Insulin Resistance and GLP1

I have only had my insulin levels checked once, back when we were TTC. The HOMA-IR number showed insulin resistance. But once we stopped TTC, the doctors wouldnt entertain measuring insulin levels or anything to measure insulin resistance.

There are other ratios in bloodwork that DO measure it. The triglyceride/HDL ratio still puts me way into the insulin resistance category despite being on a GLP1.

Since being on a GLP1, my BGLs are what they were in my 20's (around 70) and my total cholesterol is great. My triglycerides are still high. I still have skin tags, and a slight skin darkening around my neck, and now under my arms. This is newish.

I had hoped being on Zepbound would help this, but it hasnt.

I al also in perimenopause and taking progesterone. My periods are regular, albiet heavy, since starting progesterone.

My OBGYN wont perscribe estrogen because I have had migraines with aura in the past. He, like most doctors, believes the PCOS will magically dissappear when I hit menopause.

Id like to get the insulin resistance under control. I cant take metformin due to the severe GI issues it causes. I am on 10.5mg of Zepbound, and am losing weight slowly. The side-effects have been rough for me, so I am not eager to dose up yet.

My PCP said drop carbs, which i have significantly, however, if I go to low I get fatigued and mean as hell. Its always been the case with low carb diets and me.

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Any suggestions on how to get the insulin resistance under control?