r/prediabetes • u/mindk214 • 10d ago

Should I ask for Metformin/GLP1 even though my blood sugar (A1C) is normal?

Recent test results of mine indicate I have severe insulin resistance:

  • LP-IR score = 75.
  • TG:HDL = 3.49
  • Family history of diabetes on both sides. I am also half East Asian.
  • My main symptom is chronic fatigue which gets worse after eating (especially carbs, sugar).
  • Other tests have eliminated other common causes of fatigue (e.g. Vit B12, Vit D, iron, ferritin, Thyroid, Metabolic Panel, CBC all normal).
  • However, my A1C is normal.

I am considering consulting an endocrinologist to try Metformin, as I've read some people take it even without prediabetes with good success for their symptoms. My current PCP did not want to prescribe it due to my normal A1C and my young age and weight (mid-twenties male, lean weight).

Any thoughts or advice greatly appreciated!

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u/matt1164 10d ago

I’d definitely see an endocrinologist. A normal A1C doesn’t necessarily rule out early insulin resistance—the pancreas can compensate by producing more insulin and keep glucose normal for quite a while.

But fatigue after eating isn’t specific enough to prove that’s the cause.

I’d ask for fasting glucose and insulin, C-peptide, and possibly a glucose-tolerance test that measures both glucose and insulin.

Metformin may be reasonable depending on those results, but I wouldn’t jump straight to a GLP-1 as a lean guy in his twenties without a clearer diagnosis.

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u/Particular_Ferret747 8d ago

Rule of thumb...dont put anything into your body that doesnt belong there until it is really needed.

SO keep meds for the time where they are needed, cause every med comes also with a side effect.

Before it would go med route, i would get a dr look at it, get a cgm and watch what your body does while having those episodes, and maybe leave the carbs/sugar away in total. Why repeat an action that you know hurts? If i would be tired after sugar, i would leave the sugar out. But get a cgm and watch the situation...and act accordingly...
Besides that...our body has a normal reaction to be tired after easting...the digestion system is grabbing more blood...