as a primary care provider experimenting with CGM for personal and professional reasons, this video is an excellent insight into the data. Thank you!!!!
This video was outstanding. I began wearing a CGM after a T2 diagnosis. I moved to a low carb diet and have seen my A1C drop from 9.5 to 5.2 and lost 50lbs. I continue to wear a CGM to hold myself accountable in managing glucose spikes. I have been using 160 as my definition of a spike and focus managing post meal increases to 160 or below. I really appreciate your time educating us with facts based upon science.
If the keto diet is working for you, that’s great. Just be aware that it will make insulin resistance worse in the background. A diet high in saturated fat is how scientists cause insulin resistance in lab rats for studies. Keto makes the numbers look better, but the only way to reverse type 2 permanently is a very low fat diet high in whole plant foods and low in animal products. Not trying to discourage you because you’ve made a ton of progress! I just want you to know the truth. The End of Diabetes by Dr. Joel Fuhrman and the book Mastering Diabetes do an amazing job explaining the science behind it if you want to learn more.
@tarabooartarmy3654, I am sorry to disagree. If you watch the video linked below, there is basically no impact of the dietary macronutrient composition on insulin resistance, once we take body weight changes out of the equation. And similarly, the science on the impact of saturated fatty acids and their impact on insulin resistance is not nearly as clear as suggested by these and other individuals. When considering the cumulative evidence, I do not hold the view that a ketogenic diet or saturated fatty acids trigger insulin resistance. And I am saying this as someone who has published one of the few papers showing negative effects of a diet rich in saturated fatty acids on insulin sensitivity. ua-cam.com/video/ZcVenUbqsYY/v-deo.htmlsi=3zGTlJvoo2whKcvS However, a very low-carb diet such as a ketogenic diet will reduce insulin secretion, and specifically the first-phase insulin response, temporarily. That is a reversible phenomenon, and people on low-carb diets do well do eat all of their meals low-carb, and to reintroduce carbs slowly should they want to switch to a higher-carb diet. Sadly, some studies showing impacts of low-carb diets on glucose tolerance have been incorrectly interpreted by proponents of plant-based diets as suggesting that dietary fat or saturated fat trigger insulin resistance. This is, IMO, not supported by the cumulative evidence. The effect seen in these studies instead is a reduction in glucose tolerance induced by reduced insulin secretion. Best, Mario
@@tarabooartarmy3654 Where is the scientific data to support your claim. Look into Dr. Bikman who does scientific tests on fat in mice, no evidence animal fat causes insulin resistance.
I almost have no words for how impressed I was by this video. I just started using one of the new OTC CGMs and was wondering what criteria was being used for its spike notifications. I still am not sure - maybe it is the rise by 30. But thank you ever so much for the extended description of studies on normal individuals, and on what patterns correlate to chronic disease. You have just won a new subscriber!
Please make more videos. I have started to wear a CGM. I’m 57 menopausal on BHRT with Hashimoto’s. I’m also a RN currently in University for my FNP. I’m wanting to see the effects of glucose on this demographic so basically I am my own research subject. I have found your videos so helpful in understanding the scientific data. I find social media “influencers” spreading inaccurate even fear mongering information. Your channel concise, to the point and easy to understanding.
Thank you so much for making this video! I recently ordered the Dexcom Stelo CGM for non-diabetics. After two month of eating a very low carb/keto diet, my fasting glucose has gone down from 156 to 95. It’s amazing how stable my glucose remains throughout the day now, hovering close to 100/110 even when snacking on nuts, cheese, and beef jerky. I had a McDonald’s fish sandwich yesterday and it spiked quickly to 160! It amazes me which foods impact my glucose so drastically. I stick to the same foods right now, two eggs and two turkey bacon strips for breakfast, meatballs and cauliflower rice for lunch, steak and sauerkraut for dinner. I add avocado, MCT oil, olive oil, avocado mayonnaise, and butter for healthy fats to slow digestion and increase satiety. I wish you all the best on your healthcare journeys!
Just be careful not to think that your glucose response to carbs at this time, on your very low-carb diet, is a reflection of your actual glucose tolerance. The issue is that while you are eating low-carb, your first-phase insulin response (the amount of insulin secreted early after a meal) will be diminished. That is temporary and reversible though, so if you ever want to figure out whether your glucose tolerance has been improved (for example, because you have lost some weight), you should only judge that after about 2-3 weeks of eating carbs again (introducing carbs slowly). Hope this makes sense!? Cheers Mario
@@nourishedbyscience I have been on Keto, 18×6 feeding window, as well cardio and strength exercise twice a week for approximately 2 years. The reason to start it was insulin resistance, gallbladder sludge, and possibly fatty liver. I have no problem to maintain this diet indefinitely. However, I am thinking of starting to introduce complex carbs to keep my metabolic response flexible and healthy. What's your opinion about periodically, maybe once a week to switch my metabolism to carbs based diet to keep it healthy and flexible???🤔
@nourishedbyscience very helpful. I wear dexcom g7 10 days every month to correct my eating behavior so that the reading is below 140 every day. I'm none diabetic but having insulin resistance. I'm going on a transatlantic cruise next week wearing cgm. The thought of carefully choose the food I will eat on cruise is very exciting 😂
Great video! I despise all these fear-mongering influencers and "doctors". It's so irresponsible and partly even dangerous. And then people copy these weird and silly arguments, share them on social media and with friends and contribute. So thank you for doing what you're doing!
I’ve been reading and watching stuff on diabetes for years because I have family with it so I want to prevent it for myself. I’ve never once seen someone say 120 was deadly. 120 isn’t even a diabetic fasting glucose. Not sure what you read, but it’s probably a troll trying to scare uneducated viewers.
No, the problem is type twos are broken. We don’t spike for 30 minutes. We spike for 2 to 3 hours sometimes and it may take days to actually get back to normal since we know we are broken. It’s better to minimize the spike as much as possible or less is, zero spike meal is better, every spike and long duration with high insulin and BG is damaging
Another top-notch presentation. Highly recommended. I really love Mario's dispassionate no-nonsense presentation style as well as the high level of the information he presents.
Thank you so much for this grounded information. I have been eating a CGM for a week and this really helped me understand how to draw initial conclusions on whether to engage a health professional.
Thanks Mario. I wish the folks at ZOE were similarly clear about what exactly we should be concerned about and what we shouldn’t. I hope they invite you to do a ZOE podcast soon and you can put them straight. Although something tells me that your message might actually cost them because their low level fear-mongering is a significant source of revenue for the ZOE brand. More power to you. Danke aus Schottland!
one of the best video on the internet, absolutely well explained and as a scientist, I appreciate all the data and very well presented data! very well done!!!
I am using the Stelo and the near real-time data is very interesting. I’ve learned from the data that what I really want is a continuous insulin monitor to go with it. 🤷♂️
I just started the Stelo 3 days ago, and I'm getting readings about 30 points lower than a finger stick. I put mine on the back of my arm, but I'm wondering if I should move it next time. Do your readings track with a blood glucose monitor finger prick? I'm prediabetic.
@@Charactermatters1 The overall trend tracks pretty well. I’m going on my 6th week. It’s hard to tell if they track perfectly because the inter stick is just a point in time, BS varies quite a bit normally, and it’s not practically possible to develop trend data like a GCM can. I have also been on a strict keto diet for 2-1/2 months and have lost about 12 pounds so far. I’m ingesting roughly 0 net carbs per day while my daily average glucose has gone up from a low of 98 to now being around 109. This is an expected result due to neoglucogenisis from my body metabolizing stored glycogen in body into glucose. I expect that I will see this increased average blood sugar until I am no longer over weight. This is where insulin resistance becomes evident and why I am constantly trying to get my doctor to include HOMA-IR in my blood panels. Without knowing how insulin resistant that I am, blood sugar numbers regardless of their accuracy are just a number in a very complex metabolic chemical pathway. Why doctors are resistant to ordering HOMA-IR is beyond me. They’ll say that that blood test is not very accurate or reliable which is true in an absolute sense, but not not in a usefulness sense because they do correlation pretty closely with the complicated and expensive test of determining and analyzing true insulin blood levels. Charting HOMA-IR vs. Blood Glucose would be so much more helpful than just glucose alone. Without knowing how badly one’s insulin resistance is, ie. How much insulin you pancreas is releasing into your blood stream, it’s only a guess what is truly behind high or low blood sugar numbers with respect T2 diabetes.
Excellent presentation! Low carbers may note: A slower insulin response is normal (07:03) after months of carb restriction. One way to make sure is by a HOMA IR test which will quantify(?) the IR. By the way, Cortisol response due to psych. factors (fight/flight) plays havoc with blood sugar 🙄. (One solution for this is to water fast for 6~8 hours after such events.)
My BG increases from my fasting BG by 8-10 points if I walk in the morning before breakfast. I hope to be able to get a CGM sometime soon to get a better picture of the fluctuations that occur during my day and what foods and/or activities influence the changes. Thank you for this video. It will come in handy when I get one.
I’d like to see you do a video about the long-term 22:01 health risks of someone who has pre diabetes for say 5 plus years- An A1C of 5.7 to 6.1 for example. This person has higher fasting blood sugars - say 5.7 to 6.3 - but no spikes above 7.8.
This is me too! I eat healthy (I watch the quality and quantity of my carbs but not very low) I am a healthy body weight and I do resistance training. I attribute this to psychological stress (anxiety) since an event 6 years ago (working on it!) I’m also post menopausal so there’s that. I would love to see more work around the impact of stress and a sympathetically dominated system.
Thank you for such an excellent video and the info. Request - Can you please make a video on what to do if the glucose spike is wide (my glucose spike takes about 4 hours to return to baseline. What changes will make the spike a sharper peak than a wider peak, even if the spike is below 140 Much appreciate your excellent content ❤
Thanks for the kind feedback. If it takes a long time to return to baseline, this is usually a sign of insulin resistance. In that case, I recommend the following videos, in this order: To fully understand how the body regulates blood glucose levels and glucose tolerance, and what goes wrong in this process when we develop prediabetes or diabetes: Regulation of Blood Sugar: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=_0eoEnwxEJ1ZBttj The first step is to figure out whether we are insulin resistant: Measuring Insulin Resistance: ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=C681vsKNjXqWJSMq If we are insulin resistant, then the next step would be to think through the most common causes of insulin resistance to identify potential reasons for OUR insulin resistance: Causes of Insulin Resistance: The Personal Fat Threshold: ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=eK6OeDRpGNpPzOqW Insulin Resistance: Top Causes & Contributing Factors: ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=kfHudBNBlFN1NlzU To understand why insulin resistance is damaging to long-term health: Insulin Resistance Syndrome: A Neglected Risk Factor for Chronic Disease: ua-cam.com/video/Fg3n-vi2t3Y/v-deo.htmlsi=Cob6H4vwk6yCz12F Wearing a CGM can also be useful to identify early signs of glucose intolerance and insulin resistance: The Complete Guide to Understanding Your CGM Data: ua-cam.com/video/DVND90vQ0xI/v-deo.htmlsi=vpLTb-bAIvenYWjB And once you have identified potential causes or contributing factors to your glucose intolerance and/or insulin resistance, you can address these specifically. It’s important to be clear that while excess visceral and ectopic fat is a common cause of insulin resistance and glucose intolerance, it’s not the same for all people. Others are insulin resistant because of low muscle mass, chronic stress, chronic sleep deprivation, or micronutrient deficiencies. Hope this helps.
