Stop chasing perfect numbers. Your HbA1c looks fine. After meals, glucose rises then comes down fast enough. What stands out is the low blood sugar spells, and one of those could mean you don't wake up one day...

You should dial back your aGLP-1 dosing now, and possibly keep only 1 in the mix. MOTS-C does a lot of good, yet it pushes hypoglycemia in the wrong direction. Last month I went through 3 of those episodes while on tirz+reta+mots-c.

Add more complex carbs to what you eat. Pick the kind that won't send your blood sugar soaring.

Get a CGM (the Freestyle, for example) so you can track your levels and receive warnings before you pass out.

The CGM hasn't arrived yet. Until it shows up, I've been sticking my finger for readings, because Amazon misplaced my package during the weekend. Annoying. On 2 mornings the meter only displayed “Lo”, the cutoff for under 50. The remaining checks came in at 68 and 71. My hope is that once the CGM is running, I'll get a clearer picture of how fast my body deals with glucose. I believe there's some kind of 2 hour test that measures this, but the name escapes me.

MOTS-c has been dropped from my list, thanks for steering me away from it. As for Reta, I'm putting it on pause for now. I'd rather wait until I reach my goal weight, then push hard toward building muscle (to whatever degree a sedentary nerd like me is capable of), and get my tirz dose lower. I'm also dropping another mg from that starting with my next injection.

 

[Neurogroot]

Meritocrat said:


yup, thats power training aka plyometrics.

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Guess that proves how little I actually knew… Truthfully, when it comes to fitness, I’ve never put in the effort I ought to have. I was strong enough for daily life, so I simply… let it slide. Now I regret that, because as I age, the everyday strength that used to come naturally keeps fading away.

 

[GLP1Pharmacist]

RS deals with hypoglycemia, meaning blood sugar drops. That makes it key to eat several modest meals spaced evenly, rather than, say, having dinner at 6 PM and then nothing until 10 or 11am the following day. On top of that, the glp1 dose should be reduced. 50 is too low.

 

[Neurogroot]

randompersonrandom said:

Worth keeping in mind: a physician's actual duty is to inform you as well as their professional expertise allows, respond to your questions, explain what risks come with a given choice, and then back you up as best they can once you've decided what to do next.

What a physician is NOT there for is handing down orders, assuming you'll comply, and reprimanding you when you don't. I wouldn't tolerate that from ANY physician, and I doubt many would even attempt it if I spelled out what I expected from them.

Last 2 visits, my physician pushed statins and wanted me to stop smoking. I wasn't ready to give up cigarettes, and I wasn't ready to agree that statins were needed. I told him I'd begin a GLP-1, bring my weight down, and then reassess. He replied that even if I quit smoking, he doubted it would change enough. I told him fine, I'd see how it played out. If more than 6 months pass, my weight reaches normal, and LDL remains too high, we'd discuss either quitting smoking or statins; but not both simultaneously. He explained what that does to my cardiac event risk. I thanked him. We left as teammates.

At the following appointment, if my LDL is still elevated, I'm still refusing statins. My cigarette quit date is 8/1. We'll give THAT some time, then retest after a sensible interval. If it's still high, then statins. I get what that means for my risk level right now, because he told me, because that's what my insurance pays him to do. He is NOT an authority over me, and even if he believed he were, he still wouldn't be.

I bring this up because yours isn't an authority over you either. Fine, they're glp-1 negative. That's okay, they can say so, and they can explain why. You chose to go on them. They have to accept that, and they still have to do right by you even if you didn't obey them; and you're entitled to, in a completely cordial manner, hold them to it.

Honestly, this comes down to something I need to fix in myself. I'm extremely non-confrontational, and even now, at my age, I still tie certain jobs and types of people to authority. As if there's no other physician available, or some ridiculous idea like that.

If I'm being truthful, another piece of it is that I'm on specific prescriptions. Ones that were a nightmare to get approved in the first place, and plenty of doctors these days are leaning toward prescribing them less often, or forcing me to go through the entire lengthy process from scratch again.

That said, you're not wrong. I just have to toughen up and find a different doctor. Heaven knows I already spend enough on medical expenses.