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Continuous glucose monitors reveal variable glucose responses to the same meals

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Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#121

Post by stranded22 »

je42 wrote: post #25
stranded22 wrote: post #6

Yep. My wife is T1D and this is infuriating for her. She’ll think that she’s cracked it, and then the next day, with the same meal at the same time, her sugar levels go high. Her words: there is nothing else where you have studied for over 30 years and STILL feel like you know nothing. It is incredibly demoralising for her sometimes - especially when she’s suffering also from a high/low sugar level. I have the upmost…

More data can help inform semi closed loop systems to deal with this variability. For example, AAPS has since version 3.2 dynamic IFS. ( https://androidaps.readthedocs.io/en/latest/DailyLifeWithAap... ) For me this works quite well

Thank you, I’ll check it out

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#122

Post by stranded22 »

RHSeeger wrote: post #56
stranded22 wrote: post #6

Yep. My wife is T1D and this is infuriating for her. She’ll think that she’s cracked it, and then the next day, with the same meal at the same time, her sugar levels go high. Her words: there is nothing else where you have studied for over 30 years and STILL feel like you know nothing. It is incredibly demoralising for her sometimes - especially when she’s suffering also from a high/low sugar level. I have the upmost…

I like to say that the CGM is, far an away, the biggest life improvement for diabetics since the invention of insulin. And this plays into one of the reasons - You able to learn better about how your body responds to different foods - You are more secure about your blood sugar dropping when you don't expect/realize it (sleeping, driving, etc) - You better able to detect when your body isn't behaving the way you would…

She’s on closed loop and it has certainly changed her life - perimenopause was really difficult but the loop has meant she has much better control. The fact it cuts out when it drops has given her confidence to sleep better etc

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#123

Post by cyberax »

jeffybefffy519 wrote: post #104
cyberax wrote: post #84

Earlier quoted context omitted.

Why?

Because evidence based medicine is often about broader problems, medicine 3.0 is about solving problems for a specific person. It could be a rare type of cancer that a specific treatment has been crafted for that person - in this case theres no evidence to say that exact treatment works, maybe the over arching therapy is backed by evidence but it feels like a trend away from needing strong evidence to back the applic…

How is treatment crafted? Will waving a crystal stick be a part of it?

Literally all medical practitioners are trained to take individual people circumstances into account.

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#124

Post by slwvx »

goldchainposse wrote: post #61
slwvx wrote: post #46

Jessie Inchauspe [1] created a business (she's the "glucose goddess") and wrote books around the different blood sugar responses she and others have to meals, exercise, etc... I don't recall all the ideas, but here are the two I remember: Exercise before and/or after eating smooths out the blood sugar response to food. When eating a meal, it's better to eat high-fiber stuff first, then complex carbs, then protein, th…

Is the order salad, baked potato, steak, dessert?

Yeah, I think so, though my recollection is that a baked potato's glycemic index is kinda high. For more authoritative list of details, you could listen to the following podcast with Inchauspé: https://overcast.fm/+AA4G32XuwoA

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#125

Post by tharkun__ »

whycome wrote: post #116
tharkun__ wrote: post #86

Earlier quoted context omitted.

You are using one particular "definition" of the phrase common sense. It does appear when I search as well. But so do others. knowledge, judgement, and taste which is more or less universal and which is held more or less without reflection or argument. As such, it is often considered to represent the basic level of sound practical judgement or knowledge of basic facts that any adult human being ought to possess. Now…

Most? 50.1%?

To be fair, what I quoted said "any", so I guess they mean closer to 99.99% but I'm with you on "unfortunately common sense seems to not be quite as common as one might wish for" ;)

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#126

Post by pedalpete »

gcanyon wrote: post #99
pedalpete wrote: post #81

Blood glucose is dependent on more variables than just what you eat. Decreased sleep slow-wave activity (not just sleep time, but the actual restorative function of sleep) significantly decreases next day insulin response [1]. This is my area (I work in neurotech/sleeptech), but other things that come to mind are changes in changes in gut biome, which can be altered by previous meals, and I assume is always in flux (…

If a normal-weight person undergoes significant long-term sleep deprivation -- like >50% of nights on 4-6 hours of sleep over the course of decades -- what would the expected effect to be? And if the person's bloodwork nevertheless shows no particular signs of poor insulin response? Asking for a friend.

