Routine glucose monitoring may be unnecessary for people with Type 2 diabetes • Hacker News Board

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#51

Post by pnutjam » Wed, Oct 30, 2019, 4:11 PM UTC

fizwhiz wrote: post #14

Off-topic: but as someone who's not officially type 2 diabetic but would like to be proactive about measuring their sugar level (I've had my A1c at pre-diabetes levels in the past), what options do I have to secure a CGM? I've asked my physician but he said he won't be able to prescribe one that's covered by insurance. The DEXCOM website doesn't have a clear MSRP for folks like me.

Kroger, Walmart, and CVS all have identical monitors for around $10, strips are 25 for $12ish.

Unfortunately they are keyed at the end so each stores strips only fit their own device.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#52

Post by je42 » Wed, Oct 30, 2019, 4:42 PM UTC

ninjin wrote: post #26

nikkwong wrote: post #15

Earlier quoted context omitted.

Ha I've been trying to find one for forever. Can't even find cheap non-fda approved clones from alibaba/aliexpress. Would love to hear if anyone has made some headwind on this. It seems odd that only diabetics are allowed access to the tools that enable CGM. Blood glucose is an important marker of health, diabetic or not.

The FreeStyle Libre is a way cheaper option (and also way easier to gain access to for those of us in the UK under the NHS). Strictly speaking is not a CGM, as you have to manually scan the sensor to retrieve the last eight hours of data. However, there are devices sold by smaller manufacturers such as the MiaoMiao [1] or Blucon [2]. You mount these devices on top of the sensor (I have heard that wig glue is a good c…

Using the freestyle libre. however, i am still doing finger pricks, when i need to figure out my current blood sugar level and i don't have the time to wait 10 minutes, since the libre has a 10 minute lag.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#53

Post by James_Henry » Wed, Oct 30, 2019, 5:50 PM UTC

foxyv wrote: post #48

For those of you interested. Intensive Dietary Management of Type 2 Diabetes has been shown to be very effective at treating and often curing Type 2. Dr. Jason Fung runs the program up in Canada and has written a couple books about it. My partner recently was declared cured of Type 2 by his very surprised endocrinologist after focusing on dietary management and fasting. His A1C is lower than mine now... The Diabetes…

Do you know of any results besides those 3 people recounted in this paper?

https://casereports.bmj.com/content/casereports/2018/bcr-201...

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#54

Post by SpikeDad » Wed, Oct 30, 2019, 8:16 PM UTC

jp555 wrote: post #34

SpikeDad wrote: post #10

It wasn't for me. Individual anecdotal stories aren't evidence but without consistent feedback it's easy to get back into poor habits. When I eat a Twizzler and see my blood glucose spike at 180-200 FOR 1 TWIZZLER then it's the feedback I need. It's no different to me than frequent weighings. I'm sure some people don't need or want the feedback but for me it's essential. And using a CGM (I use 14 day Lifestyle) I can…

I'm glad you found something that works for you, but this is massively over-complicated for almost everyone. Constant glucose tracking is interesting, but completely unnecessary. EDIT - For most healthy individuals. It's like my father-in-law who obsesses over vitamins while he ignores being ~40 pounds overweight - he needs to simply eat less & move more, not keep reading articles until he uncovers some magic combina…

For healthy individuals - I agree 100%.

Beef spikes insulin as much as rice? Well not for me (and I suspect most people). I can eat a steak without raising my blood glucose at all - one bowl of rice and it jumps 100mg/dl.

There's not a lot of good data on glucose spikes. It's a discussion I've had with my endocrinologist a number of times. He suspects it's not bad for occasional incidents as long as A1C isn't affected but again it's not been studied yet.

Sure, eat less. It's that easy - I guess the 90% of people overweight are just stupid.

You last statement is very true however. People and doctors want to do the simple thing. For doctors it's meds and then when they don't work well enough it's insulin and then more and more insulin.

