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

[Music] all right and thank you every I'm rod and low cal down under for arranging this conference it's always so fun to see our low carb friends and I'm talking about continuous glucose monitors not in people with type 2 diabetes but in the healthy people there aren't many of but just in healthy people and I use these monitors in a lot of my patients and some of them do become a little bit worried and this controversy actually as to whether we shouldn't use them in healthy people because they do get worried so the two that I use and uh are the freestyle Libra so hopefully you all know what a continuous glucose monitor is it's just a very clever sensor that measures the blood glucose just shallow just in the your dermis and it feeds the information back to an app on your phone or to something called a reader and it's been lifechanging for people with diabetes they don't need to finger stick all the time they getting immediate feedback as to what their sleep's done to their sugar what food does to their sugar so every minute to 5 minutes they're getting this feedback so it's amazing so of course us healthy people want to have a go as well so this freestyle Libra is the one I mainly use and we're so lucky in Australia because we can just walk into the pharmacy and buy one that's sitting there behind the counter nobody asks you any questions and then you upload the lib link app onto your phone and Away you go um they do cost over $100 and they last about two weeks but at the moment there's a trial offer for $15 so quickly get on um the problem is when you buy it online they will ask do you take insulin or not the Dexcom G6 is also amazing and I never used to suggest it for patients because it was over 700 $100 but they're $10 at the moment so if you go to that website they've got a trial offer for $10 if you just Google it then you get the Dexcom G6 app on your phone and again away you go but there's a lot of controversy should we be recommending this in healthy people and this became clear to me back in 2021 so like Loren I am a big Nick norwitz fan he's amazing and Nick um he a Harvard medical student and he got 40 of his friends to wear continuous glucose monitors and they published their their findings because they all found it so helpful and they learned a lot about metabolic Health but there was outrage on Twitter about this study so everything in nutrition involves outrage uh Nick it was like how ridiculous medical students with cgms what could be more dangerous than that um and Danielle there were a few reasonable comments so Danielle Bardo is a vegan cardiologist and and and Nick was bullied a little bit um but this is quite a reasonable comment you know there's no data that using cgms in healthy people is beneficial you know until we've got robust randomized control trials we shouldn't no health professional should be recommending it and then Nicola guess is a PhD dietician very clever from Oxford and she said something and I do see this in my practice too that healthy people come to her they've worn their CGM their blood sugar just goes from 4.9 to 6.4 after they eat and they're like oh god I've got type 2 diabetes so that's what she sees so she thinks people shouldn't do it um but I'm with Nick he says well it's just data people worry when they they SC we give them a scale they weigh themselves when they measure their blood pressure at home they get worried about that you know but it's still very useful so my job today is to teach you not to worry okay you're a normal non you're not normal you're a non-diabetic person and you wear a CGM I want you not to be worried so when you set up your app it's going to ask you to set a lower and upper limit and you need to set the low as low as you can but no matter what that app is going to ring a bell if it drops to 3.1 now that does not mean you need to go and eat chocolate okay a lot of people go oh it's 3.1 I was having a hypo no this app is set up for people with diabetes on insulin and Sanol uras and that that's to save their life because they could die but that's not you you're not on insulin you're not on a Sanol Ura if your sugar is is low well that's great that's healthy so set it as low as you can and then the upper limit on the app you can either set it at 7.8 or at 10 and in a minute you'll you'll learn why it's not NASA technology it makes mistakes so often you'll put not often but sometimes you'll put your sensor on and you you get all these weird numbers one two that's a faulty sensor it's not that there's something wrong with you so you'll have to send it back to the um company keep the serial number get your GP to write a letter and they'll send you a new one the other thing is I've noticed that the Dexcom G6 can read high for the first few days so you might be worried but just let it settle in and then of course if you sleep on your sensor you're going to see huge dips