Glycated Haemoglobin (IFCC)

When high

Same marker as HbA1c % -- identical management applies (see HbA1c marker).

IFCC units (mmol/mol) are simply a different scale. Targets: <37 mmol/mol optimal for athletes (<5.5%). Conversion: mmol/mol = (% - 2.15) x 10.929.

Supplements:

• Berberine -- 500mg 2-3x/day
• Dihydroberberine -- 100-200mg 2x/day, an alternative to berberine rather than an addition. It absorbs far better: 100mg reached roughly nine times the peak plasma berberine of a 500mg berberine dose (Moon et al., 2021). Two honest caveats. That trial ran five participants over a single day, and it measured no significant difference in glucose or insulin between any condition, so the absorption advantage is established while the glycaemic benefit is not. Better tolerability is the reason dihydroberberine was developed rather than something that trial tested
• Alpha-Lipoic Acid (ALA) -- 300-600mg/day

Lifestyle:

• Low-glycaemic diet, regular cardio and strength training
• If HbA1c trending upward on GH, consider dose reduction

Pharmacological options (when supplements are insufficient):

• Metformin -- 500-2000mg/day; first-line; also has longevity/mTOR evidence
• Semaglutide / Tirzepatide -- 0.25-2.4mg or 2.5-15mg subQ weekly; GLP-1 (or GLP-1/GIP) agonist; reduces HbA1c 1-2 percentage points
• Acarbose -- 25-100mg with main carb meals; alpha-glucosidase inhibitor
• Empagliflozin / Dapagliflozin (SGLT2 inhibitors) -- 10-25mg/day; cardiovascular and renal protective
• Pioglitazone -- 15-30mg/day; PPAR-gamma insulin sensitiser; reserved for severe IR
• Reduce or pause exogenous GH -- GH antagonises insulin; dose reduction is often the most effective single intervention
• All require physician oversight