What can CGMs teach us about metabolic health?- Diet Doctor Podcast 

I used a CGM in January this year because I felt more and more short-tempered eating foods and my blood pressure was high. And I'm very active training for triathlons, don't smoke, and barely drink alcohol. My doctor was writing me off as just being genetically inclined to have high blood pressure. She prescribe me a medication. The CGM showed that me that when I would eat a lot of carbs my blood sugar would go up to 140 and stay high for 3-4 hours and then drop suddenly in a slightly hypo range. Since switching to a low carb diet my blood pressure has dropped over 20 points (both numbers) and adding fasting into my routine seems to be helping even more over time. Doctors desperately need to be taught more about nutrition. Going low carb helped me easily kick caffeine as well. The best video I've seen on RU-vid recently is Dr Pradip Jamnadas "The Bittersweet Truth". It's on the Galen Foundation's page.

I have a Freestyle Libre. I pay for it out of pocket, because I don't have a diabetes diagnosis. Forget I'm trying to NOT be diabetic. T2D runs in my family and the side effects can be devastating. I love mine and it's amazing how many "healthy" food send my blood sugar soaring...and it's clear from my graphs that my insulin kicks in late and goes on too long. If I don't challenge my blood sugar, it works just fine.

As mentioned by another commenter, the low reading during night can be from position and/or simple error. I have found that some sensors can be off by 20 to 25 points, so every time I replace one, I have to calibrate against one or two different blood stick meters which themselves can have +/- 10% to 15% standard error. The main benefit of a CGM is for the alarms and for seeing trends. I got my A1c down to 5.6% last check which is pretty rare for T1D. Others have gotten below 5, but it takes a lot of vigilance.

I have a Libre 2 CGM. My last A1C was 5.8 and my CGM alarm goes off every night about 3 am as my numbers go below 55 routinely. By using CGM overtime, eating low carb. I have reversed my diabetes. Too bad insurance won’t pay. I pay out of pocket. Still cheaper than insulin out of pocket.

It is possible that low glucose measurement on the CGM during the night, might be an artifact from position and direct pressure on the CGM or the arm during the sleep.

This may not be a helpful question but how the heck did the importance of nutrition and disease get so sidelined in medical education and treatment . I recall a doctor (Dr Jan de Winter ) who I came across 40 years ago who said ' if doctors don't become nutritionists then nutritionists will become the doctors .

Thanks Diet Doctor! This is a great addition to your work of spreading the word. Encouraging to see what started at grass roots level is now spreading to places like Harvard. Keep up the good work!

The Dexcom alarm is a pain in the tuchus. I’ve used a Dexcom for only ten days - got a sample one, but my insurance refuses to let me get anything but a Freestyle Libre - and that was what I hated about it.

Hats off to Dr. Nick.

Simply inspiring!

Perfect timing...I'm having my check-up soon and I'm planning on asking the doctor for a CGM. My opinion is that there is a lot of benefits for using a CGM but one big big concern is one of privacy. Eventually as more wearable medical devices come out and wireless connectivity is becoming the norm, who will have access to all my current medical data and how will they use it?

During sleep the CGM reading may be vastly and erroneously low due to positional compression.

0:06: 🎧 This podcast episode discusses an experiment conducted by medical students at Harvard Medical School, where they wore CGMs to monitor their blood sugar and explored the other aspects of metabolic health. 4:50: 😕 Nutrition training at Harvard Medical School is still poor in terms of time and quality. 9:20: 📚 The educational part of the study included CGM data and interpretation of screening labs to help students understand metabolic health. 14:26: 📝 Students report feeling better athletically, mentally, and self-reflecting when their blood sugar is stable between 70 and 90. 19:27: 📊 Wearing a continuous glucose monitor (CGM) can make people more aware of their food choices and help them make healthier decisions. 24:02: 📚 The speaker discusses the use of CGMs for medical education and patient advocacy. 28:41: 👏 The speaker is commended for integrating continuous glucose monitoring (CGM) into a discussion on metabolic health. 33:11: 🎙 Dr. Mark Seisler discusses his experience as a participant in a study on metabolic health and CGM wearables. 37:56: 👥 The speaker found it exciting to learn from real-time biofeedback and be more conscious of their actions, including dietary choices, as well as considering the social aspects of wearing a monitoring device. 43:12: 🍽 Monitoring the impact of various elements of life on one's own body, such as food and activities, is valuable for personalized health. 47:48: 📊 The speaker discusses the importance of biometric feedback and the potential for expanded access to monitors for improved metabolic health. 53:25: 📚 Starting with a small lesson on glucose, first-year medical students are encouraged to build their knowledge on metabolism and energy handling. 58:06: 📚 The study has sparked curiosity and motivation among the participants to learn more and conduct further experiments in nutrition. Recap by Tammy AI

I have the Dexcom, my insurance paid for most of it. The hoops I had to jump though to get it were unreal! In the end it cost me about 150, it would have been over a 1000 if my insurance didn’t cover it, I would not been able to afford it . I’m glad to have it. Very helpful!