in the night to nothing it isn't that you died it's that you've squished your sensor and so it looks like a big dip so if you see those big strange dips that's what it is the other common question is some people are brave and they do a finger stick blood glucose and then they measure their sensor and they find a different number and it's worry worries them so they're measuring two different things the the the blood one is measuring your Venus capillary blood and the Sens is just just a little bit back in in back in time because it's measuring what's in your tissues so not what's in the blood but in the tissues so they're measuring different time points so make sure if you've just had a meal you'll definitely find there's a difference and also remember there's a plus or minus 20% error rate in the technology so they're going to be a little bit different as long as the trends are the same now when you exercise strange things happen to your blood glucose so that's me going for a walk on the beach and I wasn't having a hypo my sugar just dropped to 3.2 which is beautiful my muscles are taking up the glucose so it's dipping down to 3.2 and that's terrific um but if I do intense exercise I go to the gym I can sometimes see my blood sugar it'll go up to eight but again that's fine that's my liver making glucose so that I've got lots of energy um and my muscles have got a lot of glucose to work properly so what you sort of worried what sugars should I be getting well there's not a lot of studies it's all new but wearing continuous glucose monitors in healthy young people see remember it's hard if just doing the population remember most people aren't healthy but if you pick out the super young healthy people most of the time they're under 7.8 but some of the time they do go above they can go up to 10 but they never go above 10 so you want to be pretty much most of the time under 7.8 but don't freak out if you go above it that's okay but you should be mostly under 7.8 um and if it's low that's okay as long as you're feeling fine that doesn't mean chocolate now I just want to give a plug for Mario crutz who's got an incredible blog based on science it's called nourished by science he's done a whole series about glucose spikes um and this is his diagram which I've pinched um and he said 99% of the time healthy people are under 140 which is 7.8 and only 1% of the time but that's still 15 minutes of the day they're they're shooting up to 10 up to 10 but they never go above 10 so this is where it gets interesting postprandial blood glucose so after you eat what happens to your blood glucose if you eat food with glucose in it your blood glucose will go up okay if you eat berries your glucose will go up and that's healthy and normal normal just try and keep it under 7.8 so remember Nicola guess was saying people think they've got diabetes cuz their blood sugar goes up a little bit that's healthy that's normal but when it isn't normal is when you're getting very large glucose Rises so you're shooting up to 10 or down big swings and we know particularly in diabetes that these this glucose variability is not good it causes endothelial dysfunction inflammation oxidative stress increase mortality and cardiovascular disease so if you're doing big swings look at what you just ate and maybe don't eat that and this is where it comes to low carb cheat days and and I do feel concerned if people cheat a lot because when you're following a low carb diet your body isn't ready for that glucose the the pancreas isn't ready for that glucose so you'll eat a big pizza and your glucose will go much higher than it would have if you're eating a high carb diet it it's even one meal makes a difference so if you eat a low carb meal the next meal your sugar will go higher so even one meal makes a difference if you're low carb all the time and then you eat a big glucose load you'll find your sugar will go much higher because your body's mainly running on fat and your pancreas isn't ready for it so that might be a reason to wear a CGM and do a cheat day and just check what happens so this is quite an interesting story so back in 2019 Rod Taylor was very kind and gave me a free continuous glucose monitor to wear and I was a big serial eater I wasn't low carb myself um and I was always eating porridge I loved it so I got my CGM and um I ate my bowl of porridge with unsweetened alond milk and no sugar and look what happened um and everyone will go that's cuz you're low carb no I wasn't low carb and it went to 11.7 and every single time I eat oats it happens and then look what happened I dropped right down to 3.4 now that's a big glucose variability and that doesn't make me feel good and for years I have suffered from this like midm morning I'd be shaking and not knowing what to do because of my Morning cereal and and sort of immediately that's it that's that's lifelong problem of midm morning shaking and feeling terrible fixed cuz it's