Weight loss injections with type 2 diabetes and relationship between HbA1c and goal weight

[PuzzledObserver]

I’ve had T2D for 28 years and was morbidly obese most of my adult life. After a LOT of work on my mindset around food, a complete change of eating habits. dealing with my sugar addiction and emotional eating etc, I lost a load of weight in 2024 and early 2025, getting off 2 diabetes medications in the process. For the past year or so, I have been bobbling around the 30 BMI mark, with HbA1C in the prediabetic range, without meds.

I started Mounjaro lost week with the hope of getting into the healthy BMI range, and also completely normalising my blood glucose. I’m not talking HbA1C of 40 (which is within the normal range) - I would like it to be optimal, which means around 30, give or take. I know that this may not be possible given the duration if my diabetes, but if it is possible, it will require me to further reduce my visceral fat. So far, so good.

Now to my question: is there anyone on here on WLI, with type 2 diabetes, whose HbA1C has bottomed out before they reached their weight goal? Have you completely normalised your HbA1C, and how much more weight have you lost, or want to lose, since that happened? Or has the HbA1C improvement stopped short of optimal even as you’ve lost further weight?

A year or so ago I did a lot of reading of work by Prof Roy Taylor of Newcastle University. He talks about a “personal fat threshold” which everyone susceptible to diabetes has. If you exceed it, you develop diabetes. One person’s threshold may correspond to a BMI of 32, another’s might be 36, still another might develop T2D within the normal BMI range. But even for the latter, losing weight - or more accurately, reducing fat infiltration in the liver - will result in an improvement in diabetes.

Oops, forgot to say - MJ was of course first developed to treat T2D and only later licensed for weight loss. The impact on my BG since I started has been powerful. I don’t routinely monitor BG, but had slapped a Libre Freestyle on last Tuesday evening, 3 days before my first jab.

Those 3 days my BG averaged just over 6.
It has come down every day since and my average is now sitting under 4.5.

I'm not T2 diabetic but I was diagnosed pre-diabetic at the start of this year with an hba1c of 47 and a BMI of 44 so I was teetering right on the edge! My doc suspected I had probably been in the prediabetic range for years, I just hadn't had any need for a blood test.

I started Mounjaro on 13th Jan.

On 13th July I had a follow-up test and my hba1c came back at 34. At that point I had lost 22kg and my BMI was about 33.

I won't get my blood tested again for another 6 months or so, by which time I'm hoping to be optimal in terms of both hba1c and BMI.

So for me the Mounjaro has been nothing but positive in terms of its effect on my insulin and hba1c, but I still consider myself to be a work in progress.....

I’m Type 2, I was put on Mounjaro April 25 HB1AC had got down to 47 but BMI was also 47, 6 months later HBA1C down to 36 and 2 stone down, another 6 months and HBA1C down to 34 and another 2 stone down. I’m now 5 stone down but BMI is still 35 but bloods are normal, still on MJ and next bloods due in October. I would like to lose another 2 stone but that would only take me to BMI 29. I don’t know how long I will still be prescribed MJ hopefully until I reach a better BMI. Also BP now fine and no more C-pap machine for sleep apnea.

That’s great! Sounds like you are being prescribed MJ on the NHS?

I was put on Trulicity, another GLP-1, in late 2018 with an HbA1C in the 80’s. At the time my BMI was also around 44. It did wonders for my glucose, but not much for my weight. Although to be fair, I wasn’t in a place to do the mindset and lifestyle work at that time.

in January this year my HbA1C was 45 on no meds. At the time I was very proud of myself. Still am, to be honest. But I seem to have gone as far as I can on both weight and HbA1C with lifestyle change, so am gladly taking the extra help from MJ. Private prescription, though.

I’m hopeful that by the time my next checkup is due in January, my BMi will be very close to normal, and HbA1C too. What would be great would be if my practice would take over prescribing MJ for me….. but I don’t hold out much hope, because I don’t meet the criteria to get it on the NHS, for either weight loss or diabetes,

I was prescribed MJ in Sept 2024, at that point HbA1C was 11.7% (104) and I was taking insulin and metformin with little success.

within 6 weeks I was able to stop the insulin, 3 months after that I was down from 4 x metformin a day to 1 x slow release in the morning and now I take nothing except the MJ which I will be on indefinitely.

I went from 19st 5lb to 9st 9lb, size 24(ish) to size 10/12.

HbA1c is 5.2% (33), BP is normal, cholesterol reduced to normal, kidney and liver function normal and I don’t ache and click with every movement, in fact I can now (slowly and in a really graceless, uncoordinated way) jog 5k.

I’ve been at goal and maintaining for about 8 months now.

@PuzzledObserver I was very lucky to get it prescribed by diabetic nurse, they have changed the criteria at my surgery now and HBA1C has to be over 70 to get it, so I am so grateful, if it does stop before I reach where I want to be I will continue privately as I think I will need it for life. I have PCOS and have been overweight my entire life and saw my first dietitian at age 10 and no diet ever worked, I am a very slow loser at 1lb a week but it has now slowed to 1/2 pound a week.

You’re like me, I went to my first weight watchers session age 11 and at the time I weighed over 11 stone (shame is burned into my brain). I just got bigger and bigger from that point on. It’s very odd when I think about the fact that I weigh less as. 43 year old woman than I did in primary school.

@InfoSecInTheCity you have done amazing and it’s so sad that for our entire life we thought it was our fault we couldn’t control our weight but this medication is proof there is something medically that is missing in our system.