I would recommend anyone to experiment with this. I did, and found out I was more glucose sensitive than I expected. This led me to get more broad labs done, with which I was able to find additional treatable issues that are likely the cause. If I hadn't done this, I would have found out via symptoms years later, after irreversible damage had already been done.
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.
Freestyle libre has a lot of hypoclyemia events due to pressure on the sensor. If you roll over at night, or lean on the sensor it reads way too low. It’s very annoying since you can’t disable the alarm, I have to turn off the Bluetooth at night. Similarly when you go into very cold water it will read lower incorrectly.
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.
The other insane thing is studies have shown that type 2 diabetes can be reversed by fasting. Fasting is problematic to the medical industry because it is zero cost.
"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."
> Fasting is problematic to the medical industry because it is zero cost.
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.
Speaking as someone who has spent several months trying to adjust to a CPAP machine before finally giving up, it's not because it's annoying, it's because I literally can't sleep with the damn thing strapped onto my face. I'm well aware of the benefits, and I would love it if I could have them... but between sleep apnea and no sleep at all, the choice is obvious.
Everyone has a unique situation, but wanted to share my experience because improving apnea can have such a huge impact. I have a relatively mild case, so CPAP was borderline but I tried it. Like you spent 4 months and never got past 3 hours in one night, even trying several masks. Gave up for a year, worked on sleep hygiene in general and tried again. After about 2 weeks of a new mask and adjusting settings slept through the night. 5 years on I still wish I didn’t need it, but the improved quality of life means I basically never go to sleep without it. Can’t imagine how big a deal it is to someone with severe apnea.
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.
I have a friend who got a CPAP and was happily sleeping with it on the first day, 5 minutes in. I'm very envious, but... I've already tried several different masks, went to the supplier to have them adjust that stuff to fit me etc.
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.
It's also rare for a doctor to tell a person they are too fat and to lose weight. The assumption (and most cost effective solution) is that patients just want a prescription for something and be sent on their way.
US healthcare is crisis focused, not health focused.
> It's also rare for a doctor to tell a person they are too fat and to lose weight.
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.
It its a complicating factor in almost every ailment known to humankind. A doctor would be negligent not to address it. There is no healthy level of obesity.
I'd say I'm obese, and never heard a word about it. Even through covid. I have a friend who is a doctor who has been brutally honest with me (it's appreciated), but even though I've gone to many paid doctors in the northeast US, not a peep.
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.
> It's also rare for a doctor to tell a person they are too fat and to lose weight.
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.
Humans evolved with a lot of behaviors that is or was not healthy. Evolution requires you to have offspring and have them alive until having own offsprings.
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.
I don't think that fasting is problematic to the medical industry in the US. And if it is, it's not because it's zero cost. Doctors love zero cost interventions. The real challenge is just the standard medical challenge: 1) educating doctors as new evidence comes in, 2) doctors educating patients, and 3) patients complying with the intervention.
Other studies have shown that type-2 diabetes can also be put into remission for many patients with nutritional ketosis. So, there are potentially multiple approaches to try.
The American diabetes association admitted last year that T2 can be "reversed" with the caveat that you mentioned about existing damage. However, to actually damage things to a level where they are noticeable takes years and years. If you catch it early, T2 is entirely "reversible".
This is why it made me upset to see this Doctor on TikTok telling people unless you have Diabetes, you don't need a glucose monitor and making fun of people who had one.
Where is the harm in getting data on how your own body deals with glucose?
False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.
If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.
I can learn almost anything. So, I have to put values on what it is I'm learning, so I don't waste my time. My estimation is that learning how to interpret my health data so that I can spend a lot of time gathering and then continually interpreting that health data is not going to evince any additional value in my life.
> If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.
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.
That's still the response though. You can simply say "Well, we expect an error rate of X with this new test, so in the absence of other risks factors we predict the actual odds of the condition are Y".
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.
I get your point, however I think there are a few confounding things. 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. I'm very much in favor of more testing personally, there are almost certainly folks who're on SSRIs who'd benefit more from Vit D/Mg supplementation for example.
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.
>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.