That's a hamster wheel that people need to get off.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#55

Post by lucas_membrane » Wed, Oct 30, 2019, 10:09 PM UTC

SpikeDad wrote: post #13

lucas_membrane wrote: post #9

I know someone who works at a clinic that serves diabetics without health insurance who cannot afford routine glucose monitoring. A majority of the patients show up with A1C of 10 or higher, often much higher. If uncorrected, this is tragic. A finding that most people will not find a way to comply effectively with a plan to scientifically manage T2D is not, to me, a convincing reason to make scientific management les…

Yep. But the key issue is that patients need to be helped into diets that will be lower in carbs and provide more effective A1C control. I think the fact that you can see what happens to your glucose after every bite of food you take is a powerful incentive to improve your diet. No meds are going to reduct A1C of 10 or higher to even moderately high levels of 8 or so without serious dietary changes. I personally got…

I agree completely. What the double-digit A1c people need first is to understand where they are headed, which the test substantiates if the practitioner has the nerve to spell it out. What to do about it is a different part of the problem. I am paywalled out of the article, but the word 'routine' is grievously vague to me. It could mean anything from an annual A1c to quarterly A1c's, with glucose monitoring anywhere from hourly to never.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#56

Post by hnick » Wed, Oct 30, 2019, 10:42 PM UTC

Interesting aside, I was just reading about a potential link between BPA and Type 2 diabetes: https://www.smh.com.au/national/exposure-to-chemical-in-plas...

"The link held even after the scientists adjusted for food intake, weight and physical activity."

Is there anything BPA can't do? ;)

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#57

Post by kwoff » Thu, Oct 31, 2019, 1:06 AM UTC

Is there any metric besides A1C for "type 2 diabetes"? A few years ago, I went to a doctor and my A1C was 8 something (among other issues...). I ate low-carb a couple months, and the doctor was impressed my A1C went down to 5.1 or whatever. I sorta wonder if it's a https://en.wikipedia.org/wiki/Goodhart%27s_law thing..

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#58

Post by darkerside » Thu, Oct 31, 2019, 2:11 AM UTC

projektfu wrote: post #39

darkerside wrote: post #28

Earlier quoted context omitted.

> finding that their blood sugar is not well controlled Isn't this everyone with diabetes? Hell of an exception.

I believe they mean that the insulin+metformin+diet regimen isn’t keeping sugar in a reasonable range.

They still recommended that anyone on insulin monitor blood sugar, so this refers to people not on insulin...

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#59

Post by projektfu » Thu, Oct 31, 2019, 3:54 AM UTC

darkerside wrote: post #58

projektfu wrote: post #39

Earlier quoted context omitted.

I believe they mean that the insulin+metformin+diet regimen isn’t keeping sugar in a reasonable range.

They still recommended that anyone on insulin monitor blood sugar, so this refers to people not on insulin...

Thanks, I didn’t read completely.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#60

Post by jp555 » Thu, Oct 31, 2019, 11:37 AM UTC

SpikeDad wrote: post #54

jp555 wrote: post #34

Earlier quoted context omitted.

I'm glad you found something that works for you, but this is massively over-complicated for almost everyone. Constant glucose tracking is interesting, but completely unnecessary. EDIT - For most healthy individuals. It's like my father-in-law who obsesses over vitamins while he ignores being ~40 pounds overweight - he needs to simply eat less & move more, not keep reading articles until he uncovers some magic combina…

For healthy individuals - I agree 100%. Beef spikes insulin as much as rice? Well not for me (and I suspect most people). I can eat a steak without raising my blood glucose at all - one bowl of rice and it jumps 100mg/dl. There's not a lot of good data on glucose spikes. It's a discussion I've had with my endocrinologist a number of times. He suspects it's not bad for occasional incidents as long as A1C isn't affecte…

I appreciate you sharing your thoughts with your doctor. I should have presented it as: “in this linked experiment, beef rose circulating insulin about as much as brown rice did”.

Oh and I didn’t mean to suggest fat people are lazy, eating less is simple, but not easy at all. That’s why I think people tend to end up complicating the easy stuff (and I agree meds can be an example of that) instead of doing the simple but difficult stuff.