@ this really helps- thank you so much 🙏🙏. I will review the videos you mentioned. I am already wearing a OTC CGM and am prediabetic. Trying to reverse it! thanks again 🙏🙏🙏
In my opinion, the spikes are not as important to focus on as the fact your blood glucose levels, as measured by a CGM is consistently outside the range. And if that’s the case then you certainly want to get checked as in the long run this will cause many other health issues. The spikes however do offer an interesting data for managing your pre/diabetes conditions. For example your response to certain food and how much of you can eat to limit the blood sugar increase. And in doing that, your body will eventually become more insulin sensitive. I was diagnosed with type 2 diabetes 8 months ago and was pre-diabetic for over a decade. My a1c went up to 9.2% from 5.7% My doctor recommended I use a CGM. And this was a life changing advice. After 8 months my a1c is down to 6%!! Additionally the CGM helps decide how much I eat, what and when. It tells how much I need to exercise and how much is too much.
As always, Thank you Mario! You have placed definitive cutoff readings so frequently presented within an understandable context but retained an awareness of their relevance. It is not real easy to work out personal glucose tolerance but you have removed some of the angst by providing a way forward. Cheers
This was very interesting and quite informative. Thank you for doing it. And thank you for mentioning that laying on a sensor can cause a low reading. I have been involved in a face group group for type twos in which it comes up regularly. Usually when someone new to cgm's is woken up by the alarm and not understanding its a fluke takes an excessively large amount of sugar with out doing a blood sugar check to confirm what was going on.
Thank you for this video! I found your videos a year ago after questioning the 30mg/dL rise being touted as “unhealthy” and subsequently changing CGM companies for this reason. I know exactly which company you’re talking about 😉
Thank you so much for this informativ video. I have missed your Videos so much. You have said, that after a low carb diet, we should integrate more carbs to restore our insulin respond. Could you explain why?
If you're regularly consuming carbs, the pancreas will be used to responding to them, and will actually keep some premade insulin stored so it can respond and release it right away. When you don't eat carbs it stops keeping that store because you don't need it. Then when you eat carbs unexpectedly the beta cells have to make all the insulin on the spot. So it is a slower response. But if you consume carbs for a while again the pancreas will know it needs to maintain that store again
When I was diagnosed with T2D back at the end of 2022, I was literally off the charts. At the time, I didn't understand the numbers and the fuss with my blood glucose level at being over 28mmol/L (>504mg/dL!) but the doctor and nurse who tested me seemed very urgent to get me to take medication and see other specialists for treatment. Over a year later, it's now more average around 8mmol/L (144mg/dL) and currently managing spikes (usually over 10-13mmol/L after snacks and meals) by trying out a CGM
Glad you are controlling your blood glucose better these days. If I may suggest, you may find these videos here helpful, in this order: The basics of how blood sugar levels are regulated, and what goes wrong in diabetes: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=m7T23zQwMc25Hxcp To figure out if you are insulin resistant, a common cause of glucose intolerance: ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=NJFuxjT-mh3xj2NK If you are insulin resistant, to understand why you may be insulin resistant: ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=VBUg60B2f0Y5jrLq ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=-iPi09SYz3to0ML9 To understand why insulin resistance is harmful: ua-cam.com/video/Fg3n-vi2t3Y/v-deo.htmlsi=ljX7nTAqVj8f58b_ To avoid blood sugar spikes to 180 mg/dL or higher: ua-cam.com/video/yg0Y3eNSANg/v-deo.htmlsi=gwAVoW2Ch0HRqLDI ua-cam.com/video/LVw60RIhbzg/v-deo.htmlsi=IiTbUkTjwdG_6Jen Best wishes, Mario
Very informative video. I will watch more. My interest is in the glycemic index and dietary management of diabetes. I have only recently commenced watching YT. Anyway, there are people that use their CGM to test the effects of food on their glucose levels. As example, he tested white potato and sweet potato for different Short videos and compared them. After the tests, he said that his blood glucose levels for the both foods were the same. However, white potato has a higher GI and sweet potato a lower GI. He also tested another food and ended up with about 3 peaks during the two hours of the test. I have noticed this with others, even one with Type 1 diabetes. You stated that CGM is not used to diagnose prediabetes or diabetes. This is similar to the GI because GI uses a protocol that blood glucose is tested every 15 minutes, after the premeal test and after the food is consumed, for 2 hours. CGM does not test blood glucose but interstitial glucose. You mentioned blood glucose throughout the video rather than interstitial glucose. I’m not sure whether the two are similar, because the CGM tests on YT could not possibly be used to calculate the area under the curve to obtain the GI. Your opinion would be help me greatly. Thanks
Excellent examination of blood glucose variability. I would like to add a few points however. First current CGMs are simply not as accurate as most people seem to think. It is therefore important to realize that single readings should never be assumed to be totally accurate. Patterns are therefore more important than single readings. Another factor that plays a role in assessing blood sugar response to food intake is the type of food you ingest. Obviously the higher in carbs a food is the more likely it is to cause blood sugar spikes. Not so obviously different people can respond radically differently to food. Thus one person may experience large bG increases to white bread while another person may not.
Thank you for this video. I wear a cgm and have a normal BMI of 20. I don’t eat a lot of sugar or carbs anymore but I ate some licorice mints the other day and I went above 200. When my blood sugar spikes like that, I become so tired that I immediately fall asleep for a few hours. It’s happened every time my blood sugar rapidly rises. I guess I need to see a doctor.
Thanks Mario for another superb balanced video based on science. I found one study based on oggt that suggested 1hr > 155 could be predictive for diabetes ( jcem 1hr postload hyperglycaemia 2018 fiorentino ...link wont upload) would be grateful for your views on whether this could extend to food. Thank you again for all your work.
Yes, I know that paper. It's interesting, but I am not sure it holds a lot of value for the layperson, beyond what I shared in this video. First, the papers are based on OGTTs, which constitute a very different glycemic load than normal meals. Second, the paper in essence just shows that people with higher postprandial blood glucose to a standardized load have a higher risk of later developing diabetes. That is hardly surprising, right, because glucose intolerance is a continuous process, and it would seem plausible that hyperglycemia and glucose intolerance develop gradually. That said, for most people, the spike after a meal occurs around 45 min after the start of the meal. That means that glucose levels should be on a downward movement at 60 min, and if they consistently are still above 155 mg/dL, that would strike me as a sign of at least mild glucose intolerance. Again, because the data suggest that increases in blood sugar into the 140-180 mg/dL range do occur even in very glucose tolerant people, but they are infrequent and brief. Best, Mario
@@nourishedbyscience Thanks Mario for a really detailed answer ... that is what I took from the paper too (and yes not a lay person) but many are looking for optimal and like you I believe this is an area where we can get over worried so will include this paper when i present my findings... you are so good to help us all in this way.
Thank you for this, good timing. I have been watching your videos for a while, but I was too busy to test with a CGM. I am on my second sensor, third week, with a Stelo. My A1c is 6.2, but glucose rarely spikes much over 140, I can calm down now. Another influencer says that the CGM trumpsan A1c test when it comes to glucose levels. I do compare the Stelo sensors to my finger stick meter, and the first sensor readings were quite close, the second sensor seems to be reading between 15 and 20 mg/dL high. Hopefully Dexcom will allow calibration of Stelo sensors like their other sensors. I will probably buy another pair of sensors and then stop for a while.
excellent video!!! I've realized I've done things wrong over the past 3 months where I tried to extend the non eating window and never have carbs on its own, so I would often have 1 treat after a meal, and if there were carbs in the meal it would overextend the spike even higher. Would be better to let the spike come down and then have the treat with a much lower glucose peak. I'm in the middle category with spikes that shortly go above 140 but then come down again, I'm somewhat compromised. For next 3 months I need to follow a different eating routine.
Just one standard serving of pizza, with a calibrated CGM (Dexcom G6), I went from 4.8 mmol to 13 mmol, within 30-45 minutes. We drank water. This was typical Italian pizzeria stating 100% made onsite dough and sauce, wood oven. In this same time period, did 15 min blood pricks that confirmed what the CGM said 15-20m later, and my wife that is not pre-diabetic, she went from 5.6 mmol to a max of 8 mmol. IOW, confirming what this video says. My spike was huge and it took over 4 hours to return to "normal" 5.5 mmol, where 1.5 hr later my wife was back below 6. When fasted and not spiked from previous day, my BG is 4.2/4.4 and dawn effect brings it up to 4.8-ish. So maybe the pizza test could be used as a baseline.
Very useful, thank you. That being said, I am still not clear on the difference between normal and optimal. A spike to say 170 may be normal but is it optimal? Is it something to be OK with if it happens daily? More to the point, is the pancreas meant to be "exercised" once in a while with carb challenges or is it more like the liver with respect to alcohol, i.e. a healthy one can handle 4 drinks but, really, optimal is as little as possible. Between the two extremes: keto vs very high carb diet would you say moderate low and complex carb would be ideal?
I don't think we have any data to support any specific macronutrient composition as optimal for everyone. If someone is glucose intolerant, they may benefit from reducing their carb content, at least until their glucose tolerance has been normalized. My sense is that currently we do also do not have any data to link short blood sugar increases into the 140-180 mg/dL range to negative health outcomes. It is possible, as you say, that it's suboptimal, but that would be a guess and not based on any data I am aware of. Best, Mario
Yes, correct, but IMO, this criterion should not be applied to CGM data without further testing, as the false positive rate would be too high. I think the issue is that if a patient comes into a doctors office once, usually fasting or a while after eating, and has a glucose > 200 mg/dL, the likelihood that they indeed have diabetes is high. However, with CGM, we get data every 5 minutes, including immediately after eating, and I don't think that the relationship between sensitivity and specificity of the random glucose test hold up very well under these conditions. I am hoping that we get updated criteria on this with CGM data, and would assume that the threshold for when diabetes is suspected is going to be a bit higher than 200 mg/dL. Cheers Mario
I am one of those otherwise healthy people who wore a CGM for a month. I follow a predominantly plant-based diet. My glucose levels would “spike” every time I ate anything. I could have avoided spikes by swapping my fruit and beans for beef jerky and hard boiled eggs. I’ll stick with my plants and take my chances!
