Glycated Haemoglobin

When high

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; start low (500mg) to avoid GI upset
• 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; ideal for GH/MK-677 users with weight management goals
• Acarbose -- 25-100mg with main carb meals; alpha-glucosidase inhibitor; blunts post-prandial spikes; main side effect is flatulence
• Empagliflozin / Dapagliflozin (SGLT2 inhibitors) -- 10-25mg/day; cardiovascular and renal protective; useful when concurrent BP/HCT issues
• Pioglitazone -- 15-30mg/day; PPAR-gamma insulin sensitiser; reserved for severe GH-induced IR; weight gain and oedema are notable side effects
• Reduce or pause exogenous GH -- GH antagonises insulin; dose reduction is often the most effective single intervention
• All require physician oversight

How GH and secretagogues drive HbA1c up, and the management hierarchy from diet to GLP-1: How GH and MK-677 cause insulin resistance and what to do.