165 - AMA #24 [sneak peek]: Deep dive into blood glucose: why it matters, metrics to track, CGM data

Wish we could pay per episode because at present I could not afford a monthly payment and this episode is priceless to hear in full . Peter you are amazing 🏆

Thank you thank you thank you! I’m an endocrinologist in Cleveland. This needs to go viral. You guys do incredible work

I know you did a little Testosterone Replacement Therapy talk in AMA #10, and have briefly touched on it here and there, but the topic deserves a full episode with the leading expert in the field, it’s such a hard topic to navigate on our own. I always reference your 5 part lipid discussion with Thomas Dayspring as the most informative easy to understand sources available. I’d love to see a similar series for all things hormonal for men and women as it applies to aging since it’s an important part “healthspan”.

Wearing a CGM can be a life-changing wake-up call, certainly was for me! Too bad they are by Rx only in US. I was introduced through a study I participated in, the Predict 2 Study. Shocked to discover 275 mg/dl response to the OGTT when all docs told me I was "fine" with A1C of mid 5s. I'm now managing my diet based on the Zone macros (moderate carb (veg & fruit) balanced with protein, fats, fiber) and test periodically (showed my doc the study results to get Rx for CGM) and now maintain an average of around 90, 70-125 98% of the time. I think we'd save lives & money by sending everyone a CGM, but expect many financial interests would lobby against this idea.

Love your work Peter God bless

Thanks for the info. My endo suggested me to use Libre sensor with Ambrosia Blucon cgm. I have been using it for last one year and monitor blood glucose on phone and watch.

I used a Libre CGM for a while and it always read 15-30 points low. While sleeping my readings would sometimes dip below 50. I found it useful to show peaks, when I ate something I shouldn't have.

Would agree with wearing the CGM.. not only as you mentioned about seeing the "real" numbers, but also to see situations where say the A1C is x.. but, doesn't reflect real spikes/lows to create that average.. for example, consistent spikes of 190 and lows in the 60s to be an avg of 125 isn't really a good thing either, as far as I know. Can also be interesting to see the uptake and timespan with insulin vs exercise (between the two difference glucose intake triggers)

Great stuff!

My A1c went up to just below prediabetic in about 18 months around age 66+. My regular internist wasn’t concerned but I started cutting out all foods that took me to 140 or above. (I had worn a cgm for 11 days. Paid for it myself in citizen data project. I knew my BG had been spiking; surprisingly, even after months of without those foods, my A1c barely dropped.) I even asked for a second opinion in my system but he didn’t see a problem and backed up that CGM was only for those already diabetic. I called Dr. Attia’s office a couple of times (I live in San Diego) to see about possibly becoming a patient later when I can change my insurance, leaving messages and never heard back. I wish I could at least get a cgm for a couple of weeks once a year because I occasionally test after meals and some meals that used to cause a low rise in bg now cause higher ones. It’s bumming me out. I did lose some weight-not intending to, just thought it would bring A1c down, but didn’t- last year doing bouts of 2MAD, but found out 40% of it was muscle! I am 68 and can’t afford that. Now I am scared to try even to lose fat. Boy, do I miss chickpeas and rye berries! My tests also showed that my body doesn’t process fat well anymore, so I think keto is out ( and I have hated the meals on keto.)

Just curious, as I have had T1D for 45 years, and use a CGM with a closed-loop insulin pump, do you calibrate your CGM with finger sticks? While the Dexcom does not require calibrating, I find that it can be off by 20% before calibration. Once I calibrate it with two separate fingersticks, I am generally able to trust the readings I get. I realize with T1D, I will never be as effective at maintaining blood glucose levels as a functioning pancreas, but having started my T1D journey with urine testing, the technology is life saving!

I have used Eversense CGM for 3 years and I can't live without it. I am a diabetic so I must have a CGM but I have friends who are type 2 and pre-diabetic who use this because it lasts 180 days unlike any other CGM in the world and also it can be taken off at will unlike any other CGM. In fact, my non diabetic friend only places it back on when he feels sluggish and wants to be sure his glucose levels aren't the reason. My A1C has come down from 8.9 pre CGM to 5.8 today 👍

On Keto / low carb for 3 yrs,started wearing a cgm a month ago, reading are very high 6.5 to 7.5 (U.K) .

When will mainstream medicine realize and start tracking the actual problem that leads to high glucose levels in the first place. Fasting insulin should be the standard blood test, not A1c.

So to summarize this from a practical point of view: Avoid high glycemic foods and carbs as much as reasonably possible (to minimize the insulin variability and average) and never binge on carbs (to avoid the insulin peaks)? Am I missing something or is that pretty much it?

Just ate an ice cream before watching this :/ hahaha love your work Peter

When are you going to interview Neurosurgeon Dr.Jack Kruse on Glucose and how Light affects blood glucose levels and insulin sensitivity?

I think high Ha1c is more important than high cgm blood glucose, since glycation is a negative effect and having your hemoglobin glycated more than your cgm suggests sounds like an indication of an issue.

Ok you sold me on the CGM.... now... which one is best? Thank you

I’d rather have paid ads.