Dr. Penny Figtree - 'Continuous Glucose Monitors in Healthy People' 

I diagnosed with T2D in 1996 like my father. In 2021 I was on 7 meds including 2 insulins. With help of CGM I found out the best food for my body. Lost 52lbs and cut all meds and don’t wanna kill my self anymore. I call it digital consciousness.

Great topic. So many “concerns” in the comments that “CGMs should not be used by healthy people.” Why? A) expensive B) might cause anxiety C) imprecise D) vendor says not indicated for use by healthy people. Let’s take a look. A) Expensive. Cost is a matter of context. The cost of managing chronic metabolic diseases with drugs dwarfs the cost of a CGM. Monitoring blood sugar offers an opportunity for prevention by learning how specific foods or eating styles impact an individual’s blood sugar. B) Anxiety. The key to all medical monitoring is education. If anxiety is an issue, it is only due to inadequate education. That’s on the medical community, not on the patients. When someone understands the possible scenarios they might experience, and how those scenarios play out through follow-up, they are much less prone to misconstrue the data. Yes, that subset of people who are particularly emotionally sensitive are more prone to anxiety. But again, that’s not on them, but on our educational resources. C) Precision. CGMs are subject to three general measurement issues. A bad sensor needs to be returned. Poor attachment or inadequate protection (eg during sleep or physical activity) needs to be addressed through education and experimenting with improved location/protection. Random measurement error is, as Dr Figtree explains, inherent in the technology but generally has little to no impact on interpretive value over a period of weeks to months. The data obtained reliably inform the intended learning, “how do the foods I eat and my activities affect my blood sugar?” D) Vendor recommendations clarify the original target market. Use by non-diabetics is not prohibited. Nor should it be. Actual physical risks of use are essentially nil. Use of a CGM differs in no real way from wearing a smart watch. It’s simply a live stream of information about your body. Whether the vendor intended it for one group of people or another is frankly irrelevant from the perspective of its intrinsic functionality. Look, ban cigarettes if you feel compelled to save lives, but you cannot argue that a ban on CGMs will save lives. Quite the opposite, in fact. I would rather patients monitor and adjust early rather than force them to wait until they reach a diagnosis. That WILL prevent avoidable suffering, save needless cost, and, in the long run, extend lives.

I did this 3 weeks ago using the Free Style Libre 2 CGM for 14 days and saw that I had episodes glucose dips while I slept. I thought I was healthy but found out I had to make more lifestyle modifications to level my glucose readings. It was a very interesting experiment. Definitely recommend for anyone who's interested in understanding the impact of food.

I did this more than a year ago out of curiosity - had trouble getting it in Oz without being diabetic. Paid full price online, no govt subsidy, for Freestyle libre - they sent it out, then were upset when they realised. Things seem to be changing, thank goodness. It was so paternalistic. Citizens not allowed to know stuff without a doc in charge - even highly informed and motivated patients. Luckily I have a great doc who was interested - but many are threatened.

Maintaining good metabolic health may seem to be a journey of a thousand miles but is as easy as avoiding refined carbs, sugars, seed oils and adding with any amount of active lifestyle. You will gain traction as you see positive results.

Great talk. If insulin levels are what we really need to watch, who's going to develop a continuous insulin monitor?

I wore a CGM for 10 days last month. Same effect as you had with the bowl of oatmeal. Great video. Thank you!

Figtree - what a beautiful name!

After 3 weeks on keto diet it was an enlightening experience. Every food i ate during these 2 weeks was good. All days - perfectly flat graphs. One single spike to 106 mg/dl during this time. Average 88 mg/dl. I also wanted to see what's going on during my 48h fasting I do every week. All fine. I wish they could make these sensors dual purpose for monitoring glucose and ketones, it'd be cool. I'm not a doctor, I'm an engineer, but my both parents died because of how well the system cared for their T2D. It's worth to be aware and the software is smart enough these days so CGMs should be for everyone. And I think you (doctors) would lose some of your patients, not because they die, but because they don't need your help anymore 😊

Such an easy to understand talk. I no have a name for what I used to experience in the days when I ate oats for breakfast.....Reactive Hypoglycaemia. I used to get to around 11.30 each day and have uncontrollable fits of wretching. I felt terrible and needed to eat something. Since going low carb those symptoms have never occurred

