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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

#51

Post by electrondood »

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…

GLUT-4 activation in the muscles primes them to take up glucose and other nutrients. So air squats or going for a walk before/after a meal can significantly blunt the insulin response, because there's less glucose in your blood stream, because more of it has been ported into muscles.

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

#52

Post by mh8h »

blindriver wrote: post #19

I've been diagnosed with Type 2 diabetes and wear a CGM. I find that my blood glucose spikes much later than what is suggested. For example, I might eat a meal and my blood glucose doesn't spike until after 2 hours. When it spikes, I see the body react with insulin and it drives my blood sugar levels down, so I'm not sure if I actually do have T2D or if this is just how my body works. Another thing I've noticed is th…

Have you measured the lag time for your CGM?

Typically the glucose level in the interstitial fluid takes longer to respond to your food intake, and the GCMs measure that instead of the blood glucose level.

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

#53

Post by GuinansEyebrows »

ddorian43 wrote: post #14
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…

How about just not eat carbs at all and have more consistent & lower blood sugar? (this was an interesting case https://www.youtube.com/watch?v=CG8UU7P8FBU ) I do keto diet long term but for other reasons, often the epilepsy version where it's more strict and higher fat.

every endocrinologist i've ever had says you need at least some carbohydrates. that said, they're usually not nutritionists, and there's historically been so little focus on food as medicine within western medicine that i think we "officially" know as much about that as we do about diabetes at all (which is a lot, but still surprisingly little).

there are plenty of good reasons we eat carbs (especially complex carbs, plus trying to avoid processed stuff); as a diabetic you just have to prepare ahead of time. it sucks, but honestly, as a 20+ year T1D, not eating cake sucks more than having to plan to eat cake :)

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

#54

Post by chimeracoder »

zamadatix wrote: post #49
blindriver wrote: post #19

I've been diagnosed with Type 2 diabetes and wear a CGM. I find that my blood glucose spikes much later than what is suggested. For example, I might eat a meal and my blood glucose doesn't spike until after 2 hours. When it spikes, I see the body react with insulin and it drives my blood sugar levels down, so I'm not sure if I actually do have T2D or if this is just how my body works. Another thing I've noticed is th…

I'm a fellow type 2, be sure to talk more with your doctor about these points as such comments/questions are of things they should have explained very clearly the first time they said your sugar seemed high. Type 2 "resistance" is about the quality of the response to high glucose levels, not the complete lack of a response to them. There shouldn't be a long buildup overnight in that scenario for a person without insu…

> You may well actually be prediabetic though, it just depends on the specific numbers for A1C/average & peaks combined over time and not the presence of a response itself.

Just to clarify - A1C is itself an easily-measured proxy for diabetes mellitus, but it's itself a heuristic. There are groups for whom it is known that the "standard" A1C range is actually incorrect, because of confounding factors that affect the A1C measurement but are unrelated to the metabolic dysfunction or general sugar levels.

Your point is correct, though, that what OP is describing is consistent with diabetes, and the actual clinical recommendations for prediabetes and Type II diabetes are often the same, at least in the early stages.

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

#55

Post by RHSeeger »

blindriver wrote: post #19

I've been diagnosed with Type 2 diabetes and wear a CGM. I find that my blood glucose spikes much later than what is suggested. For example, I might eat a meal and my blood glucose doesn't spike until after 2 hours. When it spikes, I see the body react with insulin and it drives my blood sugar levels down, so I'm not sure if I actually do have T2D or if this is just how my body works. Another thing I've noticed is th…

> I find that my blood glucose spikes much later than what is suggested.

I'm a type 1 and my blood glucose can response can vary wildly. Sometimes it can spike quickly (15-30 minutes), other times it can take 2, 3, or even 4 hours. The reverse is also true, in that insulin can sometimes effect me quickly, and sometimes it can take effect 3+ hours later. In general, when having a big meal, I'll take a "fairly large" amount of insulin, but not enough for the entire meal; then I'll take more[1] when my blood starts increasing into 200+ range. Otherwise, I risk it dropping because the insulin was having a "fast" day but the food was "slow".