I have gone the other way and decided to eat massively reduced carbs. This means that I have to eat more meat and dairy. I was diagnosed with prediabetes in May and I’ve managed to reverse my blood glucose with the help of a CGM. I will honestly tell you, I’d give up all the meat for some fruit or any carbs for that matter 🤤 I miss pasta 😂 I am still very sensitive to carbs unfortunately although I have kept my intake low.
Hey there are a lot of things that can help reduce your glucose response and spikes such as eating first your veggies, fiber, healhty fats like avocado before as an apple, an orange or any high glycimic fruits, also you can walk after a meal or drink vinegar before, you dont need to eat meat, please look at glucose goddess tips she has really great info also a plant based diet should be well planed to be healhty.
Better test of diabetes is measuring insulin. HOMA IR or Kraft insulin Assay Test. Early detection is better than cure. Hyperinsulinimia even if blood sugar thresholds are still normal. Definition of diabetes should change
Diabetes is actually insulin resistance + Relative Insulin Deficiency because pancreatic Beta cells fatigue or dysfunction= Type 2 Diabetes. Or not able to follow Insulin's Own Natural Circadian Rhythm.
Measuring insulin is not a 'better test of diabetes'. By definition, diabetes is a condition of glucose intolerance, and while related to insulin resistance, is not the same. Let's try to be clear and not muddle up things. Insulin resistance is important, and you'll find many videos on my channel about that as well, but glucose intolerance and hyperglycemia are independent risk factors for many severe chronic diseases in their own right. My position is we should normalize both insulin sensitivity and glucose tolerance, but this video was just about glucose tolerance and glycemia. Best, Mario
@@nourishedbyscience Science is challenging the status quo. Proving existing guidelines wrong. High insulin levels using root cause analysis and 5 why's will show that high insulin levels even if your glucose value is still low is abnormal from the acceptable fasting insulin levels or using Kraft insulin Assay Test. Catching this high insulin levels early will be the best way to cure Diabetes faster and easier with low carb or keto diet
@@nourishedbyscience Best to challenge the status quo of a glucose centered approach to diabetes. The only constant thing in this world is to change for the better
Well done for carefully presenting the important details on the use of CGM. However, I think it will be incomplete to talk about fasting blood glucose (fbg) without talking about the duration of the fast: i.e. if the person ate previous day's dinner by 6pm, the fbg will be much lower than a case of 11pm dinner. Also the time of measuring the fbg in the morning is to be considered. Also to be considered is the portion (size) of food and the carb content. For me, when I eat high carb content (e.g. 6 slices of bread with sweetened chocolate drink), I experience a spike (up to 220 from baseline of 89). But within 3 hours it goes below 100. But when I eat a high protein diet (e.g. beans) which takes a longer time to digest, the spike is only as high as 150 but takes up to 5 hours to go below 100. I understand that this is because the slower digestion of the proteinous meal slows the absorption of glucose into the blood. Hence a longer duration of the spike.
An important point is missing here. What these subjects do within those two hours matter hugely as far as glucose spike is concerned. Just a simple leg calf muscle exercise for a few minutes brings it down by 15-20 points.
Im wearing a cgm. Only for 14 days. Early on I noticed that porridge ( not instant, steel cuts oat) accompanied by Greek yoghurt made my blood sugar rise by a good 50 mg/dl. From about 80 mg/ dl to 130. So I was quite apprehensive to test 75 g glucose. But if you don't try you don't know so I did and it rose by 55 mg/dl. I expected more tbh. Or porridge and Greek yoghurt to make it rise less. I'm not diabetic nor pre diabetic and my blood sugar is able to rise from 85 to 140/ 145, easy so quite a jump. Then i it will start going down then back up again down up again for about 5 or even 6 hours hours if I consume a big meal including carbs. To reduce that length I can go for a fast walk and iit will go down quicker tho. My blood sugar rises quite a lot when I exercise. It also rises when I take a shower or do the dishes. Also when I fast. It seems whenever I need extra energy it will rise which I found strange at first but ok.. Also I tend to experience hypoglycemia ( or is that dawn syndrome or reactive hypoglycemia?) at night. But when I replace sweet snack by cheese or an avocado or don't snack at all tthen I don't go hypoglycemic. I managed to reduce this occuring from 11% to 2% so wearing a cgm has been great if only for that). Hopefully that helps give my liver a break and having to" rescue me" ;-) My BMI is 20.2 and AC1 4.7% Fascinating experience imo. It's been like a little journey within some part of my body that was so far unknown. Thank you very much for another outstanding video.
This was very good, indeed one of the best looks at the published data deciphered for a general audience. BUT the final synthesis, by emphasizing being under 140 mg/dL “most of the time,” missed the most important metric a CGM can give: average blood glucose (ie, area under the curve). Having a healthy average blood sugar between 90 and 100 mg/dL would not result if one were at around 130 “most of the time.” It’s really down to how readily one returns to a fasting level after their meals.
I suggest that if someone meets all of the criteria, as outlined, their average blood glucose will be low. That is because there are exactly zero people who have normal glucose tolerance and who keep their blood sugar in the 70-140 mg/dL range 95%+ of the time who have stable blood glucose at 130 mg/dL for more than a few minutes. If someone can regulate their blood sugar as I outline as normal, then their blood sugar will never just hang around 130 mg/dL. Does that make sense? Best, Mario
@nourishedbyscience I have been keto for years. Blood spikes are not an issue. I have been using CGM Stelo for 3 weeks now and I very very rarely have any readings below 90 ml/dl. I am OMAD and Median Avg BG = 104. How do I lower my BG so that I see many more 80 and 90 readings instead of the constant 101 to 114 range? Note that Cardio and exercise does not seem to help. BG increases and then comes down to "my" baseline of 100 to 102.
The average glucose rise needs to be accompanied by the deviation range. But otherwise I’m pleased with your presentation. BTW, I am a Type 1 diabetic over 31 years.
If someone meets the criteria, as outlined, their SD will be low. And I beliebe that these criteria are more intuitively grasped by most people than SD. Cheers Mario
Dear Mario, I appreciate the valuable educational content you provide. Regarding your discussion on high LDL levels, are you advocating for a reduction in the intake of foods high in saturated fats, such as full-fat dairy products and red meats? also about Visceral fat storage dysfunction is a contributing factor to diabetes. If dietary and lifestyle changes are not effective, what are the recommended safe medical intervention. Thank you in advance for your response and effort.
Any major surgery will trigger a massive increase in inflammation, and this by itself can trigger insulin resistance and glucose intolerance, such that many patients will be diabetic for a few days after major surgery. Therefore, my first suggestion is to ask your doctor to monitor blood sugar levels for about 1-2 weeks after major surgery. Wearing a CGM during this time may be a good idea, and modifying the diet to minimize blood sugar excursions. Other than that, chronic inactivity can also, by itself and independent of inflammation, trigger insulin resistance within a few days. I talk about this here: ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=h_4cRFxokJ2B18y0 Best wishes, Mario
@nourishedbyscience TY! I've been wearing a cgm on my own accord right before my fractured knee & surgery. Geez, my glucose spiked 250mg/dl (fasted) during 2 hr surgery. That was an eye-opener! I appreciate you🙏❤️
Thanks for this video. I was looking for something that showed what a normal persons blood glucose does after eating and even though this doesn't go into super detail, its good to know that the whole "30 points is too high of a spike" thing that so many youtubers throw around is not true. It's true that you can keep any spikes below 30 by eating nothing but meat and low carb vegetables but life gets pretty boring IMO if that is all you eat. I love fruit and am not giving it up and my blood sugar will spike 40-50 points after eating some fruit but it always comes back down to around 80-85 in 3-4 hours. I have cut out pretty much all processed foods with the exception of lunchmeat and low carb bread/tortillas which I don't eat all that often. I've lowered my A1C from 6.5 to 5.3 and lost over 50 lbs so feel like I am doing pretty well.
If your glucose levels remain elevated above 100 mg/dL about 2 hours after starting a meal, this could still be a sign of insulin resistance, and there may be value in identifying and addressing any potential triggers of insulin resistance: ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=WEhaPV3nI0Va_kID Cheers Mario
@@nourishedbyscience Oh I have no doubt I am still insulin resistant. From what I understand, there is no way to really reverse that once you have become T2 diabetic. You can lower your A1C by eating low carb but you will be insulin resistant the rest of your life (unless they figure out some medical way to reverse it). I know it is fruit and the low carb bread/tortillas that raise my blood sugar but I am not giving those up. I keep the spikes below 150 for the most part even if sometimes it stays elevated for 3 or 4 hours before going back to normal. Life is too short to not enjoy some amount of sugar which I do now with fruit instead of candy or desserts. I don't over do it and have kept my A1C down to normal levels so I am happy with where I am at.
@@admgloval That assumption is incorrect. Glucose tolerance can be improved, both by improving insulin sensitivity and - in some cases - improving insulin production. The key is to figuring out WHY you are insulin resistant, and then systematically addressing that in a way that you can maintain long-term. Best wishes, Mario
@@nourishedbyscience I may have to try your suggestion of bringing carbs back into my diet and see if glucose response improves. I went low carb for about 4 or 5 months (50 carbs or under per day) and dropped my A1C from 6.5 (what it was when I was diagnosed with T2 diabetes) to 5.3 in July. Since then I have started eating small amounts of some carbs that I had cut out completely, mainly junk type food like chips or candy. Typically when I do I see my blood sugar go up from around 85-90 to 134-140 and it will stay elevated above 100 for 3-4 hours before returning down to normal. During that time it goes up and down though between 135 and 90. I was always under the impression that once you had insulin resistance that you had it forever. When I was doing 50 carbs and under, my blood sugar was always around 80-90 with low spikes up to around 120 and then back down to normal.
Your deliverance is perfect for me for I am not a scientist, many videos are for fellow scientists. I am prediabetic and insulin resistant (both slightly), started on low carb(average 60 a day) 8 months ago, ordered my CGM yesterday. I believe all people are not the same so carbs can be an issue in some people and diabetes runs in my family. Additionally, removing grans cured my severe IBS.
Very interesting. Any thoughts on hypoglycemic readings post-Covid ( or other) vaccine? After about a month of wearing a CGM to test food reactions, I got dangerously low alerts from the Dexcom G7 in the middle of the night for the 3 consecutive nights after getting an updated Moderna Covid vaccine a few weeks ago. The first night I assumed a malfunction and removed the sensor, but it happened again with a new sensor on the opposite arm for two additional nights. I confirmed it with an old fashioned finger prick monitor, ate a few dates, then went back to sleep. Things returned to normal after that. It was definitely unexpected. I can’t say whether prior vaccines might have provoked a similar reaction as I this was my first test of a CGM.
No joke. They put extra carbs in everything! There's no need to do that, other than making "food" more cheaply. But then, they charge a small fortune for anything resembling real food. Beyond frustrating.
