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Why we go beyond A1C to assess metabolic health

We don’t wait for A1C to go up. We track insulin, HOMA-IR, genetics, and early shifts in metabolism to act before disease shows up.

Updated this week

A normal A1C doesn’t always mean you’re in the clear. Many people have normal blood sugar averages — but their metabolism is already under stress.

At Fishtown Medicine, we go beyond A1C to detect early signs of insulin resistance and metabolic dysfunction, years before they show up as prediabetes or diabetes.


🔍 What A1C misses:

A1C is a lagging indicator (3-month average) of blood sugar — but it doesn’t show:

  • How much insulin your body is pumping to stay “normal”

  • What happens after meals

  • How quickly your blood sugar recovers

  • Silent inflammation or mitochondrial overload


🧪 What we test instead:

  • Fasting insulin — often elevated long before glucose rises

  • Fructosamine and Glucose (fasting and post-meal) — tells us how your body responds to food

  • HOMA-IR — a calculated score of insulin resistance

  • Triglyceride-to-HDL ratio — a proven metabolic risk marker

  • Genetic insights — to understand inherited risk

  • CGMs (continuous glucose monitors) — a tool we use regularly to track real-time trends and tailor interventions


🧠 Why it matters:

Metabolic dysfunction often starts quietly — with fatigue, fog, belly weight, or food crashes. If we wait for A1C to change, we miss the chance to reverse course early.

Detecting and addressing these early shifts can help prevent:

  • Type 2 diabetes

  • Cardiovascular disease

  • Cognitive decline

  • Chronic inflammation and hormone disruption

  • Cancer risk


✅ What we do with the results:

Once we have your data, we help you:

  • Understand what your body’s doing behind the scenes

  • Adjust food timing, types, and rhythm

  • Support better insulin sensitivity through targeted movement, recovery, and supplements

  • Track change over time with periodic labs and CGM feedback

  • Personalize your care to your body, not a population average


You don’t have to wait for a diagnosis to act. If you want to explore this further, we’ll walk you through the testing and strategy that fits your needs.

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