Wow! Such timing, just a couple days after finishing my own low carb, CGM experiment. My blood sugar was often in the red/low, & I always felt perfectly fine. Though I admit that seeing it like that a lot did cause me some amount of worry… In the end I figured that this was probably just previous programming causing me to doubt myself, & to doubt my lack of any negative symptoms. My body feels & looks better without all those crappy carbs 🥩🍗🍖🥚♥️💪🏻 Thank you for clarifying this for us, it helps a lot 🙏🏻✨

I'm a healthy, lean 61 yo F, eating meat forward low carb, though also consume whole grains (organically sourced, heritage) - 99% of what I consume I make from scratch. I display no symptoms of high or low blood sugar. I'd like to continue this path of health and I believe a CGM, worn once or twice a year to gather N=1 data is valuable. I don't see anything unethical about doing so -- if anything, a Doctor saying it is makes me wonder at their bias and motivations -- 'don't help healthy or even borderline (and undiagnosed) people take charge of their health or I'll go broke' -- Having the education of how to interpret etc. by Dr. Figtree is vital.

Thank you for posting this terrific presentation. I am a healthy 55yo woman who has wondered if I could learn something from wearing a CGM, or whether it would be a case of 'a little info is a dangerous thing'. This talk has provided some baseline to interpret the numbers a CGM will give me. Waving hello from 🇨🇦

I used CGM for five years, the sensor failure rate was approx. 50%in my experience and opinion. I personally won't use them due to a total lack of reliability. But nice bobble at 90$ for 14 days but probably less, that's if it works.

I tried with the Freestyle 2 (given for free as trial) and 3. There are RU-vidrs reviewing them, if you need guidance between various types. I'm not diabetic but in a continuous struggle with body weight. I've learned some interesting things, wearing them during December's holiday feasting. For example, a bad meal (hypercaloric and high carb) can cause blood sugar spikes and lows even 12 hours later i.e. it takes at least a 16 hours fast to clear the "damage". Funny also how physical activity, even in fasted condition, causes glucose to rise, as dr. Figtree says at 6:30. Never had low episodes because of too much training in fasted condition, I guess this is a sign that I am quite well fat-adapted. OTOH, if I stick to my routine of IF and LC, then glucose monitoring becomes kind of boring/useless, days on end between 80 and 110, with the maximum around 7AM. To be noted, almost always (even in ultra-steady state) the CGM would read 8-12% less than the finger stick (I used them for calibration). They are expensive like hell (5€/day) but I think they should be used by non-diabetic people too, at least occasionally, along with HOMA-IR testing, to spot insulin resistance early on and to learn how food and activity affects blood sugar.

"heathy" people. For now Im done with my CGM (Libre 3), due to its huge inaccuracy (way low or way high deviation from a finger prick). Granted one day they will be much better. With my insurance I I paid $75 for two. Previously Type 2. Will low carb and eating right, I got into the low 5's A1c. In the states you have to have a prescription. Think about that, you need permission to monitor your blood. Insane! Made me furious. They should be OTC and would probably cost $10 each. It did help me see the need to strip bread and other toxic carbs out of my diet.

Why are they so expensive...it should be for everyone.... Hang on... then people will not eat a bad diet..if you know how much bad food is out there...

Thanks for educating instead of chastising ❤

That was a great lecture, thank you. 😊

Very informative. Thanks! 👍

CGM's are great if you want to learn. But if you're not into the minutia of health then just eat a clean carnivore diet. 7 days without beef makes one weak.

She said there is a massive discount atm $15 or $32.10 for 14 days at this time is awesome. Pick it up before it goes back to full price again.

I am healthy, BMI 22, maintained moderate ketosis for almost 2 years now. I wear a CGM to simply see my individual reaction to foods and combinations of foods. The Glycemic Index is based on very weak science and for the aggregate.

With 3 daily finger sticks, each day of the last 3+ years, I have pretty much figured out why/when my BG rises and falls. Still, a CGM would be nice for a few weeks. However, unlike Australia, it's still a $ making racket here in USA: need a doc's "prescription", and often a "health coach" actively involved in order to obtain a CGM, and both of those cost big $, in addition to price of the CGM. So I will just wait till the racket has ran its course, then get a CGM off the shelf at Walmart, same place other diabetes supplies are now available nowadays, at reasonable prices.