Well, you're getting into measuring sleep by time, which is an antiquated idea that we need to move on from. I write about this on the affectable sleep blog [1]. We shouldn't be looking at time, but the restorative function of sleep, and we need to take each individuals restorative function as independent. The average diet recommends 2400 calories (I think), but you wouldn't say that if someone got only 2000 calories a day, they'd starve.

However, on a population level, it is known that shift workers have increased incidence of diabetes, heart disease, obesity, etc. Some of that likely comes down to socio-economic factors, but we can't ignore that daytime sleep or potentially even shifting schedules, is not as restorative as consistent sleep, regardless of sleep time.

I feel I haven't answered your question, but I think this is the best I've got.

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#127

Post by lucas_membrane »

Taikonerd wrote: post #70
blitzar wrote: post #9

Earlier quoted context omitted.

It is wonderful that we have things like CGM's and patients can establish their own baselines and their own evidence profiles on a high(ish) frequency basis. Such tools also enable studies that can be done at a scale and cost level that is reasonable and can push forward the communal knowledge base.

This is the idea behind the "Zoe" service: https://zoe.com/en-us 1. You wear a CGM for 2 weeks, and log everything you eat. 2. At the end, you get a personalized report about how different foods that you ate affect you, personally. And they can extrapolate to other foods that you didn't eat during the testing period. 3. Zoe's model gets better and better the more people sign up, and the more data they get.

A CGM is not easy to use reproducibly. The quality control of the manufacturers is not that good, the placement of the sensor (particularly if it is near a place where insulin injections have caused lumps under the skin, or if it is on the back of the arm, where there may not be a lot of flesh) may cause some troubles, the calibration process is dubious, since CGM readings lag blood glucose by around half an hour, rapidly changing blood sugar levels seem to confuse the monitors, and very high or very low blood sugars seem to cause the accuracy of the sensors to deteriorate noticeably a few days prior to their respective expiration dates.

And how do you know that the logs are accurate? The best subjects are incarcerated subjects.

All that said, it's a long row to hoe, and the monitors are definitely worth all the annoyances; they are way better than peeing on a strip of testape like we did back in the old two-holer. But science is very hard.

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#129

Post by gcanyon »

pedalpete wrote: post #126
gcanyon wrote: post #99

Earlier quoted context omitted.

If a normal-weight person undergoes significant long-term sleep deprivation -- like >50% of nights on 4-6 hours of sleep over the course of decades -- what would the expected effect to be? And if the person's bloodwork nevertheless shows no particular signs of poor insulin response? Asking for a friend.

Well, you're getting into measuring sleep by time, which is an antiquated idea that we need to move on from. I write about this on the affectable sleep blog [1]. We shouldn't be looking at time, but the restorative function of sleep, and we need to take each individuals restorative function as independent. The average diet recommends 2400 calories (I think), but you wouldn't say that if someone got only 2000 calories…

Thanks for the effort!

Re: Continuous glucose monitors reveal variable glucose responses to the same meals

#130

Post by jeffybefffy519 »

cyberax wrote: post #123
jeffybefffy519 wrote: post #104

Earlier quoted context omitted.

Because evidence based medicine is often about broader problems, medicine 3.0 is about solving problems for a specific person. It could be a rare type of cancer that a specific treatment has been crafted for that person - in this case theres no evidence to say that exact treatment works, maybe the over arching therapy is backed by evidence but it feels like a trend away from needing strong evidence to back the applic…

How is treatment crafted? Will waving a crystal stick be a part of it? Literally all medical practitioners are trained to take individual people circumstances into account.

Taking individuals circumstances into account isn't evidence based medicine though...
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