[HN Gopher] FDA clears first over-the-counter continuous glucose...
___________________________________________________________________
FDA clears first over-the-counter continuous glucose monitor
Author : bookofjoe
Score : 743 points
Date : 2024-03-06 18:03 UTC (1 days ago)
(HTM) web link (www.fda.gov)
(TXT) w3m dump (www.fda.gov)
| RobotToaster wrote:
| So the ones already all over amazon aren't supposed to be there?
| barelyauser wrote:
| Amazon as a gateway to illegal or fraudulent products? Please,
| a trillion dollar corporation must surely have professionals
| watching this over.
| thfuran wrote:
| I just searched for one and found
|
| >Important information Legal Disclaimer : Statements regarding
| dietary supplements have not been evaluated by the FDA and are
| not intended to diagnose, treat, cure, or prevent any disease
| or health condition.
|
| At the very bottom of the description. That seems like complete
| BS that shouldn't hold up, but I don't know.
| mattl wrote:
| That's on virtually every supplement website it seems.
| thfuran wrote:
| Sure, but a blood glucose monitor isn't a dietary
| supplement. I think it's a bit dodgy that that kind of
| disclaimer means anything for a dietary supplement in the
| first place, but it certainly shouldn't apply to a medical
| device.
| mattl wrote:
| Probably just placeholder text I'm sure.
|
| Look at all the legalese at the bottom of
| https://www.freestyle.abbott/us-en/home.html
| Johnny555 wrote:
| I don't see any non-prescription CGM's on Amazon, are you using
| Amazon USA? I searched for "CGM" and "Continuous Glucose
| Monitor", and only found test-strip devices and CGM devices on
| Amazon Pharmacy available with prescription.
|
| What search string are you using? Can you post one?
| RobotToaster wrote:
| I was using the UK site, that probably explains it.
|
| Usually we lag behind the USA on approvals so just assumed if
| it wasn't OTC there it won't be OTC here.
| baby_souffle wrote:
| > So the ones already all over amazon aren't supposed to be
| there?
|
| In the US, I only see the finger prick type. I do see the
| FreeStyle Libre3 but it requires a prescription
| coldpie wrote:
| I'm T1D (insulin-dependent). I used a Dexcom for a couple years a
| while ago, back around the G3 through G5 era or so. I ended up
| stopping using it because my diabetes is very well managed, and I
| found it didn't make a huge difference to my management. With my
| insurance, each new sensor every week cost about $50, and would
| fail in various annoying ways: sometimes it would just stop
| working in the middle of the week, or not work at all from the
| start, or disconnect randomly for a few hours. Each sensor also
| used a ludicrous amount of plastic for its applicator, like a
| tennis-ball-sized hunk of hard plastic, that you just chucked in
| the trash, every week. Maybe things have improved, but it was a
| bad combo of unreliable and expensive so I just quit using it and
| went back to finger pokes.
|
| If it were like $5 per week, I might put up with it. Maybe this
| over-the-counter model will be affordable. We'll see, I guess.
| mlsu wrote:
| Dexcom and Freestyle both have options (G7, FSL2) that have a
| much narrower form factor than the old sensors. They end up
| being far more reliable, because the sensor doesn't dislodge.
| The new Dexcom sensors are more accurate. Less drift and no
| calibration.
|
| Out of pocket cost is obviously your own situation but I think
| anyone with T1 should look at them. For me they are life
| changing, even moreso if you have a pump that can deliver based
| on CGM readings.
|
| Plastic waste situation is still bad.
| coldpie wrote:
| Glad to hear they're improving, though the waste situation is
| bizarre. I will probably go back on one at some point, I
| didn't hate it, just didn't feel it was worth the
| cost/benefit ratio. It didn't impact my A1c, I've always been
| in the low 6s, and I've only had two lows that I would
| consider significant in my 25 years with the disease. Benefit
| just wasn't there for the hassle and price.
| mlsu wrote:
| That is impressive control, especially with no CGM!
| user_7832 wrote:
| > The new Dexcom sensors are more accurate. Less drift and no
| calibration.
|
| As someone using a freestyle libre who's never calibrated,
| how often do you need to calibrate it? Reason for asking is
| that I'm likely to switch to the g6 if I go with the TSlim X2
| for looping. TIA!
| mlsu wrote:
| No calibration is required for Dex G6/G7. I think you can
| optionally calibrate the G6 but I never have nor have I
| ever had to.
|
| I am going to be biased: I both work on and use the t:slim
| X2. It is well worth it, especially if covered by your
| insurance. CIQ took me from ~70 to 85%, sometimes 90% time
| in range; my understanding is that it's the best closed
| loop algorithm out there currently.
|
| Regardless of which pump you end up on, having a closed
| loop system will significantly improve your control and
| helps you get that extra little push from the 7's into the
| 6's a1c range, which I'm sure you know is tricky to do
| manually without lows.
| user_7832 wrote:
| Thanks! Hearing (I'm assuming) a fellow T1 using and
| working on a TSlim is quite a good recommendation haha.
|
| It's good to hear that calibration isn't really required.
|
| My "concern" (or rather, apprehension) with the TSlim/G6
| setup (which fortunately should be fully covered by Dutch
| insurance) is that I'm aware I can do a DIY loop using
| the omnipod dash and with a libre/g6 (using a 3rd party
| app like diabox & nightscout if necessary). From what
| I've heard TSlim does seem to be the best "official"/FDA
| approved loop; however AndroidAPS looks very powerful and
| probably has much finer tunings possible.
|
| However my diabetic nurse is strongly against the
| Dash/DIY setup, which is understandable (she isn't
| familiar with it and can't guide me, I'm also close to
| the 150u/3day limit, and it's my first time with a pump.)
|
| For what it's worth an A1C of even 8 would unfortunately
| be an improvement where I am :') so I'd rather be sure of
| reaching say 7 rather than try aggressively for something
| like 6.3 (which I had achieved in a distant era...). I
| think I'll try the 1 year trial option if I can, the
| thought of locking in a 4 year period feels quite long.
|
| If you're familiar with them, what are your opinions on
| diy loop setups? Do you have any other suggestions for
| someone in my situation? Thanks a lot!
| mlsu wrote:
| I actually have tried the DIY loop with the older
| insecure Medtronic pumps that could be controlled over
| radio. It was openAPS. I'm not sure if there are others
| or how they work.
|
| It ended up being fairly inconvenient. My setup was a pi
| zero with a radio bonnet running on my desk; it would
| connect to the internet to pull CGM data, and deliver
| boluses accordingly.
|
| I think the main issue was that I wasn't babysitting it
| enough to know if it was working or not. It was hard to
| see/understand bolus decisions it was making unless I
| checked iob, and it absolutely destroyed the battery life
| of my pump; I used a AAA once every couple days when I
| was near my desk, nevermind the battery on the rig (I had
| it plugged into the wall).
|
| Overall, the system that you actually use the most, that
| is the most reliable, is the most effective system, even
| if it's a little bit suboptimal. In my case, CIQ is
| probably a bit less aggressive than the openAPS system;
| but importantly, it is truly "set and forget." I never
| have to worry if it's enabled or when, or how, it's just
| always working, 24/7. With a condition like ours,
| consistency is the best predictor of performance. That
| makes it the clear winner imho, unless you really like to
| tinker with things and you want to be very active with
| your loop.
|
| The other thing is that the software (openAPS) was
| Javascript and Bash on a Linux system. Those architecture
| choices just make me nervous. Too many bad things that
| could happen. I'm not saying it's impossible for open
| source software to be reliable, certainly not, but the
| complexity of their system was just too large of a
| surface area to fully test. There are extremely
| significant cybersecurity risks using those older pumps
| also. It's basically root access to the bolus button.
| umvi wrote:
| > The new Dexcom sensors are more accurate. Less drift and no
| calibration.
|
| I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of
| the box. I have LADA, and G7 initially was giving me a very
| rosy view of my blood glucose levels, until I started
| pessimistically calibrating it with a finger prick glucose
| monitor.
| mjaniczek wrote:
| > life changing
|
| Yeah, seeing ~300 datapoints a day instead of 4 while
| pricking your fingers is amazing QoL improvement. Dead
| serious.
| 1123581321 wrote:
| I think your experience was unusual in that you had so many
| failures (hopefully you at least got your broken sensors
| replaced for free; both Dexcom and Libre do this) and that you
| are good at managing your diabetes without many measurements.
|
| The out-of-pocket expense can certainly be rough; I use Libre
| right now because my Dexcom out-of-pocket would be similar to
| yours and Libre is a third.
|
| I lend my CGM to people to who are possibly prediabetic. I'm
| very glad I can point them to an OTC solution now.
| Etheryte wrote:
| The plastic waste issue is one of the first things that usually
| comes up around this topic regardless of who you ask. It's such
| a shame because it's not like you have many options unless
| you're comfortable going without sensors.
| berkes wrote:
| All my diabetes stuff is free, in my country. But it must be
| shipped to my house in Quarterly deliveries.
|
| Shipped in several boxes, each filled and wrapped. then the
| GCMs, strips, refills, pump connectors come in their own
| boxes. Some per ten, some single. Each sub-box has several
| booklets with instructions and safety guidelines. Each unit
| is individually wrapped in plastic, paper. All of them are
| single use. Even connectors and rods.
|
| Our combined household has less waste than my insulin therapy
| produces. One single insulin therapy produces more plastic,
| paper and wrapping weight than what my wife and I produce
| together on everything else.
|
| It's utterly insane.
| bsder wrote:
| > Each sensor also used a ludicrous amount of plastic for its
| applicator, like a tennis-ball-sized hunk of hard plastic, that
| you just chucked in the trash, every week.
|
| Erm, let's be a little defensible here.
|
| These sensors have to be stored in sterile packaging--that
| means thick enough to be a barrier. That means it also has to
| hold the sensor in such a way that a palette can be gamma
| irradiated. It also needs to be resistant to drops, crushes,
| and other accidents.
|
| The sensor has to not be harmful with organisms irrespective of
| the understanding of the person using it. Any change to that
| packaging has to be re-evaluated for effects on that
| sterilization.
|
| And while I understand people having concerns, if the only
| reason we needed to use plastic was to treat folks with
| diabetes--I think the world would somehow manage.
| coldpie wrote:
| Eh, maybe, but the bulk of the applicator is just empty
| plastic molded to fit an adult's hand. I have to believe they
| could figure something less wasteful out (reusable
| applicator?) if they wanted or needed to. Regardless, it was
| just another downside for me weighed against the relatively
| few upsides that made me quit using it. It felt terrible to
| chuck all that in the trash, especially when I'd have to do
| it two days in a row because a sensor failed.
|
| [1] https://fm.cnbc.com/applications/cnbc.com/resources/img/e
| dit...
| thecosas wrote:
| T1D currently using G6 / Omnipod Dash / open source Loop
| app.
|
| The worst is every 90 days when I get a new G6 transmitter.
| It comes in a box the size of Two video tapes stacked on
| top of each other. I've tried reaching out to my mail-order
| pharmacy about it since I know there are smaller versions
| of it (or used to be), but nothing yet.
|
| From what I've seen, the packaging for Dexcom G7 and it's
| applicator seems much smaller than G6's.
|
| Side note: That applicator for G4 instilled fear every time
| I had to use it and I was already 20 years into T1D by
| then. The spring loaded applicators in G6/G7 are a big
| improvement as far as end user experience IMO :-)
| coldpie wrote:
| Hahaha, the huge syringe thing? That was pretty wild! The
| spring ones felt like putting a needle to a balloon
| though, always made me tense when I was putting one on.
|
| Yeah the Dexcom stuff always felt like they were going
| for super-premium Packaging Experience. But after the
| first couple weeks that wears thin, and now you've got
| all this crap to throw away. Like, guys, my pen needles
| come in a dense little cardboard box and it's totally
| fine. Chill out with the packaging.
| thecosas wrote:
| "Let me just hyperventilate really quick before I
| literally plunger this thing into my body" was always how
| it felt lol.
|
| Agreed that it's gotten old, especially if I'm traveling
| somewhere. Needing to cart what you needed (plus backups
| of course) ends up taking up a surprising amount of
| space.
|
| I will say that making the switch from a tubed pump
| (t:slim) to a tubeless (omnipod), it's _drastically_ cut
| down on the waste for pump stuff at least.
| innolitics wrote:
| I work in the medical device space (mostly software as a
| medical device). I attended the AAMI Nexus conference two
| weeks ago and attended a talk about making devices more eco
| friendly. The tension between safety and sterilization and
| packaging was definitely brought up. It's a hard balance to
| make. One example I thought was interesting was that the NIH
| did a study to see if it was necessary to swab people's skin
| and use gloves before a shot. It turned out it wasn't and it
| didn't make a difference, so they stopped requiring the
| providers to swab people's skin or wear gloves, thus saving
| an immense amount of waste when taken over all vaccine shots.
| eitally wrote:
| fwiw, my wife uses Freestyle Libre 3 and the with-insurance
| cost every two weeks is about $40. Whenever she's had one fail
| (which seems to be about 1:10), Abbott has replaced it free of
| charge and sent a pre-paid label so she can return the failed
| device for QA review.
| coldpie wrote:
| Yeah, I feel like prices are on a downward trend the last
| couple years, which is great. For me personally, I try to
| spend absolutely as little time and effort as possible
| thinking about my diabetes. So having to call the
| manufacturer or fill out forms and receive a package (more
| waste) and ship a thing back (even more waste) is just too
| much time and effort for me to want to bother. I hope they
| keep improving, it's cool tech and I'd like to like it. Just
| not there yet.
| cadr wrote:
| I just started with the G6 (still using it), and when I started
| I'd have that sometimes. Whatever they changed in the past year
| or so, it has gotten _waaaaay_ better. (They would always
| replace them if they failed early, but was still a huge pain.)
| I 'm exited to move to the G7 (mainly because of the shorter
| warmup time).
|
| Also, pairing it with the Omnipod 5 is just next level. Closed
| loop. Never having to inject in public. No tubes.
| lewismenelaws wrote:
| I have the G7 and it's incredible. On a medtronic pump...
| wanting to switch asap
| cadr wrote:
| The omnipod isn't setup with the g6 yet. Can't wait.
| T1DTech wrote:
| I think you mean G7.
| micro_cam wrote:
| The g7 is definitely a bit better on all counts except maybe
| bluetooth reliability. I use them with [open source closed
| loop](https://loopkit.github.io/loopdocs/) insulin pump
| software and it is pretty great.
|
| Still a lot of plastic but the sensor comes in a smaller
| jar/applicator in a cardboard box and it pretty reliably lasts
| 10 days cutting down waste.
|
| It sounds like this new sensor is just a g7 but with less
| stringent accuracy standards for non insulin users allowing it
| to last 15 days.
| ng12 wrote:
| You went back to finger sticks? I am floored. Do you follow a
| strict low carb diet? How often are you exercising?
| coldpie wrote:
| Definitely not low carb, no. I have a bowl of oatmeal for
| breakfast 4-6 times a week :) My diet is pretty consistent
| though. I know how that oatmeal will respond to insulin 90%
| of the time, and the remaining 10% random quirks I can just
| deal with by feel & a finger prick to confirm. The thing I'm
| most strict about is I only allow myself to have about one
| "bad diabetes meal" per week. So that's like any restaurant
| food, or doughnuts, or pizza, or whatever. I mostly only eat
| home made meals, my wife & I both love to cook. But those
| aren't low carb, just whatever we feel like cooking that
| week.
|
| I walk about a mile a day, to the bus & back for work and a
| bit for leisure and to get up from my desk. Otherwise I don't
| exercise.
| agawish wrote:
| I'm really intrigued by your statement that your diabetes is
| well managed, if I wake up in the wrong side of the bed, my
| insulin resistance change!
|
| Wondering how you can maintain that, do you have a very rigid
| routine and meal plan?
|
| I'm using Libre2 as part of my prescription and it has been
| working wonders by alerting early on before it is too low or
| too high to have enough time for a correction dose, or a small
| bite. The fact that you can see the trajectory of Glucose going
| up or down is by itself a reason to get.
