fasting glucose and a1c

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JD2020
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Re: fasting glucose and a1c

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Tincup wrote: Tue Dec 05, 2023 5:57 pm
{edit}Terrific talk by Dr Mark Cucuzzella (doctor who removed sugar from his WV hospital, USAF fitness expert, ultra-runner, all around nice guy) from the Low Carb Denver event in March 2020:
To Thine Own Self be True: CGMs Made Simple
Thanks, I will listen tomorrow. Yes, wonky readings! I took a nap and it dropped to 85 and when I woke up shot up to 137! And this morning, I scanned first thing before getting out of bed, and it said 56 (?) and 15 minutes later when I was downstairs, before coffee even, it said 150!!!
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Re: fasting glucose and a1c

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Tincup wrote: Tue Oct 31, 2023 7:45 pm
Exercise will allow translocation of GLUT 4 transporters, this action will allow the cells to draw up glucose without insulin. The intensity of exercise makes a big difference. Zone 2 intensity (which I've posted on numerous times) appears to be a sweet spot where you get the GLUT 4 translocation, but it is not intense enough for the liver to start kicking glycogen out into the bloodstream. For more intense exercise, you'd expect to see an acute increase in blood sugar with a decline later. Zone 2 is great for bringing down blood sugar levels after a meal.
Hi Tincup,
Reading through this thread. What is Zone 2 exercise? I've read going for a 20 minute walk within 2 hours of eating a meal will bring down blood sugar levels. Is walking considered Zone 2 or is Zone 2 a specific heart rate measurement? (Because walking slowly, I'll probably raise my HR higher than you if I'm less fit, you know? You'd have to walk more briskly, being fitter.)

And have you read to do the walk immediately after a meal or within 2 hours?

Thanks!
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Re: fasting glucose and a1c

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Jan18 wrote: Wed Dec 06, 2023 2:01 pm Hi Tincup,
Reading through this thread. What is Zone 2 exercise? I've read going for a 20 minute walk within 2 hours of eating a meal will bring down blood sugar levels. Is walking considered Zone 2 or is Zone 2 a specific heart rate measurement? (Because walking slowly, I'll probably raise my HR higher than you if I'm less fit, you know? You'd have to walk more briskly, being fitter.)

And have you read to do the walk immediately after a meal or within 2 hours?
Hi Barbara,

Technically, Zone 2 is defined by University of Colorado Health Sciences researcher, Iñigo San Millán, as the level where your serum lactate (tested with a finger stick & meter, like a glucometer) is between 1.7-1.9 mmol/L (podcasts on this Z2 topic with Dr. San Millán here. This is the top end of the pure aerobic metabolic zone. Above this, lactate will start to accumulate in the blood. Without getting fancy with meters, it would be a level where, if you were exercising and talking on the phone, the other person would know you were exercising, but you would not be out of breath. Trainer Phil Maffetone has a heart rate proxy that is 180 - age. My experience is that I can get a serum lactate level of 1.0 mmol/L at a heart rate with one exercise and 3.8 mmol/L at the same average heart rate for 20 minutes with a different exercise (and I'm easily nasal breathing). Also, the closer I get to my MAF heart rate (from a lower level), the more my glucose will drop.

If your glucose is remains high after 2 hours, the exercise will still drop it.

If I use walking as the exercise, I do it with hand weights in a Heavy Hands fashion, to increase my heart rate/exertion. Book1 (he wrote 2- Heavy Hands & Heavy Hands Walking). Here is a description of the system.
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Re: fasting glucose and a1c

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Tincup wrote: Wed Dec 06, 2023 7:45 pm
Without getting fancy with meters, it would be a level where, if you were exercising and talking on the phone, the other person would know you were exercising, but you would not be out of breath.
Thanks! I like the simple explanation! :lol:
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Re: fasting glucose and a1c

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You can get more info about insulin resistance and how it's influenced by your genetics here: https://www.geneticlifehacks.com/insuli ... -research/
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Re: fasting glucose and a1c

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mujprotejov wrote: Sun Dec 17, 2023 1:56 pm You can get more info about insulin resistance and how it's influenced by your genetics here: https://www.geneticlifehacks.com/insuli ... -research/
Hi mujprotejov -

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Re: fasting glucose and a1c

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The Wiki says this

HgbA1c (Glycated hemoglobin) also known as HbA1c or just A1c, gives you an indication of your average glucose over the past 1-2 months and is better than a spot check of your glucose. It is helpful to know the hemoglobin A1c, the fasting insulin, and the fasting glucose, since these offer complementary information. Hemoglobin A1c should be less than 5.3%, fasting blood glucose should be less than 90 mg/dl, and fasting insulin should be less than 5 ulU/ml. These are critical for optimal cognitive function.

I just received results....
A1c has not budged. I am still at 5.5.
Fasting glucose decreased from 101 to 97, not exceptional.
Fasting insulin is at 2.4. This is my first time testing insulin. Is lower better, or is there a point that it is too low?

I have to be honest - I am not really willing to make additional changes right now to bring down A1c. There is a lot of diabetes in my family, and I might be working against biology anyway. Should I ask the doc for metformin with the idea that getting A1c lower moves me that much further away from diabetes, or am I fine? I read Diabetes Solution - it is a pretty complicated disease.

