It would be nice if fasting insulin and other markers were tested more regularly beyond fasted glucose and a1c, since those can vary for other reasons. Not to mention catching those developing insulin resistance potentially years ahead.

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consp 3 days ago | parent | next [-]

A1c is simple, easy, reliable and readily available. You might not spot the early signs with T2 due to natural variations but it's definitely a good test for T1. Don't rule it out completely.

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mnw21cam 3 days ago | parent [-]

Agreed mostly. It's a great test. There is a slight complication because it depends on the amount of glycation "damage" that the red blood cells receive over their lifetime of a few months, so if a patient has a condition that means their red blood cells have a non-standard lifetime (for example if they have sickle cell disease) then the HbA1c measurement becomes non-standard as well.

The other thing a HbA1c measurement isn't so good for is detecting blood sugar spikes (which are really bad for you) and distinguishing that from a constant slightly higher blood sugar level (which isn't such a big deal). For instance, there's a reasonably rare condition called GCK MODY which causes the body to have a slightly higher blood glucose "set level", which shows up very clearly on a HbA1c measurement, tends to get clinicians to panic, and gets patients put on drugs or insulin which they do not need and in fact is harmful to them. My lab does many genetic tests for this condition (among others) and a fairly common message back to the clinician is to take them off all treatment.

	▲	tracker1 3 days ago \| parent [-]
		Similarly, in carnivore circles... doctors will try to put you on metformin or other medications when you hit 5.7 even though you do emphatically not have elevated glucose levels. The working hypothesis is that the cells are living longer so seeing slightly higher total glycation. Of course this is similar to ongoing lack of understanding in terms of cholesterol health. I've learned to pretty much only care about my TG/HDL ratio. Aside: my mostly carnivore/keto diet is pretty much the only course of diabetes treatment that has worked well for me over time... Trulicity/Ozempic ruined my life, and I've responded badly to very badly to almost every medication I've ever been given.

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thecosas 3 days ago | parent | prev [-]

There are also loads of tests for antibodies now; some are even (gasp) free for qualifying people. More here: https://www.breakthrought1d.org/early-detection/#screening-o...