| coldpie wrote:
| Hm, I'm not sure. I don't talk with other diabetics much so I
| guess I don't know what other's experiences are like. I go to
| sleep and wake up on the same schedule every day including
| weekends. My eating is not rigid, but does tend to be
| consistent just because my daily routine is consistent. I'm
| not "low carb" or anything, but I do follow a healthy-ish
| diet and avoid hyper sugary foods (soda, coffee milkshakes,
| sugary cereals) like the plague. Diabetes or not, no one
| should be eating that stuff :)
|
| I do miss having the moment-to-moment trajectory information.
| Knowing whether I'm still going up 90 minutes after a meal
| was valuable. But I find I'm able to feel when I'm above 200
| mg/dL, so can just correct by feel most of the time.
| post_break wrote:
| Can we do CPAP machines next?
| polishdude20 wrote:
| Technically you can buy them on Facebook marketplace,
| craigslist etc
| asow92 wrote:
| Something about a used CPAP machine raises my yuck alarm
| akulbe wrote:
| Not really. It's against ToS in both cases, to sell used
| medical equipment.
| bookofjoe wrote:
| Yet renting medical equipment is a flourishing business, at
| least in the U.S.
| dumbfounder wrote:
| I had to buy one for a friend. But then he ordered a new one
| and all he had to do was send them a picture of his old one
| (after some persistence). It's ridiculous.
| electriclove wrote:
| And contact lenses too!
| bookofjoe wrote:
| >Continuous Glucose Monitoring
|
| https://www.niddk.nih.gov/health-information/diabetes/overvi...
| 005 wrote:
| I don't think this is particularly special. In other countries
| it's possible to obtain Dexcom's current line up by purchasing it
| online (G6, ONE, G7) and other brands too like Abbott's Freestyle
| Libre.
|
| It seems like this is a stripped down version of the G7 (albeit
| with a longer wear time) as the ONE is a stripped down version of
| the G6.
| ethanbond wrote:
| "In other countries"... right... opening it up to a market of
| 340 million people with rampant metabolic problems is what's
| special about it.
| m3kw9 wrote:
| 80$ a pop for 2 weeks and most people cannot access it long
| enough
| gumby wrote:
| Hopefully they are cheaper than the copay on the Libre 3 sensors.
| rkagerer wrote:
| When your smartphone becomes a critical health device to
| support/treat a condition I wonder how that will impact case law
| around things like police confiscation.
| uxamanda wrote:
| Interesting, never thought about that. Also wonder what happens
| in Airplane mode / poor reception?
| hammock wrote:
| CGMs use bluetooth
| justinclift wrote:
| Bluetooth has a terrible reputation around reliability. :(
| pastage wrote:
| In the loop community (CGM+insuling pump) you usually
| have a list of phones that work well with Bluetooth. Yes
| that changes when the phones get new powersaving settings
| and driver updates, usually it works well on good phones.
| justinclift wrote:
| Yeah, that sounds like a practical approach for dealing
| with it. :)
| shanselman wrote:
| it's all BLE and works great on an airplane as long as BT is
| on
| saagarjha wrote:
| What happens when an officer confiscates your glucose monitor
| today? I assume you die and they claim they did it for some
| valid reason or the other.
| Terr_ wrote:
| Or just withholding the insulin itself:
| https://www.thenation.com/article/society/diabetes-police/
| mlsu wrote:
| Wow, that article is wild. For those who are not aware,
| ketoacidosis is when your body metabolizes fat for energy
| in the absence of insulin. This produces byproducts
| (keytone bodies) that raise the pH of the blood.
|
| So, having ketoacidosis feels like having your blood turn
| to acid. Death from ketoacidosis is an excruciating death.
| Fermenting from the inside out as your heart pumps your
| increasingly acidic blood through your entire body. You're
| technically starving, so you're hungry, but at the same
| time your body is trying to expel glucose at all costs, so
| everything you look at makes you sick.
|
| Extended periods of high blood glucose and lack of insulin
| especially is up there as one of the most uncomfortable
| things I've ever experienced personally. Just unimaginable
| cruelty.
| thecosas wrote:
| Can confirm, feels like crap.
| bschne wrote:
| Yes, but you can't easily use your non-smartphone glucose
| monitor as a communications device to manage a bunch of drug
| dealers which can't be confiscated because your life depends
| on it. That changes once it's your smartphone.
| saagarjha wrote:
| See, my point is that they'll do it already when it's not
| even reasonable to do so. So when they take your phone
| away, which can be done so more credibly, why would you
| expect more protections?
| bschne wrote:
| Do they? I'm not aware of cases (but generally not up to
| date on topics like this, genuinely curious)
| pastage wrote:
| Call it malice or ignorance, it is hard to tell. I have
| personally visited someone who did not get insulin for a
| whole night in jail, ended up with extremly high blood
| sugar (DKA) (s)he had to be hospitilized for three days.
| There were no penalties for the officers.
|
| Basically someone with diabetes can seem to be a very
| unhealthy and drunk person, and people do not tend to
| take these people serisouly.
| mft_ wrote:
| Type 1 diabetics have been managing their insulin for decades
| with occasional blood sugar testing - i.e. certainly not
| testing for every dose. They'd be fine to manage things for a
| period without a confiscated monitor.
| smt88 wrote:
| There are people who connect insulin pumps to their CGM.
| There will be situations where people can't quickly switch
| to manual BG management after setting up an automated
| solution.
| justinclift wrote:
| > They'd be fine to manage things for a period without a
| confiscated monitor.
|
| That could go very wrongly if they're already at the end of
| the safety period when they're grabbed by the cops.
| sunshinesnacks wrote:
| > They'd be fine...
|
| But before long there will be diabetics that never really
| learned to do that because they never had to. Even people
| that have done that for decades still mess up dosing
| sometimes.
|
| How likely is it that someone might die? I don't know. But
| saying they will be fine might not be fair.
| bradleyy wrote:
| Hi, Type 1 diabetic here.
|
| I can fast for days, my blood sugar does not go down.
|
| On my last 4 day fast, my blood sugar stayed within about
| 20Mg/Dl.
|
| And no, I cannot manage without my medical devices. Or are
| you telling me that I should fast for the entirety of
| police custody?
| user_7832 wrote:
| > Type 1 diabetics have been managing their insulin for
| decades with occasional blood sugar testing - i.e.
| certainly not testing for every dose. They'd be fine to
| manage things for a period without a confiscated monitor.
|
| This is similar to saying "X person can survive without y
| medicine which has only been around for 10 years". Or
| "people survived fine without seatbelts for so many years".
|
| That's a classic survivorship bias, because a ton of
| diabetics _didn 't_ survive, who'd possibly have a much
| higher chance of surviving today with current tech. Heck, I
| _personally_ know the brother of a late diabetic who would
| 've been alive today if he had a phone connected to a CGM
| because of it's low glucose alarm function.
|
| I understand HN is a place for discussion, but in
| potentially deadly situations like this, it's worth
| avoiding to make statements against medical care.
| smileysteve wrote:
| They jail you, give you low quality food, and eventually the
| jailer may send a medical team to manage your type 2 diabetes
| -- most likely with a finger prick and test strip; and
| they'll give you dietary guidelines that the jail/prison food
| doesn't satisfy.
|
| US version; (oh, and they'll charge you for the medical care)
| reaperman wrote:
| Sadly it will probably receive very little consideration.
| contravariant wrote:
| There's a reason most regulations are written in blood.
| BelleOfTheBall wrote:
| While there is usually some big case that then defines
| things like this, I'm worried whether any incidents of a
| person dying or developing life-threatening issues due
| their phone being confiscated will change much. We've
| historically erred on the side of police exercising their
| power to enforce laws.
| huytersd wrote:
| The cops will probably deliberately keep it from you as a
| threat.
| eitally wrote:
| Software as a Medical Device has been a regulated "thing" for
| years now, and in this case the Abbott Freestyle _app_ is a
| mandatory requirement for the CGM To function. If the app can
| 't connect to the CGM, the thing will make your phone beep
| incessantly. Similarly, if your blood glucose levels exceed
| "safe" thresholds, it will alert at full volume in a way you
| are not allowed to override. Frankly, this is as it should be,
| but it does indeed convolute things when the device interface
| (phone) is used for so much more, too.
| lacoolj wrote:
| inb4 apple watch integration
| asow92 wrote:
| I'll be buying that apple watch if it ever gets here
| cadr wrote:
| https://www.massdevice.com/dexcom-direct-to-watch-g7-cgm/
|
| (There is already an app to show on the watch, but you still
| need the phone in the loop - this is directly to the watch
| without the phone.)
| bradleyy wrote:
| Dexcom already has an integration; are you talking about
| hardware?
| mattl wrote:
| Yeah, it would be great if the watch could just do this for
| you, instead of needing to buy a new sensor every 14 days.
| thecosas wrote:
| Based on everything I've seen so far, the technology for
| non-invasive glucose monitoring is still far away.
| Recently, the FDA even released a warning that any
| companies claiming they could are misleading people [1][2].
|
| Don't get me wrong; I have had T1D for 30+ years and would
| love to have reliable, non-invasive, glucose monitoring on
| my wrist.
|
| We've come so far already from a finger stick that would
| take 2 minutes to get a result. Have hope :-)
|
| [1] https://www.fda.gov/medical-devices/safety-
| communications/do...
|
| [2] https://www.theverge.com/2024/2/21/24079495/smartwatch-
| smart...
| gamepsys wrote:
| I like this trend of the FDA making more and more things OTC.
| hanniabu wrote:
| Don't be fooled by the reason though
|
| > The markup on OTC products is generally higher than on
| prescription medications.
|
| https://www.eposnow.com/us/resources/how-do-pharmacies-
| make-....
| nickthegreek wrote:
| For medical products though, it seems great. OTC hearing aids
| are a big win for society.
| LordKeren wrote:
| I have an extremely hard time buying into the idea that that
| the reason for making glucose monitors available over the
| counter is simply to increase the profit margins of drug
| stores.
| reaperman wrote:
| I haven't noticed this as a consumer in the context we're
| talking right now. I think that article is measuring the
| difference between OTC and pharmacy pricing _after_ a drug is
| approved OTC. But it is not looking at prices pre- vs. post-
| OTC approval.
|
| Olopatadine eye drops are amazing for allergy season, and
| they used to be like $250-400/bottle just 5 years ago or so,
| even the generic version. Then they went OTC for like
| $10/bottle.
|
| This pricing difference might be true for things that are
| already mostly cheap, like Omeprazole -- where branding on
| consumer products drives OTC markup, but consumers don't pick
| the brand when doctors prescribe it and the pharmacy just
| gives them whatever cheapest generic they have in the back
| that they negotiated excellent pricing on.
|
| Though you can easily close the gap on these prices by
| shopping for the store-brand generics at Costco, Walmart,
| Sam's Club, etc.
| bobthepanda wrote:
| It turns out when you strip out as much of the billing
| bureaucracy as possible, that things become cheaper.
| reaperman wrote:
| I think "captive market" probably contributes more than
| "billing bureaucracy" ... the billing is still the same
| issue after the generics have gotten OTC approval for
| doctor prescriptions filled by a pharmacist. It's still
| very common for doctors to prescribe, and pharmacists to
| fill OTC drugs, and the payments go through the same
| insurance company red tape as any other Rx.
|
| And yet, the article from GP shows that the added cost of
| this insurance billing bureaucracy is still less than the
| added cost of consumer shelf-branding markups.
| bobthepanda wrote:
| > "CGMs can be a powerful tool to help monitor blood glucose.
| Today's clearance expands access to these devices by allowing
| individuals to purchase a CGM without the involvement of a
| health care provider," said Jeff Shuren, M.D., J.D., director
| of the FDA's Center for Devices and Radiological Health.
| "Giving more individuals valuable information about their
| health, regardless of their access to a doctor or health
| insurance, is an important step forward in advancing health
| equity for U.S. patients."
|
| Says nothing about it being cheaper; and honestly, taking the
| requirement to see a doctor out of it may end up reducing the
| total cost for a patient anyways.
| crakenzak wrote:
| Is the FDA capturing any of that markup somehow? I fail to
| see how it would impact their decision process on approving
| if it had no impact on their incentives.
| drdaeman wrote:
| I don't get why things like CGMs require a prescription. It's
| just a kind of a wearable sensor. While typically only a
| diabetic person would need it, I fail to see any harm for any
| adult human if they get curious and want to stick one.
|
| There are odd things like glasses or CPAP machine prescriptions
| - but at least I understand it's theoretically possible to
| cause some harm to oneself with those, if someone is really
| uneducated, reckless or stupid. With a CGM I just can't think
| of a sensible scenario. Except for the really stupid ones, but
| then a simple kitchen fork is a four times worse hazard.
| csours wrote:
| I wish Theranos had worked on a more reasonable goal - like an
| implantable CGM.
|
| I had T2D, well controlled now, my A1C is below the diabetic
| diagnostic range.
|
| I used CGMs, and they taught me a lot about how my body reacted
| to food and exercise.
|
| But I sweat a lot and they would always fall off, halving the
| useful life of each monitor. I would probably still use them from
| time to time if they didn't sweat off; and if an implantable
| version was available for a reasonable price (under $500, with no
| ongoing costs), I'd probably get it.
|
| I feel like a lot of prediabetic people could learn a lot about
| their situation with this. I think this is a very good thing.
| guidopallemans wrote:
| I used to have this problem as well, so I talked it over at my
| endo office. They suggested that I order some specially shaped
| stickers to keep them on, but instead I just bought some
| Kinesiology Tape (hansaplast, but also exists store-brand).
| 10cm of that works perfectly, even for heavy contact sports
| combined with sweating (and many showers).
| mapkkk wrote:
| Just make sure you cut a small circle from the tape overlying
| the breather hole of the sensor - that hole serves to let
| moisture buildup from underneath the sensor escape.
| csours wrote:
| Yup, I tried this. I sweat A LOT
| crimsontech wrote:
| I tried different tapes, Kinesiology tape didn't stick for
| me but Hypafix did, I can't get this stuff off without
| soaking it.
|
| If you ever want to give it another go, try Hypafix. I tore
| my skin the first time and quickly learned to soak it and
| use soap to remove the GCM.
| T1DTech wrote:
| Eversense is implantable, but you have to have a healthcare
| provider insert it and remove it. So mini surgery every six
| months. I'll pass.
| philsnow wrote:
| I dove into CGMs a little bit about a year ago, mostly just for
| fun. Yes, I paid money to some online prescription mill for CGMs
| (Abbott Freestyle Libre 3, IIRC), and then put one in my arm (the
| applicator is a short syringe section that has the monitor tube
| threaded into it, so the tube stays in your arm and your skin
| under the monitor remains broken) for a couple weeks. Just to see
| how various foods would affect my blood glucose, to see whether
| the "facts" I'm telling my kids about the glycemic index of
| various foods actually has the expected impact on a measurable
| result. You know, as you do. For fun.
|
| (It actually _was_ fun, and I'll do it again when the data
| ecosystem improves.)
| hasty_pudding wrote:
| I would love to see the results of that!
| haswell wrote:
| Aside from the fun, how did it go? Find anything surprising or
| insightful in the process?
|
| It sounds like an experiment I'd like to do for the purpose of
| optimizing my daily habits and establishing a better mental
| model for how my eating habits impact me throughout the day.
| But I really dislike needles.
| smt88 wrote:
| If the needle in the CGM bothers you, don't let it. It's a
| quick, painless jab with a tiny needle at the beginning and
| then the needle comes out. The part that stays in your body
| is just a flexible filament made of plastic.
|
| I did this experiment as well, and the main thing it did was
| completely stop me from snacking. My habits got better
| because I could see how my BG could never return to baseline
| if I allowed myself to snack between meals.
|
| Other than that, it was also interesting to see certain
| things would badly spike my BG and other things wouldn't, and
| they weren't always what you'd expect. A lot of "keto" and
| "diabetic-friendly" products are terrible for most people's
| BG and were for mine. I found that some things, like black
| tea, actually made my BG drop as well.
|
| Overall it's worth doing at least once.
| coffeebeqn wrote:
| Where do you put the needle thing? Does it get in the way
| of everyday things?
| singlow wrote:
| Typically it is on the back of the upper arm where it is
| covered by a short sleeve shirt. Generally it does not
| get in the way.
| RecycledEle wrote:
| I also use a piece of kinesiology tape to make sure my
| CGM does not fall off.