It’s really not that hard. Buy real food instead of the processed junk. And stay away from bread pasta potatoes. It’s simple. But people are literally addicted to the processed crap located mostly in the aisles of the grocery store.
@@jean4157 You are right, in a way, but also not quite correct in saying it's simple. It depends a lot of where you live, and whether you have access to those foods/ingredients. Grocery stores have caught on to the fact that more people are wanting to eat more healthfully. In some areas of the US, fresh vegetables are very expensive. Frozen vegetables are (sometimes) not pleasant to eat. Canned vegetables are loaded with extra ingredients. Fruits have all the same problems. Think about it. Someone who lives in a larger city, who does not own a car, earns Federal minimum wage - they are not going to have time and energy to shop frequently, prepare for cooking and then actually cook a lot of wholesome, healthy food. Besides, who was supposed to teach them how to cook? Their mother, who likely raised them on prepackaged, cheap, convenience food? School? The other end of the spectrum - those who live in the country literally have no feasible way to get more than a handful of groceries home from the store. They are going to look for lightweight items that they can carry easily. Not everyone has the privilege of living in Pleasantville suburbia, with easily accessible transportation, and an affordable supermarket every couple of miles.
I have glucose peaks of 170 to 200 when I eat more than 30 to 70 grams of carbohydrates in a single meal, after 2 hours it drops to 80 to 70, sometimes it goes from 150 to 80 in 15 minutes. But, I just finished the keto diet 3 days ago, so I guess as the days go by I will improve. My fasting insulin at the end of the diet was 2.4 fasting, meaning I wasn't producing enough insulin I guess.
Your low fasting insulin probably means that you are very insulin sensitive. My best guess is that you have a (temporarily) diminished first-phase insulin response due to your long-term low-carb diet. The first-phase insulin response is based on pre-formed insulin that is stored in the pancreatic beta-cells and that can be secreted into the blood within seconds of consuming carbs. That first insulin secretion prevents a spike from happening. Just re-introduce carbs a bit more gradually, and eat some non-starchy veggies or salad AND some protein before you eat carbs for the next few weeks. That'll slow down your carb digestion, and the protein also stimulates insulin secretion before your carbs are absorbed. Cheers Mario
Great video. Info about 1,5 AG as a biomarker was interesting. I would have liked a bit more emphasis on the area under the curve and the convexity of the curve in the post peak. Ideally the peak should come down rapidly l and we know that. But how much should the rate of decrease be and how could it be an indicator of developing insulin resistance would be interesting to know
@@nourishedbyscience Yes. By rapid I meant the average downward slope in healthy homeostasis of glucose levels. Any variation on either side is likely to be indicative of an imbalance for sure.
Just created my 30 average of hourly readings over a 24hr period. It was quite a revelation. Knowing the physiology and biochemistry of glucose helped me further understand my personal response to a challenge with different glycemic foods ingested under different conditions.
I wear a CGM and it tracks every 15 minutes. When i had large quantities of carbs, my glucose spiked to 210 but after 30-45 mins ,it came back to 105 mg/dl. Is it normal for such a high spike in glucose?
So a few months ago my fasting BS was 77 and A1C 5.1. Since having covid, my morning sugars are 100 to 105 in my CGM..... Very frustrating. Hoping time and keto/IF will bring it down.
Thanks for the video. BTW, given glucose concentration 5mmol/L and molar mass 180g/mol, the homeostatic glucose in the blood in human readable form is 0.9g/l or 4.5g for the whole 5 liters blood volume. The glucose adsorption is around 96%. There is the question: why we abuse the body with the external glucose in many times bigger concentration that body have? We know that there is no storage for glucose nowadays for sedentary population.
I feel strongly that the issue we should address is glucose intolerance, and that blaming carbs is short-sighted. If someone is glucose tolerance, they can eat all the carbs they want and not have any problems. What we should be talking about a lot more is why people are glucose intolerant, and - again - it's not carbs per se IMO. Best, Mario
@@nourishedbyscience , thanks. Based on Glucose - Fatty acid cycle, historically, we rarely mixed glucose with non-glucose sources, until last 12-10k years ago. Given that, the genetic and evaluation aren't fast process, IMO, I'm still not convinced it was long enough to get humans adapted to such glucose surge every meal. BTW, Homo Paranthropus extinct.
5:46 what is a definition of a “your typical meal”? There could be a meal with almost no any carbs and there won’t be any spikes, or another meal with lot of carbs, so that spike can be elevated for hours… it would be more helpful if you can provide concrete numbers, like “after a meal with about xxx grams of carbs”. Also, it is very important to mention for what kind of person size/gender/age/activity level that stats are relevant. Because for one person 75g of glucose is “full stomach” dose, for another it is not even a half…
15:56 “fasting state” is another uncertain definition. After year of experiments with CGM I realized that “fasting state” is very outdated meaning. The morning blood sugar numbers could be easily manipulated with meals taken day(s) before the measurement. And another factor is body composition and amount of physical activities before the measurement. Say a person with high muscle mass can easily consume glucose from blood with just few minutes of walk and little stretching… I’m just trying to say, that the diagnosis by measuring blood glucose with single test is outdated, it must be considered in the dynamic.
Yes, I agree that ideally a doctor would diagnose diabetes or prediabetes based on several tests. It is definitely true that morning/fasting glucose can fluctuate a little bit up and down based on a few factors. However, I had good reasons to not provide more specifics about the exact g of carbs during a meal. While the amount of carbs plays a role, the quality of these carbs (i.e., their glycemic index) matters at least as much, as does the composition of the rest of the meal. As long as we are eating some carbs, however, all of these things are dwarfed by our glucose tolerance. As I explain in the video, as long as we are regularly eating some carbs as we are wearing a CGM, we should be able to get a pretty good sense of our glucose tolerance, irrespective of what the specific amounts and GIs of these carbs are. If I had included specifics of what a optimal blood glucose response would be in response to a specific glycemic load, the video would have immediately become useless, because most people cannot or don't want to calculate the glycemic load of their meals. So, of course, this could be done in a more academically precise way, but I believe the way I have presented it here is the better balance between usefulness rigorous consideration of what is known about normal glucose homeostasis. Hope this makes sense. Best, Mario
Still.....how do we know that we're even supposed to eat the foods that raise the blood sugar that much? Also how do we know what normal is if the study's general purpose is to find exactly that with "normal" individuals?
This is an excellent question. Love this. Thanks. My view here is that from observing the normal range in which the body keeps glucose regulated, we can actually get a sense of which foods our ancestors ate as we evolved. From the data I shared, it does seem very clear that the body makes substantial efforts to keep blood glucose in the 70-180 mg/dL AT ALL TIMES. That is absolutely remarkable, because the amounts of glucose we often eat in a typical mixed meal are multiples of the total glucose content in all of our blood. And this system shows some evidence of redundancies, such that defects in one component can be compensated by another component (insulin resistance can be compensated by higher insulin secretion). So the fact that such a nuanced, robust glucose homeostatic mechanism exists seems like indirect evidence to me that humans are adapted to consume glucose-containing foods (sugar, starch). To phrase differently, our body does NOT seem to have any homeostatic mechanisms to always keep blood glucose in the 70-100 mg/dL. Admittedly, this is not strong, conclusive evidence, but to me suggests that humans evolved on diets that contained at least some carb-containing foods. Cheers Mario
@@nourishedbyscience Very interesting look....you can definitely find logic in that. But going the same route...how about blood pressure regulation? BP is also pretty tightly regulated and the body if healthy would increase it to 150/100 for example when stressed. But these days everybody is stressed overtime, numbers climb and we have new normal. Despite many people are very sick and have degenerated cardiovascular system, the body is still giving its best to keep the numbers under 200 systolic. But that's not healthy we can agree? Acute stress is better than chronic stress....but lower instances of acute stress is even better. If I eat as similar as possible to our ancestors, my glucose would absolutely never rise more that 20-25mg/dl. Also if we get even more basic - if we're close to peeing out sugat at that levels 180mg/dl.....how the hell would testing the absolute limits of the system regularly be healthy?
I started using a keto Mojo monitor, about a year ago. This year I decided to get a CGM. I can tell you , that the finger prick on the Mojo monitor, gives different readings sometimes drastically even with the same drop of blood... this is why I got the CGM. Which one is more accurate?
@@TasteOfButterfliesThat’s not entirely accurate. Type I is when they don’t produce any insulin at all, or at times, very little. But even type I patients can develop insulin resistance based on their self-administered doses.
I suggest you watch this video here on how insulin resistance relates to glucose tolerance: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=gIGcgWXuN1hwuTPR Cheers Mario
as a primary care provider experimenting with CGM for personal and professional reasons, this video is an excellent insight into the data. Thank you!!!!
This video was outstanding. I began wearing a CGM after a T2 diagnosis. I moved to a low carb diet and have seen my A1C drop from 9.5 to 5.2 and lost 50lbs. I continue to wear a CGM to hold myself accountable in managing glucose spikes. I have been using 160 as my definition of a spike and focus managing post meal increases to 160 or below. I really appreciate your time educating us with facts based upon science.
If the keto diet is working for you, that’s great. Just be aware that it will make insulin resistance worse in the background. A diet high in saturated fat is how scientists cause insulin resistance in lab rats for studies. Keto makes the numbers look better, but the only way to reverse type 2 permanently is a very low fat diet high in whole plant foods and low in animal products.
Not trying to discourage you because you’ve made a ton of progress! I just want you to know the truth. The End of Diabetes by Dr. Joel Fuhrman and the book Mastering Diabetes do an amazing job explaining the science behind it if you want to learn more.
@tarabooartarmy3654, I am sorry to disagree. If you watch the video linked below, there is basically no impact of the dietary macronutrient composition on insulin resistance, once we take body weight changes out of the equation. And similarly, the science on the impact of saturated fatty acids and their impact on insulin resistance is not nearly as clear as suggested by these and other individuals. When considering the cumulative evidence, I do not hold the view that a ketogenic diet or saturated fatty acids trigger insulin resistance. And I am saying this as someone who has published one of the few papers showing negative effects of a diet rich in saturated fatty acids on insulin sensitivity.
ua-cam.com/video/ZcVenUbqsYY/v-deo.htmlsi=3zGTlJvoo2whKcvS
However, a very low-carb diet such as a ketogenic diet will reduce insulin secretion, and specifically the first-phase insulin response, temporarily. That is a reversible phenomenon, and people on low-carb diets do well do eat all of their meals low-carb, and to reintroduce carbs slowly should they want to switch to a higher-carb diet.
Sadly, some studies showing impacts of low-carb diets on glucose tolerance have been incorrectly interpreted by proponents of plant-based diets as suggesting that dietary fat or saturated fat trigger insulin resistance. This is, IMO, not supported by the cumulative evidence. The effect seen in these studies instead is a reduction in glucose tolerance induced by reduced insulin secretion.
Best,
Mario
@@tarabooartarmy3654 you are so wrong!
