#33

I take 50 mg with my 2 daily meals on the acarbose, and have had HbA1C’s 4.6-5.2% and have good insulin sensitivity.

@Thiago Great on the values, and yes, HOMA-IR of 0.5 is perfect.

I cannot make an argument for you to take Acarbose. I think it is synergistic with rapamycin, and on a risk/benefit as long as no major GI side effects, I’d still favor taking it, but not as a high priority. But if trying to push the envelope to every advantage …

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#34

Though, perhaps oddly and confined to me, drinking a glass of whole milk has very little effect on my blood glucose level.

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#35

Do you have the genes to digest lactose? If not, like me, the lactose goes to the intestine where it’s digested by the bacteria instead of being split by lactase and going into the blood so not much of a spike if any for me with milk.

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#36

This indicates you are lactose intolerant - like ~65% of adults, though it varies significantly by ethnicity

#37

Thank you DrF for the dosage info. Do you think one can have too low a fasting insulin and thus should avoid adding Acarbose to the longevity mix? I ask given my two recent fasting insulin numbers were 1.8 (3 months ago) and 1.9 (6 months ago) range: 2.6-24.9)? I do take 1500 mg of Metformin daily (split up twice into 2 daily doses) and my A1c is normally 5.0-5.1.

#38

There might be evidence that you’d want lower than your ~5% though and to consider avoiding your spikes above 140.

Here is one place to look a bit about the rationale for that:

And here he gives his view on that lower average glucose is better* and puts that in context of success with a patient who came down to 84 mg/dL and hence at or below a predicted 4.6% HbA1c:

To recap my position and interpretation of the data available (more of which you can find in the AMA 24 show notes), lower is better than higher when it comes to average glucose, glucose variability, and glucose peaks, even in nondiabetics. In other words, there’s a lot of evidence suggesting that people with glucose in the normal range can benefit from lowering their numbers.

Let me give you an anecdote, among several I could share, to demonstrate why I find CGM useful in nondiabetics. I have a patient who came to me with normal glucose tolerance by standard metrics. He began CGM and after about two weeks it revealed an average glucose of 104 mg/dL over that time. The standard deviation in his glucose readings, which is a metric of glucose variability, was 17 mg/dL. He averaged more than five events per week in which his glucose levels exceeded 140 mg/dL. All three of these metrics are considered normal by conventional standards, but does that mean there’s no room for improvement? I like to see my patients with a mean glucose below 100 mg/dL, a glucose variability below 15 mg/dL, and, as noted above, no excursions of glucose above 140 mg/dL. After about a four-week intervention that included exercise changes and nutritional modifications his average glucose fell to 84 mg/dL [~at or below 4.6 HbA1c] , his glucose variability to 13 mg/dL, and he had zero events exceeding 140 mg/dL. If he can maintain this way of living in the long-run, it’s likely to translate into an improvement in healthspan and reduce his risk of glucose impairment.

See here: Cardiovascular Health - #184 by Neo

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#39

In general, I don’t think metformin is a great longevity medication in non-diabetics, and promotes sarcopenia. I don’t think I have any non-diabetic or non-PCOS patients on this, but have a lot of patients who are non-diabetic on acarbose.

As much as agents like metformin, acarbose, GLP-1’s, and SGLT2-i individually don’t cause hypoglycemia, which is a bad thing, I think most people tolerate the last 3 in combination, even with no T2DM and without having hypoglycemia.

I’m more excited about the last 3 than metformin.

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#40

There is potentially an issue of frailty with the drugs which reduce appetite or glucose.

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#41

I don’t think we see the sarcopenia issue with acarbose, SGLT2i’s, or GLPs all of which I advocate taking if tolerated and seem safe for the individual (talk with your physician).

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#42

What is the formula for equating 84 mg/dl to an HbA1c of 4.6%? The only formula I am aware of, that has been shown to not be accurate, is:
(FBG x 3%) + 2.6 = HbA1c.