| Aqua_Geek wrote:
| The sensor typically goes on the back of your upper arm
| (your tricep). You can accidentally bump into things with
| it, but it was infrequent enough that it didn't bother
| me.
|
| The needle is only used in the application of the sensor.
| It's spring-loaded and retracts after the sensor is
| attached. I hate needles, but I found that the tape on
| the sensor provided enough stimuli to overwhelm my brain
| and not really feel the needle when it went in.
| pastage wrote:
| No it never gets in the way. I would not recommend doing
| it unless you are a diabetic, the results are not that
| interesting. It took me two years to get used to smacking
| that needle into the upper arm/stomach/leg, spending up
| to 20 min -40 min getting over the fear was not a fun
| time.
| RecycledEle wrote:
| I feel for anyone who has both diabetes and a fear of
| needles.
|
| Having said that, it's no bug deal for 90% of people.
| Projectiboga wrote:
| T1D here, needles are nothing compared to everything else
| an insulin dependent diabetic deals with. I guess only
| maybe 1 out of less than 100 shots hurt that much. It
| only happens when a nerve bundle is hit, then it smarts
| but it is still less bad than either high, or low blood
| sugar as well as how insane most every part of American
| 'health care' is. The main tricks for comfort are go with
| 29 gauge not the narrower more fragile types with the
| higher number gauges. The narrower ones have more fragile
| needle points and they can get damaged by bending during
| the insertion into the bottle. The other trick is to make
| sure the alcohol is dry before you take the shot.
| RecycledEle wrote:
| The needle stick a flexible tube in a few mm, then the
| needle pulls out.
|
| Think of it as a 5mm thick patch and ignore the tiny tube
| sucking your blood.
| xen2xen1 wrote:
| I keep mine on the front of my upper arm, where I
| automatically notice and protect it. The back of my arm
| usually means it's off in a few hours.
| TaylorAlexander wrote:
| My understanding is that for healthy individuals, spiking
| blood glucose levels is not a problem. Did you get in to
| any of the research on that? Glucose is a problem for
| diabetics because they can't regulate it, but healthy
| people can. At least this is loosely what I have heard,
| somewhat third hand. Any information is appreciated.
| pie420 wrote:
| Not a doctor, but from what I have seen, there is a
| healthy amount of spiking from eating normal foods, but
| our modern diets are so sugar and carb heavy that the
| glucose spikes are way outside the range that our bodies
| evolved to handle. Hunter gatherers would maybe eat some
| berries here (much smaller and less sweet than modern
| berries) and there. The modern human eating pizza, tons
| of bread, ice cream, soda, etc. creates such massive
| glucose spikes that they are unhealthy and unsustainable
| for the pancreas to handle for 60+ years.
|
| Again, not a doctor and not sure if this is accurate, but
| this is my very limited understanding
| throwup238 wrote:
| _> Hunter gatherers would maybe eat some berries here
| (much smaller and less sweet than modern berries) and
| there._
|
| Archaic humans had access to plenty of wild fruit that
| were high in sugar and tubers that were high in complex
| carbs. They even had access to concentrated forms of
| sugar like sugarcane and honey.
|
| They obviously didn't have refined sugars in everything
| they eat like we do but that they had access to limited
| sugar in the form of berries is a persistent myth. They
| would have been exposed to large glucose spikes regularly
| whenever they came upon a new tree that was in season
| while migrating.
| amenghra wrote:
| We live 2x-3x longer than we used to. We should take the
| best possible care of our bodies.
| Fricken wrote:
| Only as a statistical average. Hunter gatherers who
| survived past age 5 had a good chance of living into
| their 60s and 70s.
| amenghra wrote:
| There would be skeletal evidence of that. The oldest
| remains of early humans points to 35-40 year olds with
| high child mortality rates per
| https://www.hurriyetdailynews.com/people-lived-up-
| to-40-year...
| CadmiumYellow wrote:
| Not to mention humans 150 years ago who ate plenty of
| bread and still didn't have the problems we have with
| obesity and diabetes. Or even 50 years ago...
| NoPicklez wrote:
| That could also be because a fair amount of the bread in
| supermarkets today is closer to confectionary than
| homemade sourdough.
| EasyMark wrote:
| light bread starts turning into sugar almost instantly in
| the mouth and stomach. It's only one step removed and
| saliva can break it down quickly because it has amylase.
| Sour dough and whole wheat/grain breads tend to break
| down a bit slower. You can freeze bread overnight and
| make it a bit more "resistant" to breaking down quickly
| and I pretty much do this with all my breads along with
| toasting them a bit for sandwiches. Pasta can similarly
| have its glycemic index lowered by first making it "cold"
| int_19h wrote:
| Do you mean that they need to be cold when they are
| consumed, or is it the process of freezing itself that
| does something, even if it's later reheated?
| imp0cat wrote:
| The process of cooling down converts starches in rice,
| pasta, potatoes etc... to a more resistant forms that
| your body cannot process easily.
| thimkerbell wrote:
| Does chilling also work to convert bread starches into
| resistant ones, or does it only work for rice and
| potatoes?
| int_19h wrote:
| GP mentioned bread specifically. I looked up some
| studies, and they are in agreement:
| https://pubmed.ncbi.nlm.nih.gov/17426743/
| amanaplanacanal wrote:
| They don't need to be cold when consumed.
| TylerE wrote:
| That's not really a fair statement. Many problem who
| would die of diabetes today would have died of something
| else 200 years ago long before the diabetes got them.
| Non-juvenile diabetes is a slow killer, it's really hard
| for it to kill you before the age of reproduction.
|
| A diagnosis today that is imminently manageable like
| asthma was far more readily in a world without
| antibiotics, steroids, or even medical oxygen.
|
| Even something like a CPAP that many of us take for
| granted has only been readily available for 30 years or
| so.
|
| Plus, diabetes is much like AIDS in that it's more of a
| systemic thing than acute. It doesn't really have
| symptoms that kill you. It just slowly weakens your body
| until your heart gives in, or you have a serious
| infection, or something like that. No one dies "of"
| diabetes, they die with it.
| cableshaft wrote:
| They also moved around more than most people do today.
| Most of us are stuck sitting pretty much all day in front
| of a computer.
| EasyMark wrote:
| fruit and berries do have sugars but in their wild state
| they tend to have much less than their modern equivalents
| bred to be sweeter and tastier. Even then they still
| typically are 75-95% water and often have some fiber,
| antioxidants, and vitamins which all can help with
| inflammation unlike snickers bars.
| watwut wrote:
| I have better life expectancy then them.
| jablongo wrote:
| It's not really that the pancreas itself can't handle it
| (though this may be true also). What happens is that
| having high blood glucose, even if it's not continuously
| high, is just bad for you by virtue of the high
| concentration of glucose in your blood. Having high blood
| glucose leads to the creation of "Advanced Glycation
| Endproducts" (AGEs) which bind to certain receptors
| (RAGEs). The AGE-RAGE interaction is linked to downstream
| diabetes side effects like atherosclerosis.
| philsnow wrote:
| There's also research that indicates that cancer thrives
| in high-glucose environment, and that starving cancers of
| glucose reduces their size over time.
| 462436347 wrote:
| Wrong:
|
| https://www.sciencedirect.com/science/article/abs/pii/S00
| 472...
| anorwell wrote:
| The longevity people think that blood glucose levels are
| an important predictor for rate of (biological) aging.
| See e.g. https://www.lifespan.io/topic/blood-glucose-is-
| a-biomarker-o...
| Attummm wrote:
| Well, they're not just people. They are longevity
| scientists.
| 1234letshaveatw wrote:
| longevity scientists are just people
| pcorsaro wrote:
| I'm not the OP, but I had a CGM several times through
| Levels. I can tell you that the major spikes (glucose
| over 200 after sitting between 80-90) really made me feel
| like shit. The 2 times I can remember it getting that
| high were when I had too much sushi, and a huge bowl with
| white rice from Chipotle. Brown rice never seemed to
| spike me nearly as bad, especially if paired with
| something high in fiber like black/brown beans. From a
| long term health perspective, I have no idea if it's a
| problem or not. I didn't like how bigger spikes felt, so
| there's probably something to it being bad for you long
| term. Obviously the more often you spike as a "healthy"
| person, the less sensitive your body is to insulin.
| Staying even on my glucose levels is always where I felt
| the best.
| EasyMark wrote:
| straight rice and bread break down into sugars -very-
| quickly in the stomach, that's why mixing them with stuff
| like you mentioned (heavy in fat and/or protein) can
| really dampen the spikes in my own observations. Those
| are just anectdotal though and what works for me doesn't
| work for everyone. I do like to eat a salad first with
| some good fibrous veggies though OR something like eat
| some of a chicken/fish entree or steak if I'm having that
| as part of a meal.
| T1DTech wrote:
| With Type 1 Diabetes, your pancreas is no longer
| producing insulin, with Type 2, it's typically that it's
| not producing enough insulin. My child is healthy, but
| his pancreas stopped producing insulin years ago. He
| lives with T1D.
| smt88 wrote:
| My A1c is right on the edge of prediabetes, so I wasn't
| as concerned about the spikes as I was about my baseline,
| how long spikes last, etc.
| haswell wrote:
| That's good to know. I think my aversion to needles is so
| strong that it stopped me from going beyond basic research.
| Bad on me.
|
| But this does sounds like an interesting thing to try, if
| only to get a better idea of how my body works.
|
| I've been tracking walking vs. resting heart rate, HRV,
| blood oxygen levels, and sleep for a few years using the
| Apple Watch, and while I know these measurements are
| imperfect, they've helped me better understand the impact
| of certain choices.
|
| There's something that seems really beneficial about
| feeding my brain data about myself as a way to do the
| healthier things I've always wanted to want to do. The more
| data I have, the easier it feels to implement positive
| habit changes in a way that doesn't involve sheer
| willpower. There's something very satisfying about seeing
| the very tangible changes on a graph over time that
| indicate better health, even when it doesn't feel like the
| changes have done anything noticeable yet.
| philsnow wrote:
| > A lot of "keto" and "diabetic-friendly" products are
| terrible for most people's BG and were for mine.
|
| Absolutely, there are a lot of companies trying to cash in
| on this new-ish market, and they'll do anything to their
| products to get the net carbs down to 0-2g "per serving" --
| scare quotes around that because this is a particular
| annoyance of food labeling in the States: food labels
| declare the amount of various nutrients per "serving", but
| 1) they get to choose the serving size [0] and 2) they get
| to round numbers, so if they just pick the serving size
| such that it's 1.499g of carbs per serving, they get to put
| that it's "1g", and so on.
|
| It makes it impossible to compare food labels between
| different items even among the same manufacturer (and even
| the same SKU but different/later packaging, because they
| don't have to issue a new SKU when they change the food
| label). If instead they were required to show amounts in g
| per kg (or ml per l for liquids, or whatever), they could
| be compared more easily.
|
| [0] The FDA provides "Reference Amounts Customarily
| Consumed" and asks manufacturers to refer to them when
| deciding their serving sizes, but (from [1]):
|
| > FDA's guidance documents, including this guidance, do not
| establish legally enforceable responsibilities. Instead,
| guidances describe our current thinking on a topic and
| should be viewed only as recommendations [...]
|
| so really they can pick almost anything they like
|
| > [...] unless specific regulatory or statutory
| requirements are cited.
|
| unless the food is medicinal in some way, I guess?
|
| [1] https://www.fda.gov/media/102587/download
| pastage wrote:
| If you want to know more about it you can just read about how
| diabetics treat different foods. Short version; high GI is
| fast high blood sugar, lots fat and sugar can results long
| period of with high blood sugars.
|
| It is a CGM more or less what you would expect, insulin is
| the only hormone that lowers blood sugar, then you have all
| the stress hormones that raise it like adrenalin, growth
| hormone and cortisol plus glucagon for long time storage of
| sugars in the body. So measuring blood sugar with a CGM gives
| you a value between 2.9-13.5 mmol/liter that is supposed to
| give you picture of a rather complex system. A CGM also needs
| perfect access to your free flowing blood which in it self is
| a difficult task.
| haswell wrote:
| I'm more curious about the experience a non-diabetic person
| has. For one, the purpose of using the device is quite
| different, and not related to a life threatening situation.
| And because the focus isn't to manage this specific issue,
| the insights and potential utility seem like they'd be of
| an entirely different variety.
|
| e.g. I know that the things I eat impact my blood sugar,
| but don't have the same kind of intimate awareness a
| diabetic person would have, nor would the changes in my
| levels have the same meaning/impact.
|
| Put another way, and setting aside the issue of
| oversimplifying a complex system (so is measuring RHR, HRV,
| blood oxygen, etc.), the benefit of CGM for a diabetic
| person is obvious. The benefit of CGM for a curious person
| less so.
| Projectiboga wrote:
| Main benefit is more data, only work is to accurately log
| meals and activity.
| pastage wrote:
| It is probably easier to find interesting things curious
| people with diabetes has done, sure you might want help
| to sort out the interesting bits.
|
| Optimizing sugar in take for exercise might be an
| interesting thing todo as non diabetic. There is no tool
| to continuously measure ketons though which is the fun
| part. CGMs are so slow. I really see no use at the
| moment.
| EasyMark wrote:
| I'm asking out of curiosity here: I've always heard that
| fat doesn't spike your glucose at all and protein only if
| you a considerable amount of it. So from what you said if
| you ate a fatty cheeseburger (plated like a steak and
| without the bread) that your blood sugar will spike? I'm
| currently doing a Mediterranean style diet during the week
| and slacking off a bit on the weekends friday evening
| through Sunday morning. I have done keto in the past though
| with the readings I've done on it saying that lots of fat,
| some protein, and just a little bit of carbs should
| basically keep any glucose spikes very low. I could only
| handle the keto for a couple months though.
| eternauta3k wrote:
| > A CGM also needs perfect access to your free flowing
| blood
|
| I thought CGMs measure the interstitial fluid?
| galago wrote:
| Freestyle Libre 3 only has a plastic filament and the plastic
| applicator pushes it in without pain. Very different than
| metal lancets (stick test). I can't feel it at all when its
| in the back of my arm. If I were worried about sweating too
| much and it not sticking I would get one of the third party
| over-patches that create a lager adhesive area. I might do
| that in the Summer.
| spc476 wrote:
| My girlfriend uses the Libre 3 and I was wondering how it
| worked with just that plastic filament. She doesn't feel it
| at all when I apply it. We found that if she washes the
| area with soap and then just relaxes her arm and lets it
| hang freely, I apply it to the back upper arm, it just
| stays on and doesn't get in the way.
| crimsontech wrote:
| I did it for fun about a year ago and found out I had T2
| diabetes.
|
| I was shocked but obviously glad I found out. I use them from
| time to time just to see how I'm doing and how different
| foods (and amounts of them) impact me.
|
| I found I can control it through diet alone and exercising
| when there is a spike by using a GCM for the constant
| feedback.
|
| They are very expensive here though (UK) and my doctor won't
| prescribe me one because metformin is cheaper, so it's not
| something I can use all the time.
|
| I hate needles, this really isn't like a needle though, it's
| a small filament which sits just under your skin, you can't
| feel it, I thought it hadn't gone in until I saw the reading
| appear on my phone.
|
| Some things I found out besides what foods and amounts give
| me big spikes are that I have a blood glucose spike in the
| morning just before I wake up, and that if I eat a small
| enough portion of white rice, ice cream, bread, whatever I
| can reduce the spike quickly by going for a walk. If I had a
| lot though, a walk isn't going to help.
| philsnow wrote:
| I almost completely forgot about the monitor itself, and only
| paid attention to the numbers on my phone. It's that
| unobtrusive (at least the Libre 3 one that I used).
|
| I let the needle (actually: annulus? see sibling comment) get
| into my head because I was curious and looked at it. It looks
| a lot scarier than it is, kind of like using contact lenses
| for the first time: before you've used them, you get into
| your own head about it, but once you've done it a couple
| times it's just rote and easy.
