Your annual physical probably ran a CMP and called the day done. A CMP is 14 markers covering kidney, liver, and electrolyte status - it's wide, but shallow. It will not catch pre-diabetes, insulin resistance, thyroid dysfunction, ApoB, or any hormone issue. Here's what it flags, what it hides, and the four panels you actually need alongside it.
The 14 markers a CMP actually runs
Fasting glucose, BUN, creatinine, eGFR, sodium, potassium, chloride, CO2, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, AST, and ALT. That's the whole list.
Together they cover kidney filtration, liver enzymes, electrolyte status, a single glucose snapshot, and protein balance. Useful as a safety screen before any medication gets written - required before GLP-1, metformin, or TRT.
What's missing: HbA1c, fasting insulin, lipid panel, ApoB, thyroid, vitamin D, sex hormones, ferritin, hs-CRP. None of those live on a CMP. If you've only ever run a CMP, you haven't been screened for the things that actually predict outcomes.
How we read a CMP in context
eGFR under 60 mL/min/1.73m² shifts the medication conversation - tirzepatide and semaglutide are safe above that threshold, but dosing strategy changes below. Creatinine trends matter more than one reading.
ALT above 40 U/L or an ALT:AST ratio above 1.0 points toward fatty liver, especially paired with waist circumference above 40 inches (men) or 35 inches (women). CMP can flag it; an imaging or fibrosis score confirms.
Albumin under 3.8 g/dL in an otherwise healthy adult is worth a second look - usually protein intake, chronic inflammation, or undiagnosed GI disease. Check with the rest of the picture before acting.
The four panels that fill the gap
Metabolic health: HbA1c, fasting insulin, ApoB, and a full lipid panel. This is the pre-diabetes and cardiovascular risk floor - fasting insulin above 10 uIU/mL is often the earliest flag CMP misses entirely.
Fatigue and cognition: TSH, free T3, free T4, ferritin, vitamin D, vitamin B12. A "normal" CMP with TSH above 4 mIU/L or ferritin under 50 ng/mL explains most "I'm tired and my labs are fine" cases.
Hormones (if symptoms): total and free testosterone, SHBG, estradiol, DHEA-S for men; add progesterone and FSH for women. Inflammation: hs-CRP - anything above 3.0 mg/L is worth routing.
What to do now
If your last CMP was clean and nothing hurts, run the Advanced lab panel - it includes the CMP plus HbA1c, fasting insulin, ApoB, full hormones, and hs-CRP in one draw.
If a medication is on the table (GLP-1, TRT, HRT, peptide), confirm the CMP is inside 90 days and book the assessment. Provider review can't run without it.