On-bike CHO for Type 2 Endurance Athlete
I am a 62 yr old active cyclist (~10 hours/week exercise, 5’-7”,130 lbs) and have an A1C in the pre-diabetic range. I’m looking for references for a safe level of glucose increase during rides over 2 hours to dial in my on-bike carb intake. I have been using a CGM for a couple of months and find that my readings during rides can go up 50 to 80 points over starting baseline. I am afraid that this is too high and is causing me harm in the long term. I fuel at the generally recommended levels of CHO (<1.5hrs-0g,>1.5hrs-30g,>2.5hrs-60g,>3.5hrs-90g). I am seeking information about what level of blood glucose during endurance exercise is safe and acceptable for someone with pre-diabetes. Should I use a minimum amount of CHO during rides? Both the absolute level of blood glucose as well as the delta above baseline are values that I am looking for. I have not been able to find any studies that directly address this question.
Semaglutide & Lean Body Mass
I remember you saying on your podcast and heard you on the Megyn Kelly Show saying that you were seeing that 2/3 of weight loss for patients put on semaglutide was lean body mass loss. Taking a look at this study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089287/), this seems way off the mark and in fact, the patients' ratio of lean body mass to fat mass increased. What gives?
converting visceral fat cm2 to your metrics
I got a whole body DEXA and was given a reading of visceral fat as cm2. In your podcasts you're always discussing it as pounds. Can you please help us figure how to convert this, or take the other metrics we are given to calculate it ourselves. Also - when they say some of my DEXA readings are "normal" - are they really? You've pointed out that in some figures they've just bumped what is 'normal' to accommodate the bad shape most people are in these days (like BMI normal having shifted over time). Is the standard for VAT normal true or skewed like this?