Got my latest labs back this morning and I actually cried. A1C: 5.4%. For context, here's my trajectory:
| Date | A1C | Fasting Glucose | Weight | Meds |
|---|---|---|---|---|
| Jan 2025 | 9.2% | 198 mg/dL | 267 lbs | Metformin 2000mg + Glipizide 10mg |
| Apr 2025 | 7.8% | 156 mg/dL | 248 lbs | Metformin 2000mg + Sema 0.5mg |
| Jul 2025 | 6.9% | 128 mg/dL | 231 lbs | Metformin 1000mg + Sema 1.0mg |
| Oct 2025 | 6.1% | 108 mg/dL | 218 lbs | Metformin 1000mg + Sema 1.7mg |
| Jan 2026 | 5.6% | 96 mg/dL | 207 lbs | Metformin 500mg + Sema 2.4mg |
| Jun 2026 | 5.4% | 91 mg/dL | 201 lbs | Sema 2.4mg only |
My endocrinologist officially removed the T2D diagnosis code from my chart and replaced it with "history of." She said she almost never gets to do that. I'm off metformin entirely as of last month.
F/52, 5'6". Diagnosed T2D in 2019. Was told I'd be on medication for life.
This is legitimately life-changing. An A1C of 5.4 isn't just "controlled diabetes" — that's a completely normal, non-diabetic value. Your pancreatic beta cells clearly still had reserve capacity, and removing the glucotoxicity let them recover.
The fasting glucose trend is almost as impressive. 198 to 91 is textbook metabolic restoration.
A few questions if you don't mind:
- Did you make significant dietary changes beyond what the appetite suppression naturally caused?
- Any hypoglycemic episodes during the transition off glipizide?
- What's your CGM data look like now? Time in range?
Great questions.
Diet: Yes, beyond just eating less I made a deliberate shift to lower glycemic index foods. More protein, more vegetables, dramatically less refined carbs. But I'm not keto or anything extreme — I still eat fruit, whole grains, sweet potatoes. The appetite suppression made it easier to be intentional about food choices rather than just grabbing whatever was fastest.
Hypoglycemia: One scary episode about 3 weeks after starting sema while still on glipizide. Blood sugar dropped to 54, shaky, sweating, the works. That's when my endo pulled the glipizide. Lesson: GLP-1 + sulfonylureas need careful management.
CGM: Libre 2. Time in range (70-180) is 97%. Time below 70 is basically 0% now. My average glucose over the last 14 days is 104 with a standard deviation of 18. Before treatment my SD was in the 40s.
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View ResultsThis is a beautiful case study in metabolic recovery. A few clinical points for anyone reading who's in a similar situation:
- A1C below 5.7% is officially non-diabetic range. 5.4% is solidly there.
- The fact that fasting glucose is 91 (well under 100) suggests genuine insulin sensitivity restoration, not just medication-masking.
- Glucose variability (SD of 18) is excellent — that's better than many people who were never diabetic.
The critical question now is sustainability. The semaglutide is doing heavy lifting for both appetite/weight and direct glycemic effects. If you ever need to discontinue, a careful transition plan with your endo is essential.
Congratulations. Truly.
I'm sitting here with my A1C of 8.1 feeling hopeful for the first time in a while. Just started sema 3 weeks ago. Thank you for posting this.