Talk to me about Pre-Diabetes

#1

I have read conflicting information about “Pre-Diabetes.” Would appreciate your thoughts/pointers.

My recent Hemoglobin A1C is 5.8. Back in 2017, the last time it was measured before this March, it was 5.9. In between, fasting glucose was about 100. So glucose has been high consistently for years, though none of my doctors ever told me to do anything about it. I decided that I wanted to take Metformin.

Have been on 1000mg Metformin for about 2 years. Also on Repatha and Exetimibe --(major concern was Lp(a) of 50 mg/dl now down to 29) and blood lipids are now good except for HDL which is crazy high – about 120. All the other factors are good: weight, exercise, diet, cardio function, but CAC of 0.96.

Genetic Data suggests that I might have an inborn tendency to both the higher glucose and HDL but don’t know what to make of that.

Article in the NYT says that prediabetes in women my age (70’s) progresses to diabetes less than about 30% of the time, so watch but don’t worry (or take meds).

So: how worried should I be? And is it OK to start Rapamycin with blood glucose at current levels?

#2

Seems like a question that would be easy to monitor and answer. Try the Rapa and see what it does to your glucose.

#3

I won’t give an individual medical advice on this forum, but happy to communicate in generalities.
An optimal HbA1C is 4.7%. Generally good advice to get to that level - not necessarily for Rapamycin - but for general longevity reasons. Rapamycin could increase your current blood glucose levels.
A fasting insulin level is useful to understand if the issue is insulin resistance or lack of production. I see a lot of older patients who simply have a pancreas that is happy with watching and not responding to higher than ideal blood sugar levels. These patients may have some response to diet/wt loss - but generally that isn’t the winning strategy. Folks who have a high serum insulin level - are much more likely to have great response to lifestyle change.
In general a non-ideal HbA1C should be optimized - but doesn’t influence being on rapamycin - it is just one thing that should be monitored and managed in an optimal range.

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