Fasting Glucose

When high

Supplements:

• Berberine -- 500mg 2-3x/day (20 min before carb meals, comparable to Metformin)
• Alpha-Lipoic Acid (ALA) -- 300-600mg/day (with carb meals)
• Cinnamon Extract -- as directed

Medical:

• Metformin -- 500-1000mg/day if Berberine insufficient (start low to avoid GI upset)

Lifestyle:

• Reduce refined carbohydrates, increase fibre intake
• If on GH, consider dose reduction if glucose remains elevated

Pharmacological options (when metformin is insufficient or weight management is also a goal):

• Semaglutide (Ozempic / Wegovy) -- 0.25-2.4mg subQ weekly; GLP-1 agonist; ideal for GH/MK-677 users with concurrent insulin resistance and weight management goals; off-label use for non-diabetic athletes is increasingly common but requires physician oversight
• Tirzepatide (Mounjaro) -- 2.5-15mg subQ weekly; dual GLP-1/GIP agonist; superior glucose and weight effects vs semaglutide
• Retatrutide -- investigational triple agonist (GLP-1/GIP/glucagon); not yet approved
• Acarbose -- 25-100mg with each main meal; alpha-glucosidase inhibitor; blunts post-prandial glucose spikes; useful adjunct for GH users on high-carb diets; main side effect is flatulence
• Empagliflozin / Dapagliflozin (SGLT2 inhibitors) -- 10-25mg/day; cardiovascular and renal protective; emerging interest in athletic context for cardio-renal protection on AAS
• Pioglitazone -- 15-30mg/day; PPAR-gamma agonist insulin sensitiser; reserved for severe GH-induced IR when metformin/berberine insufficient; weight gain and oedema are notable side effects
• Reduce or pause exogenous GH -- GH directly antagonises insulin; lowering or cycling off GH is often the most effective single intervention
• All require physician oversight; monitor renal function and glucose response