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.
1 Like
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?
2 Likes
I also would agree up their Acarbose, and get rid of Metformin. For me, Metformin was a real killer in fatigueā¦ low energyā¦ constant diarrhea, everything bad ā¦ and the dose was pretty high. On the Acarboseā¦ lower dose and just a little gas, otherwise things seem great.
1 Like
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!
4 Likes
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. Itās really useful to have an innovative Family/Internal Med Physician who will work with you.
2 Likes
Thanks for the quick reply. Not real sure about the normalā fasting insulin levels ā¦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 ā¦echoed by others ā¦and drop metformin ā¦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
2 Likes
I am working on my PCP ā¦trying to get him interested in the Healthspan curve. There is a paucity of physicians in the āmainstreamā who venture too far from established protocol. Based on the feedback, it seems to make sense to increase the acarbose and drop the metformin ā¦and see what happens in 3 months. I did not mention I also take 50mg Atorvastatin ā¦ which is likely contributing to the glucose concernā¦I will say that all my lipid markers are in the green (Apo(a) came in at <8.5)
2 Likes
Maybe try a free continuous glucose monitor for two weeksā¦
Libre 3 currently offers a 2 week free sample.
Good idea ā¦have registered ā¦will see how that process works.
Metformin reduces glucose intolerance caused by rapamycin treatment in genetically heterogeneous female mice
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892694/
In general, simply looking at ApoB is adequate for lipids, and certainly knowing oneās 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 isnāt 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 oneās metabolism.
The issue with metformin, is there is a risk, which is dose dependent of muscle loss, which then is a health risk. Iām choosing other options most of the time in non-diabetic patients. We have options that are likely better longevity candidates in this space.
2 Likes
Thanks ā¦ I am slowly getting smarter about taking rapamycin in terms of itās 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 ā¦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 āout thereā.
1 Like
There is a definite personal limit on acarbose dosage based on where I amā¦ 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 ā¦which have me at about 10 years younger than the real age.
2 Likes
Hi guys sorry to hop in here but I feel like it is better to add to a thread rather than creating a new one. Got blood test results today my doctor ordered since my blood pressure was high despite otherwise being healthy (runs in the family). My follow up appointment is in 2 weeks and I am impatient so wondered if you guys might have some thoughts in the meantime. Anything looking a bit off that I should keep an eye on? Sorry if the units arenāt the most intuitive for all you Americans out there! Diet/ lifestyle/ prescription drugs/ supplements details are all on my profile bio. Did not take rapamycin for 5 weeks before the test as I was on a break.
Thyroid:
Serum TSH level 1.69 mU/L [0.27-4.2]
Serum free T4 level 18.6 pmol/L [11.0-22.0]
Haemoglobin A1c level IFCC standardised 26 mmoL/moL [20.0-41.0] (Online converter calculator puts it at 4.5% DCCT)
Liver profile:
Serum total protein level 71 g/L [60.0-80.0]
Serum albumin level 49 g/L [35.0-50.0]
Serum globulin level 22 g/L [21.0 - 37.0]
Serum total bilirubin level 12 umol/L [0.0-20.0]
Serum alanine aminotransferase level 17 U/L [10.0-50.0]
Serum alkaline phosphatase level 65 U/L [40.0-129.0]
Full blood count:
Haemoglobin concentration 141 g/L [130.0-178.0]
Red blood cell count 4.64*10^12/L [3.01-6.79]
Haematocrit 0.420 L/L [0.4-0.5]
Mean cell volume 90 fL [80.0-100.0]
Mean cell haemoglobin level 30.3 pg [27.0-32.2]
Mean cell haemoglobin concentration 337 g/L [300.0-350.0]
Red blood cell distribution width 13.7% [8.0-14.0]
Platelet count - observation 208*10^9/L [150.0-400.0]
Mean platelet volume 10 fL
Total white blood count 4.1*10^9/L [4.0-11.0]
Neutrophil count 2.1*10^9/L [2.2-8.0] below reference limit
Lymphocyte count 1.4*10^9/L [0.5-4.0]
Monocyte count - observation 0.5*10^9/L [0.1-1.1]
Eosinophil count - observation 0.1*10^9/L [0.0-0.4]
Basophil count 0.0*10^9/L [0.0-0.5]
Nucleated red blood cell count 0.0*10^9/L [0.0-0.0]
Urea and electrolytes:
Serum sodium level 140 mmol/L [133.0-146.0]
Serum potassium level 4.0 mmol/L [3.5-5.3]
Serum urea level 2.3 mmol/L [2.5-7.8] below low reference limit
Serum creatinine level 117 umol/L [59.0-104.0] above high reference limit
GFR calculated abbreviated MDRD 72 ml/min/1.73m2 AKI NA (no idea what that means) If I do the calculation adjusting for height and weight the eGFR is high 90s
Full lipid profile:
Serum cholesterol level 2.4 mmol/L (92.8 mg/dl)
Serum triglyceride levels 0.61 mmol/L (54.0 mg/dl)
Serum HDL cholesterol level 1.02 mmol/L (39.4 mg/dl)
Calculated LDL cholesterol level 1.1mmol/L (42.5 mg/dl)
Serum cholesterol/HDL ratio 2.4
Serum non HDL cholesterol level 1.4 mmol/L (54.1 mg/dl)
Sorry about the data dump but I know how much you nerds love blood test results!
3 Likes
I entered the above in https://www.asklongevitygpt.com/ and got some answers. It is limited to 300 words for an input so I had to trim the last result from that section of your test. You could go through your test results about 5 lines at a time.
Give it a try 
Summary
-
Total Cholesterol: Desirable
-
Triglycerides: Normal
-
HDL Cholesterol: Slightly low, consider lifestyle changes to increase HDL
-
LDL Cholesterol: Optimal
-
Cholesterol/HDL Ratio: Desirable
3 Likes