I wear a dexacom g6 you can calibrate it with a finger stick test and it learns and adjusts to you. Its fantastic to learn how my blood sugar reacts to different foods. (Type 2 on meds and eat low carb with chronic illnesses)

Wait .. After Drs Berry, Baker, Salad-ino we now have a Dr Figtree as well? Who is making this s* up? It's about time for Dr Ribeye to enter the low carb realms. 😁

Low blood sugar at night. I awake with my dawn phenomenon 3:00 am. I’m hungry. I wore a cgm and yes my blood sugar drops at night while I’m sleeping. I have had sever reactive hypoglycemia most of my life but I started low carb a year ago. I eat paleo ketogenic diet; Strict for 8 months. I am not diabetic I see an endocrinologist and have been referred for tumor evaluation on my pancreas. My A1c is 4.9. I do or at least did have a metabolic disorder. Skin darkening around neck and groin. Skin tags, mental health disorder( pmdd) reversed with paleo keto diet. But now I am having these low blood sugars at night. Cgm revealed them. I am going to to try eating some protein and fat right before bed.

I've gotten exercise induced hypoglycemia a few times. It's awful! If I didn't know where it came from, getting that feeling sprung on me out of nowhere would be bad for my mental health. If people get that effect from eating the wrong foods, I can totally see how a CGM could help.

CGM is extremely useful to wear it at least once, especially during holidays. I have my CGM results saved along with exact list of everything that was eaten during the time (MyFitnessPal/Cronometer log). With this I found out my 24h average is 90 mg/dL and that it stays within normal range for the 95% of the time. I do have expected spikes when I eat 80-100g oats (30 minutes to peak and 30 minutes back to normal, without overshoot, does not dip). My night glucose is flat and no morning spike before breakfast. Glucose goes up at the beginning of exercise. Glucose response is lower if the same oats shake is taken during weightlifting. But eating "holidays" food with a piece of cake does bring glucose up close to 200 and makes it stay there for 2 hours before it went back to 100mg/dL (even that it was still within daily calorie limit). I can only imagine someone eating junk/sweets often and daily, glucose must be elevated all the time.

subsidised CGM for type 1 but not for T2 insulin dependent who are basically a type 1

My experience with Freestyle Libre is very poor quality control. Too many break when applied and, particularly, consistently read too low. Between a 20% ERROR RATE (!!! utterly irresponsible) , faulty sensors and the ones that dont apply properly ... i wouldnt recommend them to anyone until they fix the problem

Convinced me and I am watching from Bangkok. Here there a gazillion Chinese and Indian knock offs with the UltraHuman ring very popular because of its app- its all about the trends as Doctor Penny said.

What makes you think that old people like me aren't healthy? I'm close but not quite. But older people are sometimes much healthier than the super young.

No no no don’t worry about us CGMUsers, we just want to see the data of ourselves. Many of us just discovered that the MDs and nutritionists don’t know much about blood glucose and it’s ups and down, they are on the brink of being completely useless with their nutrition guidelines, they are mostly just laughable. We do our own research, we talk to each other, we experiment with cold exposure and meat and salad and fasted runs and no breakfast…and so much more. We also read books and papers from pubmed. In real life we are technicians or accountants or pilots or scientists, yet we are treated as 5 year olds by MDs, we are not stupid little children we understand a lot more about nutrition than what nutritionists can imagine, we leave them behind because they are nearly useless sorry to say 👋

Check that your phone is compatible. Mine isn't.

They do ask a couple of questions over the counter but I just lied 😅

Great rebuttal @ketolomics. Any thoughts about the underlying reasons why there would be public opposition to “healthy individuals” from monitoring their food intake and the impact it may have on their insulin levels?

Dr. Bikman should address why glucose spikes is lower when protein is mixed with carbs. Insulin response is much higher? I think so from his earlier lecture. So is mixing protein with carbs? Probably not.

I can only find free trial for 14 days on the British web site. Which is not the same as buying at a low price.

I get it. But, I'm definitely not going to wear this 24/7. Keep it for someone else.

I used glucose monitor, but it was useless since I am using sauna and cold plunges. I just wasted money, they would last only few days with this temperature range.

great idea just to get a base line profile of what is going on when you eat, expensive but not horrifically so $110/14 = $7.85 a day so less than 2 takeaway coffee's or 1 beer

What about people who are pumping out a ton of insulin causing blood sugar readings to appear normal. Or will the glucose monitor pick up the pre insulin glucose spike?