@@tarabooartarmy3654 lol
@@tarabooartarmy3654 Where is the scientific data to support your claim. Look into Dr. Bikman who does scientific tests on fat in mice, no evidence animal fat causes insulin resistance.
Thanks!
Finally, the information I cannot get from US medical system. Thanks so much for your videos and clarifications
Ditto I have been trying to find info like this for over a year!! No one wants to give a straight answer.
Academic-level information presented in a clear, understandable way!
Thanks, Saba.
Cheers
Mario
I almost have no words for how impressed I was by this video. I just started using one of the new OTC CGMs and was wondering what criteria was being used for its spike notifications. I still am not sure - maybe it is the rise by 30. But thank you ever so much for the extended description of studies on normal individuals, and on what patterns correlate to chronic disease. You have just won a new subscriber!
You are welcome. Thank you for your kind feedback.
Cheers
Mario
¡Gracias!
Thank you for your support!
Please make more videos. I have started to wear a CGM. I’m 57 menopausal on BHRT with Hashimoto’s. I’m also a RN currently in University for my FNP. I’m wanting to see the effects of glucose on this demographic so basically I am my own research subject. I have found your videos so helpful in understanding the scientific data. I find social media “influencers” spreading inaccurate even fear mongering information. Your channel concise, to the point and easy to understanding.
Thank you so much for making this video! I recently ordered the Dexcom Stelo CGM for non-diabetics. After two month of eating a very low carb/keto diet, my fasting glucose has gone down from 156 to 95. It’s amazing how stable my glucose remains throughout the day now, hovering close to 100/110 even when snacking on nuts, cheese, and beef jerky. I had a McDonald’s fish sandwich yesterday and it spiked quickly to 160! It amazes me which foods impact my glucose so drastically. I stick to the same foods right now, two eggs and two turkey bacon strips for breakfast, meatballs and cauliflower rice for lunch, steak and sauerkraut for dinner. I add avocado, MCT oil, olive oil, avocado mayonnaise, and butter for healthy fats to slow digestion and increase satiety. I wish you all the best on your healthcare journeys!
Just be careful not to think that your glucose response to carbs at this time, on your very low-carb diet, is a reflection of your actual glucose tolerance. The issue is that while you are eating low-carb, your first-phase insulin response (the amount of insulin secreted early after a meal) will be diminished. That is temporary and reversible though, so if you ever want to figure out whether your glucose tolerance has been improved (for example, because you have lost some weight), you should only judge that after about 2-3 weeks of eating carbs again (introducing carbs slowly).
Hope this makes sense!?
Cheers
Mario
That's great, stop eating the carbs, sugar and processed food.
@@nourishedbyscience
I have been on Keto, 18×6 feeding window, as well cardio and strength exercise twice a week for approximately 2 years. The reason to start it was insulin resistance, gallbladder sludge, and possibly fatty liver.
I have no problem to maintain this diet indefinitely.
However, I am thinking of starting to introduce complex carbs to keep my metabolic response flexible and healthy.
What's your opinion about periodically, maybe once a week to switch my metabolism to carbs based diet to keep it healthy and flexible???🤔
@nourishedbyscience very helpful. I wear dexcom g7 10 days every month to correct my eating behavior so that the reading is below 140 every day. I'm none diabetic but having insulin resistance. I'm going on a transatlantic cruise next week wearing cgm. The thought of carefully choose the food I will eat on cruise is very exciting 😂
And you don't gain weight?
This is the best lecture I have heard about glucose tolerance and glucose spike.
Great video! I despise all these fear-mongering influencers and "doctors". It's so irresponsible and partly even dangerous. And then people copy these weird and silly arguments, share them on social media and with friends and contribute. So thank you for doing what you're doing!
One of the best videos about this subjects I have ever seen. A lot of people are obsessed with their blood sugar and tell people 120 mg/dl is deadly.
So true!😊
I’ve been reading and watching stuff on diabetes for years because I have family with it so I want to prevent it for myself. I’ve never once seen someone say 120 was deadly. 120 isn’t even a diabetic fasting glucose. Not sure what you read, but it’s probably a troll trying to scare uneducated viewers.
In a fasted state it's too high indeed.
The subject is spikes not fasted blood sugar.
No, the problem is type twos are broken. We don’t spike for 30 minutes. We spike for 2 to 3 hours sometimes and it may take days to actually get back to normal since we know we are broken. It’s better to minimize the spike as much as possible or less is, zero spike meal is better, every spike and long duration with high insulin and BG is damaging
Well done
Thank you!
Another top-notch presentation. Highly recommended. I really love Mario's dispassionate no-nonsense presentation style as well as the high level of the information he presents.
Props to you!! I've been searching for a video with this information for days! Great work, thank you!
Thanks!
Thank you for your support!
Many thanks for these useful facts ,Mario!
You remain the best educator in this field to me and many more like me . Keep it we are supportive 🙏🏼
Thank you.
Thank you so much for this grounded information. I have been eating a CGM for a week and this really helped me understand how to draw initial conclusions on whether to engage a health professional.
Much needed video!
Thanks Mario. I wish the folks at ZOE were similarly clear about what exactly we should be concerned about and what we shouldn’t. I hope they invite you to do a ZOE podcast soon and you can put them straight. Although something tells me that your message might actually cost them because their low level fear-mongering is a significant source of revenue for the ZOE brand. More power to you. Danke aus Schottland!
I stopped watching Zoe for the reason you described.
one of the best video on the internet, absolutely well explained and as a scientist, I appreciate all the data and very well presented data!
very well done!!!
Best info and Explanation I have seen, and I totally appreciate it without all the podcast hype. Thank you
I am using the Stelo and the near real-time data is very interesting. I’ve learned from the data that what I really want is a continuous insulin monitor to go with it. 🤷♂️
I just started the Stelo 3 days ago, and I'm getting readings about 30 points lower than a finger stick. I put mine on the back of my arm, but I'm wondering if I should move it next time. Do your readings track with a blood glucose monitor finger prick? I'm prediabetic.
@@Charactermatters1 The overall trend tracks pretty well. I’m going on my 6th week. It’s hard to tell if they track perfectly because the inter stick is just a point in time, BS varies quite a bit normally, and it’s not practically possible to develop trend data like a GCM can. I have also been on a strict keto diet for 2-1/2 months and have lost about 12 pounds so far. I’m ingesting roughly 0 net carbs per day while my daily average glucose has gone up from a low of 98 to now being around 109. This is an expected result due to neoglucogenisis from my body metabolizing stored glycogen in body into glucose. I expect that I will see this increased average blood sugar until I am no longer over weight. This is where insulin resistance becomes evident and why I am constantly trying to get my doctor to include HOMA-IR in my blood panels. Without knowing how insulin resistant that I am, blood sugar numbers regardless of their accuracy are just a number in a very complex metabolic chemical pathway. Why doctors are resistant to ordering HOMA-IR is beyond me. They’ll say that that blood test is not very accurate or reliable which is true in an absolute sense, but not not in a usefulness sense because they do correlation pretty closely with the complicated and expensive test of determining and analyzing true insulin blood levels. Charting HOMA-IR vs. Blood Glucose would be so much more helpful than just glucose alone. Without knowing how badly one’s insulin resistance is, ie. How much insulin you pancreas is releasing into your blood stream, it’s only a guess what is truly behind high or low blood sugar numbers with respect T2 diabetes.
Thank you. This adds some rationale to understanding my CGM.
Thanks! It was useful.
Thank you.
Excellent presentation! Low carbers may note: A slower insulin response is normal (07:03) after months of carb restriction. One way to make sure is by a HOMA IR test which will quantify(?) the IR. By the way, Cortisol response due to psych. factors (fight/flight) plays havoc with blood sugar 🙄. (One solution for this is to water fast for 6~8 hours after such events.)
I thought fasting with high cortisol makes it worse?
Thanks so much, highlighting some very important points that even endocrinologists don't know how to answer.
Thanks!
Thank you for your support.
Like the new scenario! Amazing video as always
Thanks a lot for this valuable information! Glad that I found your channel
Thanks! Type II trying to prevent Type 1 with CGM
Thank you for your support.
Extremely helpful!! The best I’ve heard. Thank you.
Brilliant! Thank you!
My BG increases from my fasting BG by 8-10 points if I walk in the morning before breakfast. I hope to be able to get a CGM sometime soon to get a better picture of the fluctuations that occur during my day and what foods and/or activities influence the changes. Thank you for this video. It will come in handy when I get one.
I’d like to see you do a video about the long-term 22:01 health risks of someone who has pre diabetes for say 5 plus years- An A1C of 5.7 to 6.1 for example. This person has higher fasting blood sugars - say 5.7 to 6.3 - but no spikes above 7.8.
This is me too! I eat healthy (I watch the quality and quantity of my carbs but not very low) I am a healthy body weight and I do resistance training. I attribute this to psychological stress (anxiety) since an event 6 years ago (working on it!) I’m also post menopausal so there’s that.
I would love to see more work around the impact of stress and a sympathetically dominated system.
Thank you for such an excellent video and the info. Request - Can you please make a video on what to do if the glucose spike is wide (my glucose spike takes about 4 hours to return to baseline.
What changes will make the spike a sharper peak than a wider peak, even if the spike is below 140
Much appreciate your excellent content ❤
Thanks for the kind feedback.
If it takes a long time to return to baseline, this is usually a sign of insulin resistance. In that case, I recommend the following videos, in this order:
To fully understand how the body regulates blood glucose levels and glucose tolerance, and what goes wrong in this process when we develop prediabetes or diabetes:
Regulation of Blood Sugar:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=_0eoEnwxEJ1ZBttj
The first step is to figure out whether we are insulin resistant:
Measuring Insulin Resistance:
ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=C681vsKNjXqWJSMq
If we are insulin resistant, then the next step would be to think through the most common causes of insulin resistance to identify potential reasons for OUR insulin resistance:
Causes of Insulin Resistance: The Personal Fat Threshold:
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=eK6OeDRpGNpPzOqW
Insulin Resistance: Top Causes & Contributing Factors:
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=kfHudBNBlFN1NlzU
To understand why insulin resistance is damaging to long-term health:
Insulin Resistance Syndrome: A Neglected Risk Factor for Chronic Disease:
ua-cam.com/video/Fg3n-vi2t3Y/v-deo.htmlsi=Cob6H4vwk6yCz12F
Wearing a CGM can also be useful to identify early signs of glucose intolerance and insulin resistance:
The Complete Guide to Understanding Your CGM Data:
ua-cam.com/video/DVND90vQ0xI/v-deo.htmlsi=vpLTb-bAIvenYWjB
And once you have identified potential causes or contributing factors to your glucose intolerance and/or insulin resistance, you can address these specifically. It’s important to be clear that while excess visceral and ectopic fat is a common cause of insulin resistance and glucose intolerance, it’s not the same for all people. Others are insulin resistant because of low muscle mass, chronic stress, chronic sleep deprivation, or micronutrient deficiencies.