My endo finds it weird, but we've gone over specific cases of it, including exactly what I ate, when, and what the CGM history for the day looked like. I'm just defective :)

[1] Note I'm not talking about reactively taking more insulin after the "right" amount turned out not to be enough (which is generally a bad idea). Rather, I'm talking about splitting what I know to be about the right amount... into 2 different doses.

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

#56

Post by RHSeeger »

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 normally expect it to (the point we're discussing here)

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

#57

Post by Imme_Play_5550 »

My mother and I recently did an oral glucose tolerance test while wearing CGMs and discovered that in us, the CGM measurements (Dexcom G7) and the reference instrument measurements (whatever Quest Diagnostics uses) virtually _never_ lined up, even when including the G7's advertised error margins. The blood glucometer readings in me didn't line up either. Admittedly this was on the first day using the G7, when it's apparently less accurate, but due to this I've been doubtful of CGM readings in me/her. I'm sure CGMs work on a population level, but for us, on that day? Nope.

My graph: https://i.imgur.com/FzPdH1g.png

Mom's graph: https://i.imgur.com/5DR1G30.png

Discussion: https://reddit.com/r/PeterAttia/comments/1k301o4/my_ogtt_exp...

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

#58

Post by Aurornis »

csours wrote: post #8

Some assumptions are so obvious no one bothers to state them, or even remember them. Assumption: Medical professionals are trained to use Evidence Based Medicine (EBM). One might assume that EBM means something specific, and I'm sure it does, but that specific thing is different for different people. One thing that EBM sometimes means is: common sense is no substitute for evidence. There are uncountable times that co…

> So, you have a lot of people commenting here that this is obvious common sense

There's a lot of reductionist commentary that happens under these links primarily because people aren't reading past the headline or a brief skim of the article.

The topic might be common sense, but measuring and quantifying it with hard data is valuable.

The PR-massaged headlines usually omit the interesting parts and focus on something basic because they want to appeal to a wide audience, not because the study itself was so simplistic that it could be summarized by a headline.

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

#59

Post by pixl97 »

RHSeeger wrote: post #55
blindriver wrote: post #19

I've been diagnosed with Type 2 diabetes and wear a CGM. I find that my blood glucose spikes much later than what is suggested. For example, I might eat a meal and my blood glucose doesn't spike until after 2 hours. When it spikes, I see the body react with insulin and it drives my blood sugar levels down, so I'm not sure if I actually do have T2D or if this is just how my body works. Another thing I've noticed is th…

> I find that my blood glucose spikes much later than what is suggested. I'm a type 1 and my blood glucose can response can vary wildly. Sometimes it can spike quickly (15-30 minutes), other times it can take 2, 3, or even 4 hours. The reverse is also true, in that insulin can sometimes effect me quickly, and sometimes it can take effect 3+ hours later. In general, when having a big meal, I'll take a "fairly large" a…

Also a T1D and yea, I know what you mean.

Physical activity, mental activity, and sickness can also massively effect dose.

On days I'm physically active I feel like I need less than half the dose of insulin then days I'm caught behind a desk. This said, high impact mental stress that requires lots of thinking can rapidly drop my glucose level.

And that's not counting being ill where my body will pretend like it's insulin resistant for hours then suddenly try to process it all at once.

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

#60

Post by Aurornis »

taeric wrote: post #5

Odd, I would have expected this to be somewhat the case? Specifically, I would expect your activity leading into the meals, along with your expectations of what you will be doing after, would have some impact? Probably more impact from how hungry you were going into a meal. If you were already sated, for example, I'd expect your body to largely try and push the meal through as fast as it can. Neat to see what other p…

> Odd, I would have expected this to be somewhat the case?

Well of course. Studies like this help collect data and quantify the variations.

There's more to the study than the headline or even the simple summary. Knowing the range of variations is important, as well as starting to build a foundation to understand some of the factors that lead to the variations.

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