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Comment by andy_ppp | Hacker News Reader

I’m willing to bet we can see longevity improvements from better blood sugar control. Not 100% certain but extremely likely, this would include potential heart attack and dementia reduction…

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This has been tested actually. A clinical trial looking at tight blood sugar regulation was aborted after it resulted in multiple cardiac events.

That's not a fair representation of what happened. That study was going for _aggressive_ control - beyond what any normal person would do. They were combining multiple drugs to force blood sugar down rapidly, including right after meals (when it _should_ be going up).

Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks.

From the AI

> The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.

Interesting! Found this overview: https://emcrit.org/pulmcrit/tight-glycemic-control/

Nonsense, you can fast or live in ketosis for years without any adverse consequences.

I said absolutely nothing about fasting or ketosis

No, you were deliberately disingenuous (I understood that) but I decided to answer the best possible interpretation of what you meant. I'd seriously reconsider this argument style, just because it's common doesn't mean any of us should think it's acceptable to pass of half truths as pithy commentary. You won't listen of course, nobody does anymore, they just want some ego points of being technically right in the narrowest of ways. Pointless point scoring.

I was being deliberately disingenuous? I think the person who invented a strawman augment that I didn't make is the disingenuous one. Takes some balls to do that and then lecture me on honest discourse.

Fasting and ketosis has nothing to do with tight blood sugar control. Your body manages blood sugar even if you're fasted or burning ketones.

I'll be showing my bias here, but you're probably referring to NICE-SUGAR, which I think suffered mainly from having a pretty uninspired control algorithm. We built and simulated it and several other clinical protocols and it had the widest spread of performance, but it lost a ton of points to hypoglycemia performance, which is where you get into increasing mortality. The NICE-SUGAR protocol [1] has no notion of weight based dosing, and even has some completely missed edge cases. There have been similar studies in Japan with a better algorithm and they showed the expected benefits.

[1] - https://www.glycemiccontrol.net/NICE/StudyDesign/NiceALGORIT...

IMO blood sugar is too simple and focused on because of ease of measurement. Someone can have rollercoaster blood sugar and be far more metabolically healthier than someone with low and steady blood sugar. Continious insulin and cortisol monitors are far more interesting IMO

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