Hope this helps.
@ this really helps- thank you so much 🙏🙏. I will review the videos you mentioned.
I am already wearing a OTC CGM and am prediabetic. Trying to reverse it! thanks again 🙏🙏🙏
In my opinion, the spikes are not as important to focus on as the fact your blood glucose levels, as measured by a CGM is consistently outside the range. And if that’s the case then you certainly want to get checked as in the long run this will cause many other health issues.
The spikes however do offer an interesting data for managing your pre/diabetes conditions.
For example your response to certain food and how much of you can eat to limit the blood sugar increase.
And in doing that, your body will eventually become more insulin sensitive.
I was diagnosed with type 2 diabetes 8 months ago and was pre-diabetic for over a decade.
My a1c went up to 9.2% from 5.7%
My doctor recommended I use a CGM. And this was a life changing advice.
After 8 months my a1c is down to 6%!!
Additionally the CGM helps decide how much I eat, what and when.
It tells how much I need to exercise and how much is too much.
As always, Thank you Mario! You have placed definitive cutoff readings so frequently presented within an understandable context but retained an awareness of their relevance. It is not real easy to work out personal glucose tolerance but you have removed some of the angst by providing a way forward. Cheers
This was very interesting and quite informative. Thank you for doing it. And thank you for mentioning that laying on a sensor can cause a low reading. I have been involved in a face group group for type twos in which it comes up regularly. Usually when someone new to cgm's is woken up by the alarm and not understanding its a fluke takes an excessively large amount of sugar with out doing a blood sugar check to confirm what was going on.
Very nice . Mario is very knowledgeable and explain very well , and his content is evidence based.
Nice to hear from you, you have such a good quality content 🤗
Thank you so much 🤗
👏👏 best talk on this topic. Congratulations
So clear, practical and helpful - thank you.
Thank you! Helpful
Welcome back. I was sent here by a recommendation by Nutrition Made Simple.
What a good discussion, as always well thought out, with data and presented in a logical manner. congratulations for the great work you do Dr.
Thank you for another great video! So grateful for you!
Thank you Mario. Helps distinguish silence from hype!
Incredibly informative - thanks
Thank you for this fantastic episode. Very informative and clearly explained in a neutral manner.
Excellent video! Thank you for disseminating evidence based information!
Objective and scientific knowledge 🎉❤🎉❤
Excellent video. Thank you.
Thank you for this video! I found your videos a year ago after questioning the 30mg/dL rise being touted as “unhealthy” and subsequently changing CGM companies for this reason. I know exactly which company you’re talking about 😉
Thank you for your video! It contains valuable information!
Thank you so much for this informativ video. I have missed your Videos so much. You have said, that after a low carb diet, we should integrate more carbs to restore our insulin respond. Could you explain why?
If you're regularly consuming carbs, the pancreas will be used to responding to them, and will actually keep some premade insulin stored so it can respond and release it right away. When you don't eat carbs it stops keeping that store because you don't need it. Then when you eat carbs unexpectedly the beta cells have to make all the insulin on the spot. So it is a slower response.
But if you consume carbs for a while again the pancreas will know it needs to maintain that store again
Yes, what @tselski said! Thanks!
When I was diagnosed with T2D back at the end of 2022, I was literally off the charts. At the time, I didn't understand the numbers and the fuss with my blood glucose level at being over 28mmol/L (>504mg/dL!) but the doctor and nurse who tested me seemed very urgent to get me to take medication and see other specialists for treatment. Over a year later, it's now more average around 8mmol/L (144mg/dL) and currently managing spikes (usually over 10-13mmol/L after snacks and meals) by trying out a CGM
Glad you are controlling your blood glucose better these days.
If I may suggest, you may find these videos here helpful, in this order:
The basics of how blood sugar levels are regulated, and what goes wrong in diabetes:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=m7T23zQwMc25Hxcp
To figure out if you are insulin resistant, a common cause of glucose intolerance:
ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=NJFuxjT-mh3xj2NK
If you are insulin resistant, to understand why you may be insulin resistant:
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=VBUg60B2f0Y5jrLq
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=-iPi09SYz3to0ML9
To understand why insulin resistance is harmful:
ua-cam.com/video/Fg3n-vi2t3Y/v-deo.htmlsi=ljX7nTAqVj8f58b_
To avoid blood sugar spikes to 180 mg/dL or higher:
ua-cam.com/video/yg0Y3eNSANg/v-deo.htmlsi=gwAVoW2Ch0HRqLDI
ua-cam.com/video/LVw60RIhbzg/v-deo.htmlsi=IiTbUkTjwdG_6Jen
Best wishes,
Mario
@@nourishedbyscience thankyou
Excellent content & presentation
Very informative video. I will watch more. My interest is in the glycemic index and dietary management of diabetes. I have only recently commenced watching YT. Anyway, there are people that use their CGM to test the effects of food on their glucose levels. As example, he tested white potato and sweet potato for different Short videos and compared them. After the tests, he said that his blood glucose levels for the both foods were the same. However, white potato has a higher GI and sweet potato a lower GI. He also tested another food and ended up with about 3 peaks during the two hours of the test. I have noticed this with others, even one with Type 1 diabetes. You stated that CGM is not used to diagnose prediabetes or diabetes. This is similar to the GI because GI uses a protocol that blood glucose is tested every 15 minutes, after the premeal test and after the food is consumed, for 2 hours. CGM does not test blood glucose but interstitial glucose. You mentioned blood glucose throughout the video rather than interstitial glucose. I’m not sure whether the two are similar, because the CGM tests on YT could not possibly be used to calculate the area under the curve to obtain the GI. Your opinion would be help me greatly. Thanks
Awesome explaination.
Very helpful, mil grazie Mario.
Excellent examination of blood glucose variability. I would like to add a few points however. First current CGMs are simply not as accurate as most people seem to think. It is therefore important to realize that single readings should never be assumed to be totally accurate. Patterns are therefore more important than single readings. Another factor that plays a role in assessing blood sugar response to food intake is the type of food you ingest. Obviously the higher in carbs a food is the more likely it is to cause blood sugar spikes. Not so obviously different people can respond radically differently to food. Thus one person may experience large bG increases to white bread while another person may not.
Please make a video or a short about Berberine!
Thank you!!!!!
Reassuring: thank you sooo much xx
Thank you for this video. I wear a cgm and have a normal BMI of 20. I don’t eat a lot of sugar or carbs anymore but I ate some licorice mints the other day and I went above 200. When my blood sugar spikes like that, I become so tired that I immediately fall asleep for a few hours. It’s happened every time my blood sugar rapidly rises. I guess I need to see a doctor.
Thanks Mario for another superb balanced video based on science. I found one study based on oggt that suggested 1hr > 155 could be predictive for diabetes ( jcem 1hr postload hyperglycaemia 2018 fiorentino ...link wont upload) would be grateful for your views on whether this could extend to food. Thank you again for all your work.
Yes, I know that paper. It's interesting, but I am not sure it holds a lot of value for the layperson, beyond what I shared in this video. First, the papers are based on OGTTs, which constitute a very different glycemic load than normal meals. Second, the paper in essence just shows that people with higher postprandial blood glucose to a standardized load have a higher risk of later developing diabetes. That is hardly surprising, right, because glucose intolerance is a continuous process, and it would seem plausible that hyperglycemia and glucose intolerance develop gradually.
That said, for most people, the spike after a meal occurs around 45 min after the start of the meal. That means that glucose levels should be on a downward movement at 60 min, and if they consistently are still above 155 mg/dL, that would strike me as a sign of at least mild glucose intolerance. Again, because the data suggest that increases in blood sugar into the 140-180 mg/dL range do occur even in very glucose tolerant people, but they are infrequent and brief.
Best,
Mario
@@nourishedbyscience Thanks Mario for a really detailed answer ... that is what I took from the paper too (and yes not a lay person) but many are looking for optimal and like you I believe this is an area where we can get over worried so will include this paper when i present my findings... you are so good to help us all in this way.
Thank you for this, good timing. I have been watching your videos for a while, but I was too busy to test with a CGM. I am on my second sensor, third week, with a Stelo. My A1c is 6.2, but glucose rarely spikes much over 140, I can calm down now. Another influencer says that the CGM trumpsan A1c test when it comes to glucose levels. I do compare the Stelo sensors to my finger stick meter, and the first sensor readings were quite close, the second sensor seems to be reading between 15 and 20 mg/dL high. Hopefully Dexcom will allow calibration of Stelo sensors like their other sensors. I will probably buy another pair of sensors and then stop for a while.
excellent video!!! I've realized I've done things wrong over the past 3 months where I tried to extend the non eating window and never have carbs on its own, so I would often have 1 treat after a meal, and if there were carbs in the meal it would overextend the spike even higher. Would be better to let the spike come down and then have the treat with a much lower glucose peak. I'm in the middle category with spikes that shortly go above 140 but then come down again, I'm somewhat compromised. For next 3 months I need to follow a different eating routine.
Just one standard serving of pizza, with a calibrated CGM (Dexcom G6), I went from 4.8 mmol to 13 mmol, within 30-45 minutes. We drank water.
This was typical Italian pizzeria stating 100% made onsite dough and sauce, wood oven.
In this same time period, did 15 min blood pricks that confirmed what the CGM said 15-20m later, and my wife that is not pre-diabetic, she went from 5.6 mmol to a max of 8 mmol.
IOW, confirming what this video says. My spike was huge and it took over 4 hours to return to "normal" 5.5 mmol, where 1.5 hr later my wife was back below 6.
When fasted and not spiked from previous day, my BG is 4.2/4.4 and dawn effect brings it up to 4.8-ish.
So maybe the pizza test could be used as a baseline.
Very useful, thank you. That being said, I am still not clear on the difference between normal and optimal. A spike to say 170 may be normal but is it optimal? Is it something to be OK with if it happens daily? More to the point, is the pancreas meant to be "exercised" once in a while with carb challenges or is it more like the liver with respect to alcohol, i.e. a healthy one can handle 4 drinks but, really, optimal is as little as possible. Between the two extremes: keto vs very high carb diet would you say moderate low and complex carb would be ideal?
I don't think we have any data to support any specific macronutrient composition as optimal for everyone. If someone is glucose intolerant, they may benefit from reducing their carb content, at least until their glucose tolerance has been normalized.
My sense is that currently we do also do not have any data to link short blood sugar increases into the 140-180 mg/dL range to negative health outcomes. It is possible, as you say, that it's suboptimal, but that would be a guess and not based on any data I am aware of.
Best,
Mario
Love your videos. FYI in the US T2DM can also be diagnosed with a random blood glucose level ≥ 200 mg/dL (11.1 mmol/L) at any time of the day.
