(It actually was fun, and I’ll do it again when the data ecosystem improves.)
(It actually was fun, and I’ll do it again when the data ecosystem improves.)
So on a second by second basis numbers that would be concerning across an hour are fine. Similarly your average over an hour post meal can be much higher than a healthy average across a day.
Like most things, it’s mostly about area under the curve, as long as the extremes aren’t too much so.
It seems there has been this age old knowledge that taking a short walk after a meal is really good for you, which somehow got lost in some/many cultures. My parents would always say they had to sit after a meal to let their food digest... it never really made sense to me. My grandma, on the other hand, is 103 and gets pretty upset if people try to stop her from walking after a meal (or whenever she wants). We always just thought she liked walking, but maybe there is something else driving her, it seems to have worked out for her. It was very interesting to hear the CGM back up some of these practices that have likely been going on for hundreds or thousands of years.
I have been wanting to try one. This approval opens up the door. I think seeing something like this with my own eyes, with my own body, with actual numbers, would have a bunch bigger impact than some anecdotal stories from others and nice sayings which align.
It looks like there is some research being done in the area as well.
https://link.springer.com/article/10.1007/s40279-022-01649-4
I get the same feeling (of my body directing me to take some action) but it's not after meals, for me it's after having more than one beer. After 2-3 beers I want to go walk around the neighborhood for half an hour (and it's a bummer when the neighborhood is not pedestrian-friendly).
Literally "if you walk a hundred steps after eating and sleep on you left, there won't be any doctor's shenanigans"
That's not how it works, at least for the Freestyle Libre 3. The cross section of the needle has C shape rather than a O (technically I believe it's called a cannula). When you remove the applicator that C shape allows the needle to be removed through the hole at the top of the sensor, and only the flexible filament stays I your arm.
It sounds like an experiment I’d like to do for the purpose of optimizing my daily habits and establishing a better mental model for how my eating habits impact me throughout the day. But I really dislike needles.
I did this experiment as well, and the main thing it did was completely stop me from snacking. My habits got better because I could see how my BG could never return to baseline if I allowed myself to snack between meals.
Other than that, it was also interesting to see certain things would badly spike my BG and other things wouldn't, and they weren't always what you'd expect. A lot of "keto" and "diabetic-friendly" products are terrible for most people's BG and were for mine. I found that some things, like black tea, actually made my BG drop as well.
Overall it's worth doing at least once.
The needle is only used in the application of the sensor. It’s spring-loaded and retracts after the sensor is attached. I hate needles, but I found that the tape on the sensor provided enough stimuli to overwhelm my brain and not really feel the needle when it went in.
Having said that, it's no bug deal for 90% of people.
Think of it as a 5mm thick patch and ignore the tiny tube sucking your blood.
Again, not a doctor and not sure if this is accurate, but this is my very limited understanding
Archaic humans had access to plenty of wild fruit that were high in sugar and tubers that were high in complex carbs. They even had access to concentrated forms of sugar like sugarcane and honey.
They obviously didn't have refined sugars in everything they eat like we do but that they had access to limited sugar in the form of berries is a persistent myth. They would have been exposed to large glucose spikes regularly whenever they came upon a new tree that was in season while migrating.
However, this study seems to compare freshly baked bread to a frozen/toasted one.
I'd guess that the difference will be smaller when regular store-bought bread is used instead.
A diagnosis today that is imminently manageable like asthma was far more readily in a world without antibiotics, steroids, or even medical oxygen.
Even something like a CPAP that many of us take for granted has only been readily available for 30 years or so.
Plus, diabetes is much like AIDS in that it’s more of a systemic thing than acute. It doesn’t really have symptoms that kill you. It just slowly weakens your body until your heart gives in, or you have a serious infection, or something like that. No one dies “of” diabetes, they die with it.
But this does sounds like an interesting thing to try, if only to get a better idea of how my body works.
I've been tracking walking vs. resting heart rate, HRV, blood oxygen levels, and sleep for a few years using the Apple Watch, and while I know these measurements are imperfect, they've helped me better understand the impact of certain choices.
There's something that seems really beneficial about feeding my brain data about myself as a way to do the healthier things I've always wanted to want to do. The more data I have, the easier it feels to implement positive habit changes in a way that doesn't involve sheer willpower. There's something very satisfying about seeing the very tangible changes on a graph over time that indicate better health, even when it doesn't feel like the changes have done anything noticeable yet.