Also, why would lower average blood glucose be better, as a rule? Lower than 100 mg/dl sounds right, but lower than 84 mg/dl sounds too low unless totally flat over time. Hypoglycemia is no fun in terms of quality of life not to mention health detriments that I know nothing about.

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#43

I tend to agree that there is an optimal level as well as keeping peaks below 8/140. I did get a test result at 4.18% once, but I am not sure that was particularly healthy.

What was interesting wearing the CGM was getting a moving glucose average which gave an arguable HbA1c. Particularly as I could see the effect of 77mg equivalent of Rapamycin.

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#44

Hello.

What do you mean with your last paragraph?

Thank you

#45

@约瑟夫_拉维尔

Not sure if you are shooting the messenger here

I was referring to a source that @Thiago might want to look at since he said he wanted to research and understand this question better.

My added personal framing was only that that Peter Attia episode seems to suggests that 5.0% HbA1c and glucose spikes above 140 might be higher than optimal if one is truly seeking to optimize one’s glucose.

You can see the whole Peter Attia episode and show notes in the link I had originally pasted above and now have repasted below.

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#46

Is that a question to me? If so there is a topic on this.

#47

Again, the Peter Attia episode linked above lays out why he feels/felt so based on some triangulation of literature

If you end up looking at the episode or reading the show notes I’d love to hear if there is anything you think he is wrong above and if so what and why

[btw, I think he means within bounds, not crazy, crazy low]

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#48

I think the healthspan issue with glucose is clear. High levels of glucose overclock the mitochondria producing more ROS than the endogenous anti-oxidants can handle without mtDNA damage.

That substantially, but not totally, is aging.

The other material short term (under 200 years) issue is senescent cells.

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#49

@Neo No bullets fired. I asked a genuine question. Blood sugar is a concern of mine. I try to get it lower an average. I cannot understand the “lower is better” theme … I believe there is a sweetspot. Hypoglycemia is definitely a bad thing…although I don’t know all the ways it is harmful.

Is it harmful during sleep? My CGM thought so (alarm).

My only experience with daytime hypoglycemia is in “bonking” which is when the liver runs out of glycogen during endurance exercise, and the brain has a “fit” (heart attack symptoms, I’m told). I can attest it is very unpleasant. I thought I was dying the first time it happened. It only happens to me occasionally, and only if I fasted for at least 12 hours and then did HIIT.

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#50

Absolutely agree with your Joe and also like the info and rationale provided by @Neo .

I don’t think the lower is better is necessarily the goal. I’d reframe this to running it as low as possible while not having symptomatic hypoglycemia. For example, when my blood sugar is in the 50’s, absolutely no symptoms at all. With the regimen I use, I still have times with food where I’ll go up to 180 mg/dL if I eat a fair bit of carbs, briefly, but have been running an HbA1C right around 5%.

It’s is more the issue of avoiding side effects. I personally find a combination of GLP-1, SGLT2i, Acarbose seems safe for most people and generally doesn’t lead to symptomatic hypoglycemia. Each of these items has longevity and neurocognitive benefit. However, if there are side effect/hypoglycemia, then it needs to be backed away from.

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#51

Great, all good :+1:

Part of my goal is to have a low variance - so also decrease any steep down movements

In general think

Captures roughly my personal heuristic

(And also that what is optimal for longevity (perhaps the way Mike Lustgarten works out) is not necessarily the as I what is needed/optimal
for an endurance athletes - at least around key endurance work)

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#52

You sure this is a real alarm and not because your body weight ended up on the arm with the sensor for a bit?

I was having that issue, and then I moved the sensor to where the arm is a bit more fleshy a bit “higher” AND closer to the arm pit (as I think Levels suggests) and then I did not have that issue with low glucose alarms on the CGM anyone during night time.

I figured it out once during the day when the alarm went off when I was as lying on a sofa during the day

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