Yes, correct, but IMO, this criterion should not be applied to CGM data without further testing, as the false positive rate would be too high.
I think the issue is that if a patient comes into a doctors office once, usually fasting or a while after eating, and has a glucose > 200 mg/dL, the likelihood that they indeed have diabetes is high. However, with CGM, we get data every 5 minutes, including immediately after eating, and I don't think that the relationship between sensitivity and specificity of the random glucose test hold up very well under these conditions. I am hoping that we get updated criteria on this with CGM data, and would assume that the threshold for when diabetes is suspected is going to be a bit higher than 200 mg/dL.
Cheers
Mario
I am one of those otherwise healthy people who wore a CGM for a month. I follow a predominantly plant-based diet. My glucose levels would “spike” every time I ate anything. I could have avoided spikes by swapping my fruit and beans for beef jerky and hard boiled eggs. I’ll stick with my plants and take my chances!
So how did ypu manage the spikes?
You could still try to front-load your high-glycemic carb meals with fiber-rich veggies, salad, and plant protein.
I have gone the other way and decided to eat massively reduced carbs. This means that I have to eat more meat and dairy. I was diagnosed with prediabetes in May and I’ve managed to reverse my blood glucose with the help of a CGM. I will honestly tell you, I’d give up all the meat for some fruit or any carbs for that matter 🤤 I miss pasta 😂 I am still very sensitive to carbs unfortunately although I have kept my intake low.
Hey there are a lot of things that can help reduce your glucose response and spikes such as eating first your veggies, fiber, healhty fats like avocado before as an apple, an orange or any high glycimic fruits, also you can walk after a meal or drink vinegar before, you dont need to eat meat, please look at glucose goddess tips she has really great info also a plant based diet should be well planed to be healhty.
Many thanks very helpful
Better test of diabetes is measuring insulin. HOMA IR or Kraft insulin Assay Test. Early detection is better than cure. Hyperinsulinimia even if blood sugar thresholds are still normal. Definition of diabetes should change
Diabetes is actually insulin resistance + Relative Insulin Deficiency because pancreatic Beta cells fatigue or dysfunction= Type 2 Diabetes. Or not able to follow Insulin's Own Natural Circadian Rhythm.
Measuring insulin is not a 'better test of diabetes'. By definition, diabetes is a condition of glucose intolerance, and while related to insulin resistance, is not the same. Let's try to be clear and not muddle up things.
Insulin resistance is important, and you'll find many videos on my channel about that as well, but glucose intolerance and hyperglycemia are independent risk factors for many severe chronic diseases in their own right. My position is we should normalize both insulin sensitivity and glucose tolerance, but this video was just about glucose tolerance and glycemia.
Best,
Mario
@@nourishedbyscience
Science is challenging the status quo. Proving existing guidelines wrong. High insulin levels using root cause analysis and 5 why's will show that high insulin levels even if your glucose value is still low is abnormal from the acceptable fasting insulin levels or using Kraft insulin Assay Test. Catching this high insulin levels early will be the best way to cure Diabetes faster and easier with low carb or keto diet
@@nourishedbyscience
Best to challenge the status quo of a glucose centered approach to diabetes. The only constant thing in this world is to change for the better
@@nourishedbyscience
Interview Dr Ben Bikman expert in insulin
Well done for carefully presenting the important details on the use of CGM.
However, I think it will be incomplete to talk about fasting blood glucose (fbg) without talking about the duration of the fast: i.e. if the person ate previous day's dinner by 6pm, the fbg will be much lower than a case of 11pm dinner.
Also the time of measuring the fbg in the morning is to be considered.
Also to be considered is the portion (size) of food and the carb content.
For me, when I eat high carb content (e.g. 6 slices of bread with sweetened chocolate drink), I experience a spike (up to 220 from baseline of 89). But within 3 hours it goes below 100.
But when I eat a high protein diet (e.g. beans) which takes a longer time to digest, the spike is only as high as 150 but takes up to 5 hours to go below 100.
I understand that this is because the slower digestion of the proteinous meal slows the absorption of glucose into the blood. Hence a longer duration of the spike.
An important point is missing here. What these subjects do within those two hours matter hugely as far as glucose spike is concerned. Just a simple leg calf muscle exercise for a few minutes brings it down by 15-20 points.
Yes, good point. Thanks for chiming in.
Im wearing a cgm. Only for 14 days. Early on I noticed that porridge ( not instant, steel cuts oat) accompanied by Greek yoghurt made my blood sugar rise by a good 50 mg/dl. From about 80 mg/ dl to 130. So I was quite apprehensive to test 75 g glucose. But if you don't try you don't know so I did and it rose by 55 mg/dl. I expected more tbh. Or porridge and Greek yoghurt to make it rise less. I'm not diabetic nor pre diabetic and my blood sugar is able to rise from 85 to 140/ 145, easy so quite a jump. Then i it will start going down then back up again down up again for about 5 or even 6 hours hours if I consume a big meal including carbs. To reduce that length I can go for a fast walk and iit will go down quicker tho.
My blood sugar rises quite a lot when I exercise. It also rises when I take a shower or do the dishes. Also when I fast. It seems whenever I need extra energy it will rise which I found strange at first but ok..
Also I tend to experience hypoglycemia ( or is that dawn syndrome or reactive hypoglycemia?) at night. But when I replace sweet snack by cheese or an avocado or don't snack at all tthen I don't go hypoglycemic. I managed to reduce this occuring from 11% to 2% so wearing a cgm has been great if only for that). Hopefully that helps give my liver a break and having to" rescue me" ;-)
My BMI is 20.2 and AC1 4.7%
Fascinating experience imo. It's been like a little journey within some part of my body that was so far unknown.
Thank you very much for another outstanding video.
This was very good, indeed one of the best looks at the published data deciphered for a general audience. BUT the final synthesis, by emphasizing being under 140 mg/dL “most of the time,” missed the most important metric a CGM can give: average blood glucose (ie, area under the curve). Having a healthy average blood sugar between 90 and 100 mg/dL would not result if one were at around 130 “most of the time.” It’s really down to how readily one returns to a fasting level after their meals.
I suggest that if someone meets all of the criteria, as outlined, their average blood glucose will be low. That is because there are exactly zero people who have normal glucose tolerance and who keep their blood sugar in the 70-140 mg/dL range 95%+ of the time who have stable blood glucose at 130 mg/dL for more than a few minutes. If someone can regulate their blood sugar as I outline as normal, then their blood sugar will never just hang around 130 mg/dL.
Does that make sense?
Best,
Mario
@@nourishedbyscienceit does to me, cheers.
Super....
@nourishedbyscience
I have been keto for years. Blood spikes are not an issue. I have been using CGM Stelo for 3 weeks now and I very very rarely have any readings below 90 ml/dl. I am OMAD and Median Avg BG = 104. How do I lower my BG so that I see many more 80 and 90 readings instead of the constant 101 to 114 range? Note that Cardio and exercise does not seem to help. BG increases and then comes down to "my" baseline of 100 to 102.
Exactly my situation.
The average glucose rise needs to be accompanied by the deviation range. But otherwise I’m pleased with your presentation. BTW, I am a Type 1 diabetic over 31 years.
If someone meets the criteria, as outlined, their SD will be low. And I beliebe that these criteria are more intuitively grasped by most people than SD.
Cheers
Mario
Dear Mario, I appreciate the valuable educational content you provide. Regarding your discussion on high LDL levels, are you advocating for a reduction in the intake of foods high in saturated fats, such as full-fat dairy products and red meats? also about Visceral fat storage dysfunction is a contributing factor to diabetes. If dietary and lifestyle changes are not effective, what are the recommended safe medical intervention. Thank you in advance for your response and effort.
Thank you, brilliant talk. Any discussions on how BS respond after an injury/ surgeries that prevents normal activities?
Any major surgery will trigger a massive increase in inflammation, and this by itself can trigger insulin resistance and glucose intolerance, such that many patients will be diabetic for a few days after major surgery. Therefore, my first suggestion is to ask your doctor to monitor blood sugar levels for about 1-2 weeks after major surgery. Wearing a CGM during this time may be a good idea, and modifying the diet to minimize blood sugar excursions.
Other than that, chronic inactivity can also, by itself and independent of inflammation, trigger insulin resistance within a few days. I talk about this here:
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=h_4cRFxokJ2B18y0
Best wishes,
Mario
@nourishedbyscience TY! I've been wearing a cgm on my own accord right before my fractured knee & surgery. Geez, my glucose spiked 250mg/dl (fasted) during 2 hr surgery. That was an eye-opener! I appreciate you🙏❤️
@@lesworks No need to panic; it's very common, and almost certainly temporary. Still probably a good idea to limit such spikes.
Thanks for this video. I was looking for something that showed what a normal persons blood glucose does after eating and even though this doesn't go into super detail, its good to know that the whole "30 points is too high of a spike" thing that so many youtubers throw around is not true. It's true that you can keep any spikes below 30 by eating nothing but meat and low carb vegetables but life gets pretty boring IMO if that is all you eat. I love fruit and am not giving it up and my blood sugar will spike 40-50 points after eating some fruit but it always comes back down to around 80-85 in 3-4 hours. I have cut out pretty much all processed foods with the exception of lunchmeat and low carb bread/tortillas which I don't eat all that often. I've lowered my A1C from 6.5 to 5.3 and lost over 50 lbs so feel like I am doing pretty well.
If your glucose levels remain elevated above 100 mg/dL about 2 hours after starting a meal, this could still be a sign of insulin resistance, and there may be value in identifying and addressing any potential triggers of insulin resistance:
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=WEhaPV3nI0Va_kID
Cheers
Mario
@@nourishedbyscience Oh I have no doubt I am still insulin resistant. From what I understand, there is no way to really reverse that once you have become T2 diabetic. You can lower your A1C by eating low carb but you will be insulin resistant the rest of your life (unless they figure out some medical way to reverse it). I know it is fruit and the low carb bread/tortillas that raise my blood sugar but I am not giving those up. I keep the spikes below 150 for the most part even if sometimes it stays elevated for 3 or 4 hours before going back to normal. Life is too short to not enjoy some amount of sugar which I do now with fruit instead of candy or desserts. I don't over do it and have kept my A1C down to normal levels so I am happy with where I am at.
@@admgloval That assumption is incorrect. Glucose tolerance can be improved, both by improving insulin sensitivity and - in some cases - improving insulin production. The key is to figuring out WHY you are insulin resistant, and then systematically addressing that in a way that you can maintain long-term.
Best wishes,
Mario
@@nourishedbyscience I may have to try your suggestion of bringing carbs back into my diet and see if glucose response improves. I went low carb for about 4 or 5 months (50 carbs or under per day) and dropped my A1C from 6.5 (what it was when I was diagnosed with T2 diabetes) to 5.3 in July. Since then I have started eating small amounts of some carbs that I had cut out completely, mainly junk type food like chips or candy. Typically when I do I see my blood sugar go up from around 85-90 to 134-140 and it will stay elevated above 100 for 3-4 hours before returning down to normal. During that time it goes up and down though between 135 and 90. I was always under the impression that once you had insulin resistance that you had it forever. When I was doing 50 carbs and under, my blood sugar was always around 80-90 with low spikes up to around 120 and then back down to normal.
