Statins and PCSK9i such as Repatha lower cholesterol but raise blood glucose. My experience bears this out, and I don’t know how to balance so would welcome inputs.
In May 2023 I started Repatha upon learning that my Lp(a) was 40. LDL-C was about 125 and HDL 117 so Chol/HDL ratio was good. APOB aout 93. But was concerned about the Lp(a) because of family history and genetics (9p21 risk allele, 1.9 x risk of coronary artery disease).
By June 2024, Repatha lowered LDL to 72, Lp(a) to 27 and even HDL to 92, with APOB of 76. Low Trigs (53) and CRP of 1.0.
But HA1C went from 5.6 to 5.9 and FBG also went up.
Concerned about the glucose, decided to go off Repatha. Added 500-800 Berberine to 500, sometimes 1000mg Metformin. Tried a bit of Rybelsus and lost weight and got kidney stones.
Insulin and C-peptide are low. I believe what I have is a glucokinase inactivating polymorphism which causes pre-diabetic levels of glucose that usually do not progress, nor cause problems, nor require treatment, and are not impacted by diet. I had a referral to an endocrinologist in March 2024 but by the time I was able to get in to see him, six months later, the blood glucose had gone down to low-moderate pre diabetic levels. He said: no treatment required.
October 2024 – Ha1C down to 5.5, but cholesterol levels are up to about where they were before starting Repatha.
I do recognize that neither the glucose or cholesterol levels are alarming. I am also concerned about the possible neuro cognitive adverse effects from PCSK9i (also statins). Given everything I know about my health and family history, I believe I will live long and get Alzheimers so my biggest concern is actually neither cardio nor diabetes. It is neurocognitive decline.
I was considering restarting the Rybelsus at a very low intermittent level, (primarily because research suggests it is neuroprotetcive) but am inclined not to do that. After getting the recent lipids retested, I am poised to restart Repatha, and monitor glucose carefully, may-be increase Berberine. Am already taking gymnema sylvestre and a couple of other supposed sugar-lowering supplements.
In my head I hear Tom Dayspring saying that if Lp(a) is elevated, you want to get LDL levels low “like a kid again.” Should I be following that advice? I don’t know LDL particle size but the low trigs and high HDL suggest that the LDL is likely mixed to the “large bouyant” end of the range. CAC score was 0.96 and I am thin, generally healthy.
How to optimize glucose versus cholesterol? Try a bit of an SGLT2? Is the glucose or cholesterol a greater concern? or is neither a concern at these levels? Should I just close the book on all of this?