Absolutely, there are a lot of companies trying to cash in on this new-ish market, and they'll do anything to their products to get the net carbs down to 0-2g "per serving" -- scare quotes around that because this is a particular annoyance of food labeling in the States: food labels declare the amount of various nutrients per "serving", but 1) they get to choose the serving size [0] and 2) they get to round numbers, so if they just pick the serving size such that it's 1.499g of carbs per serving, they get to put that it's "1g", and so on.
It makes it impossible to compare food labels between different items even among the same manufacturer (and even the same SKU but different/later packaging, because they don't have to issue a new SKU when they change the food label). If instead they were required to show amounts in g per kg (or ml per l for liquids, or whatever), they could be compared more easily.
[0] The FDA provides "Reference Amounts Customarily Consumed" and asks manufacturers to refer to them when deciding their serving sizes, but (from [1]):
> FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe our current thinking on a topic and should be viewed only as recommendations [...]
so really they can pick almost anything they like
> [...] unless specific regulatory or statutory requirements are cited.
unless the food is medicinal in some way, I guess?
It is a CGM more or less what you would expect, insulin is the only hormone that lowers blood sugar, then you have all the stress hormones that raise it like adrenalin, growth hormone and cortisol plus glucagon for long time storage of sugars in the body. So measuring blood sugar with a CGM gives you a value between 2.9-13.5 mmol/liter that is supposed to give you picture of a rather complex system. A CGM also needs perfect access to your free flowing blood which in it self is a difficult task.
e.g. I know that the things I eat impact my blood sugar, but don't have the same kind of intimate awareness a diabetic person would have, nor would the changes in my levels have the same meaning/impact.
Put another way, and setting aside the issue of oversimplifying a complex system (so is measuring RHR, HRV, blood oxygen, etc.), the benefit of CGM for a diabetic person is obvious. The benefit of CGM for a curious person less so.
Optimizing sugar in take for exercise might be an interesting thing todo as non diabetic. There is no tool to continuously measure ketons though which is the fun part. CGMs are so slow. I really see no use at the moment.
I thought CGMs measure the interstitial fluid?
I was shocked but obviously glad I found out. I use them from time to time just to see how I’m doing and how different foods (and amounts of them) impact me.
I found I can control it through diet alone and exercising when there is a spike by using a GCM for the constant feedback.
They are very expensive here though (UK) and my doctor won’t prescribe me one because metformin is cheaper, so it’s not something I can use all the time.
I hate needles, this really isn’t like a needle though, it’s a small filament which sits just under your skin, you can’t feel it, I thought it hadn’t gone in until I saw the reading appear on my phone.
Some things I found out besides what foods and amounts give me big spikes are that I have a blood glucose spike in the morning just before I wake up, and that if I eat a small enough portion of white rice, ice cream, bread, whatever I can reduce the spike quickly by going for a walk. If I had a lot though, a walk isn’t going to help.
I let the needle (actually: annulus? see sibling comment) get into my head because I was curious and looked at it. It looks a lot scarier than it is, kind of like using contact lenses for the first time: before you've used them, you get into your own head about it, but once you've done it a couple times it's just rote and easy.
I had started the first one a day before I started a few weeks of (6-days-on, 1-day-off) keto. Keto guides will say that you should have <= 25g net carbs per day, but I specifically wanted to see how front-loading (having almost all the day's planned carbs in one meal) affected blood glucose, and also whether the number (25g) is accurate for my physiology. I found that my number was closer to 30g and that when I stayed under it, my blood glucose spikes had very short duration but when I went significantly over it, blood glucose stayed higher for longer.
edit: One more thing, I used this time to play around with various sugar substitutes and see how they affected my blood glucose. Allulose came out as the winner (if money is no object) based on not having any noticeable off-taste or aftertaste and on measuring gram-for-gram the same as sugar (well sort of, it's only like 80% as sweet as sugar, so you get the same mechanical effects of sugar if you weigh it gram-for-gram and your baked goods or whatever come out not quite as sweet, which is perfect for me. Creaming butter with liquid stevia extract or something just plain doesn't work.
I do this with a lot of consumer measurement devices. Both for thermometers and scales (food, human, and cheap 0.1mg scales). As well as thermostats, like the kitchen oven. I also do it for my multimeters. I validate my volumetric measuring cups/spoons by weighing water in them but I don’t correct them, just return if they’re way off.
It’s okay if the reading is off as long as I can correct it the same way every time and get a pretty accurate result.