@@nourishedbyscienceHow do you figure out 'why' and then how do you improve insulin sensitivity?
Thank you
Your deliverance is perfect for me for I am not a scientist, many videos are for fellow scientists. I am prediabetic and insulin resistant (both slightly), started on low carb(average 60 a day) 8 months ago, ordered my CGM yesterday. I believe all people are not the same so carbs can be an issue in some people and diabetes runs in my family. Additionally, removing grans cured my severe IBS.
Very interesting. Any thoughts on hypoglycemic readings post-Covid ( or other) vaccine? After about a month of wearing a CGM to test food reactions, I got dangerously low alerts from the Dexcom G7 in the middle of the night for the 3 consecutive nights after getting an updated Moderna Covid vaccine a few weeks ago. The first night I assumed a malfunction and removed the sensor, but it happened again with a new sensor on the opposite arm for two additional nights. I confirmed it with an old fashioned finger prick monitor, ate a few dates, then went back to sleep. Things returned to normal after that. It was definitely unexpected. I can’t say whether prior vaccines might have provoked a similar reaction as I this was my first test of a CGM.
"that's a pretty easy thing, you just need to eat fewer carbs" - that's actually a very hard thing to do.
No joke. They put extra carbs in everything! There's no need to do that, other than making "food" more cheaply. But then, they charge a small fortune for anything resembling real food. Beyond frustrating.
It’s really not that hard. Buy real food instead of the processed junk. And stay away from bread pasta potatoes. It’s simple. But people are literally addicted to the processed crap located mostly in the aisles of the grocery store.
@@jean4157 You are right, in a way, but also not quite correct in saying it's simple.
It depends a lot of where you live, and whether you have access to those foods/ingredients. Grocery stores have caught on to the fact that more people are wanting to eat more healthfully. In some areas of the US, fresh vegetables are very expensive. Frozen vegetables are (sometimes) not pleasant to eat. Canned vegetables are loaded with extra ingredients.
Fruits have all the same problems.
Think about it. Someone who lives in a larger city, who does not own a car, earns Federal minimum wage - they are not going to have time and energy to shop frequently, prepare for cooking and then actually cook a lot of wholesome, healthy food. Besides, who was supposed to teach them how to cook? Their mother, who likely raised them on prepackaged, cheap, convenience food? School?
The other end of the spectrum - those who live in the country literally have no feasible way to get more than a handful of groceries home from the store. They are going to look for lightweight items that they can carry easily.
Not everyone has the privilege of living in Pleasantville suburbia, with easily accessible transportation, and an affordable supermarket every couple of miles.
I have glucose peaks of 170 to 200 when I eat more than 30 to 70 grams of carbohydrates in a single meal, after 2 hours it drops to 80 to 70, sometimes it goes from 150 to 80 in 15 minutes. But, I just finished the keto diet 3 days ago, so I guess as the days go by I will improve. My fasting insulin at the end of the diet was 2.4 fasting, meaning I wasn't producing enough insulin I guess.
Your low fasting insulin probably means that you are very insulin sensitive. My best guess is that you have a (temporarily) diminished first-phase insulin response due to your long-term low-carb diet. The first-phase insulin response is based on pre-formed insulin that is stored in the pancreatic beta-cells and that can be secreted into the blood within seconds of consuming carbs. That first insulin secretion prevents a spike from happening. Just re-introduce carbs a bit more gradually, and eat some non-starchy veggies or salad AND some protein before you eat carbs for the next few weeks. That'll slow down your carb digestion, and the protein also stimulates insulin secretion before your carbs are absorbed.
Cheers
Mario
@@nourishedbyscience Thank you
Great video. Info about 1,5 AG as a biomarker was interesting. I would have liked a bit more emphasis on the area under the curve and the convexity of the curve in the post peak. Ideally the peak should come down rapidly l and we know that. But how much should the rate of decrease be and how could it be an indicator of developing insulin resistance would be interesting to know
I would simply pay attention to the glucose concentrations two hours after beginning a meal: is it usually back to around my baseline, ideally
@@nourishedbyscience Yes. By rapid I meant the average downward slope in healthy homeostasis of glucose levels. Any variation on either side is likely to be indicative of an imbalance for sure.
Just created my 30 average of hourly readings over a 24hr period. It was quite a revelation. Knowing the physiology and biochemistry of glucose helped me further understand my personal response to a challenge with different glycemic foods ingested under different conditions.
People should start making difference between acute and chronically
I wear a CGM and it tracks every 15 minutes. When i had large quantities of carbs, my glucose spiked to 210 but after 30-45 mins ,it came back to 105 mg/dl. Is it normal for such a high spike in glucose?
So a few months ago my fasting BS was 77 and A1C 5.1. Since having covid, my morning sugars are 100 to 105 in my CGM..... Very frustrating. Hoping time and keto/IF will bring it down.
but i eat no carbs and my blood sugar is high. if i eat a steak it goes up. only if i eat fat it doesn’t go up.
Thanks for the video. BTW, given glucose concentration 5mmol/L and molar mass 180g/mol, the homeostatic glucose in the blood in human readable form is 0.9g/l or 4.5g for the whole 5 liters blood volume. The glucose adsorption is around 96%. There is the question: why we abuse the body with the external glucose in many times bigger concentration that body have? We know that there is no storage for glucose nowadays for sedentary population.
I feel strongly that the issue we should address is glucose intolerance, and that blaming carbs is short-sighted. If someone is glucose tolerance, they can eat all the carbs they want and not have any problems. What we should be talking about a lot more is why people are glucose intolerant, and - again - it's not carbs per se IMO.
Best,
Mario
@@nourishedbyscience , thanks. Based on Glucose - Fatty acid cycle, historically, we rarely mixed glucose with non-glucose sources, until last 12-10k years ago. Given that, the genetic and evaluation aren't fast process, IMO, I'm still not convinced it was long enough to get humans adapted to such glucose surge every meal. BTW, Homo Paranthropus extinct.
5:46 what is a definition of a “your typical meal”?
There could be a meal with almost no any carbs and there won’t be any spikes, or another meal with lot of carbs, so that spike can be elevated for hours… it would be more helpful if you can provide concrete numbers, like “after a meal with about xxx grams of carbs”. Also, it is very important to mention for what kind of person size/gender/age/activity level that stats are relevant. Because for one person 75g of glucose is “full stomach” dose, for another it is not even a half…
15:56 “fasting state” is another uncertain definition. After year of experiments with CGM I realized that “fasting state” is very outdated meaning. The morning blood sugar numbers could be easily manipulated with meals taken day(s) before the measurement. And another factor is body composition and amount of physical activities before the measurement. Say a person with high muscle mass can easily consume glucose from blood with just few minutes of walk and little stretching… I’m just trying to say, that the diagnosis by measuring blood glucose with single test is outdated, it must be considered in the dynamic.
Yes, I agree that ideally a doctor would diagnose diabetes or prediabetes based on several tests. It is definitely true that morning/fasting glucose can fluctuate a little bit up and down based on a few factors.
However, I had good reasons to not provide more specifics about the exact g of carbs during a meal. While the amount of carbs plays a role, the quality of these carbs (i.e., their glycemic index) matters at least as much, as does the composition of the rest of the meal. As long as we are eating some carbs, however, all of these things are dwarfed by our glucose tolerance. As I explain in the video, as long as we are regularly eating some carbs as we are wearing a CGM, we should be able to get a pretty good sense of our glucose tolerance, irrespective of what the specific amounts and GIs of these carbs are. If I had included specifics of what a optimal blood glucose response would be in response to a specific glycemic load, the video would have immediately become useless, because most people cannot or don't want to calculate the glycemic load of their meals. So, of course, this could be done in a more academically precise way, but I believe the way I have presented it here is the better balance between usefulness rigorous consideration of what is known about normal glucose homeostasis.
Hope this makes sense.
Best,
Mario
Still.....how do we know that we're even supposed to eat the foods that raise the blood sugar that much? Also how do we know what normal is if the study's general purpose is to find exactly that with "normal" individuals?
This is an excellent question. Love this. Thanks.
My view here is that from observing the normal range in which the body keeps glucose regulated, we can actually get a sense of which foods our ancestors ate as we evolved. From the data I shared, it does seem very clear that the body makes substantial efforts to keep blood glucose in the 70-180 mg/dL AT ALL TIMES. That is absolutely remarkable, because the amounts of glucose we often eat in a typical mixed meal are multiples of the total glucose content in all of our blood. And this system shows some evidence of redundancies, such that defects in one component can be compensated by another component (insulin resistance can be compensated by higher insulin secretion). So the fact that such a nuanced, robust glucose homeostatic mechanism exists seems like indirect evidence to me that humans are adapted to consume glucose-containing foods (sugar, starch).
To phrase differently, our body does NOT seem to have any homeostatic mechanisms to always keep blood glucose in the 70-100 mg/dL.
Admittedly, this is not strong, conclusive evidence, but to me suggests that humans evolved on diets that contained at least some carb-containing foods.
Cheers
Mario
@@nourishedbyscience Very interesting look....you can definitely find logic in that. But going the same route...how about blood pressure regulation? BP is also pretty tightly regulated and the body if healthy would increase it to 150/100 for example when stressed. But these days everybody is stressed overtime, numbers climb and we have new normal. Despite many people are very sick and have degenerated cardiovascular system, the body is still giving its best to keep the numbers under 200 systolic. But that's not healthy we can agree? Acute stress is better than chronic stress....but lower instances of acute stress is even better. If I eat as similar as possible to our ancestors, my glucose would absolutely never rise more that 20-25mg/dl. Also if we get even more basic - if we're close to peeing out sugat at that levels 180mg/dl.....how the hell would testing the absolute limits of the system regularly be healthy?
I started using a keto Mojo monitor, about a year ago. This year I decided to get a CGM.
I can tell you , that the finger prick on the Mojo monitor, gives different readings sometimes drastically even with the same drop of blood... this is why I got the CGM. Which one is more accurate?
Very good information. Thank you. I'm wondering, is glucose intolerance the same as insulin resistance? or does one precede the other?
Insulin resistance is one possible reason of glucose intolerance.
Type 1 diabetes is glucose intolerance without insulin resistance.
@@TasteOfButterfliesThat’s not entirely accurate. Type I is when they don’t produce any insulin at all, or at times, very little. But even type I patients can develop insulin resistance based on their self-administered doses.
I suggest you watch this video here on how insulin resistance relates to glucose tolerance:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=gIGcgWXuN1hwuTPR
Cheers
Mario