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

[@pattayapimp]

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 🏆

[@zoa0gray]

Me too. For me it's the conversion rate to $ from my currency. Maybe there are ready calculators to localise prices. I'm still on the side of paying for your teams hard work.

[@RealMonoid]

Agreed.

[@keefeweekers5739]

Agreed! It's really good information, but its indeed a bit pricey for me aswell at the moment.

[@drsaintdc]

I have found the investment to be a good one. It has led to other purchases, but I have found it fruitful

[@mariamstevens3699]

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

[@sandiegojoey1]

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”.

[@RKO1988]

Don’t do it. I think we’re gonna find out that it causes prostate cancer

[@DonnaLHaney]

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.

[@einstini15]

So only way to get an rx is to eat cake 3x a day for 90 days? So dumb.

[@einstini15]

I would think insurers would want this as it would save them money down the line on diabetic treatments... insulin, toe removals, liver and kidney treatments... etc

[@DonnaLHaney]

@@einstini15 exactly! Punish those who make good choices, reward those who fail to do so! 😞

[@DonnaLHaney]

@@einstini15 My insurance does NOT pay for my CGM prescription because I have no diagnosis which requires it. I pay... see above...

[@doctork1708]

Unless you’re eating a lot of beans/legumes you are NOT getting fiber from protein or fats with “moderate carb (veg & fruit)”, If you’re eating a lot of beans/legumes then you are unlikely to be doing “moderate carbs,” whatever that is.

[@johnhard7629]

Love your work Peter God bless

[@jselectronics8215]

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.

[@eugeneabreut960]

You need to wait 24 hrs to activate it. You will get much better readings.

[@oolala53]

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.)

[@betsywestbrook7169]

So my understanding Dr Attia utilizes 2 diff glucose drugs? If he eats carbs he can take something that stops his glucose from spiking. A Dr. Access to prescriptions is easier then ours so they can easily get access to medications that the rest of us have to hope our Drs. Will provide for us.

[@foreverseethe]

As of 11:35 neither person actually said why it matters and written in the description. Especially for non diabetic.

[@donnaallgaier-lamberti3933]

I am not SmartPhone literate and frankly at age 74, I don't want to be I recently bought a Keto-Mojo to test by blood glucose and my ketosis. I am listening here to learn.

[@jaynedouglas9556]

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!

[@merrieleiderman]

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.

[@KrackerJack5586]

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 👍

[@andreyseas]

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?

[@mohitbansal5130]

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.

[@yoestraining9460]

Could you please tell me the CGM that you are using? I can't seem to find the model on my own. Thanks!

[@IB_Trader01]

Can we please get a link to the shirt Peter is wearing please!

[@akibuky]

The typography is not quite the same, but that's the best I could find. Hope it'll help. www.redbubble.com/i/t-shirt/Autophagy-Cells-Itself-Fasting-Exercise-Nutrition-by-Melaniekul62/60700926.FB110

[@ZeroLongevity]

You've got it! shop.zerofasting.com/collections/apparel/products/autophagy-cells-itself?variant=31277753729124

[@kimdavis7812]

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

[@DavidC-rt3or]

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)

[@DigitalWebOwner]

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.

[@danmauney8394]

Thanks Peter, I wore a CGM for 14 days and my average glucose was 105. I also had a fasting insulin which was 15. Hba1c was 5.8. I have been keto for 2 years addressing T2d, A1c was 7.8. Using a blood glucose monitor I average 125. . I don't know what to think about my glucose trend but the CGM experience seems to show that my range 90to 140 . Blood glucose tests are usually higher for me 125 fasting and range to 160 after meals but I hover around 125 mostly. Do I need to be concerned about the 125 ?

[@TheShumoby]

If you're that concern about the 125 after meal, do 100 air squats.

[@merrieleiderman]

Are you losing weight? That is the only way to lower your fasting insulin and reverse T2DM.

[@danmauney8394]

I have lost 50 lbs already and I have 20 lbs to go for my ideal weight. I have 25% body fat and I have 20% as my goal. At 67 years old I thought it might be hard to fight insulin resistance and keep a normal 85 glucose?

[@merrieleiderman]

@@danmauney8394 That's awesome! Make sure to test your fasting insulin when you get to what you think is your ideal weight. Your glucose level can be "normal" while you are still insulin resistant, meaning you have more fat to burn. Hopefully you are also lifting weights and eating a high protein diet to build/maintain muscle mass.

[@duststorm7287]

Fasting insulin of 15? Mine is 2.

[@theshadypersonify]

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

[@jaykana7677]

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) .

[@Edmond347]

Love Peter, but what is needed is research into glucose level values and A1C values in endurance athletes. I am one and measured recently in a pre-diabetic range on both FGL and A1C which blew my mind. It was low and nearly on the cusp, but made no sense to me. I consume virtually no simple sugars and cycle about 15 hours a week plus the gym and walking. I'm a poster child for healthy diet and exercise. From what I see, the values for "normal" people do not hold for athletes.