Some classically trained engineers may tell you the "true" value should always be plotted on the x-axis as it is often considered to be the more "independent" variable...but this is highly debatable, and you can skip some simple algebra later if you put the measured value on the x-axis. Then look at the shape of the scatter plot. Ideally it will be linear, so you ask Excel to do a linear curve fit (y=m*x+b). Write this on the scale, and now whenever you take a measurement on the scale, whip out your phone and do "measured_value * m + b". And that's your true value. If it's not a linear fit (quadratic, log, etc) ... that's interesting, and often it's likely "wrong", but also "it is what it is". Classically trained engineers will say you have to do a linear fit if that's what the theory says is appropriate, but for one-off home device calibration...do whatever works for you. Just as long as you don't overfit with some stupid 4, 5, 6, etc-term equation. Any reasonably simple equation with 2-3 terms is fine IMHO.
I use a set of heavy objects whose mass I know fairly precisely. They're not perfectly 10.000lbs, 20.000lbs, etc ... they're just "around 10lbs, around 20lbs" and I've used a good actually-calibrated scale (at work, some commercial business with calibrated scales that you can access, whatever) to weigh them and wrote their weights in sharpie on a piece of tape stuck to the objects. Ideally you'd go for around 10% increments. If the scale can weigh 400lbs, that would be every 40 lbs or so. But it really doesn't matter as long as you have enough good points around the range you truly intend to measure, and then a few outside of that target range at semi-regular intervals.
For my 0.1mg-resolution mass balance I have some actual calibration weights, but they're a relatively affordable OIML "M1" class, and did not come with expensive calibration certificates. The OIML tolerance ratings go E1, E2, F1, F2, M1, M2, M3 (from best to worst). For a 100g test weight, M1 precision gets you +/- 0.005g, guaranteed, for $50 ($135 if you want a calibration certificate). E1 gets you +/- 0.00005g at 100g test weight, for $500 ($1200 with cal cert). For smaller calibration weights like 10mg you'll generally want to go a step up from M1 (+/- 0.25mg) to F2 (+/- 0.08mg) for about $27.
For temperature, it's a bit trickier because the only "true" temperatures you can create are -6°F/-21°C and 228°F/109°C. If these temperatures are helpful to you, you can create them by pouring shitloads of salt in water and stirring+heating it until no more salt will dissolve and you just have a pile of salt in the bottom of the container. You can try to go for "0°C/100°C" using distilled water and it would probably be close enough but you can't know it exactly unless you use super pure de-ionized water and use extremely absurd lab technique (usually involving washing your glassware and tools with de-ionized water over and over for several days straight to get rid of trace contaminants).
So instead, to get "true" temperature in the range I care about, I use some thermocouples attached to a high-quality multimeter or oscilloscope. Then I calibrate these thermocouples using the method above, and average their reading for the oven temperature. This works and extrapolates well enough outside the range of calibration because the error of a thermocouple is basically guaranteed to be a very linear error.
In this link[0] topics 1-6 ("weeks") get into the fine details of all this and provide some worksheets/excel sheets already made up for this type of thing. If you're really getting into the weeds with this, understanding propagation of error[1] really helps but is super unnecessary for 99% of people unless they're doing actual engineering.
0: https://pages.mtu.edu/~fmorriso/cm3215/laboratory_exercise_s...
1: https://pages.mtu.edu/~fmorriso/Pintar_Error_Analysis_or_UO_...
Each time the CGM is applied, the situation is different because of the exact position and various other factors. And the CGM is not 100% consistent.
You do/can calibrate the CGM as needed. For example, when the CGM first activates, standard practice is to check with a fingerprick to see how accurate the CGM is this time and (sometimes) calibrate. (As noted in other comments, the CGM and fingerprick are not detecting exactly the same thing.)
And the next time you apply the CGM (we use a Dexcom G6, which is changed every 10 days), any previous calibration is irrelevant. There's a lot of variability and many factors that can affect results (exact location, scar tissue from previous CGM application, recent exercise, a recent hot shower, etc.)
(I didn't explain that well, but hopefully you get the idea.)
Try doing a few fingerpricks in a row. The variability will surprise you!
That means a lancet poke can be quite different from a meter like the freestyle, and both can be quite different from the level in your veins that a lab would get. So if your level is 200 one device can read 240 and the other 160 and both can be considered “correct”.
I found that the freestyle libre 2 and libre light are characteristically low while the FS 3 is characteristically high. So I use them for the shape of the curve, and that is useful.
Trying to get it filled and picked up was slightly annoying as the pharmacy initially did not want to fill it without some prodding, and I waited a while for them to figure out how to get the promotion billed.
It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.