|
| I had started the first one a day before I started a few
| weeks of (6-days-on, 1-day-off) keto. Keto guides will say
| that you should have <= 25g net carbs per day, but I
| specifically wanted to see how front-loading (having almost
| all the day's planned carbs in one meal) affected blood
| glucose, and also whether the number (25g) is accurate for my
| physiology. I found that my number was closer to 30g and that
| when I stayed under it, my blood glucose spikes had very
| short duration but when I went significantly over it, blood
| glucose stayed higher for longer.
|
| _edit: One more thing, I used this time to play around with
| various sugar substitutes and see how they affected my blood
| glucose. Allulose came out as the winner (if money is no
| object) based on not having any noticeable off-taste or
| aftertaste and on measuring gram-for-gram the same as sugar
| (well sort of, it 's only like 80% as sweet as sugar, so you
| get the same mechanical effects of sugar if you weigh it
| gram-for-gram and your baked goods or whatever come out not
| quite as sweet, which is perfect for me. Creaming butter with
| liquid stevia extract or something just plain doesn't work._
| LegitShady wrote:
| what other sweeteners did you try? Can't get allulose in
| canada (unless you buy it from a shady importer) because
| Health Canada says there isn't enough data to say its safe,
| so its not approved sweetener.
| itpragmatik wrote:
| At least for me the readings that it shows are not accurate
| (when verified with old style finger pricking glucose
| monitoring machine). These CGMs are good for knowing the
| general variability of glucose level in your blood based on
| your diet exercise etc; I don't trust the absolute numbers from
| CGM like Freestyle Libre - haven't used any other one though
| yet.
| reaperman wrote:
| It would be interesting to see whether a group of 20-100
| people could manually calibrate their readings by fitting
| their CGM readings to their fingerprick glucose readers. I
| wonder what the accuracy would be after a very basic personal
| curve fit.
|
| I do this with a lot of consumer measurement devices. Both
| for thermometers and scales (food, human, and cheap 0.1mg
| scales). As well as thermostats, like the kitchen oven. I
| also do it for my multimeters. I validate my volumetric
| measuring cups/spoons by weighing water in them but I don't
| correct them, just return if they're way off.
|
| It's okay if the reading is off as long as I can correct it
| the same way every time and get a pretty accurate result.
| alright2565 wrote:
| Calibrating my scales and thermometers would be nice. What
| procedure do you use for it? is it documented online
| anywhere?
| reaperman wrote:
| I basically use an Excel sheet. Make a scatter plot of
| the "true" values on one axis, and the "measured
| (slightly wrong)" values on another axis. Then do best-
| fit to y=mx+b and manually adjust it according to that
| equation using my phone calculator in the future.
|
| Some classically trained engineers may tell you the
| "true" value should always be plotted on the x-axis as it
| is often considered to be the more "independent"
| variable...but this is highly debatable, and you can skip
| some simple algebra later if you put the measured value
| on the x-axis. Then look at the shape of the scatter
| plot. _Ideally_ it will be linear, so you ask Excel to do
| a linear curve fit (y=m*x+b). Write this on the scale,
| and now whenever you take a measurement on the scale,
| whip out your phone and do "measured_value * _m_ + _b_
| ". And that's your true value. If it's not a linear fit
| (quadratic, log, etc) ... that's interesting, and often
| it's likely "wrong", but also "it is what it is".
| Classically trained engineers will say you have to do a
| linear fit if that's what the theory says is appropriate,
| but for one-off home device calibration...do whatever
| works for you. Just as long as you don't overfit with
| some stupid 4, 5, 6, etc-term equation. Any reasonably
| simple equation with 2-3 terms is fine IMHO.
|
| I use a set of heavy objects whose mass I know fairly
| precisely. They're not perfectly 10.000lbs, 20.000lbs,
| etc ... they're just "around 10lbs, around 20lbs" and
| I've used a good actually-calibrated scale (at work, some
| commercial business with calibrated scales that you can
| access, whatever) to weigh them and wrote their weights
| in sharpie on a piece of tape stuck to the objects.
| Ideally you'd go for around 10% increments. If the scale
| can weigh 400lbs, that would be every 40 lbs or so. But
| it really doesn't matter as long as you have enough good
| points around the range you truly intend to measure, and
| then a few outside of that target range at semi-regular
| intervals.
|
| For my 0.1mg-resolution mass balance I have some actual
| calibration weights, but they're a relatively affordable
| OIML "M1" class, and did not come with expensive
| calibration certificates. The OIML tolerance ratings go
| E1, E2, F1, F2, M1, M2, M3 (from best to worst). For a
| 100g test weight, M1 precision gets you +/- 0.005g,
| guaranteed, for $50 ($135 if you want a calibration
| certificate). E1 gets you +/- 0.00005g at 100g test
| weight, for $500 ($1200 with cal cert). For smaller
| calibration weights like 10mg you'll generally want to go
| a step up from M1 (+/- 0.25mg) to F2 (+/- 0.08mg) for
| about $27.
|
| For temperature, it's a bit trickier because the only
| "true" temperatures you can create are -6degF/-21degC and
| 228degF/109degC. If these temperatures are helpful to
| you, you can create them by pouring shitloads of salt in
| water and stirring+heating it until no more salt will
| dissolve and you just have a pile of salt in the bottom
| of the container. You can try to go for "0degC/100degC"
| using distilled water and it would probably be close
| enough but you can't know it exactly unless you use super
| pure de-ionized water and use extremely absurd lab
| technique (usually involving washing your glassware and
| tools with de-ionized water over and over for several
| days straight to get rid of trace contaminants).
|
| So instead, to get "true" temperature in the range I care
| about, I use some thermocouples attached to a high-
| quality multimeter or oscilloscope. Then I calibrate
| these thermocouples using the method above, and average
| their reading for the oven temperature. This works and
| extrapolates well enough outside the range of calibration
| because the error of a thermocouple is basically
| guaranteed to be a very linear error.
|
| In this link[0] topics 1-6 ("weeks") get into the fine
| details of all this and provide some worksheets/excel
| sheets already made up for this type of thing. If you're
| really getting into the weeds with this, understanding
| propagation of error[1] really helps but is super
| unnecessary for 99% of people unless they're doing actual
| engineering.
|
| 0: https://pages.mtu.edu/~fmorriso/cm3215/laboratory_exer
| cise_s...
|
| 1: https://pages.mtu.edu/~fmorriso/Pintar_Error_Analysis_
| or_UO_...
| ksaun wrote:
| The entire system is too complicated, and the CGM too
| variable in accuracy, for such calibration to work in the
| way I think you are suggesting.
|
| Each time the CGM is applied, the situation is different
| because of the exact position and various other factors.
| And the CGM is not 100% consistent.
|
| You do/can calibrate the CGM as needed. For example, when
| the CGM first activates, standard practice is to check with
| a fingerprick to see how accurate the CGM is this time and
| (sometimes) calibrate. (As noted in other comments, the CGM
| and fingerprick are not detecting exactly the same thing.)
|
| And the next time you apply the CGM (we use a Dexcom G6,
| which is changed every 10 days), any previous calibration
| is irrelevant. There's a lot of variability and many
| factors that can affect results (exact location, scar
| tissue from previous CGM application, recent exercise, a
| recent hot shower, etc.)
|
| (I didn't explain that well, but hopefully you get the
| idea.)
| pastage wrote:
| This is highly personal thing it is apparently very
| inaccurate for some people, I've never been below or over
| dangerous levels without it giving a warning. What has
| happend once or twice over the decade I've used it is that it
| will get stuck in a bad reading, so you do not see the
| variations. It has always got unstuck when I've gone below
| 3.5 mmol/liter or so.
| mlsu wrote:
| It actually may actually be the other way around, at least
| for newer CGMs.
|
| Try doing a few fingerpricks in a row. The variability will
| surprise you!
| Engineering-MD wrote:
| There is generally a latency of a few minutes between blood
| and interstitial fluid (the CGM) readings- up to 15 minutes.
| You may find if you account for latency your consistency
| between the two increases
| gumby wrote:
| Apart from the latency of diffusion from bloodstream to
| interstitial fluid (and the lower levels in the interstitial
| fluid) the FDA requires that consumer devices be with 20% of
| the venipuncture level.
|
| That means a lancet poke can be quite different from a meter
| like the freestyle, and both can be quite different from the
| level in your veins that a lab would get. So if your level is
| 200 one device can read 240 and the other 160 and both can be
| considered "correct".
|
| I found that the freestyle libre 2 and libre light are
| characteristically _low_ while the FS 3 is characteristically
| _high_. So I use them for the shape of the curve, and that is
| useful.
| jablongo wrote:
| Another reason they are sometimes different is because there
| is a lag in the CGM data. It's estimated the lag is about 12
| minutes.
| turtlebits wrote:
| Same, but my doctor pointed me to a promotion for a free
| sensor. It did require a prescription, but since I don't have
| diabetes, it's not covered by insurance.
|
| Trying to get it filled and picked up was slightly annoying as
| the pharmacy initially did not want to fill it without some
| prodding, and I waited a while for them to figure out how to
| get the promotion billed.
| znpy wrote:
| What's the lifetime of a single device? Are you supposed to
| remove it before a shower and reapply it later?
| hlfshell wrote:
| No, it's mostly water proof. You wear it through showers and
| even swimming for 2 straight weeks. The adhesive is pretty
| good; rarely does it come off on its own prior to say, a week
| and a half in.
|
| It holds 8 hours of data (1 reading per minute) and you can
| just hold up your phone to read the last 8 hours of data for
| your overall data.
| znpy wrote:
| thanks for the reply!
| jseliger wrote:
| Before I got cancer, I had one through Levels, and it was
| informative. Dessert is _much_ worse than I 'd thought. Rice,
| too, including brown rice. I remember eating some biryani and a
| small bit of naan at an Indian restaurant and thinking that I'd
| been pretty healthy, only to see a spike of like 80.
| meindnoch wrote:
| Momentary high blood sugar is perfectly fine after eating
| carbohydrate-rich meals.
| Retric wrote:
| This was down voted, but it's all about the time scale. A
| major pathway of transporting energy from your food to your
| cells is via glucose in your blood and your cells then use
| or store it for later. Insulin production reduces the
| spike, but that response isn't instantaneous.
|
| So on a second by second basis numbers that would be
| concerning across an hour are fine. Similarly your average
| over an hour post meal can be much higher than a healthy
| average across a day.
| TylerE wrote:
| Yup. A1C, which is the main diagnostic measure, due to
| the way it's measured is a roughly 90 day moving average
| with somewhat of a recency bias.
|
| Like most things, it's mostly about area under the curve,
| as long as the extremes aren't too much so.
| EasyMark wrote:
| for sure, the length of the spike is just as important,
| it's like energy and it's an area under the curve type of
| phenomena
| colordrops wrote:
| Is 80 high? That seems totally fine.
| TylerE wrote:
| 80, as an absolute reading, is on the low side of normal.
| Like, that's what it might be first thing in the morning
| before you eat. Anything sub 50 starts to get dicey.
| illegalsmile wrote:
| Desserts can definitely send your levels quite high but I
| don't think I'd qualify some biryani and naan with a reading
| of 80 as unhealthy. You probably ate a healthy portion and
| left it at that. Is 80 not well within the normal range?
| pastor_bob wrote:
| He probably means it spiked 80 from where it was (e.g. 100
| to 180)
| TylerE wrote:
| Which is still pretty normal, low for a full meal if
| anything, if not presiding with insulin.
| al_borland wrote:
| I saw an interview a while back between Tim Ferriss and
| someone who had tried CGM for fun/research. One thing he
| noticed was the huge impact a short walk after a meal brought
| down his blood sugar levels. Tim then mentioned he
| experienced the same thing and that there is a saying in
| China, something to the effect of, "take 100 steps after a
| meal, live 99 years." This also linked up with something I
| had looked up a few years ago when I noticed that I always
| saw families of Indian decent walking around neighborhoods,
| but never anyone else. I looked it up, and founds there is a
| word in Marathi of taking 100 steps after a meal.
| (https://en.wikipedia.org/wiki/Shatapawali)
|
| It seems there has been this age old knowledge that taking a
| short walk after a meal is really good for you, which somehow
| got lost in some/many cultures. My parents would always say
| they had to sit after a meal to let their food digest... it
| never really made sense to me. My grandma, on the other hand,
| is 103 and gets pretty upset if people try to stop her from
| walking after a meal (or whenever she wants). We always just
| thought she liked walking, but maybe there is something else
| driving her, it seems to have worked out for her. It was very
| interesting to hear the CGM back up some of these practices
| that have likely been going on for hundreds or thousands of
| years.
|
| I have been wanting to try one. This approval opens up the
| door. I think seeing something like this with my own eyes,
| with my own body, with actual numbers, would have a bunch
| bigger impact than some anecdotal stories from others and
| nice sayings which align.
|
| It looks like there is some research being done in the area
| as well.
|
| https://link.springer.com/article/10.1007/s40279-022-01649-4
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8912639/
| philsnow wrote:
| That's fascinating -- you know how your body sometimes
| manifests a craving for a food when it "knows" that you're
| deficient in some nutrient that food will provide?
|
| I get the same feeling (of my body directing me to take
| some action) but it's not after meals, for me it's after
| having more than one beer. After 2-3 beers I want to go
| walk around the neighborhood for half an hour (and it's a
| bummer when the neighborhood is not pedestrian-friendly).
| neeleshs wrote:
| Taking 100 steps after a meal is a common saying in India
| as well. The saying also advises sleep on ones left side
| for good health. Goes like this in Kannada - "Undu nooradi
| nadedu, edamaggulagi malagidare vaidyana bhandatavilla
| sarvajna"
|
| Literally "if you walk a hundred steps after eating and
| sleep on you left, there won't be any doctor's shenanigans"
| EasyMark wrote:
| sleeping on your left side can help with gastrointestinal
| issues somewhat (like reflux) or after eating an acidic
| dinner.
| o_____________o wrote:
| Eat fiber first. Add more protein. Eat reheated rice
| (resistant starches). Isn't it interesting how much these
| little details matter?
| EasyMark wrote:
| healthy proteins and fats are good for you, both will slow
| down digestion time. I rarely eat only rice as the main
| course of a meal, and usually eat something either with it
| or before it, and it's almost always brown rice.
| gregschlom wrote:
| > so the tube stays in your arm and your skin under the monitor
| remains broken
|
| That's not how it works, at least for the Freestyle Libre 3.
| The cross section of the needle has C shape rather than a O
| (technically I believe it's called a cannula). When you remove
| the applicator that C shape allows the needle to be removed
| through the hole at the top of the sensor, and only the
| flexible filament stays I your arm.
| rnewme wrote:
| I belive he called the flexible filament "tube" and that you
| are both saying the same thing. Ie skin stays open (albeit in
| very tiny spot where the filament is sticked in)
| barbazoo wrote:
| What symptoms would one have to present for an "online
| prescription mill"/"virtual care provider" to prescribe a CGM?
| I'm fascinated by this and would love to try it out but I don't
| want to bother my family doctor with this.
| CaptainNegative wrote:
| The only symptoms needed are a pulse, the ability to type out
| a credit card number, and availability for a sham phone call.
| It's virtually impossible to not get prescribed one from a
| mill.
| EasyMark wrote:
| How much would a month or two cost me if it was out of
| pocket? I wouldn't mind doing it for science.
| terhechte wrote:
| I bought a Sibionics GS1 recently and am about to use it
| (SIBIONICS GS1 Sensor Continuous...
| https://www.amazon.de/dp/B0CPDHKGYK?ref=ppx_pop_mob_ap_share).
| Reading this thread I'm wondering if it is a safe / good product
| to use. Does anybody happen to have knowledge?
| dddiaz1 wrote:
| Great to see it be OTC. But it's weird that it is advertised to
| last for 15 days, while the prescription version for T1ds/T2ds
| only lasts for 10 days. The hardware looks the same.
| thecosas wrote:
| Had the same thought!
| https://news.ycombinator.com/item?id=39621575
|
| Also... does this mean they are direct-to-consumer as well as
| retail channels? https://news.ycombinator.com/item?id=39622192
| anonfornoreason wrote:
| I would recommend anyone to experiment with this. I did, and
| found out I was more glucose sensitive than I expected. This led
| me to get more broad labs done, with which I was able to find
| additional treatable issues that are likely the cause. If I
| hadn't done this, I would have found out via symptoms years
| later, after irreversible damage had already been done.
