Routine glucose monitoring may be unnecessary for people with Type 2 diabetes
nytimes.com
nytimes.com
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 get readings whenever I want and also get data like trends that I can't get from finger sticks. I can see my blood glucose overnight for example which helps me tailor my meds and food to avoid the common overnight glucose rise that's pretty common.
So sorry NYTimes article but I'm going to disagree. I don't think enough people are encouraged to use CGM for example so that some real data can be extracted on diet compliance.
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 combination of micronutrients.
Beef spikes insulin just as much as rice does. Acute insulin spikes are not bad, and can be very beneficial. Chronically elevated insulin is not good, but it's almost always simple to address that - just eat less, less often.
But people seem to prefer to focus on complicating easy things instead of consistently doing simple but difficult things.
https://watermark.silverchair.com/1264.pdf?token=AQECAHi208B....
""Between 50–60% of protein becomes glucose and enters the bloodstream about 3–4 hours after eaten." Perhaps 50–60% of protein goes through the process of gluconeogenesis in the liver, but virtually none of this glucose enters into the general circulation."
http://journal.diabetes.org/diabetesspectrum/00v13n3/pg132.h...
Here you can see while its not the exact same, the insulin scores of beef & rice (brown especially) are very close to each other. Definitely much closer than most popular culture advice would suggest.
But it should also be said that this is for healthy individuals.
https://watermark.silverchair.com/1264.pdf?token=AQECAHi208B....
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.
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.
Citation?
That should be the takeaway lesson from this study. Just because some people stuck their fingers and gathered BG numbers three times a day does not mean they acted on that info to change their health. Until health pros make this clear to patients, that they need to actually use this info to adapt their lifestyle on a daily basis, there's simply no point in gathering daily info like this. And certainly not at a frequency of 3 or 4 times a day.
Once you've dialed in your lifestyle into regular eating and exercise habits, repeatedly gathering daily numbers is redundant overkill. Gathering BG numbers no more than one day a week should suffice, just to confirm you remain homeostatic.
Gathering info, by itself, changes nothing.
(BTW, I've had T2D for 15 years now. So I've walked the walk.)
When we're talking about diabetics and blood sugar, one data point could be the difference between life and death.
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.
Can you order them over the counter in Canada?
Edit: yes, you can: https://libre.myfreestyle.ca/
$97 CAD for a new sensor, not bad. That’s about $73 USD
[2]: https://www.ambrosiasys.com/our-products/blucon
A word on accuracy, as a type 1 diabetic I have not pricked my fingers once since I got onto the FreeStyle Libre almost six months ago and I am achieving excellent control of my day-to-day levels. Take from this single data point what you may, but I want to offer it as a counter weight to the “need for calibration” I heard before I received the device.
I am currently holding off on getting a MiaoMiao2 until mid-November just to avoid the first few batches of the device that may or may not have manufacturing issues (simply being cautious, I have no evidence). Having easy access to continuous historical data changed my life as a type 1 diabetic, imagine having pain-free and instant access to your levels when you are on the go, stressed out, sick, or just as you wake up in the middle of the night. Then add to this being able to look back eight hours in time to adjust your mental model when things go wrong. It is a matter of night and day. Now I am hoping that turning it all live will make things even better.
One other aspect of the FreeStyle Libre that I was not expecting was a feeling of accountability. When I was just finger-pricking I could essentially hide high blood sugars. Say I had eaten some sweets or something, and forgotten to take my insulin, I could sort of hide from the responsibility of that high reading by just taking my insulin when I remembered and testing in a few hours - my Consultant would never know. However, now I am aware that my sensor is going to read that high sugar, and that makes me feel accountable for it - so I have seen my insulin taking get more consistent, and this has resulted in less hyperglycemia and hypoglycemia (as a result of mistiming the insulin and whatever I have eaten).
On your point about accuracy - I have found it to be a little out in the extreme highs or lows - for example there have been a number of times when my sensor has given me a reading of, say, 2.4. However when finger-pricking I might be 3.9 or 4. Now this could be because the reading is about 15 minutes behind, and since that moment my liver has pumped out some glycogen. But I have had similar accuracy issues when high - say above 18. Having said that, to me this is not a problem, and the accuracy between 4 and 18 is pretty spot on (apart from one sensor that went bananas and was reading at least 15 above what I was for about a week).
Unfortunately they are keyed at the end so each stores strips only fit their own device.
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 Code: ISBN 9781925548891
https://casereports.bmj.com/content/casereports/2018/bcr-201...
I've seen the freestyle libre but it still seems like a costly option that most probably couldn't afford.
There are many other Drs that have gone on record.
It is somewhat costly ($38 every 2 weeks) but for me it's worth it.
The only times I can remember daily glucose monitoring was for the insulin dependent (as they need regular monitoring to make sure they are using the right amount of insulin), or those who we were trying to track to give the doctor more information on how to treat, but also to push the patients into making lifestyle changes (not eat that sugary meal in the morning if their blood sugar is already high when they wake up, for example).
Glad to see that the evidence suggests no different in A1c outcomes regardless of what is done.
> Of course, there are exceptions. When patients are acutely ill, or changing regimens, or finding that their blood sugar is not well controlled, testing may be appropriate.
So about the regimens: unless the patient eats the same every week (same ingredients, same quantities) without any significant variation, it’s still the way to go IMHO. General guidelines can be followed by the patient but usually they don’t have that much nutrition knowledge to judge if a new food is going to hurt them (besides the most obvious sugary stuff). There are exceptions and all that.
I supported a member of my family who’s gone from pre-diabetic to dangerous levels of A1c (well beyond “need insulin”, more like “go to the ER right now”) and the regular pricking helped a lot to know what could still be eaten (full keto wasn’t an option).
And even this story has a happy end: no insulin and very minimal pre-diabetes medication. Regular pricking still happens when significant (usually healthy) changes in diet happen and it helped to detect what should be avoided. And luckily it’s affordable.
Disclaimer: not a doctor, just a nutrition freak.
Isn't this everyone with diabetes? Hell of an exception.
"The link held even after the scientists adjusted for food intake, weight and physical activity."
Is there anything BPA can't do? ;)
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 my A1C down from 11 to 5.4 in 5 months with diet, exercise and meds but from my doctors own comments and my research the meds (Metformin and Victoza) really only contribute maybe 1.5 point reduction. If I have an A1C of 9.5 instead of 11 it's not going to make much difference. But at 5.4 I'm essentially normal.
Since diabetes are heart diseases are tightly coupled it's prudent to monitor blood pressure everyday