Thoughts About Connect
10 years ago my GP off-handedly says... "yea it looks like you may have a bit of hypoglycemia" during my 'annual' health exam.
WTF does that mean?!? But I'm ushered out the door because, you know, he has to see 50 patients a day and my 9 minutes was up.
18 months ago I heard Peter Attia (pretty sure best personal doc there is) talking about glucose and CGMs on his podcast.
I call my GP (different one by then) and schedule an appt.
Doc, I want a CGM, can you write me a script?
Why, here's why, why, here's why, and on and on...
GP somewhat reluctantly write script for Dexcom G6. Wahoooo!
Drop $400 for the Dexcom G6 setup (30 days worth of sensors).
Install that thing and instantly realize shit ain't good...
That Tropical Smoothie across the street from the office was sending me straight to 180-200 at lunch, and then way back down. No wonder I'm always tired in the afternoon...
Months and months of food testing ensure...
So here's what I'm seeing...
Time of day. A breakfast burrito in the morning is not the same as a tacos for dinner...
They're basically the same right? More or less.. But for me, I'm wayyyyy more sensitive at breakfast and lunch than dinner.
Lunch is by far my riskiest meal from a spike perspective.
I can handle a lot more carbs at dinner, even with desert most of the time.
Order.
Bread is by far the worst appetizer every invented. I can still have that lovely focaccia, but it'd be better as desert.
Why? Order matters.
Having fat and protein before carbs makes a significant difference in where the levels will go during a meal.
To a lesser extent mixing fat and protein with carbs in the same dish helps too.
Postprandial (fancy word for after eating) exercise.
If I walk after a meal, spikes are kept down.
Even just 10 minutes of walking 20-30 minutes after eating turns what would be mountains into hills.
Total AUC (area under curve), or the impact from the food, has been shown to be about the same, but keeping the spike lower is better.
Fruit is nature's candy.
I've found zero evidence that 'natural' sugars are better from a metabolic perspective than manufactured.
An apple can spike as much as a snickers.
Not saying the nutrients of an apple aren't better than a cupcake, but just from an 'impact to glucose'.
Everyone is different.
This is why it's tough.
What spikes you might not spike me. And vice versa.
You may be fine with quinoa. I have to watch it.
Sleep and Exercise
A terrible night's sleep will make glucose more sensitive the next day.
I'm not a doctor, but I'm guessing there are specific reasons for this.
Armed with this knowledge, I'm more or less able to keep my glucose within the acceptable ranges and structure meals in a way that doesn't cause me to severely spike.
So why is any of this important?
If you're like me, you want to be optimizing in the 4th quartile, not just surviving.
But there is a major epidemic happening right now, and soooo many people have no idea what they are headed for.
From a recent Time magazine issue dedicated to sugar:
More than 34 million people in the United State have diabetes, and an additional 88 million have prediabetes, according to the CDC. To give you a sense of how many people that is, 1 in 10 of us now has the disease, and 1 in 3 has prediabetes. More than 40% of people in the U.S. are expected to develop Type 2 Diabetes.
So what's the optimal goal?
From Peter Attia
- Keep average glucose < 100 mg/dL
- Keep standard deviation < 15 mg/dL (a proxy for how much insulin is needed to accomplish #1
- Keep number of times > 140 mg/dL to a minimum
More on sensors:
Dexcom
Pros:
- Truly continuous. Do not have to scan to capture reading.
- Syncs to Apple Health, so you can tie data with other sources more easily.
Cons:
- Prohibitively expensive out of pocket. ~$400 a month to get 30 days worth.
Abbott Libre:
Pros:
- Much cheaper than Dexcom. Around $70-80 for 28 days worth of sensors.
Cons:
- Have to scan with iphone or reader at least once every 8 hours to capture the previous data. This really isn't a problem except that it can lead to a little bit of data loss overnight in some cases.
- Data is not easily exported out of the Abbott ecosystem.
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