|
| You are your only medical advocate, no one else is going to do it
| for you. The standard of care is shit, don't rely on it.
| epistasis wrote:
| Agreed, this is one of the better things I have done to take
| control of my own health!
|
| It was very very surprising which foods, and quantities of
| foods, caused huge spikes.
|
| However, this stuff is difficult to interpret. What should be
| the goal number for managing glucose spikes? What's good,
| what's bad? Ultimately there's a lot of judgement calls, just
| as there is with any health or fitness goal.
|
| I learned a lot from Peter Attia's podcasts, but that required
| hours of listening.
|
| My doctor offered to review my data with me, which was amazing.
| But many people's primary care docs may not have the experience
| or time.
| anonfornoreason wrote:
| +1 +1 +1 to Peter Attia, huge amounts of great content. My
| philosophy is that if there's any single topic where I should
| be spending five hours a month researching, it's personal
| health.
|
| As far as spikes are concerned, I convinced my wife and my
| dad to both try out the same CGM. Neither of them really ever
| had any spikes of significance (maybe up to 130's), even when
| eating cake, etc. Obviously it varies from person to person,
| but the fact I would spike easily above 140 with boring foods
| (steel cut oats with no sweetener as an example) said to me
| something was wrong. My daily averages hovering around 100 to
| 105 were not in the pre-diabetes level but were close to it,
| even when eating minimal carbs and being extremely fit with a
| natural healthy diet. Also most of what you read out there
| with CGMs is related to people who actually have diabetes.
|
| Finally, there's no one really to talk to about this stuff.
| You can eclipse your doctor's knowledge on the topic with
| about 5-10 hours of research. You can go get a broad set of
| labs and be right at the edge of the reference range on
| something (which is, depending on the lab, just a range of
| the general population, not a healthy range) and your doctor
| will shrug it off. The system is setup so that as long as you
| are in a sort of average, even with that average being pretty
| bad (half of the country is fat and pre-diabetic), the
| standard of care is to ignore it until you fall off the end.
| The line between hypochondria and being on top of your health
| is pretty thin, and most doctors will consider you a
| hypochondriac if you research and come ready to talk about
| the topic with any level of knowledge.
| Projectiboga wrote:
| Try melatonin it makes what insulin you have go farther.
| Type 2 diabetes is caused by excess inflammation.
| happytiger wrote:
| That's some sage advice.
|
| People are often surprised when I tell them about the insane
| levels of pre-diabetes in the US:
|
| > The National Center for Chronic Disease Prevention and Health
| Promotion notes that approximately 96 million U.S. adults aged
| 18 years and older (38% of the adult population) have
| prediabetes, and nearly 80% of them are unaware that they have
| it.
|
| It's honestly insane to continue a way of life that's doing
| this to the majority of the population.
|
| https://www.uspharmacist.com/article/prediabetes-trends-
| amon....
| narrator wrote:
| The other insane thing is studies have shown that type 2
| diabetes can be reversed by fasting. Fasting is problematic
| to the medical industry because it is zero cost.
|
| "Some studies found that patients were able to reverse their
| need for insulin therapy during therapeutic intermittent
| fasting protocols with supervision by their physician."
|
| https://clindiabetesendo.biomedcentral.com/articles/10.1186/.
| ..
| Aurornis wrote:
| > Fasting is problematic to the medical industry because it
| is zero cost.
|
| No, fasting is problematic because people don't like it.
|
| Health conscious people don't understand how much
| resistance the average patient has to advice about
| lifestyle modifications, or how difficult it is to get
| patients to adhere to recommended lifestyle changes.
|
| A good example is sleep apnea and CPAP machines: In theory,
| a CPAP machine should provide life-changing improvements in
| sleep quality and daytime energy for someone with sleep
| apnea, yet patient adherence rates are shockingly low (even
| when covered by insurance). Many patients are simply
| annoyed by the machines and give up on it.
|
| That's not to mention the fact that weight loss is
| extremely effective in many (though not all) sleep apnea
| situations, but it's rare that patients will actually
| follow through with that.
| psychlops wrote:
| It's also rare for a doctor to tell a person they are too
| fat and to lose weight. The assumption (and most cost
| effective solution) is that patients just want a
| prescription for something and be sent on their way.
|
| US healthcare is crisis focused, not health focused.
| TeaDrunk wrote:
| > It's also rare for a doctor to tell a person they are
| too fat and to lose weight.
|
| Genuinely curious... have you ever been an obese person?
| Every fat person I've known have told me they're
| constantly shamed about being fat in medical settings,
| some to the point where they actively avoid going to a
| doctor anymore because they've given up on anything
| beyond being told they're fat.
| porkbeer wrote:
| It its a complicating factor in almost every ailment
| known to humankind. A doctor would be negligent not to
| address it. There is no healthy level of obesity.
| TeaDrunk wrote:
| So... you get my confusion and skepticism at this claim
| that it is "rare" for doctors to bring up obesity to an
| obese patient!
| psychlops wrote:
| I'd say I'm obese, and never heard a word about it. Even
| through covid. I have a friend who is a doctor who has
| been brutally honest with me (it's appreciated), but even
| though I've gone to many paid doctors in the northeast
| US, not a peep.
|
| I don't want to confuse my experience with actual data.
| Also, I don't think it's shaming if it's a health issue
| and obesity should be recognized as such.
| metabagel wrote:
| > It's also rare for a doctor to tell a person they are
| too fat and to lose weight.
|
| I don't think this is true. Doctors do tell patients if
| they are overweight, and they do encourage them to make
| lifestyle changes including losing weight.
| psychlops wrote:
| Okay, that's fair, I didn't provide data so you responded
| in kind. So I went to find a study:
|
| "Fewer than one of five overweight patients and slightly
| over half of obese patients reported being told they were
| overweight by their provider."
|
| So "rare" is the wrong word.
|
| https://www.commonwealthfund.org/publications/journal-
| articl...
| watwut wrote:
| Disordered eating is more dangerous then obesity.
| porkbeer wrote:
| Both are worse than eating right. It's not a binary.
| slily wrote:
| I doubt that's true unless the degree is extreme. Humans
| evolved with "disordered eating" and fasting is well-
| researched.
| watwut wrote:
| Humans evolved with a lot of behaviors that is or was not
| healthy. Evolution requires you to have offspring and
| have them alive until having own offsprings.
| int_19h wrote:
| Speaking as someone who has spent several months trying
| to adjust to a CPAP machine before finally giving up,
| it's not because it's annoying, it's because I _literally
| can 't sleep_ with the damn thing strapped onto my face.
| I'm well aware of the benefits, and I would _love_ it if
| I could have them... but between sleep apnea and no sleep
| at all, the choice is obvious.
| binoct wrote:
| Everyone has a unique situation, but wanted to share my
| experience because improving apnea can have such a huge
| impact. I have a relatively mild case, so CPAP was
| borderline but I tried it. Like you spent 4 months and
| never got past 3 hours in one night, even trying several
| masks. Gave up for a year, worked on sleep hygiene in
| general and tried again. After about 2 weeks of a new
| mask and adjusting settings slept through the night. 5
| years on I still wish I didn't need it, but the improved
| quality of life means I basically never go to sleep
| without it. Can't imagine how big a deal it is to someone
| with severe apnea.
|
| You don't need to completely throw in the towel if you
| don't want to. Take breaks, try different masks as much
| as you can, get your dr to help adjust pressures. At
| least for some of us it does eventually click.
|
| Good luck!
| int_19h wrote:
| I have a friend who got a CPAP and was happily sleeping
| with it on the first day, 5 minutes in. I'm very envious,
| but... I've already tried several different masks, went
| to the supplier to have them adjust that stuff to fit me
| etc.
|
| At the end of the day, we are all different, and the
| threshold for what physical sensations a person can
| tolerate is highly variable. Everyone understands that
| about pain (I hope!), but this goes just as much for all
| these other things that are not necessarily painful as
| such, but are still physical.
| staypegged wrote:
| >Fasting is problematic to the medical industry because it
| is zero cost.
|
| Is this just an American thing? Every GP I've ever seen has
| asked me about my diet and exercise despite me being in the
| healthy BMI range.
| epistasis wrote:
| I don't think that fasting is problematic to the medical
| industry in the US. And if it is, it's not because it's
| zero cost. Doctors _love_ zero cost interventions. The
| real challenge is just the standard medical challenge: 1)
| educating doctors as new evidence comes in, 2) doctors
| educating patients, and 3) patients complying with the
| intervention.
| NegativeK wrote:
| It's a pessimism thing.
|
| I've had doctors (in America) tell me to not worry about
| medical issues and others recommend a battery of tests to
| look for correlated but uncommon issues. My current GP
| recommends basic, palatable approaches to diet and
| exercise that have nothing to do with giving them money
| (and, presumably, reduce my medical costs with them down
| the road.)
|
| I've also had doctors suggest that I get an issue
| reclassified so they could do surgery. That could be
| viewed as them wanting money, but I view it as them
| seeing a problem that can be fixed by surgery because, as
| a surgeon, that's how they approach problems.
| 1234letshaveatw wrote:
| Are you asking if your anecdotal evidence is sufficient
| to make an inference for all of Europe and the US?
| nradov wrote:
| Other studies have shown that type-2 diabetes can also be
| put into remission for many patients with nutritional
| ketosis. So, there are potentially multiple approaches to
| try.
|
| https://www.virtahealth.com/research
| graeme wrote:
| to be clear this isn't reversing T2 diabetes. Rather, it
| allows you to manage it. But the physical damage causing T2
| diabetes generally remains
| yurishimo wrote:
| The American diabetes association admitted last year that
| T2 can be "reversed" with the caveat that you mentioned
| about existing damage. However, to actually damage things
| to a level where they are noticeable takes years and
| years. If you catch it early, T2 is entirely
| "reversible".
| Aaronstotle wrote:
| This is why it made me upset to see this Doctor on TikTok
| telling people unless you have Diabetes, you don't need a
| glucose monitor and making fun of people who had one.
|
| Where is the harm in getting data on how your own body deals
| with glucose?
| queuebert wrote:
| False positives in medicine can cause unnecessary
| interventions that carry their own risks. Believe it or not,
| there is an optimum level of ignorance for maximum health.
| eurleif wrote:
| If having more information leads to worse outcomes, that's
| fundamentally a problem with how you're responding to the
| information, not with having the information.
| akira2501 wrote:
| If I'm not trained to correctly respond to the
| information then why should I believe that I'm going to?
| mhb wrote:
| You can learn?
| akira2501 wrote:
| I can learn almost anything. So, I have to put values on
| what it is I'm learning, so I don't waste my time. My
| estimation is that learning how to interpret my health
| data so that I can spend a lot of time gathering and then
| continually interpreting that health data is not going to
| evince any additional value in my life.
| queuebert wrote:
| If you knew which signals were false positives, they'd be
| true negatives.
| user_7832 wrote:
| > If having more information leads to worse outcomes,
| that's fundamentally a problem with how you're responding
| to the information, not with having the information.
|
| Not necessarily.
|
| Rohin Francis (Medlife crisis) has I think a video on
| overtesting, but for example, if you have a new
| technology that tests and suspects a tumor, which results
| in CT scans for patients, if millions of users use this
| tech there's a likely non-zero number of people who may
| get cancer from the CT exposure.
|
| "What about those who actually had the tumor?"
|
| Well it's possible that 99% of these cases would've been
| symptomatic anyway in a few more months.
|
| By explanation isn't the best, but over-medication is not
| a non-issue.
| graeme wrote:
| That's still the response though. You can simply say
| "Well, we expect an error rate of X with this new test,
| so in the absence of other risks factors we predict the
| actual odds of the condition are Y".
|
| Then you can decide whether a test makes sense or doesn't
| make sense, given the tradeoffs of radiation and cost vs.
| the risks of harm.
|
| In the real world, information absolutely can lead to
| harm, but it's still all in the response and how medicine
| and patients use information.
|
| But as information gets cheaper and more common we can
| develop ways of dealing with it. If it was difficult and
| expensive to test for fever you'd see people in the
| medical profession warning against it because it could
| lead to overreaction.
| user_7832 wrote:
| I get your point, however I think there are a few
| confounding things. For a lot of people, if you get a
| positive result from a test that a doctor brushes off
| that's not going to go well. I'm very much in favor of
| more testing personally, there are almost certainly folks
| who're on SSRIs who'd benefit more from Vit D/Mg
| supplementation for example.
|
| Another thing I seem to remember in his video was that a
| tumor is not necessarily dangerous. Out of a hundred
| (say) tumors in a person's life, only maybe 5 are risky.
| But I'm paraphrasing this badly.
|
| Edit: https://www.youtube.com/watch?v=7kQk9-KLPfU is one
| of the videos, however I think he's talked about this
| more (likely on instagram or another video too).
| psychlops wrote:
| What sort of risky false positives and interventions are
| you anticipating from knowing glucose levels?
| gtirloni wrote:
| The unnecessary interventions are done by licensed doctors?
| Why?
| queuebert wrote:
| Doctors make mistakes. Procedures carry inherent risks,
| such as infection, allergies, blood clots, etc. Even
| driving to the doctor to discuss your blood glucose
| carries a risk of car accident. All of these are low
| probability events, but non-zero.
| tetramer wrote:
| You don't know if it's a false positive or not until you
| do further interventions. Realizing it's unnecessary is
| only evident in hindsight.
|
| E.g. CT scan shows an incidental, tiny lung nodule. You
| do a biopsy. Unfortunately, during the process of getting
| a biopsy, you develop a pneumothorax (an uncommon but
| well-known complication of a lung biopsy) and need a
| chest tube, hospitalization, etc. You get discharged and
| you're fine, but man, that wasn't fun. Biopsy comes back
| negative for cancer. Nodule goes away on its own with
| time.
|
| Edit: that being said, I'm excited about OTC CGMs! But
| the "data" we have in medicine is not as accurate as
| other fields and always subject to false
| positives/negatives.
| unlikelytomato wrote:
| the gap between cgm and a biopsy from a CT scan is vast.
| CGM is not enough to trigger any such intervention.
| Unnecessary interventions are absolutely a concern. A CGM
| is about as controversial as someone taking their own
| heart rate to help them calm down from panic attacks.
| Minimally invasive and nobody would base a dramatic
| intervention on this data alone.
| tetramer wrote:
| Sure. As I stated in my original comment, I'm excited
| about CGMs being widely available. The example in my
| comment was very specifically answering "why do doctors
| perform unnecessary interventions?".
| gtirloni wrote:
| Agreed. Thanks for the perspective. Never considered
| downsides of such interventions (as I have been mostly a
| lab rat for doctors but never experienced things like
| that, but it's understandable).
| abletonlive wrote:
| Dumb framework for dealing with incompetence.
|
| "I'm so incompetent that more data is going to lead to
| worse outcomes! So let me stick my head in the sand and not
| measure!"
|
| Imagine if any other profession operated under this
| framework:
|
| "Ehhh, if we inspect too hard we might make a repair on
| this airplane that will cause further damage, lets just not
| do the inspection"
| queuebert wrote:
| Do you think tearing apart a working airplane and putting
| it back together in order to inspect it between every
| flight is a safe practice?
|
| Did you see the 737 door plug accident?
|
| You are missing part of the picture here. And that part
| is not that everyone else is dumb but you.
| abletonlive wrote:
| > Do you think tearing apart a working airplane and
| putting it back together in order to inspect it between
| every flight is a safe practice?
|
| Do you think this is....the same thing as a continuous
| glucose monitor?
| queuebert wrote:
| Mathematically, yes. The probabilities involved are
| different, however.
| rockooooo wrote:
| There are downsides to over-medicating, even if your personal
| budget for health is ~unlimited. Nobody wants to be a false
| positive.
| Aurornis wrote:
| > Where is the harm in getting data on how your own body
| deals with glucose?
|
| We have a relatively good indicator of long-term glucose
| levels: HbA1c blood testing. It's included in a lot of
| physicals now because it's relatively cheap. It's not 100%
| sensitive to every possible condition, but it's quite good as
| a screening mechanism for the general population.
|
| CGMs will often give an "estimated HbA1c" value based on
| statistics from the collected data.