One comment about CGM: RTFM. I didn't. Some of them get completely thrown of, show way to high values, when you supplement with Vitamin C. You have to stop that couple days before applying the device. Secondly we get to see Dr. Figtree CGM data, I assume. It looks like it^s mostly around 5 mmol/l. What am I missing here? isn't that a tad high as a baseline which should be 4.5 or lower? (70-80 mg/dl range)?

Is there a puplication where the plots of the CGMs of the trial of Nick Norwitz are illustrated? In this study: "Metabolic Health Immersion for Medical Education: A Pilot Program with Continuous Glucose Monitors in Medical and Dental Students" there are none.

I don't have T2D but based on family history, I'm highly susceptible to developing it without gaining much weight. We're a family of skinny diabetics. I switched to a LCHF way of eating over 8 years ago for this reason; however, I'm now in menopause and I certainly notice an unpleasant difference in how and where excess weight accumulates. I haven't yet tried a CGM but would like to, just to learn which foods affect ME. The outrage over CGMs for nondiabetics seems akin to saying that people shouldn't bother with a smoke detector until flames are present. Knowing which foods cause a big rise in BG and insulin, especially for someone like me whose diet is generally very low-carb but who occasionally splurges on things most people would consider "keto" (e.g., nuts, dairy).

I love my CGM! Everyone should have one 😂. Problem is insurance wont cover cost unless you're diagnosed diabetic. Not even 'pre'. Funny thing, the PPO insurance I had thru my employer paid for it. Medicare will not unless diabetic. You can work work with your pharmacy to find discounts. Currently I pay $90 for 1 month which is 2 devices. But what i don't get is, if I'm paying out of pocket why do I need a scrip? It's not a drug its a device...

I can reliably tell whenever my ketones are above 0.3. I can feel it 100%. 0.3 is where it is at for me. And whenever that is the case, my glucose is below 100. And that guarantees low insulin. If my glucose is below 100, and I feel great, my ketones are up. For me, whenever I feel like myself, I know that I am both in ketosis and have low blood-glucose. No meter required. Hell, I can tell if my partner is in "ketosis" just by her telling me how she feels. And she doesn't eat ketogenic. She just sometimes eats stuff pushing her into the 0.2-0.3 range, and it is noticeable. Whenever she tells me that she isn't hungry, but her last meal was sooo long ago, and she feels good, I know. And we've tested that quite a few times. I don't buy the 0.5 threshold for ketosis. There are significant changes in feeling and well-being at much lower levels.

Accuracy of cgm is big issue

FYI: Freestyle is not indicated for use in non-diabetics, as stated by the company that makes them.

Is an NDSS card required in to gain the subsidy when purchasing the CGM's?

Need an insulin monitor. Do I need a prescription for aCGM?? Can I get around this?

Is this discount only on the freestyle libre website? I cant see any results of that price from pharmacies when I search

I'm not young but I must be pretty healthy. My glucose is typically quite low.

One issue is that the definition of 'healthy' isn't precise. It's usually just done by eye.

Saying people shouldn't use CGM's if they are healthy is like saying thermometers should not be used by people who don't have a fever.

why can't we just measure insulin. Imagine a continuous Insulin monitor?

“Strike me down, and I will become more powerful than you could possibly imagine.” - Dr. Penny Figtree

Anybody intolerant to coffee and chocolate (skin rash, insomnia) while on low carb diet? No way to regain tolerance? Thank you.

If you are in ketosis will 5 grams of carbs in cofee with milk spike blood sugar and take you out of ketosis?

Waste of money if you are strictly carnivore and eat zero carbs.

Eat a Proper Human Diet and skip the doctors and the monitors and feel good. I only watch these vids because I love to hear their Aussie accents

So expensive and not going to help healthy people except make them nervous.

Sorry, but I’m not sure about these increasingly “trendy” plastic devices (for those who are not diabetic). Yes, they are a vital, life-changing advance for those whose lives depend upon them. But those fortunate enough to be able to buy them as a “healthy lifestyle choice” may only gain more obsessive “self-checking behaviours” leading to nothing better than long-term health anxiety. Easy for those who are profiting from promoting them (via the wealthy health-conscious) to say that they stave-off cardiovascular disease etc. Really?

Do you think a people Have money fór sensors in this time of crisis😂, expensive , nobody want to pay IT if youre not diabetic already, i think Its a must fór some people .....

What a waste using these on non diabetics! They are meant for people who need them!

⁸😮😮

Not accurate at all.