Is It Working: Diabetes

Monitoring Clinical Markers

1. Glycemic Control (Daily/Weekly)

  • Fasting glucose (FG): Track first thing in the morning; aim for a steady trend rather than day-to-day perfection.

  • Post-prandial glucose (PPG at 1–2 hr): Watch meal spikes; the goal is lower peaks and a faster return toward baseline.

  • Glucose variability: Fewer big swings (“rollercoasters”) across the day; smoother curves on CGM (if used).

  • Hypoglycemia frequency: No increase in lows; ideally fewer symptomatic dips as meals are better tolerated.

Early signal (2–6 weeks): PPG spikes begin to flatten; fewer extreme highs/lows.

2. A1c and Longer-Horizon Metrics (Monthly/Quarterly)

  • HbA1c: Expect meaningful shifts on a 8–12 week cycle; a 0.3–0.8% drop over 3–6 months suggests improved insulin sensitivity and lower average glucose.

  • Fructosamine or GMI (if on CGM.: Corroborates shorter-term trend before A1c catches up.

 Medium signal (3–6 months): Downward trend in A1c or stable A1c with fewer symptoms/less variability.

3. Insulin Sensitivity & Medication Response

  • Total daily dose (if on insulin): Stable or decreasing requirements without loss of control.

  • Oral meds: Reduced need for rescue adjustments (under clinician guidance).

  • Dawn phenomenon: Softer pre-breakfast rise.

 If meds can be cautiously de-escalated while glucose remains stable, sensitivity is improving.

4. Body Composition & Cardiometabolic Vital Signs

  • Waist circumference: Gradual reduction indicates visceral fat shift.

  • Weight/BMI or fat-free mass: Move toward healthier composition without sarcopenia.

  • Blood pressure: Fewer hypertensive readings, especially morning values.

  • Resting heart rate/HRV (if tracked): Better recovery/stress balance.

Cardiometabolic risk should ease over 3–6 months as AMPK and lipid handling improve.

5. Lipid & Liver Profiles (Terrain Markers)

  • Triglycerides / HDL: Lower TG and higher HDL suggest better insulin sensitivity.

  • LDL-P or ApoB (if available): Downward trend supports reduced atherogenic risk.

  • ALT/AST & hepatic ultrasound (NAFLD/NASH): Enzymes normalize; liver fat stable or reduced.

 Expect movement over 3–9 months as bile flow, hepatic glucose output, and fatty acid partitioning improve.

6. Kidney & Vascular Protection

  • Urine albumin/creatinine ratio (UACR): Stabilization or reduction points to endothelial protection.

  • eGFR: No acceleration of decline; ideally stable over time.

  • Peripheral circulation: Warmer feet, fewer cramps, better capillary refill.

 Microvascular protection is a key “leveling out” sign over 6–12 months.

7. Neuropathy & Foot Health

  • Paresthesia/burning pain: Decreased frequency/intensity at night.

  • Monofilament sensation (if checked): Stable or improved.

  • Foot integrity: No new ulcers, calluses resolving, faster wound healing.

 Nerve pain improvements can begin in weeks to months; structural changes need longer.

8. Gut–Barrier & Microbiome Function

  • Bloating/gas after meals: Less frequent; meals feel “lighter.”

  • Bowel rhythm: More regular; less alternating constipation/loose stools.

  • Food tolerance: Fewer reactive meals; less post-meal fatigue.

 These shifts often precede A1c change and support steadier glycemia.

9. Energy, Cognition, and Cravings

  • Post-meal fatigue: Less post-prandial crash.

  • Mental clarity: Fewer “foggy” periods mid-afternoon.

  • Sugar/starch cravings: Reduced intensity and frequency.

 Subjective, but early motivators that correlate with smoother glucose curves.

10. Inflammation & Infection Susceptibility

  • CRP/IL-6 (if measured): Stable or trending down.

  • Dental/gum health & skin infections: Fewer issues; faster resolution.

  • Yeast/UTIs: Lower frequency (important in dysglycemia).

 Lower inflammatory tone supports vascular and insulin pathways.

11. Sleep & Autonomic Function

  • Sleep continuity: Fewer nocturnal awakenings to urinate; improved deep sleep.

  • Nocturnal heart rate: Trending lower; fewer sympathetic surges.

  • Morning readiness: More refreshed wakefulness.

 Better sleep improves insulin sensitivity; improvements reinforce each other.

12. Quality of Life

  • Daily capacity: More consistent ability to complete planned tasks.

  • Physical activity tolerance: Can walk farther or lift slightly more without glycemic fallout.

  • Mood resilience: Fewer days derailed by glucose swings.

 QoL stabilization is often what patients notice first and value most.

13. Trajectory Markers (Long View)

  • Complication curve: No new microvascular events (retinopathy, neuropathy, nephropathy) over 12–24 months.

  • Screenings: Stable retinal exams; stable UACR; stable or improved liver ultrasound.

  • Acute care avoided: No ER visits for hyper/hypoglycemic crises.

 A “leveled” trajectory means fewer complications and steadier control year to year.

Timeline Expectations

  • Weeks (2–6): Smoother post-meal curves, fewer crashes, better GI tolerance, improved sleep/energy.

  • Months (3–6): A1c begins to fall; TG/HDL shift; BP trends easier; neuropathic symptoms start easing.

  • Years (6–12+ months): NAFLD markers improve; kidney microalbumin stabilizes; complication risk plateaus or declines.

Safety & coordination: Adjustments to insulin or oral agents should be clinician-guided to avoid hypoglycemia as sensitivity improves. Continue routine eye, kidney, foot, and cardiovascular monitoring.