|
| The challenge with CGMs is that it can he harder to know
| what's "normal" or not than you might think. There are a lot
| of stories of people becoming unnecessarily worried about
| occasional spikes or dips that are virtually inconsequential
| in the grand scheme of things.
| crimsontech wrote:
| At the age of 45 I had never had an HbA1c test. I found out
| I had T2 diabetes from getting a CGM as part of a health
| study I applied for, and seeing my blood glucose was at
| 22mmol (it should be under 10). I ordered a finger prick
| test kit from Amazon assuming the GCM was faulty but it
| wasn't. After this I went to the doctors who confirmed with
| an HbA1c and put me on Metformin.
|
| It certainly should be part of routine checkups in my
| opinion, but I had never had more than blood pressure check
| and a weigh in from my doctor.
| bialpio wrote:
| Where are you based? I have it tested annually, but only
| after moving to USA (from Poland). I don't remember if I
| had such a test done earlier - I think I might have had
| it done as a part of screening for whether I'd be allowed
| to go scuba-diving or something else sports-related.
| Aurornis wrote:
| HbA1C has been checked by all of my primary care
| providers across several locations in the US.
|
| I also had an insurance provider who gave us a cash bonus
| if we had it tested (they paid) every year for a while.
|
| It's surprising that some doctors aren't checking it
| still.
| akira2501 wrote:
| > Where is the harm in getting data on how your own body
| deals with glucose?
|
| That's not what you're actually measuring though. You're just
| measuring instantaneous blood sugar levels.
|
| You're hoping that your process for correlating this data
| with other events and trends in your life is accurate and
| useful. Unless you're planning on bringing a lot of
| documentation and other data recording to pair with this,
| it's not likely this single data point is going to
| beneficially change outcomes for you.
| pastor_bob wrote:
| What are 'treatable' causes other than food intake?
| anonfornoreason wrote:
| One example is an iron overload disorder. Excess iron
| accumulates in various organs including your pancreas, liver,
| and pituitary gland. Catch it early and you can avoid liver
| cirrhosis, busted pituitary function, poor pancreatic
| function, heart issues, dementia, etc. Wait too long and you
| are on the transplant list.
| NotGMan wrote:
| I second, I wore it multiple times as a non-diabetic and it was
| very enlightening.
| znpy wrote:
| I'd really love to be able to do that (experimenting) but i'm
| in the EU and haven't looked at the possibilities yet (i'm not
| diabetic).
|
| However i recently saw a video of a woman that carried a
| glucose monitor (even if she didn't need one) as part of a
| study (she volunteered) and was able to correlate her mood and
| her weight take/loss with sugar intake.
|
| I'm very curious about this. I've started a diet recently and
| after quitting many sources of sugar completely I'm very
| surprised how long i can go without eating and how little
| calories per day i can consume (well, as long as i have fat to
| burn at least).
|
| If anybody wants to chime in and suggest a glucose monitor that
| i can get without prescription in EU (Italy) and from which i
| can pull off data, please do.
| dhoe wrote:
| I'm in the Netherlands and just bought a Freestyle Libre 3
| from https://www.dia-centrum.nl/. It didn't require a
| prescription and was easy to set up and you can get the data
| out of Freestyle's website, as a CSV download if I remember
| correctly.
|
| I had a doctor comment that he'd never seen anybody wearing
| one just out of interest, and he was slightly condescending
| about it.
| ps2fats wrote:
| Perfect, I'm also in the NL and was hoping someone would
| have more information. I totally believe the GP being
| condescending about it, they are trained as gatekeepers to
| medical care to reduce costs to the system (wife is a
| doctor). It is also unimaginable to them, for whatever
| reason, that people would pay for things out of pocket.
| dhoe wrote:
| Haha, yeah, don't get me started. My other
| recommendations along these lines for people who don't
| want to argue with their GP about which blood tests "make
| sense" is https://onedayclinic.nl/. Their pricing is
| somewhat confusing but you can just email them everything
| you'd like to measure and they'll make you a (reasonable)
| offer.
| Aurornis wrote:
| Read up on what's normal, though.
|
| I tried a CGM twice. I triggered the hypoglycemia (blood sugar
| too low) alarm multiple times, but felt completely fine.
|
| After some research I discovered it's actually not uncommon for
| healthy people to have occasional dips below the preset
| hypoglycemia threshold, but as long as you're not having
| symptoms then there's no cause for concern.
|
| I also talked to a doctor who complained that she had multiple
| patients showing up with concerns about their glucose numbers
| for various reasons after trialing CGMs, but they had similar
| spurious and unimportant problems (brief excursions out of
| range, etc.).
|
| So if you're going to experiment, at least familiarize yourself
| with what's truly problematic. It's easy to misinterpret the
| data if you don't know what it means.
| dreewf wrote:
| Freestyle libre has a lot of hypoclyemia events due to
| pressure on the sensor. If you roll over at night, or lean on
| the sensor it reads way too low. It's very annoying since you
| can't disable the alarm, I have to turn off the Bluetooth at
| night. Similarly when you go into very cold water it will
| read lower incorrectly.
| coldcode wrote:
| I found out I was barely in the diabetic range a couple of
| months ago; hopefully, with diet changes and Metformin, I will
| see my A1C at a better number in a month or so. Otherwise, I
| would like to try a CGM to see what I am missing.
| sdo72 wrote:
| I think I would recommend the opposite unless you are diabetic
| or pre-diabetic. Using this may make people think eating high
| GI food causes diabetes.
| epistasis wrote:
| Prevention of diabetes or even of pre-diabetes is well worth
| the experiment. At least for folks in the US, where metabolic
| syndrome is hanging over the head of a huuuuuge percentage of
| the population.
|
| Hiding information from people because they might
| misinterpret it is not a successful medical strategy, the
| better strategy is to educate, see if the information will be
| welcome, then provide the information in the context of what
| it means.
|
| I wasn't technically pre-diabetic, but did have a few higher-
| than-expected resting glucose blood tests, and the CGM showed
| me that I'm actually _really_ close to pre-diabetes.
|
| That was the kick I needed to clean up my diet (specifically
| eat less), exercise 5-7 days of the week, and I'm feeling
| better than ever.
|
| Anecdata, of course, but there is no single intervention that
| has been discovered to improve people's weight and metabolic
| problems in the US (except perhaps the new GLP-1 inhibitors).
| Adding a CGM, at least for people interested in it, can be
| very effective, and we should use all the tools we have to
| improve the population's health.
| sdo72 wrote:
| I think your approach is that giving more data to
| individuals so that they can be informed and make better
| decision about life choices. However, if we look at
| reality, the data is already there, without experimenting
| we can already get a ton of data. Then the question is have
| people made better decisions about their life choices. I
| think the answer is No.
|
| And thus I doubt very much that with this device or devices
| like this, the diabetic population will be reduced. In
| fact, I believe it to be the opposite.
| RecycledEle wrote:
| I assume you mean you experimented with another CGM, since this
| one is not on the market yet.
| simple10 wrote:
| Experimenting with GCMs is by far the most useful and fun
| biohacks I've tried. I was part of the early beta for Levels
| Health.
|
| Even if you don't suspect underlying health issues, the data
| provided for health optimization and gamification is worth it.
|
| I used the GCM for 4 weeks and mostly tested how my body
| responds to various types of foods and meal timing. I also used
| an Oura ring to track sleep.
|
| Main lessons learned: fat loading in the morning with a
| bulletproof (ghee) coffee didn't spike glucose and provided
| sustainable energy. Carbs for dinner helped with sleep but only
| if the meal was several hours before bed, allowing enough time
| for the double glucose spikes to return to baseline.
|
| And Japanese sweet potatoes massively spike my glucose unless
| they're slightly undercooked. Cooking methods significantly
| changed how my body responded to the food.
| mikenew wrote:
| Can you share a little about the "additional labs" you did?
|
| I wore a CGM for about a month. Also found that my glucose
| numbers were not nearly as good as I would have expected,
| especially considering that I'm quite active and not
| overweight. But it's the "what next" that I'm stuck on.
| smallerfish wrote:
| Check out Peter Attila's book. He has a couple chapters on
| metabolic syndrome that should be helpful.
| mikenew wrote:
| I've read Outlive (and am a big fan of Peter Attia in
| general), but there's really not much there besides
| "exercise more, eat better".
|
| I was on strict keto for a year, with daily blood tests to
| monitor ketone levels. My fasting glucose would still be
| above 100 often enough. Even a moderately sized carb-heavy
| meal can send my BG above 200 (even after being off of keto
| for a few months).
|
| Maybe if I paid the $2500 for his "Early" program that
| details all the labs he does I might get some insight, but
| that is clearly priced for someone outside my tax bracket.
| FigurativeVoid wrote:
| I'm a T1 diabetic, and CGMs are a great tool for blood sugar
| management. Combined with a closed loop system, they are
| literally life changing.
|
| I am glad to see an increase in access to live changing medical
| care for a disease that is mostly just bad luck.
| thecosas wrote:
| T1D here too. Fun to see others having an interest in CGMs :-)
| chx wrote:
| I got the dexcom g6 three years ago via a simple online order in
| Canada. Is Canada more lax? What's the difference?
| coldcode wrote:
| In the U.S., until this one, you needed a prescription to buy
| one. Many countries allow them to be purchased without.
| moralestapia wrote:
| Great news. Reading through their website and just found out
| they're disposable(!).
|
| Anyone knows if there's a reason for this? I don't want to think
| is just a money grab. Perhaps the patch wears off?
| coldcode wrote:
| All CGMs only work for a period of time, like a couple of weeks
| or so. Then you get a new one. To keep the size reasonable it
| can't be too big.
| mapkkk wrote:
| The patch does wear off but the main reason is because there's
| a finite amount of enzyme (glucose oxidase) on the filament
| that does the actual glucose measurement on the sensor. So over
| time the enzyme is "spent". That, and of course it's lucrative.
| There are clever ways people have come up with (particularly
| from low income regions) where you can trick these sensors or
| the apps to reset and apparently you can get way longer
| lifespans like that (for the dexcom you also have to file down
| the bluetooth transceiver so that you can get at the battery
| within) at the risk of no longer being able to trust the
| readings.
|
| There's one company that's experimenting with an implantable
| CGM that will supposedly have a 6 month lifespan, with a
| bluetooth powered patch that you apply on the skin overlying
| the implant.
| EMCymatics wrote:
| It can help your health but I'm concerned how often the data will
| get abused.
| galago wrote:
| I'm currently wearing the Freestyle Libre 3. It communicates with
| the app every minute. I have something between pre-diabetes and
| diabetes so I have a slight chance at being able to treat my
| condition with diet/weight/exercise. Its definitely changing my
| behavior--I'm aware that it is not as accurate as the stick test
| but I have a plot of my blood sugar throughout the day. Currently
| I'm consuming very little carbohydrates. I've learned from my own
| data what foods will cause my blood sugar to spike.
|
| The app is missing some obvious features, and people are right to
| complain, but its way better it seems than devices that came
| before.
| NelsonMinar wrote:
| So glad to see medical monitoring made available to people.
| Different problem but an O2Ring continuous blood oxygen monitor
| was a big help to me in understanding my sleep apnea and getting
| it treated.
| sdo72 wrote:
| I don't know why modern days we get so many problems wrong.
|
| A -> B, then B -> A => incorrect
|
| In a fire, we see firefighters, that doesn't mean firefighters
| cause fire. In diabetic patients, we see high glucose level. That
| doesn't mean eating high GI food causes someone to have diabetes.
|
| If we look at the Blue Zone, many people eat mostly carb. So
| carb/high GI food definitely doesn't cause diabetes.
|
| Devices like this will make other people fearful of high glucose
| and think they're getting diabetes. People without the disease
| shouldn't focus on monitoring the glucose level, focus on eating
| healthy instead. And of course eating healthy is another complex
| topic.
| migro23 wrote:
| > In a fire, we see firefighters, that doesn't mean
| firefighters cause fire. In diabetic patients, we see high
| glucose level. That doesn't mean eating high GI food causes
| someone to have diabetes.
|
| This is correct but probably not in the way you think. It is
| not the glucose in and of itself that is the problem but the
| level of the hormone insulin circulating around your system
| that is at the root of Type II diabetes. Glucose and insulin
| are highly related. Insulin is released by the pancreas to help
| control the level glucose in our blood.
|
| Virtually no insulin is required when metabolising fats, a
| small amount is required for protein and a larger amount of
| insulin is required when dealing with glucose dense
| carbohydrate based foods. The faster a carbohydrate is
| metabolised the greater the dose of insulin required to quell
| the resulting glucose rush in the blood.
|
| What does the insulin do? As a hormone it has many functions.
| The presence of insulin in the blood signals to all cells to
| burn sugar (glucose) rather than fats (ketones) for their
| energy. It prompts the cells in the skeletal muscles to store
| up glucose in the form of glycogen for later use and it signals
| the liver to store excess glucose that is not immediately
| needed. Once the liver and muscles are full then the liver then
| converts any excess to triglycerides.
|
| Where do the triglycerides go? They get stored as subcutaneous
| fat all over but largely in the belly (in men) and bum/upper
| legs (in women). What happens when subcutaneous stores are
| full? Then the triglycerides are shoved anywhere and
| everywhere. Fat is pushed into muscle cells as well as the
| cells in individual organs. The fat molecules present in cells
| in organs are particularly pernicious (visceral fat) but any
| cells that contain these triglycerides seems to disrupt the
| insulin signalling within the cell. This results in insulin
| resistance i.e., the ineffectiveness of insulin to signal to
| the cell to take up excess glucose.
|
| When sufficient threshold of insulin resistance is reached, you
| will get higher blood sugar readings and a higher A1C at which
| point your doc will say you have prediabetes or full on type II
| diabetes.
|
| Insulin is the master key variable that unlocks the type II
| diabetes puzzle. High blood sugar levels are just a symptom.
| The problem with modern day Type II diabetic care is they
| consider the high blood sugar as the root problem. So this is
| treated with meds such as metformin and eventually MORE
| insulin. Understanding type II diabetes as a disease of too
| much insulin sheds the disease in a very different light.
|
| Anyway, you are correct, the high glucose level per se is not
| the cause, but high levels of insulin constantly circulating
| around your system is the big problem. Of course an effective
| way of doing that is to continuously eat foods dense in glucose
| and fructose that are metabolised very quickly e.g., cookies,
| ice-cream, orange juice etc.
|
| > If we look at the Blue Zone, many people eat mostly carb. So
| carb/high GI food definitely doesn't cause diabetes
|
| Blue Zone areas such as Okinawa, you do find people eating carb
| rich foods but they are also high in fibre e.g., root
| vegetables, sweet potatoes etc. look at books by Robert Lustig
| to learn more about the importance of fibre in relation to
| metabolism and diabetes risk.
| sdo72 wrote:
| Thank you for the detail :). And yes, I do believe lacking of
| fibre is one of the key important factors causing many kinds
| of diseases, and the modern diet is totally missing lots of
| fibre.
| migro23 wrote:
| You're welcome. I must add that I am not a doctor so take
| the above with the appropriate level of skepticism on your
| behalf. I am only summarising what I have learned from
| books and have omitted _A LOT_ of detail.
|
| Recommended further reading
|
| - Pure, White and Deadly (John Yudkin)
|
| - Fat Chance (Robert Lustig)
|
| - Outlive (Peter Attia) contains an excellent and concise
| synopsis of the mechanisms behind metabolic disease
| ravenstine wrote:
| Glycemic index is only sort of useful for people who actually
| have diabetes, where blood sugar dysregulation makes insulin
| regulation equally as precarious. For anyone who doesn't have
| diabetes, GI doesn't really mean anything other than that their
| insulin may or may not spike in a short period of time related
| to a food. Glucose spiking, hence insulin spiking, _is not_
| something you want, but this also doesn 't mean that something
| with a lower GI score is better for you and doesn't cause you
| to release as much insulin. Whether it's table sugar or whole
| grain pasta, they'll become glucose that the body will use or
| store in one way or another. Fasting glucose will still remain
| higher.
|
| > Devices like this will make other people fearful of high
| glucose and think they're getting diabetes.
|
| Elevated glucose is _exactly_ what causes type 2 diabetes. Take
| away the glucose supply, and you don 't have elevated insulin.
