You are your only medical advocate, no one else is going to do it for you. The standard of care is shit, don't rely on it.
I tried a CGM twice. I triggered the hypoglycemia (blood sugar too low) alarm multiple times, but felt completely fine.
After some research I discovered it's actually not uncommon for healthy people to have occasional dips below the preset hypoglycemia threshold, but as long as you're not having symptoms then there's no cause for concern.
I also talked to a doctor who complained that she had multiple patients showing up with concerns about their glucose numbers for various reasons after trialing CGMs, but they had similar spurious and unimportant problems (brief excursions out of range, etc.).
So if you're going to experiment, at least familiarize yourself with what's truly problematic. It's easy to misinterpret the data if you don't know what it means.
People are often surprised when I tell them about the insane levels of pre-diabetes in the US:
> The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.
It’s honestly insane to continue a way of life that’s doing this to the majority of the population.
https://www.uspharmacist.com/article/prediabetes-trends-amon....
"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."
https://clindiabetesendo.biomedcentral.com/articles/10.1186/...
No, fasting is problematic because people don't like it.
Health conscious people don't understand how much resistance the average patient has to advice about lifestyle modifications, or how difficult it is to get patients to adhere to recommended lifestyle changes.
A good example is sleep apnea and CPAP machines: In theory, a CPAP machine should provide life-changing improvements in sleep quality and daytime energy for someone with sleep apnea, yet patient adherence rates are shockingly low (even when covered by insurance). Many patients are simply annoyed by the machines and give up on it.
That's not to mention the fact that weight loss is extremely effective in many (though not all) sleep apnea situations, but it's rare that patients will actually follow through with that.
US healthcare is crisis focused, not health focused.
Genuinely curious... have you ever been an obese person? Every fat person I've known have told me they're constantly shamed about being fat in medical settings, some to the point where they actively avoid going to a doctor anymore because they've given up on anything beyond being told they're fat.
I don't want to confuse my experience with actual data. Also, I don't think it's shaming if it's a health issue and obesity should be recognized as such.
I don't think this is true. Doctors do tell patients if they are overweight, and they do encourage them to make lifestyle changes including losing weight.
"Fewer than one of five overweight patients and slightly over half of obese patients reported being told they were overweight by their provider."
So "rare" is the wrong word.
https://www.commonwealthfund.org/publications/journal-articl...
You don’t need to completely throw in the towel if you don’t want to. Take breaks, try different masks as much as you can, get your dr to help adjust pressures. At least for some of us it does eventually click.
Good luck!
At the end of the day, we are all different, and the threshold for what physical sensations a person can tolerate is highly variable. Everyone understands that about pain (I hope!), but this goes just as much for all these other things that are not necessarily painful as such, but are still physical.
Is this just an American thing? Every GP I've ever seen has asked me about my diet and exercise despite me being in the healthy BMI range.
I've had doctors (in America) tell me to not worry about medical issues and others recommend a battery of tests to look for correlated but uncommon issues. My current GP recommends basic, palatable approaches to diet and exercise that have nothing to do with giving them money (and, presumably, reduce my medical costs with them down the road.)
I've also had doctors suggest that I get an issue reclassified so they could do surgery. That could be viewed as them wanting money, but I view it as them seeing a problem that can be fixed by surgery because, as a surgeon, that's how they approach problems.
Where is the harm in getting data on how your own body deals with glucose?
Not necessarily.
Rohin Francis (Medlife crisis) has I think a video on overtesting, but for example, if you have a new technology that tests and suspects a tumor, which results in CT scans for patients, if millions of users use this tech there's a likely non-zero number of people who may get cancer from the CT exposure.
"What about those who actually had the tumor?"
Well it's possible that 99% of these cases would've been symptomatic anyway in a few more months.
By explanation isn't the best, but over-medication is not a non-issue.
Then you can decide whether a test makes sense or doesn't make sense, given the tradeoffs of radiation and cost vs. the risks of harm.
In the real world, information absolutely can lead to harm, but it's still all in the response and how medicine and patients use information.
But as information gets cheaper and more common we can develop ways of dealing with it. If it was difficult and expensive to test for fever you'd see people in the medical profession warning against it because it could lead to overreaction.
Another thing I seem to remember in his video was that a tumor is not necessarily dangerous. Out of a hundred (say) tumors in a person's life, only maybe 5 are risky. But I'm paraphrasing this badly.
Edit: https://www.youtube.com/watch?v=7kQk9-KLPfU is one of the videos, however I think he's talked about this more (likely on instagram or another video too).
>For a lot of people, if you get a positive result from a test that a doctor brushes off that's not going to go well.
This is precisely because of the rarity of testing. Suppose the cost of testing dropped 1000x and we could get tests for things each day or each month. We'd start to have systems that put these things on context.
When you have a single isolated result there really isn't that much to go on.
E.g. CT scan shows an incidental, tiny lung nodule. You do a biopsy. Unfortunately, during the process of getting a biopsy, you develop a pneumothorax (an uncommon but well-known complication of a lung biopsy) and need a chest tube, hospitalization, etc. You get discharged and you're fine, but man, that wasn't fun. Biopsy comes back negative for cancer. Nodule goes away on its own with time.