Excellent podcast

what is the difference when your monitor reads low (60 and below) and a blood droplet test at the same time shows 30 to 40 points higher?

Inspiring to see the up and comers getting 'woke' about the nutritional deficiencies the health industry is built on. Can't wait to see the future changes 👏 🙌 It is my understanding (according to Dr Fung) that some people can go into ketosis at night I'm assuming that would account for the low dips in blood sugar. As he says we don't die every night because our body goes into ketosis...

Inspiration!

I have found when sleeping depends on cgm location and pressure gives lower readings. Example cgm on my arm and I sleep on that side lowers my numbers more then what it should be.

Is there a link to the study report?

FYI my non diabetic wife is a cold water open water swimmer and her CGM reads mid 40’s when she swims in the SF bay

Let's be real, doctors would riot if the pastries were removed from their lounges

Love the term "metabolic health".

Nice to see the young medical kids are catching up! As a non diabetic, metabolically flexible person it will be nice to see the info on blood sugar in that group of people. My CGM shows my blood glucose staying at 5/6 without change for 10/20/24 or how many hours I don’t eat. Never going low. Hopefully the years of taking snapshot info and basing some “universal truth” that every man, woman, pre menaupausal , post menopausal, vegan, carnivore, vegan , omnivore, ancestral group, should adhere to will die.

Have always loved Dr Nick but his reference to star-bellied sneetches put me over the top! Love his work and style. Thanks for all you do, Nick!!

i would love to see the diet doctors results with the cgm.

I listened to this podcast on my morning walk today. I am trying to get my doctor to cover a CGM currently - this effort will be in vain, I anticipate, and I will end up having to buy one myself at a very high cost (currently on hold with the insurance company). The pod was somewhat interesting, but I was hoping for more. For instance, it may be somewhat understandable that HCPs push back against the idea of covering CGM for pre-diabetes and non-diabetics because they (docs) themselves would be the ones having to take the time to review this information. (Is this true? This possibility just occurred to me.) Wouldn't it be good if insurers would cover CGM to go directly to the patient with the availability of physician opt-in. This doesn't reflect well on me, but I found myself getting disgusted at all the privileges at Harvard.

I like how my CGM tracks my A1C so closely.

Is there a link of the article or pre-print of this study?

Add 32:30, Bret says/agrees/admits that not everyone should be using a CGM. I'd like to understand this position in more detail. It might be best use of scarce resources if government or other insurers only provide or subsidise these monitors for people with diabetes. But I can't see why Joe Public should be discouraged from using one. What are the risks? What is the "inappropriate use" that he mentions around 32:50? Do we discourage people from measuring their weight or girth? Maybe Bret is just trying to clarify that he wouldn't *recommend* a CGM for everyone.

What’s cgm?

Sorry to be a stickler for spelling, but is Dr Hoenig’s first name ‘Melanie’ or ‘MEALnie’?

Continuous glucose monitor

His point of hospitals not understanding blood sugar.... I am T2D since 2017. October 2022 I went in for surgery (to have a plate removed) with a BS of 111. I was working hard to lower it and keep it in control. The next day (in recovery) they took my BS and it was 160 because they added glucose IN my IV? Why??????????

are continuous insulin monitors on the horizon?

So.... what is a CGM??

Star Trek Medical Tricorder.

The idea that it is OK to eat foods that spike sugar level as long as the sugar level comes back to normal level after 45 minutes is wrong. If you eat foods that spike sugar level frequently, it will affect your insulin sentivity in the long run.

Lying on your CGM at night will give very low and erroneous readings…

Too bad that a cgm cost too much and of course insurance wont pay for one, even when youre a diabetic

Nurses? Dieticians? Not even mentioned? C'mon.

20min in. Nick is very hesitant to say going to a 140 blood sugar, but coming down quickly as being normal. This is what is concerning about his whole ideology. He really thinks people should be under 100 all the time. Yet, he’s the “coach” training people in this study? Scary 😬

Totally irrelevant to topic… Nick is so dang cute!

This is silly as hell for non diabetics or T2 folks who simply need to lose fat in a caloric deficit under personal fat threshold. This isn't an issue of eating too many fibrous carbs or lean protein or health fats. This Doc to be is a keto nut. You reduce your credibility by keeping nuts on.