It resolves reasonably quickly. You can see that in the results on a topic. I think things adjust generally within about a week. My HbA1c result from Tuesday’s blood draw was 4.71%. I had taken another high dose on Sunday, but it takes a while for that affect HbA1c.
Yes, acarbose would mitigate postprandial glucose, at least for carbs that are affected by acarbose (i.e. no effect on pure glucose or other monosaccharides). I don’t know if anyone has definitely answered the question about microbiome health vs postprandial glucose spikes (vs some combination of both) when it comes to acarbose 's health benefits. It seems hard to disentangle since you need the carbs in the meal to both show a blunting of glucose spike and for the effect on the microbiome (since those carbs then get fermented by colonic microbes).
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Yes, MB is in some UTI meds like Uribel where it turns your pee a bluish green. Feels very relieving when you’ve got pain down there or any sort of flare up.
One more point for SGLT1: The Impact of SGLT1 Inhibition on Frailty and Sarcopenia: A Mediation Mendelian Randomization Study 2024
SGLT1 inhibition potentially mitigated frailty and sarcopenia through several biological mediators, shedding new light for therapeutic intervention.
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Why would SGLT1 inhibit Sarcopenia where SGLT2I would not?
They might both prevent sarcopenia as the article notes that the effect is driven by insulin sensitivity: “The two-step MR analysis demonstrated the role of insulin resistance phenotype in mediating SGTL1 inhibition on alleviating frailty (mediation proportion = 19.56% [95% CI: 8.42%, 30.70%]).”
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Empagliflozin + insulin, intranasally:
https://www.medscape.com/viewarticle/intranasal-insulin-drug-combo-promising-alzheimers-2024a1000k86
The Empagliflozin is working great for weight loss. I’ve now hit a new low that I haven’t been at in 5-6 years. I hope the streak continues! Total weight loss has been around 6 lbs since July.
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It’s a paper from last year but it’s very good: Impact of baseline kidney function on the effects of sodium-glucose co-transporter-2 inhibitors on kidney and heart failure outcomes: A systematic review and meta-analysis of randomized controlled trials 2023
Meta-regression analyses showed a significant direct relationship between baseline eGFR and the magnitude of SGLT2is’ renal protection (P = .003). The greatest risk reduction was in participants with an eGFR of 90 ml/min/1.73m2 or higher (HR 0.43, 95% CI: 0.32-0.58) and the smallest was in those with an eGFR of less than 30 ml/min/1.73m2 (HR 0.73, 95% CI: 0.62-0.86, P < .001). Conversely, for HF, the greatest risk reduction was in those with an eGFR of less than 30 ml/min/1.73m2 (HR 0.68, 95% CI: 0.48-0.96) and the smallest was in those with an eGFR of 90 ml/min/1.73m2 or higher (HR 0.87, 95% CI: 0.56-1.34).
SGLT2i offer more kidney protection to… healthy people! One more reason to start taking them earlier? (poke @Yoo)
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I have elevated A1c of 5.8, so prediabetic range. Doing a lot of fingerprick glucose readings over time, especially around meals and exercise, I have concluded that gluconeogenesis has some role in my BG readings, because certain features of my diet (avoiding added sugars, only complex carbs, tons of fiber etc.) should ordinarily allow better BG profile. For a variety of reasons I have decided to start taking empagliflozin next month to see if I can’t get my BG under control. In this light, I have come across this - Chinese paper, but reviewed by non-Chinese institutions, and the study is in mice:
Quote:
“These findings demonstrated that empagliflozin partially reduced hepatic gluconeogenesis and increased glycogen contents by the AMPK/CREB/GSK3β signalling pathway in vivo .”
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My problem exactly. E25 may have lowered fasting glucose by 5 or 10. Not enough for me to put up with having to get up in the night to pee. Let me know if you find something that works.
I’m trying chromium 1000 next. Started this morning.
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Semaglutide/tirzepatide?
I’m starting with 12.5mg (bought 25mg tabs from India, will split in two). I’ll give it some time, if not enough happens I’ll go to 25mg/day. If still not enough I’ll have to see what else is out there. Many supps don’t work for me, such as chromium or turmeric. Interestingly I was on 500mg/day of metformin for a year, and it did absolutely nothing for me, total bust - and I was unwilling to up the dose because of poor effect on exercise (allegedly). I did buy acarbose, but I’m just sitting on it, because if it really is all gluconeogenesis, then I don’t see what aca can do for me - of course, I might ultimately experiment with it, just to see the impact, but I want to try other interventions first. I suppose at some point I might be forced to look into the whole GLP-1 mess if my BG continues to be trash.
For my father and I, empagliflozin at your dosing level does not affect our HBA1C scores, which, like you, are at 5.8.
However, our urine smells a lot different now!
I think the next step for me is an oral GLP-1 (Rybelsus). Maybe berberine. My father doesn’t have any extra weight to drop, but he’s 78 yo.
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Do you take taurine? It might increase gluconeogenesis. I stopped using it myself as a test.
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Yes, I do take taurine, 3-4g/day, but I only started a few months ago, and my glucose problems I’ve had for years. I don’t think taurine is the issue in my case, but perhaps it’s not helping, I don’t know.
The funny thing is that I generally keep my calories on the low side, and I have a very strong reaction to exercise, like in it raises my BG very strongly. I do my weight lifting after 18 hour overnight fasting, and my BG spikes from like 98 to 115 after exercise. Which is why I conclude that gluconeogenesis is my problem, as my meals don’t spike my BG to crazy levels (very rarely above 140, usually in the 120’s). But my morning BG is usually above 100, and fasted exercise 115.
I really thought metformin would stop my liver from overproducing glucose, but no such luck. Now I’m hoping empa gets rid of the BG excess, so was happy to see the possibility it might even impact gluconeogenesis, though I’m a bit sceptical. We’ll see in a few weeks. I’ll keep testing daily, snd then get an A1c test after 90 days or so of empa.
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I’m in the exact same situation. Eating low carbs, tried 500mg metformin, 500mg berberine, acarbose plus any supplement and intervention supposed to help but my liver happily makes too much glucose and any exercise above zone 2 increase the blood glucose even more. I then tried empagliflozin 12.5mg for more than 3 months now and my A1C went from 6.0 to 6.0 
I’m now starting rybelsus. Hopefully this will have a greater effect.
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I took metformin from 2014 to 2021 then switched to Jardiance
However, morning BS was often above 100 until I discovered Akkermansia. Pendulum https://pendulumlife.com sells a product containing this and now my BS is typically under 90
Seems gut health is connected to metabolic health - who knew?
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You are lucky, I tried Pendulum glucose control for more than 6 months and it didn’t do anything to my A1C which is still 5.9~6.0.
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I would gladly test it, but they still don’t deliver to the EU, same issue with iHerb.
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