You don't know if it's a false positive or not until you do further interventions. Realizing it's unnecessary is only evident in hindsight.
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.
Agreed. Thanks for the perspective. Never considered downsides of such interventions (as I have been mostly a lab rat for doctors but never experienced things like that, but it's understandable).
the gap between cgm and a biopsy from a CT scan is vast. CGM is not enough to trigger any such intervention. Unnecessary interventions are absolutely a concern. A CGM is about as controversial as someone taking their own heart rate to help them calm down from panic attacks. Minimally invasive and nobody would base a dramatic intervention on this data alone.
Sure. As I stated in my original comment, I'm excited about CGMs being widely available. The example in my comment was very specifically answering "why do doctors perform unnecessary interventions?".
Doctors make mistakes. Procedures carry inherent risks, such as infection, allergies, blood clots, etc. Even driving to the doctor to discuss your blood glucose carries a risk of car accident. All of these are low probability events, but non-zero.
> Where is the harm in getting data on how your own body deals with glucose?
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.
At the age of 45 I had never had an HbA1c test. I found out I had T2 diabetes from getting a CGM as part of a health study I applied for, and seeing my blood glucose was at 22mmol (it should be under 10). I ordered a finger prick test kit from Amazon assuming the GCM was faulty but it wasn’t. After this I went to the doctors who confirmed with an HbA1c and put me on Metformin.
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.
Where are you based? I have it tested annually, but only after moving to USA (from Poland). I don't remember if I had such a test done earlier - I think I might have had it done as a part of screening for whether I'd be allowed to go scuba-diving or something else sports-related.
I've had it checked as part of a yearly blood test in the past, but at my last doctor visit a week ago, they did an instant A1c test. Came back in just a couple minutes. Love to see these type of advances in care rolling out.
> Where is the harm in getting data on how your own body deals with glucose?
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.
Agreed, this is one of the better things I have done to take control of my own health!
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.
+1 +1 +1 to Peter Attia, huge amounts of great content. My philosophy is that if there's any single topic where I should be spending five hours a month researching, it's personal health.
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.
Experimenting with GCMs is by far the most useful and fun biohacks I've tried. I was part of the early beta for Levels Health.
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.
I'd really love to be able to do that (experimenting) but i'm in the EU and haven't looked at the possibilities yet (i'm not diabetic).
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'm in the Netherlands and just bought a Freestyle Libre 3 from https://www.dia-centrum.nl/. It didn't require a prescription and was easy to set up and you can get the data out of Freestyle's website, as a CSV download if I remember correctly.
I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.
Perfect, I'm also in the NL and was hoping someone would have more information. I totally believe the GP being condescending about it, they are trained as gatekeepers to medical care to reduce costs to the system (wife is a doctor). It is also unimaginable to them, for whatever reason, that people would pay for things out of pocket.
Haha, yeah, don't get me started. My other recommendations along these lines for people who don't want to argue with their GP about which blood tests "make sense" is https://onedayclinic.nl/. Their pricing is somewhat confusing but you can just email them everything you'd like to measure and they'll make you a (reasonable) offer.
Can you share a little about the "additional labs" you did?
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.
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....
I've read Outlive (and am a big fan of Peter Attia in general), but there's really not much there besides "exercise more, eat better".
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.
One example is an iron overload disorder. Excess iron accumulates in various organs including your pancreas, liver, and pituitary gland. Catch it early and you can avoid liver cirrhosis, busted pituitary function, poor pancreatic function, heart issues, dementia, etc. Wait too long and you are on the transplant list.
I found out I was barely in the diabetic range a couple of months ago; hopefully, with diet changes and Metformin, I will see my A1C at a better number in a month or so. Otherwise, I would like to try a CGM to see what I am missing.
Prevention of diabetes or even of pre-diabetes is well worth the experiment. At least for folks in the US, where metabolic syndrome is hanging over the head of a huuuuuge percentage of the population.
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.
I think your approach is that giving more data to individuals so that they can be informed and make better decision about life choices. However, if we look at reality, the data is already there, without experimenting we can already get a ton of data. Then the question is have people made better decisions about their life choices. I think the answer is No.
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.
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.