| Fear of glucose that is _too high too often_ is entirely
| justified and is not something that should be going on if
| people can avoid it. Sugar molecules are damaging to cells and
| are related to other things like cardiovascular calcification.
|
| > If we look at the Blue Zone, many people eat mostly carb.
|
| So-called "Blue Zones" are not science. They are anecdotal,
| cherry-picked, uncontrolled, and can't be tested. Also, some of
| those zones, such as Okinawa, are mythical. Okinawans
| historically have eaten a lot of pork, and still eat a ton of
| pork. They also used to not keep much in the term of birth
| records, so there was really no way to know how old any of
| those people were back when they were studied.
|
| > So carb/high GI food definitely doesn't cause diabetes.
|
| Propose a model of type 2 diabetes that doesn't involve
| dysregulation of blood glucose and come back to us.
| 462436347 wrote:
| > Elevated glucose is exactly what causes type 2 diabetes.
| Take away the glucose supply, and you don't have elevated
| insulin. Fear of glucose that is too high too often is
| entirely justified and is not something that should be going
| on if people can avoid it. Sugar molecules are damaging to
| cells and are related to other things like cardiovascular
| calcification.
|
| No, it doesn't:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602127/
| ravenstine wrote:
| Reread that article. It has literally nothing to do with
| cause and effect. The study finds an association between
| intramyocellular lipids and insulin resistance, and has
| absolutely nothing to say about whether diabetes is caused
| solely by glucose dysregulation or something else.
| sdo72 wrote:
| Every response you have don't relate to my comment! and I
| believe you have incorrect info in your responses as well.
| ravenstine wrote:
| Surely you have a good example of what I am incorrect about
| instead of merely saying I am wrong?
| sdo72 wrote:
| Your comments aren't the responses to my comments. Let's
| take an example, my comment is neither proposing a model
| for T2D nor saying CGM is part of any model.
|
| You said Okinawa people eat a ton of pork, please compare
| with something.
|
| You said they don't have birth record accuracy which is
| not totally true. In many asian culture, they use Zodiac
| and similar methods to keep track of age, the exact date
| may be off, but the year cannot be off because if it's
| off, that's 12 year difference. I cannot be a dragon and
| claim myself to be 84 when I am only 72 because all of my
| friends around know how old I am around.
|
| When 1 or 2 persons say it, it may be mythical. But when
| most of population say it, there must be some truth. And
| it's also up to you how you believe it.
| 462436347 wrote:
| > If we look at the Blue Zone, many people eat mostly carb. So
| carb/high GI food definitely doesn't cause diabetes.
|
| While obesity is known to be the greatest risk factor for T2DM,
| you can induce insulin resistance in weight-stable individuals
| just by shifting the macro composition of their diet towards
| saturated fat:
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291812/
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171936/
|
| Sugar, amusingly, doesn't seem to have the same effect.
|
| Given that the typical recreational CGM wearer (in my
| experience) is a low-carb/keto type (who ruined their insulin
| sensitivity), you should probably take the comments in this
| thread touting CGM use with a grain of salt.
| hnburnsy wrote:
| Hope this integrates with Garmin...
|
| https://www.garmin.com/en-US/blog/health/how-garmin-and-dexc...
| fgkramer wrote:
| I'm currently wearing a CGM from Lingo
| (https://www.hellolingo.com/) which is pretty much the easiest
| way I've found to get my hands on one without a prescription (as
| I'm not diabetic).
|
| So far it's shown me that the sluggishness after a carb-heavy
| meal its heavily correlated with the glucose spike and how good
| my organism copes with it.
|
| Can't wait for the day we have our own Fallout style Pip-Boys!
| autoexec wrote:
| It'd be pretty interesting to see that kind of data, but it looks
| like this product violates my policy on not buying hardware that
| requires a cell phone app to use, and my policy on keeping as
| much of my medical information as far away from my mobile device
| as possible. I'm not sure exactly who the app itself sells/leaks
| the data being collected to, but even having that kind of data on
| the device would make me uncomfortable.
|
| A quick read of their privacy policy suggests that the mobile app
| is full of personalized ads and they use your data for "direct
| marketing" as well as "research". They offer your data to third
| parties for both "marketing" and "analytics" reasons. They'll
| send your data overseas whenever it suits them, even to places
| where your data will not have the same protections, and they'll
| keep the data they collect forever unless you submit a request
| for them to delete it and they are actually required to do so by
| law.
|
| Since I'm only mildly curious to see what the numbers would look
| like, I'm fine with waiting until someone puts one on the market
| that saves its data to storage that can later be copied over to
| an offline PC.
| spc476 wrote:
| My girlfriend as the Libre 3, and she has both the cell phone
| app, and a stand alone unit to store results. You can only use
| one or the other, not both at the same time (the Libre 3 uses
| Bluetooth). We have the stand alone unit because of insurance
| reasons.
| xen2xen1 wrote:
| Dexcoms also have small cell phone like devices you can use.
| I've never put a wifi password in I can recall.
| mlsu wrote:
| They sell the data to nobody. It's considered PHI so covered by
| HIPAA. Dexcom has to trace custody of the data from the sensor
| to app to wherever it goes, so it is encrypted the whole way.
|
| Nobody has access unless the patient wants them to.
| autoexec wrote:
| Their own privacy policy says they share data for marketing
| purposes. I don't think they'd do that without any
| compensation and their app includes personalized ads.
|
| HIPAA only covers "protected health information" and not all
| of the data collected by their products.
|
| They also state: "You can ask us not to use or share certain
| protected health information for treatment, payment, or our
| operations. We are not required to agree to your request"
|
| Once a year you can also request that they send you a report
| on who they shared your data with and why without paying them
| for it, but it will not include anything involving
| "treatment, payment, and health care operations, and certain
| other disclosures (such as any you asked us to make)."
|
| see https://www.dexcom.com/notice-of-privacy-practices
| mlsu wrote:
| I'm bet they probably do collect e.g. your phone's
| operating system and use that to figure out which market
| segment you belong to. But as far as I know Dexcom doesn't
| have any agreements with anyone to sell their user's data;
| If they have ads in the dex app I've never seen one. I
| would be extremely surprised if that were the case.
|
| >You can ask us not to use or share certain protected
| health information for treatment, payment, or our
| operations. We are not required to agree to your request
|
| What they're talking about here isn't necessarily what you
| expect. It's that, if you e.g. encounter a bug in the
| product that they need to disclose to the FDA, you cannot
| withhold information from them that would prevent them from
| doing that. Or, if they need to know what kind of diabetes
| you have so that they can charge your insurance for the
| correct prescription, you can't say "you're not allowed to
| share that." (doesn't really apply here, but that's kind of
| what's meant in that clause). You can see: treatment,
| payment, or operations. The scope of each of those is kept
| as small as possible, and they do have audits from time to
| time ensuring that it is.
|
| I assure you that CGM readings, trends, averages, reports,
| etc. ALL of that stuff is absolutely, positively considered
| PHI and considered extremely privileged. The only time
| anyone, even in the company, can see that data is if they
| are a customer support agent helping a specific customer,
| or if they are on the data science team looking at broad
| trends to help e.g. calibrate the product.
|
| >Once a year you can also request that they send you a
| report on who they shared your data with and why without
| paying them for it, but it will not include anything
| involving "treatment, payment, and health care operations,
| and certain other disclosures (such as any you asked us to
| make)."
|
| It's because they have extra requirements around storage,
| retention, etc of that PHI data. It's very likely that they
| can't send you a report because all parties have much
| stricter access controls on that data so it can't be
| aggregated and put in a report without filing a mountain of
| paperwork.
|
| I assure you, these companies do not fuck around with
| patient data. They don't even do things that give off the
| appearance of fucking around with patient data, because
| they know that if the HHS thinks that they are that's
| millions of dollars in audit costs.
| chefandy wrote:
| I'm a lot more concerned by what my insurance company can
| do with the data than marketing companies-- they
| regularly deny claims based on data collected by device
| vendors.
|
| In the following article, see: Sleep aid or surveillance
| device?
|
| https://www.npr.org/sections/health-
| shots/2018/11/21/6697510...
|
| Maybe glucose monitoring data is different than sleep
| data, but I don't see why it would be. In that article,
| even random customer service representatives had access
| to his device data despite his asking them to stop
| storing it. I had a similar experience with a medical
| device that the person in the article had with their CPAP
| machine: I yanked a wireless modem out of the thing and
| stuck a flash card in there, because fuck those creeps.
| They sent me a very large bill retroactively denying
| coverage for the device for non-compliance, but luckily I
| didn't end up having to pay because they accepted the
| local data I provided without (much of) a fight. But what
| if the claim wasn't for a comparatively inexpensive
| machine, and it was for an inpatient medical procedure
| with surgery, lots of imaging, and a 10k ambulance ride?
| You better fucking believe I'm not going to voluntarily
| help them weasel out of coverage.
| bsilvereagle wrote:
| For the Freestyle Libre 3, you can use it without an account.
| That does not mean that Abbott is not still sending your
| readings to the cloud, but at least your name is not attached
| to it.
|
| It takes some work, but you can "liberate" your data from the
| app without the cloud account: https://frdmtoplay.com/freeing-
| glucose-data-from-the-freesty...
| darreninthenet wrote:
| My wife already buys a Libre Freestyle over the counter here in
| the UK... are we talking the same thing? Why are (or were) they
| prescription only in the US..?
| alexnewman wrote:
| CGM is cool but it interferes with my ability to swim in the
| ocean on the reg
| dansitu wrote:
| If you find this field interesting, Know Labs is working on a
| non-invasive continuous glucose monitor using RF spectroscopy:
|
| https://www.knowlabs.co
| huytersd wrote:
| Non invasive would be a golden goose. I don't think I want to
| have something sticking into my skin for weeks on end.
| teleforce wrote:
| This is a promising non invasive glucose sensor namely
| GlucoRx Wearable BioXensor using microwave technique [1]. For
| the technical background how the sensor work and the clinical
| trials results please check this paper (paper also available
| from their university website) [2].
|
| [1] Meet the inventor: Professor Adrian Porch from Cardiff
| University:
|
| https://www.med-technews.com/medtech-insights/latest-
| medtech...
|
| [2] Microwave Noninvasive Blood Glucose Monitoring Sensor:
| Human Clinical Trial Results:
|
| https://ieeexplore.ieee.org/document/8058721
| thecosas wrote:
| T1D here who has been using Dexcom G6 for many years now.
| Interesting to see the differences between Stelo and G7 which are
| built on the same platform.
|
| Curious if anything is driving the increase in wear time other
| than battery life savings from reporting back fewer readings.
| CGM: G7 / Stelo Wear time: 10
| / 15 days Time between readings: 5 / 15 minutes
| user_7832 wrote:
| I seem to remember there was a "trick" with the g6 where you
| remove and reinsert the transmitter to get it to last longer...
| I suspect the time estimates are quite conservative.
| thecosas wrote:
| Yep, I've definitely used my G6 for two sessions using
| "tricks". It would definitely get wonky towards the end of
| that time period, but it worked.
| jonlucc wrote:
| I'm not sure how much I can say; I don't work for a CGM
| company, but my company is very interested in diabetes. There
| are non-device reasons you can't use a CGM indefinitely. The
| site becomes less reliable over time, and it varies from peron
| to person. I'm not sure if the Stelo has addressed any of
| those, or if the G7 was overly cautious, or something else, but
| there are biological things happening at the site that affect
| the time too.
| thecosas wrote:
| Ah, that makes sense. I'm certain we'll never "know" but just
| found it interesting and was curious if people knew other
| trade-offs they may have been making for increased wear time,
| especially given that would offer a sharp reduction in cost
| over time for patients (and their insurance companies, etc).
|
| A 50% increase in wear time is HUGE in my opinion.
| mangoman wrote:
| I recently had an unusual health event that resulted in me
| passing out. My wife, who is a physician, thought it might be
| hypoglycemia, since i'm at high risk for diabetes. She found a
| super friendly endocrinologist who put me on a CGM for two weeks.
| I never hit the hypoglycemia range during those two weeks, so it
| didn't really explain what my issue... but honestly the data was
| SUPER interesting. Just observing the various spikes made me make
| healthier choices, or noticing when I was feeling extra tired and
| seeing if that correlated to not having eaten for little while,
| or eating something sugary before.
|
| It's sort of like tracking your steps when you first get a smart
| watch. It may not have been the reason you got the device, but
| seeing the data, people are encouraged to act on it, even if you
| don't have an acute issue. since I didn't have a prescription, I
| couldn't get one here (didn't want to go through some sketch
| online site). I tried to get one from my family in India, but the
| prices were really high and they couldn't get the fancier one
| that tracks straight to your phone, so I didn't get one.
|
| I think this could be a god send for preventing pre-diabetic
| people who would take preventative steps if it weren't such a
| pain in the ass to measure consistently.
| lr4444lr wrote:
| What kinds of food intake/non-intake habits aside from the
| obvious culprits surprised you?
| rodly wrote:
| Long-term they will likely make no changes because human
| desire, habits and behaviors are rarely unknown to us.
|
| The parent comment mentioned feeling tired after consuming
| something with a lot of sugar, was that really a mystery
| prior to using CGM? I doubt it.
|
| Sure it's interesting to correlate to your perceived wellness
| (or lack thereof) with a wearable spitting out data but after
| the novelty of this discovery wears off my guess is that
| people will simply stop caring to check what they already
| know to be the case.
| sxg wrote:
| > The parent comment mentioned feeling tired after
| consuming something with a lot of sugar, was that really a
| mystery prior to using CGM? I doubt it.
|
| They may not have known just how sugary that item was since
| most people don't bother to calculate the sugar content of
| everything they consume, but the CGM puts a number on it.
| That experience could be enough to change the OPs behavior.
| I agree that most people may not care to make behavioral
| changes in response to more data, but there are definitely
| other people who will.
| o_____________o wrote:
| It's more than intake. It's food order, stress, sleep,
| context, and so on. Did you eat enough fiber, did you add
| more fat this time, did you drink the night before? Did you
| walk afterwards? Unless your life is extremely regimented
| and uniform, they provide a ton of data.
| dleink wrote:
| > Long-term they will likely make no changes because human
| desire, habits and behaviors are rarely unknown to us.
|
| It seems like this thinking leads to desires, habits and
| behaviors remaining a mystery to us.
| dog_boxer72 wrote:
| Is it really such a stretch to imagine that maybe some
| people really don't correlate those things? People aren't
| research papers, we have multiple cognitive distortions
| working all the time obfusticating the truth, but tech like
| this can help bypass them
| jxramos wrote:
| there is something powerful about the objective outside-of-
| self confirmation of something because it eliminates the
| doubt that can be casted as it all being in ones head.
| External confirmation is enlightening and motivating.
| jeremiahbuckley wrote:
| My view: I'm busy, I have a lot of things I'm trying to
| figure out. For example, All of my free time should be
| spent getting better at AI programming. Seemingly infinite
| horizon.
|
| I could carefully track a half dozen signals to correlate
| consumption to effect, but if the effect is "I'm tired and
| don't have much willpower", that's hard to remember to
| track. I just haven't built up that habit; heck I'm having
| a hard time keeping up the habit of light exercise.
|
| I have a cousin who was diagnosed with some stage of
| diabetes; got a continuous blood sugar monitor; ended up
| losing a ton of weight. I'm definitely in the market for
| this--something to make it easier for me. It's undoubtedly
| healthier for me than mainlining wygovey, which is another
| option on the table.
| temp_praneshp wrote:
| The ones on diabetic warehouse don't work well enough
| (https://www.diabeticwarehouse.org/collections/continuous-
| glu...? Or is that site sketch for you? I think you can just
| get one if you are willing to burn $500 (not cheap, but only in
| the price range of a higher-end smartwatch)
| vlabakje90 wrote:
| Keep in mind that a single sensor will work for only a week
| or two, depending on the type. So it's not exactly right to
| compare the price to a smartwatch.
| temp_praneshp wrote:
| Ah okay, thanks for telling me that; I thought you keep
| recharging the battery every week from the description.
| pwthornton wrote:
| No. They are single-use, and it embeds into your skin
| with a probe.
| cheriot wrote:
| Thanks for confirming. Normal feedback on health habits is
| delayed by months/years and hard to trace back to specific
| actions so your story makes a lot of sense.