Thanks.
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Re: fasting glucose and a1c

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JD2020 wrote: Mon Feb 19, 2024 5:33 pm The Wiki says this

HgbA1c (Glycated hemoglobin) also known as HbA1c or just A1c, gives you an indication of your average glucose over the past 1-2 months and is better than a spot check of your glucose. It is helpful to know the hemoglobin A1c, the fasting insulin, and the fasting glucose, since these offer complementary information. Hemoglobin A1c should be less than 5.3%, fasting blood glucose should be less than 90 mg/dl, and fasting insulin should be less than 5 ulU/ml. These are critical for optimal cognitive function.

I just received results....
A1c has not budged. I am still at 5.5.
Fasting glucose decreased from 101 to 97, not exceptional.
Fasting insulin is at 2.4. This is my first time testing insulin. Is lower better, or is there a point that it is too low?

I have to be honest - I am not really willing to make additional changes right now to bring down A1c. There is a lot of diabetes in my family, and I might be working against biology anyway. Should I ask the doc for metformin with the idea that getting A1c lower moves me that much further away from diabetes, or am I fine? I read Diabetes Solution - it is a pretty complicated disease.

Thanks.
I am far from an expert on questions about A1c and possible use of metformin for people without Type 2 diabetes. At least one source from a registered dietician states that while 5.3 is considered optimal, your level of 5.5 would still be considered to be normal: https://www.elo.health/biomarkers/hba1c-overview/53/
Here's another source that may be reassuring:
You don’t have to do anything with an A1c level of 5.5 as long as you don’t have any other risk factors such as high blood pressure, high cholesterol or if your A1c has been increasing over time.
https://mymedicalscore.com/hemoglobin-a1c-levels/5-5/

I have heard at conferences that there's a lot of interest in finding out if metformin would be useful in prevention of cognitive impairment in healthy people. Here's an excerpt from an article in the October 2023 Journal of Prevention of Alzheimer's Disease (JPAD) [The article is behind a paywall; I have access as someone who attended the CTAD conference virtually).] I've adapted the quote to put the studies as a list, with key details.
There are several ongoing or planned clinical trials.
  • Metformin in Alzheimer ’s dementia Prevention (MAP) ... is an ongoing multisite 18 month 1:1 randomized placebo-controlled clinical trial of extended-release metformin 2000 mg in 326 persons with amnestic MCI without T2D in the United States. It includes cognitive outcomes and biomarker outcomes, including measures of neurodegeneration and cerebrovascular disease on brain MRI, amyloid and tau in brain PET, and plasma biomarkers of amyloid, tau, and neurodegeneration. MAP is planned for completion in 2026.
  • Preventing Cognitive Decline with Metformin (MetMemory Study... is a 3-year randomized clinical trial of extended release metformin vs. placebo in 242 persons with mild cognitive impairment with a hemoglobin A1C < 6.5% with cognitive and biomarker outcomes based currently under way in Australia.
  • METformin and Finger Intervention to Prevent Cognitive Impairment and Disability in Older Adults at Risk for Dementia (MET-FINGER... is a 24 month 1:1:1 randomized trial of metformin 2000 mg/day vs. 1000 mg/day vs placebo to be conducted in the United Kingdom, Finland, and Sweden. Six hundred persons at risk for dementia will be randomized 1:1 to the FINGER 2.0 intervention vs. comparator intervention; those in the FINGER 2.0 group at increased risk for diabetes will be randomized to the metformin arms
. Conclusion Metformin is a safe and effective treatment for T2D, also used for the prevention of T2D, that has multiple metabolic benefits that have been hypothesized to ameliorate diseases such as cancer and diseases related to aging in general... it is necessary to conduct placebo-controlled randomized clinical trials of metformin in large samples of persons without T2D with relatively long duration and state of the art AD/ADRD phenotyping.
You have the option to call this current score normal for you and wait a year or two for the prevention studies to report out. Doing so may reduce your stress in thinking about how to change something that represents a difference of 0.2% of your overall blood supply.
4/4 and still an optimist!
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Re: fasting glucose and a1c

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NF52 wrote: Tue Feb 20, 2024 7:12 am You have the option to call this current score normal for you and wait a year or two for the prevention studies to report out. Doing so may reduce your stress in thinking about how to change something that represents a difference of 0.2% of your overall blood supply.
That is super helpful and super reassuring, thank you. I am a numbers person, and that 0.2% settled me right down!

I was at 5.3 and jumped to 5.5. The jump was the concern. I had to gain weight, as I've mentioned too often, and I made that the first priority. Then I tried to find a middle ground between ketoflex 12/3 and eating the carbs I needed to maintain weight. I haven't had a banana since wearing the CGM. There is a deli here in town and the bread is so good - 1/2 sandwich increased by glucose by 98 points, so I don't go there anymore. It is frustrating to make changes and not see any results.

What I would like to try to see if it makes a difference is doing a longer fast 3 days per week. The million dollar question is what the heck to eat that (a) maintains weight, (b) doesn't increase LDLs and APOB, (c) doesn't spike BG. I've been doing this since late 2019, and I still haven't figured it out.

I guess I'll get another CGM and keep working at it. Thank you again for your response.
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Re: fasting glucose and a1c

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JD2020 wrote: Mon Feb 19, 2024 5:33 pm I just received results....
A1c has not budged. I am still at 5.5.
Fasting glucose decreased from 101 to 97, not exceptional.
Fasting insulin is at 2.4. This is my first time testing insulin. Is lower better, or is there a point that it is too low?
You might want to do a Glucose-Insulin tolerance test. This shows much more than just fasting insulin - it shows how your insulin production ramps up to meet increased glucose. It is a long test, but gives you best picture. Sometimes low fasting insulin means you aren't producing enough. I'm that way. My wife is the opposite and has way too much.
Sonoma Mike
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