Fasting Insulin

When high

Supplements:

• Berberine -- 500mg 2-3x/day (before carb meals)
• 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

Medical:

• Metformin -- 500-1000mg/day if supplements insufficient

Lifestyle:

• Reduce refined carbs, increase fibre
• If on GH, consider reducing dose
• Fasting and time-restricted eating can improve insulin sensitivity

Pharmacological options (when fasting insulin remains elevated despite metformin):

• Semaglutide / Tirzepatide / Retatrutide -- 0.25-2.4mg, 2.5-15mg, or investigational dose subQ weekly; reduce fasting insulin by 30-50% via insulin sensitisation and modest weight loss; first-line for GH-induced hyperinsulinaemia
• Pioglitazone -- 15-30mg/day; PPAR-gamma agonist, direct insulin sensitiser; useful when GLP-1 or metformin is insufficient; weight gain and oedema are notable side effects
• Acarbose -- 25-100mg with main carb meals; reduces postprandial glucose load and downstream insulin demand
• Empagliflozin / Dapagliflozin (SGLT2 inhibitors) -- 10-25mg/day; cardiorenal protection in addition to glucose lowering
• Reduce or pause exogenous GH -- GH directly antagonises insulin and is the dominant driver of elevated fasting insulin in this population; dose reduction is often the most effective single intervention
• All require physician oversight; monitor renal function, glucose, and weight response

Why GH and MK-677 raise fasting insulin, and when HOMA-IR should trigger action: How GH and MK-677 cause insulin resistance and what to do.

Fasting insulin is the most draw-timing-sensitive marker on a once-monthly incretin, and comparing a day-5 draw to a day-26 draw measures your calendar rather than your metabolism: the MariTide (AMG 133) bloodwork guide.