Edit: that being said, I'm excited about OTC CGMs! But the "data" we have in medicine is not as accurate as other fields and always subject to false positives/negatives.
"I'm so incompetent that more data is going to lead to worse outcomes! So let me stick my head in the sand and not measure!"
Imagine if any other profession operated under this framework:
"Ehhh, if we inspect too hard we might make a repair on this airplane that will cause further damage, lets just not do the inspection"
Did you see the 737 door plug accident?
You are missing part of the picture here. And that part is not that everyone else is dumb but you.
Do you think this is....the same thing as a continuous glucose monitor?
We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population.
CGMs will often give an "estimated HbA1c" value based on statistics from the collected data.
The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.
It certainly should be part of routine checkups in my opinion, but I had never had more than blood pressure check and a weigh in from my doctor.
I also had an insurance provider who gave us a cash bonus if we had it tested (they paid) every year for a while.
It’s surprising that some doctors aren’t checking it still.
That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels.
You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.
It was very very surprising which foods, and quantities of foods, caused huge spikes.
However, this stuff is difficult to interpret. What should be the goal number for managing glucose spikes? What's good, what's bad? Ultimately there's a lot of judgement calls, just as there is with any health or fitness goal.
I learned a lot from Peter Attia's podcasts, but that required hours of listening.
My doctor offered to review my data with me, which was amazing. But many people's primary care docs may not have the experience or time.
As far as spikes are concerned, I convinced my wife and my dad to both try out the same CGM. Neither of them really ever had any spikes of significance (maybe up to 130's), even when eating cake, etc. Obviously it varies from person to person, but the fact I would spike easily above 140 with boring foods (steel cut oats with no sweetener as an example) said to me something was wrong. My daily averages hovering around 100 to 105 were not in the pre-diabetes level but were close to it, even when eating minimal carbs and being extremely fit with a natural healthy diet. Also most of what you read out there with CGMs is related to people who actually have diabetes.
Finally, there's no one really to talk to about this stuff. You can eclipse your doctor's knowledge on the topic with about 5-10 hours of research. You can go get a broad set of labs and be right at the edge of the reference range on something (which is, depending on the lab, just a range of the general population, not a healthy range) and your doctor will shrug it off. The system is setup so that as long as you are in a sort of average, even with that average being pretty bad (half of the country is fat and pre-diabetic), the standard of care is to ignore it until you fall off the end. The line between hypochondria and being on top of your health is pretty thin, and most doctors will consider you a hypochondriac if you research and come ready to talk about the topic with any level of knowledge.
Even if you don't suspect underlying health issues, the data provided for health optimization and gamification is worth it.
I used the GCM for 4 weeks and mostly tested how my body responds to various types of foods and meal timing. I also used an Oura ring to track sleep.
Main lessons learned: fat loading in the morning with a bulletproof (ghee) coffee didn't spike glucose and provided sustainable energy. Carbs for dinner helped with sleep but only if the meal was several hours before bed, allowing enough time for the double glucose spikes to return to baseline.
And Japanese sweet potatoes massively spike my glucose unless they're slightly undercooked. Cooking methods significantly changed how my body responded to the food.
However i recently saw a video of a woman that carried a glucose monitor (even if she didn't need one) as part of a study (she volunteered) and was able to correlate her mood and her weight take/loss with sugar intake.
I'm very curious about this. I've started a diet recently and after quitting many sources of sugar completely I'm very surprised how long i can go without eating and how little calories per day i can consume (well, as long as i have fat to burn at least).
If anybody wants to chime in and suggest a glucose monitor that i can get without prescription in EU (Italy) and from which i can pull off data, please do.
I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.
I wore a CGM for about a month. Also found that my glucose numbers were not nearly as good as I would have expected, especially considering that I'm quite active and not overweight. But it's the "what next" that I'm stuck on.
I was on strict keto for a year, with daily blood tests to monitor ketone levels. My fasting glucose would still be above 100 often enough. Even a moderately sized carb-heavy meal can send my BG above 200 (even after being off of keto for a few months).
Maybe if I paid the $2500 for his "Early" program that details all the labs he does I might get some insight, but that is clearly priced for someone outside my tax bracket.
https://www.ultalabtests.com/test/advanced-cardiovascular-he... https://www.ultalabtests.com/test/hormone-health-men-compreh...
Front page has 20% off coupon. This should get you a pretty wide view. You can add on extras, but this should get you most of what you want to understand. But, this level of lab work is going to require 20+ hours of research to understand, and even more if you pop funny values and want to figure out why. Have fun....
Hiding information from people because they might misinterpret it is not a successful medical strategy, the better strategy is to educate, see if the information will be welcome, then provide the information in the context of what it means.
I wasn't technically pre-diabetic, but did have a few higher-than-expected resting glucose blood tests, and the CGM showed me that I'm actually really close to pre-diabetes.
That was the kick I needed to clean up my diet (specifically eat less), exercise 5-7 days of the week, and I'm feeling better than ever.
Anecdata, of course, but there is no single intervention that has been discovered to improve people's weight and metabolic problems in the US (except perhaps the new GLP-1 inhibitors). Adding a CGM, at least for people interested in it, can be very effective, and we should use all the tools we have to improve the population's health.
And thus I doubt very much that with this device or devices like this, the diabetic population will be reduced. In fact, I believe it to be the opposite.