the porridge then I ate some rice so that's a big swing you know people talk about spikes that's a spike not just a normal up so of course I sort I was freaking out I was going oh my goodness what is this gosh so then I got on the internet and I was very grateful to this study from 2018 there's different gluca types we all react differently to carbohydrates we're all a bit different and um this is uh Professor Snider um and from from Stanford um and he's saying covert spikes are a problem because they can contribute to cardiovascular disease risk and insulin resistance even individuals considered normoglycemic by standard measures so that's me um exhibit high glucose variability using CGM with glucose levels reaching pre-diabetic and diabetic ranges 15% and 2% of the time so I was very reassured so that's that's seen on this study using cgms in healthy people and of course this can unmask this thing called reactive hypoglycemia and again people get concerned about this I even had a lady email me today thinking that just cuz she her sugar went to 6.9 and then went down to 3.8 after berries was reactive hypoglycemia it isn't it's when it goes very high and then you see it dip right down low and you get symptoms you don't feel well um so that's actually my sister so I got her to wear one and look her sugar with porridge goes to 11 and then drops to 2.9 I mean that she's not feeling good at that 2.9 okay so the problem with reactive hypoglycemia which is defined as a glucose um below 3.9 after food which actually I don't like that definition is you feel awful and it makes you hungry and it's proven it makes you seek out higher calorie foods so that's why you're in the tea room after the porridge at 11:00 a.m. eating biscuits because it it's reactive hypoglycemia so how do you avoid it okay it's obvious you go low carb isn't it so obvious but not everyone wants to go low carb if you add protein then that seems to help so you can see me porridge for breakfast I eat two eggs before I don't get the terrible Spike so eat some more protein or go low carb now the last thing I want to talk about is why is my glucose higher in the morning a lot of people ask me this it's often seen in diabetes so overnight your blood sugar's creeping up but you didn't eat anything where's that glucose coming from and that's one of my patients and you can see she's got diabetes she's got the high sugars most of the time above 7.8 but overnight she's got that big big glucose coming in and that's the liver making glucose it's the liver making glucose that's where it came from um and so this happens because at about 3:00 a.m. you're making these hormones glucagon adrenaline cortisol um and their job is to push push up your your glucose get you ready for the day if you're not a diabetic you usually make enough insulin to keep that under control but if you're a diabetic it's going to go up but interestingly on a low carbohydrate diet we have high blood sugars in the morning and it may be because it's such a low insulin state I'm not sure why it happens but it definitely does but again we don't get huge sugars it might be six people say why is my first morning sugar higher and it's because of this thing called the dawn effect finally we're not measuring insulin so I do have some patients who I know are metabolically unwell and they wear the CGM and they get a much better Trace than me they get beautiful sugars and they'll come back and go hey I'm perfect you go no we're not measuring insulin because it's underneath working very hard to keep the blood glucose under wraps so it doesn't you don't know what the insulin's doing and finally there's this study just out in June cgms in healthy people um so they looked at all the information that we have based on the published evidence we suggest most adults could benefit from wearing a CGM to recognize how different foods affect their own glycemic response control glucose variability because that reduces your risk of cardiovascular disease and may help with weight loss hunger sleep and mental health so they're arguing wearing a CGM you can pick up big swings in your blood glucose and of course avoid foods that do that so I strongly believe that healthy people can benefit from sometimes wearing a CGM you might pick up that you do have diabetes you might be above 7.8 a lot of the time um you can measure your response to carbohydrate containing foods and pick up that glucose variability and see do you have this terrible reactive hypoglycemia and low carb Works beautifully for me I have a beautiful flat Trace I don't get reactive hypoglycemia I can go all day without rushing to the tar room to eat cakes thank [Applause] [Music] you

Channel: Low Carb Down Under

Views: 43,809

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Sydney 2023, Continuous Glucose Monitor, CGM, Blood Sugar Levels, Diabetes, Low carb

Id: B5T5B1dJEyI

Length: 16min 13sec (973 seconds)

Published: Sat Jan 06 2024