[@my-yt-inputs2580]

As a T2D wearing a CGM is a game changer indeed. However the one issue I see is sensor accuracy. Using the Libre 14 day I find the sensor measurements are at least 5 to 10 points lower than actual finger stick measurement values. Right now my current sensor, which is a replacement for an earlier faulty sensor, is reading approx 20 points low. I set my normal range from 70-105 as I'm controlling my glucose via diet. Of course you can adjust mentally for reading errors but it would be better if those errors remained constant.....which they don't. According to my meter measurements my current 90 day blood glucose average is at 94 mg/dL which means my A1C would be approx 4.9. I'm sure it will be somewhat higher than that due to sensor inaccuracies. I read of the same issues with the one being worn here by Peter. Type 1s don't seem to care as much about CGM accuracy.

[@ericrayner3389]

I have seen such discrepancies between my meter and what gets measured for blood work 15 minues later so I would not be so quick to trust you meter being the more accurate device

[@my-yt-inputs2580]

@@ericrayner3389 Yes I understand that however when I am testing sensor accuracy I verify with 3 separate meters. My main meter is the Freestyle Lite which so far has been pretty good. I am not the only one seeing these discrepancies either. This is a huge problem for many CGM users, no matter the brand.

[@duststorm7287]

They set it to read low. They dont want you actually going low. 00 will read as 70. So you will think youre doing good. Mine ran 45 to 50 all the time. Annoying as hell.

[@TOF893]

Where to find a CGM except the expensive dexcom?

[@sanjayrajsoni]

Same here, looks like you need a prescription here in the USA

[@anewmaniphone]

Levelshealth

[@GTB1]

@@anewmaniphone Levels still not selling or approved in US.

[@texastexas4541]

Glucose is lower in the interstitial fluid when compared to that in the circulating blood. Therefore, it is possible that Attia's A1C number is more accurate than CGM measurement. Another important point: Arterial and capillary blood glucose is higher than that of venous glucose because significant portion of glucose goes into the tissue and so.....all the blood that end up eventually in veins contains less glucose. This means that mature erythrocytes get exposed to higher amounts of glucose in the arterial and capillary system than in veins or the interstitial fluid. Thus, measuring average glycosylation of A1C gives us a better picture (excluding some diseased condition) of circulating glucose. .....definitely not the interstitial glucose. Any comments, Dr. Attia?

[@charminrocks]

I’d rather have paid ads.

[@revilodraw88]

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

[@texastexas4541]

Vitamin C decreases glycosylation (very good) and also decreases A1C. Vitamin C increases blood glucose readings significantly, leading you to believe that your blood glucose is higher when in reality it is not.

[@MrFreeeeeedom]

Great stuff!

[@MrJustCallMeJames]

Paywalling all this info really should get much more criticism. Should be viewed similarly to paywalling research papers.

[@TheShumoby]

💯 %

[@cgrass4035]

I still can’t figure out why they are so expensive…

[@darrylevanetich]

Bro cut this off at the worst possible time 😭 got me thinking about subscribing jus to find out those 3 key metrics

[@simev500]

I do not see how short-interval snapshot of BP can provide any more useful data than the average or trend recorded between longer intervals over several days for a less-than-critical patient. Have anyone seen the scriggly lines when a hospital's holter monitor is attached to an ambulating patient after a cardiac procedure? Every time the patient coughs or gets out of bed, the live monitor screen HR & BP tracings look like those of seismometers in the US Geological Society.

[@sachint9784]

How doe's Peter keep his blood glucose low , without doing keto anymore ?

[@jamesschallau308]

You can do low carb but not so low you go into keto territory. As he says elsewhere, his goal is to keep the variance of blood glucose and the overall level of it within appropriate thresholds. You can do that and safely eat carbs. Timing of feeding, glycemic index, and total quantity can be your guide.

[@johnsonpaul1914]

Fasting insulin would be much more informational than A1C

[@1flybyguy]

At first glance that library background looked like a prison housing unit (I was a corrections officer for 30 years).

[@scottk1525]

I think it's time for the podcast community to retire the phrase "deep dive."

[@kennrayy]

Any chance of providing the formula for reverse engineering your CGM stats to your A1C?

[@king28401]

I love Bob Kaplan’s library. Is that his private library?

[@arnisni777]

It's a puplic library (from the city of Stuttgart in Germany).

[@MsTony1402]

I don’t get how a CGM is giving you a real a1c while a proper a1c blood test is a prediction. Surely a properly done a1c blood test is a real measure? I’ve had a CGM for 4 weeks and all my measurements were way off from figures I got from using test strips for blood glucose. The CGM can be way off and for me was totally useless...

[@rickt9975]

some brands of CGM's are more accurate than others, Libre being less accurate. Some can be calibrated. The newer ones coming out such as Dexcom G7 are supposed to be a lot better.

[@nathaneley6486]

Thoughts on Wegovy?

[@alilaith5749]

8:30

[@RKO1988]

Hopefully they talk about blood glucose increasing on a low carb diet

[@JustWatchMeDoThis]

Not for everyone. For most of us it lowers. I guess that's a good reason to keep track of it.

[@JustWatchMeDoThis]

99 is not high. Also this video can explain a lot about reading based on your blood. And also for most people, it goes down from their previous normal. Everyone is different. But low catnip certainly tends to go down, not up.

[@RKO1988]

@@JustWatchMeDoThis low catnip?!

[@Sabastianspreadworth]

I wish I could afford it. I can only watch the free stuff.

[@joekraus250]

I listen to your whole podcast, and then, when you were gonna give me the goods you didn’t. I will not listen to another one. Thumbs down.

[@wmp3346]

Very little useful info in that clip.