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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

#81

Post by pedalpete »

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 (not my area of expertise), hormonal changes, I'm sure there are others.

However, the conclusion that it undermines the CGM measurements. In fact, I think this makes CGMs more valuable, not less. For those without diabetes, I always thought you'd use the CGM for a few weeks, figure out what your body responds to, and then sort out your diet.

This shows that it isn't that simple, and that we likely need to be monitoring more regularly. If my breakfast spiked my glucose unexpectedly, that may be a signal that I should change my lunch in order to reduce the likelihood of another spike. It becomes about constant management, rather than a 1 time look under the hood.

https://doi.org/10.1016/j.sleep.2022.03.005

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

#82

Post by happyopossum »

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.

This is the type of thing that the linked studies refute - there are either too many external variables to control, or our bodies glucose response is far more complex than we currently understand. Or both - both of the above seem possibly true at the same time.

Either way, if something as simple as eating a few bites of bacon before you eat your toast can change your glucose response, manually logging your meals for Zoe isn’t gonna provide enough data for any reliable extrapolations.

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

#83

Post by cogman10 »

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…

> My other pet peeve with EBM is that it does a poor job of understanding that different interventions work for different people

This has not been my experience with doctors throughout the years. In fact, I'd say the opposite has been true.

In my experience, particularly when diagnoses are trickier, doctors are more likely check the efficacy of the current treatment and change things up if it's not working out.

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

#84

Post by cyberax »

jeffybefffy519 wrote: post #74
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…

If you think about it, Evidence Based Medicine is very much against Medicine 3.0 whereby individualized treatments/therapies are used.

Why?

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

#85

Post by blindriver »

UomoNeroNero wrote: post #66
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 diabetic and manage it with a CGM and insulin pump (HbA1c at 6.8 after many years of struggles). For convenience and my experiment, I eat practically the same meals at lunch every day, precisely weighed, always starting from very similar morning glucose levels, and strictly respecting timing and consistency. I NEVER get the same response. Never. It’s an experiment I’ve been running on myself for a year. It’s usef…

I think the “experts” thought they knew but CGM is showing they really don’t know.

Sometimes my blood glucose will be high-ish like maybe 135. Then if I drink some coke, ie pure sugar, it causes my blood glucose to spike and then my insulin kicks in and it drives it back down to 110-120. It’s as if the switch to turn on the insulin wasn’t turned on because there was a slow steady creep up of blood glucose and then it needed to be woken up.

The body sure is strange but one thing I do know is that CGMs are changing things for sure.

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

#86

Post by tharkun__ »

jodrellblank wrote: post #43
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 " You have this about everything, everywhere. It's a pet peeve how much stuff people will attribute to "common sense" so they can do the internet "I'm superior" thing. "Wear sunscreen, it's just common sense". No it isn't. We evolved on Earth under the sun, we feel good when going out in the sun, it's bright and beautiful. Rubbing petr…

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 with that definition some of what you said very definitely would no longer be the case as the above definition would seem to automatically "adjust with the times" so to speak in that what we might expect most adults to know and understand changes over the years, decades and definitely centuries.

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

#88

Post by NoPicklez »

aucisson_masque wrote: post #79

> if an individual eats the same meal on two occasions but starts with the vegetables on one occasion but not the other, this may lead to different glucose responses to the same meal within the same individual. > Other behavioral and individual factors are known to influence CGM responses.[22][6] Postmeal physical activity — even as minor as leg fidgeting[23] and walking for a few minutes every hour — reduces postmea…

It is interesting, but it has been long well "known" that if you eat the more fibrous foods first this effectively slows the digestion of what comes next.

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

#89

Post by utopcell »

Here's a (Gemini) AI summary that seems to be capturing the main point that the article wants to convey.

``` This page summarizes a study about continuous glucose monitors (CGMs) and how individuals can have highly variable glucose responses even when eating the same meals. The study, which involved 30 participants without diabetes, found a weak-to-moderate correlation between glucose responses to identical meals, with about 80% of the variation attributed to within-participant differences or measurement error.

The article notes that high glucose variability is linked to increased risk of death, greater hunger, and poorer mental health and sleep. While CGMs are beneficial for people with diabetes to prevent hypoglycemic episodes, this study suggests that developing personalized nutrition recommendations for glycemic control may be more complex than previously thought due to inconsistent individual responses. The authors emphasize the need for more reliable dietary assessment and a deeper understanding of the behavioral, dietary, and individual factors that influence glucose responses. ```

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

#90

Post by utopcell »

It would be unfortunate if this article were to discourage folks from trying CGMs out. I am not diabetic but have found a lot of value in using a Stelo CGM sensor. At minimum, it gives me awareness of my current state. I routinely check it before considering desserts for example. Also, I was shocked at the spikes I would get from some food. Maybe an "obvious in retrospect" feedback was drinking a bottle of (non-diet) Coke. It consistently gave me 50 unit spikes (mg/dL). Nothing came close to it, including large meals or meals + desserts. On the other hand, drinking diet coke had absolutely no impact, which was contrary to what I've read before (the body is confused and produces insulin). Another surprising observation is the effect of consuming Feta (a particular kind of Greek cheese) : no matter what else I may have eaten, a piece of feta always leads to a reduction of 10 to 20 points for at least half an hour after consuming it(!) I doubt this is generally true, which speaks to each body reacting differently.
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