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Alpha-lipoic acid with NMN or NR: glucose, thyroid and low-sugar episode tracker
List your alpha-lipoic acid, NMN or NR, diabetes and thyroid medicines, record fasting glucose, HbA1c and thyroid tests at baseline and 8 to 12 weeks, and log any low blood sugar episode with the time since your last alpha-lipoic acid dose.
What you take
Alpha-lipoic acid productR-ALA or racemic; mg per dose and doses a day
Taken with food?
NMN or NR product and mg a day
Glucose-lowering medicines and dosesinsulin, sulfonylurea, metformin, GLP-1, SGLT-2
Levothyroxine dose and time taken
Biotin supplement and mg a day
Tell your prescriber before starting if any apply
- Insulin or a sulfonylurea such as glipizide, glyburide or glimepiride
- Metformin, a GLP-1 medicine or an SGLT-2 inhibitor
- Hypothyroidism that is not yet stable on treatment
- Biotin above 5 mg a day
- Pregnant or breastfeeding
Labs at baseline and 8 to 12 weeks
| Test | Baseline date and result | Follow-up date and result | Notes |
|---|---|---|---|
| Fasting glucose | |||
| HbA1c | |||
| TSH | |||
| Free T4 | |||
| Free T3 |
Low blood sugar episodes
Shakiness, sweating, a pounding heart, hunger or confusion. Record a glucose reading if you can take one.
| Date and time | Hours since alpha-lipoic acid | Symptoms | Glucose reading | What you did |
|---|---|---|---|---|
What the studies report
- In a meta-analysis of randomized trials in people with metabolic diseases, alpha-lipoic acid lowered fasting glucose, insulin, insulin resistance and HbA1c compared with control.[1]
- Alpha-lipoic acid has been linked to insulin autoimmune syndrome, a rare cause of repeated low blood sugar that can alternate with high readings after meals. Onset was typically one to four weeks after starting, and the lowest dose linked to it was 200 mg a day.[2]
- In most reported cases, the low blood sugar resolved within weeks to months after alpha-lipoic acid was stopped.[2]
Questions for your prescriber
- Does my diabetes medicine need a dose review if I add alpha-lipoic acid?
- Should my TSH and free T3 be checked before I start and again at 8 to 12 weeks?
- If I get a low glucose reading and I am not on diabetes medicine, who do I call?
- Should I pause biotin before my thyroid blood tests?
Sources for the facts on this sheet
- Akbari M, Ostadmohammadi V, Lankarani KB, et al. The effects of alpha-lipoic acid supplementation on glucose control and lipid profiles among patients with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials. Metabolism 2018. PMID 29990473. https://pubmed.ncbi.nlm.nih.gov/29990473/
- Vallianou NG, Kounatidis DC, Dalamaga M, et al. Alpha-lipoic acid as a trigger of insulin autoimmune syndrome: Current evidence, a case-based approach, diagnostic pitfalls, and practical management. Metabol Open 2026. PMID 42662728. https://pubmed.ncbi.nlm.nih.gov/42662728/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.