75yo male with pre-diabetic and pre-hyperlipidemia history Started on rapa (6mg/week) in January, added acarbose 25mg/meal in early Feb, metformin 50mg in the morning, Glucovantage 200mg evening. Worried about the glucose/A1C. Should I discontinue rapa periodically (ie skip one week per month) or go to a once every other week?
Blood test in Dec, Feb and June
Glucose. 116. 104. 129
A1C. 5.7. 5.8. 6.1
Insulin. 11.4. 7.5. 12.3
All other markers improved.
I would consider upping the acarbose and dropping metformin. Take 50mg every meal that includes carbs. No reason why the glucose/A1C would not stabilize at a lower level. Give it more time. Test in 3 more months. Do you find insulin ~10-12 to be normal for your recent past?
I also would agree up their Acarbose, and get rid of Metformin. For me, Metformin was a real killer in fatigue… low energy… constant diarrhea, everything bad … and the dose was pretty high. On the Acarbose… lower dose and just a little gas, otherwise things seem great.
Thanks for chiming in Agetron, I have read many of your posts. Been a lurker here for a few weeks, that was my first post/reply. Amazing community and looking forward to rapamycin journey starting soon. I need to get my lipids a little better before starting. Recovering alcoholic here, cholesterol is too high. Better health and longevity is in my hands!
In general when starting Rapa, anticipate some slight worsening of lipids and glycemic control. It is something to manage and usually pre-empt. Lots of options of things to do to tighten up the glycemic control.
I agree that metformin and likely berberine might not be at the top of the list. Lots of factors in choosing which drugs to use. It’s really useful to have an innovative Family/Internal Med Physician who will work with you.
Thanks for the quick reply. Not real sure about the normal’ fasting insulin levels …it did fall to 7.5 befor going up to 12. The Feb test were very encouraging.but I slid back some. I came off the rather indulgent holiday, and hit the NY resolutions hard. Will try your advice …echoed by others …and drop metformin …up the acarbose and re-test after 3 months. I did not mention I also take Atorvastatin 10mg, which is not helping the glucose/A1C/insulin, but is helping keep all the lips markers in the green. Will report back after the next test. PS: APo(a) came in at <8.5
I am working on my PCP …trying to get him interested in the Healthspan curve. There is a paucity of physicians in the ‘mainstream’ who venture too far from established protocol. Based on the feedback, it seems to make sense to increase the acarbose and drop the metformin …and see what happens in 3 months. I did not mention I also take 50mg Atorvastatin … which is likely contributing to the glucose concern…I will say that all my lipid markers are in the green (Apo(a) came in at <8.5)
Maybe try a free continuous glucose monitor for two weeks…
Libre 3 currently offers a 2 week free sample.
Good idea …have registered …will see how that process works.
In general, simply looking at ApoB is adequate for lipids, and certainly knowing one’s Lp(a). A HOMA-IR (just need fasting glucose and insulin) will do a reasonable look at insulin sensitivity and an HbA1C for longer tracking would be the key items.
The first thing is to see if there is a problem in this area - and if so, then modify factors to optimize. It is pretty easy to do in general.
Acarbose is fine - but depends how big of an abnormality one is treating, as it isn’t that potent, but is a good start.
I also think everyone should wear a CGM at least once in their life - it is a great tool, and a great way to see one’s metabolism.
The issue with metformin, is there is a risk, which is dose dependent of muscle loss, which then is a health risk. I’m choosing other options most of the time in non-diabetic patients. We have options that are likely better longevity candidates in this space.
Thanks … I am slowly getting smarter about taking rapamycin in terms of it’s effect on pre-existing lipid and glycemic control It is a little better than a drunk stumbling down an alley. I am scheduled for a zoom call with my PCP to get the prescription for a CGM …definitely agree with the value of a better understanding of glucose management; plus, I should be able to evaluate the role of acarbose as well. As a mere mortal, the complexity of making sense out of the interaction of all the variables is daunting. Hope there will be some AI help soon. In the meantime, I will continue to tweak the number/dosages/timing of the Rx and supplements, continue to monitor blood markers, work on diet/exercise, and keeping up with the science and experiences ‘out there’.
There is a definite personal limit on acarbose dosage based on where I am… anything over 25mg per meal. I plan offset that limitation with smarter eating habits/diet. I am encouraged by a few of the epigenetic age calculations …which have me at about 10 years younger than the real age.