|
| I might have to get over my dislike of needles :|
| mikenew wrote:
| It's more akin to a finger prick than a needle. Might still
| be a bit psychologically challenging but I've done it and
| it's really not bad at all.
| jorvi wrote:
| I'm not even diabetic but they always pre-check your blood
| during blood / plasma donating. I would say it doesn't even
| register as a pinprick and feels more like the percussive
| slap of a tiny elastic band.
| mikepurvis wrote:
| Ha, I would say quite the opposite, that the finger prick
| is my least favourite part of giving blood-- it's ironic
| that taking a few drops could be that much worse than the
| big honking needle which draws an entire pint, but I
| guess fingertips just have a lot of nerve endings.
| RHSeeger wrote:
| As a diabetic, I've always found that the finger prick
| for testing my blood hurt more than the insulin needles.
| 0_____0 wrote:
| Not sure if the blood center people have a protocol for
| this but in athletic labs you can sample from the earlobe
| to take blood lactate readings
| jxramos wrote:
| definitely, catching the "quantified self" bug is a real thing!
| dkarras wrote:
| how is having low blood sugar a sign of pre-diabetes? I get
| frequent bouts of hypoglycemia.
| murukesh_s wrote:
| At some point a person's body may become resistant to insulin
| and start to need more insulin to have normal functioning
| (pre-diabetes), sometimes this causes large variation in
| glucose levels, though not as drastic as taking a medication.
| Eventually your body would adapt to it when you reach the
| diabetes phase.
| keymasta wrote:
| It could be related but I also want to weigh in here and say
| this. Hypoglycemia can occur with no relation to the other
| side of diabetic symptoms, i.e, hyperglycemia. In other words
| there are people who suffer from hypoglycemia without ever
| getting high blood sugar, and so they are not "diabetic"
| which would mean you can have issues from both directions.
| bakedoatmeal wrote:
| What is the connection between being at risk of diabetes and
| hypoglycemia? Wouldn't a pre-diabetic be very protected from
| hypoglycemia?
| ijustlovemath wrote:
| No, diabetes is fundamentally a _lack of ability to control_
| your blood sugar. This means you get lots of highs but also
| lots of lows. It 's a common misconception that diabetes just
| means your blood sugar is always high; rather, your sugar is
| high because your body no longer controls it actively.
| bakedoatmeal wrote:
| Diabetes mellitus is an insulin problem- either a lack of
| insulin (Type 1) or insufficient response to insulin (Type
| 2). Insulin is responsible for lowering blood glucose. The
| hormones responsible for raising blood glucose (cortisol,
| IGF-1, glucagon, epinephrine) still function normally.
|
| My understanding was hypoglycemia only occurs in diabetes
| in the presence of medications used to lower blood glucose
| (insulin formulations, sulfonylureas, etc.) and not because
| of diabetes itself, which when untreated invariably leads
| to hyperglycemia.
| TylerE wrote:
| It's not either or, either. Some really unlucky folks end
| up with a hybrid and have both problems... they don't
| produce enough insulin or react well to what they do.
| cstrahan wrote:
| I'm pretty certain you're mistaken here. Diabetes is
| specifically characterized by elevated blood glucose,
| either due to pancreas not producing enough insulin _or_
| your body becoming descensitized to insulin.
|
| You will find that diabetics often _do_ have low blood
| sugar, but that 's because they overestimate how much
| insulin they need to inect, causing their blood sugar to go
| too low. The hypoglycemia in this scenario is not caused by
| diabetes, but rather a dangerous side effect of the
| treatment.
|
| OP doesn't have diabetes, and (unless he's abusing insulin
| for body building purposes) isn't taking insulin. His
| postprandial hypoglycemia is likely a benign case of
| "reactive hypoglycemia"
| (https://www.mayoclinic.org/diseases-
| conditions/diabetes/expe...).
| beanjuiceII wrote:
| You don't get lows from diabetes
| pgporada wrote:
| Are you being pedantic on purpose?
| veryfancy wrote:
| Wondered this too. Diabetics are at risk for hypoglycemia
| because of the insulin they take, not the diabetes itself.
| Maybe metformin for a prediabetic could have this effect?
| TylerE wrote:
| Nah, even as a full blown diabetic metformin doesn't drive
| you low. It basically just makes the same amount of
| (naturally produced) insulin do more, essentially.
| pgporada wrote:
| even as a full blown type 2 diabetic*
| code_duck wrote:
| There is something called reactive hypoglycemia.
|
| https://en.wikipedia.org/wiki/Reactive_hypoglycemia
|
| It can occur for various reasons. Personally, I was
| developing adult onset type 1 (LADA) for a couple of years
| before I was diagnosed and I had all sorts of effects. While
| it was of course mainly effects of chronic hyperglycemia and
| shortage of insulin, I also had some episodes of
| hypoglycemia. Now that I'm on insulin, I'm very familiar with
| hypoglycemia resulting from an imbalance of exogenous insulin
| and carbohydrates. However, I looked back and realized this
| happened to me a few times before I was on insulin. I recall
| waking up a few times at night, sweating and shaking, and
| having a strong urge to consume food. I'd drink some juice or
| eat chips, feel better in 20-30 minutes and go back to sleep.
| This occurred after drinking alcohol, which makes sense as
| alcohol intensifies the effect of insulin and also prevents
| your body from releasing chemicals which raise your blood
| glucose level. I didn't think much about it at the time but
| now I can see it was related to T1 onset.
|
| My understanding is that essentially the body's systems which
| regulate blood glucose are disrupted. This happens a with
| type 1 in general - not only problems with the system that
| produces and releases insulin to lower blood glucose by
| allowing it into cells, but also the part that does the
| opposite and release glucose to raise blood glucose levels.
| Sometimes the glucose-raising system doesn't work at all
| while other times it's inappropriately in overdrive. The same
| is true for the insulin releasing/glucose lowering system as
| it fails.
| necovek wrote:
| I personally wouldn't mind having the data if a need comes up,
| but this is simply overtracking for no particular purpose.
|
| Basically, our bodies go through much "turmoil" over the course
| of any day, and watching over one too many parameters is like
| getting hooked to TV or a video game.
|
| Generally, medical science can mostly tell you what averages or
| most common patterns are, so if you do not line up with them
| and don't understand this, you can get overstressed.
|
| So unless you are really someone who can objectively consider
| your readings combined with effects you might be seeing, I'd
| say don't do it.
| necovek wrote:
| And reading further, there is evidence of people getting
| worked up about what are not problematic readings in this
| very thread.
| lynx23 wrote:
| Watching a heartrate monitor sometimes has the reserve-
| progress-bar effect. You know the deal. You realize the
| pump is on a hightened frequency, so you see what your
| smart watch says. And the more you watch it, the more
| anxious you get, so the rate stays more or less high.
| bookofjoe wrote:
| aka "white coat hypertension":
| https://www.mayoclinic.org/diseases-conditions/high-
| blood-pr....
| TylerE wrote:
| More importantly for life style monitoring A1C is the more
| important number anyway, and doesn't require wearing
| anything, just a simple blood test. It's basically a 3 month
| moving average.
| RHSeeger wrote:
| At least for a diabetic, A1C is less looked at nowadays.
| With CGMs, we can lookt to see our time-in-range, highs,
| lows, and patterns. It's... amazing.
|
| Plus, you can see just how much different types of foods
| directly impact your blood sugar. For example, white rice
| and pizza are crazy for raising glucose levels. I knew
| about pizza, but I had no idea that white rice what quite
| _that_ bad.
| salad-tycoon wrote:
| Doesn't have to be white. Rice is how I helped screen my
| wife for gestational diabetes instead of that awful
| nukacola sugar slam they make pregnant women do and then
| check sugars at predetermined times when challenged with
| 50g rice or 50g sugar.
|
| Anyways, yeah rice is basically the insulin dietary
| equivalent of sugar.
| whatshisface wrote:
| Getting hooked on smooth blood sugar changes sounds like a
| possible counterweight to what our brains are designed to get
| hooked on... Oreos.
| cleandreams wrote:
| I am prediabetic and I have one. It's partly covered by
| insurance. By the metrics my estimated average glucose has gone
| down from 129 to 98 or so (normal). I haven't had my HbA1c in
| awhile.
|
| I think they are amazing. It's been SO HELPFUL. However I don't
| think it makes sense for normal people. I am on a reddit group
| for prediabetes and it's not unusual that people who are
| underweight (anorexic?) and have completely normal metrics come
| in and post in an utterly freaked out state. These are people
| who are somewhat compulsive and anxious. I think that if you
| are normal for blood glucose having access to all this data can
| make you compulsive and anxious.
|
| However, for me as a prediabetic, it is really useful. It tells
| you what's going on with your blood sugar in real time with no
| ideology. In the beginning I was spiking from things that a
| nutritionist would say was OK. I found whole grains didn't work
| for me. I was shocked at how much I spiked from oatmeal. What
| causes blood glucose spikes does not map directly to number of
| carbs and also every body is different.
|
| After 6 mo of lowered carbs, weight training, and getting down
| to normal BMI, I can now eat SMALL portions of things like
| brown rice. My health has improved. It's great. IMHO all
| prediabetics and diabetics should have one, covered by
| insurance. It would really improve health and reduce
| complications.
| TylerE wrote:
| What's also surprising is what doesn't. I've found for
| instance, that potatoes, even French fries, don't do a whole
| lot to mine.
| michaelcampbell wrote:
| > I was shocked at how much I spiked from oatmeal.
|
| Was it oatmeal, or what you ate oatmeal with (milk,
| sweetener, etc), or do you know?
| eternauta3k wrote:
| Also, instant oatmeal / rolled oats / steel cut oats / the
| whole dang oat?
| pwthornton wrote:
| The people at Levels, who do continuous glucose monitoring,
| say that oatmeal is one of the worst offenders.
|
| You really need to spike your oatmeal with fats, protein,
| and fiber.
|
| I regularly eat steel-cut oats for breakfast. My go-to is
| steel-cut oats, two tablespoons of Chia seeds mixed in
| (tons of fat and fiber), and a serving of mixed nuts and
| berries on top. On the side, I eat four scoops of powdered
| peanut butter mixed with water. This version of peanut
| butter is much higher in protein and much lower in fat and
| calories than normal peanut butter.
|
| Doing all of this can keep the spikes to a reasonable
| amount (I also eat the powdered peanut butter first). Any
| kind of oatmeal by itself is bad. Instant oatmeal is worse.
| Instant oatmeal with all that sugar and stuff thrown in is
| terrible.
|
| I suspect if you made your oatmeal with milk instead of
| water, it would help a lot, but I can't do this from being
| lactose intolerant.
| lawlessone wrote:
| >However I don't think it makes sense for normal people.
|
| I agree , but if it's anything like gluten free foods, having
| more people buying that don't need to, might push prices down
| for you.
| aledalgrande wrote:
| I actually just got one of these CGMs after listening to Peter
| Attia's (audio)book Outlive and started monitoring my glucose
| and experimenting with meals and exercise to see what effects
| they have. Apart from the weirdness of having something
| attached to your skin, it's like having another watch and you
| won't notice after a while. It's pretty cool and a lot more
| people than just diabetics would benefit from this knowledge.
|
| Like I just learned for example about resistant starches, of
| which one is cooled potatoes: I ate the exact same dish but the
| first time, right after cooking, my levels shot up (not
| abnormally but you should ideally never have spikes, so your
| body doesn't have to keep pumping insulin), and then the second
| time, reheated, it was like I didn't eat anything. I was
| surprised so I researched and found
| https://www.webmd.com/diet/what-to-know-resistant-starches
|
| Everyone is different so I definitely suggest to try them out
| for a month and see what gives you spikes in your diet. Then
| try to get rid of those spikes.
| technological wrote:
| can you post link to the device which you brought
| mlrtime wrote:
| Probably a Dexcom G6/G7?
| aledalgrande wrote:
| I'm using an Abbott Freestyle 2, but any of the available
| big brands that have an app would work.
| droopyEyelids wrote:
| You got me real curious about why this is.
|
| I know there are waxy and starchy potatoes that have higher
| rations of amylopectin vs amylose starch respectively.
|
| One interesting thing is that if you continuously mix an
| amylopectin potato, it turns into a gooey, ropey substance
| that we don't use much in western cooking but is how some
| Chinese mashed potatoes are supposed to be prepared. I wonder
| if that transformation affects the resistance of the starch.
|
| I also wonder what exactly is making the cooled potato
| tougher to digest.
| melagonster wrote:
| Excuse me, this is stupid question. but can't you buy Freestyle
| Libre?
| TylerE wrote:
| Yes, but need a prescription.
| melagonster wrote:
| wow... I am sorry. in my country the condition is reversed.
| it cheaper than prescription version, so I ask it. good
| luck bro.
| hackernews1134 wrote:
| Which county is that please? If you don't mind sharing.
| yurishimo wrote:
| You can buy them OTC in most of western Europe.
| seesaw wrote:
| Were you able to find out what may have caused you to pass out
| ? I had a similar incident with no root cause. But that did set
| me on the path to become more healthy.
| zxienin wrote:
| I use Abbott Freestyle Libre 3 and it has been deeply insightful
| about my progress with T2D. An increase in fasting glucose over
| 2-3 days tells me I need course correction (more movement, choice
| of food). I also noticed consistent correlation between bad sleep
| days and raised glucose levels over the day. Made me internalize
| how important sleep is.
|
| I believe, next major uptick will come from CGM in wearables like
| Apple/Samsung watches [1][2]. I hope, even non diabetic folks use
| it to improve their health.
|
| [1] https://www.macrumors.com/2023/09/14/apple-watch-blood-
| gluco... [2] https://www.macrumors.com/2024/01/23/samsung-racing-
| to-beat-...
| thecosas wrote:
| Just noticed this line in the press release from Dexcom [1]:
| Stelo will be available for purchase **online** without a
| prescription starting summer 2024.
|
| I wonder if that means that this will be direct-to-consumer in
| addition to retail channels (CVS, RiteAid, Amazon, etc).
|
| [1] https://investors.dexcom.com/news/news-details/2024/Stelo-
| by...
| lhl wrote:
| I'd highly recommend anyone considering trying one out to give it
| a pin. I've used a CGM multiple times besides being a great
| feedback mechanism, it also can give you really interesting
| insights. Here's one interesting tidbit showing that having an
| ice cream cone in between an hour-long walk actually caused no
| postprandial glucose spike compared to an earlier "healthy" meal
| served with no activity (at a metabolic health conference)
| https://fediverse.randomfoo.net/notice/Aafczv5LO83OOwXrbU
| daveisfera wrote:
| I haven't seen price info anywhere, but anyone have info on what
| that will be?
| metabagel wrote:
| I put something like this on my cat, because the vet thought she
| may be pre-diabetic, but stress response can also cause blood
| sugar to spike, so we needed to see what her blood sugar was like
| multiple times per day.
|
| The device worked for 5 days until she had managed to dislodge it
| enough so it wouldn't get a reading. The skin glue lasted another
| 5 days before the device fell off. Since then, she has had a
| "crop circle" behind her shoulder where her fur was shaved away,
| and which is ever so slowly filling in.
|
| Her readings were fine, so we are feeding her low carbohydrate
| food, because the vet thinks she may become diabetic in the
| future.
|
| Unfortunately, I had to place the reader device almost directly
| on the sensor, which was a pain, because my cat likes to hide
| under the bed. So, I had to squirt her with water to get her out,
| which was undesirable, but didn't seem to affect the readings.
|
| The device was the Freestyle Libre 2.
|
| https://www.freestyle.abbott/us-en/products/freestyle-libre-...
| mzs wrote:
| I wonder what the price will be: https://www.dexcom.com/en-
| us/stelo
| apatheticonion wrote:
| I currently sticky-tape my Fitbit Inspire 3 to my tricep to get
| continuous low effort health/sleep tracking.
|
| I used sticky tape as an experiment because there are no arm
| bands for Fitbit products. That was a year and a half ago and
| have worn it like that every day since.
|
| I can't wait until trackers can be implanted under the skin,
| track blood glucose, and improved accuracy.
|
| Let's gooooo
| UI_at_80x24 wrote:
| It's worth mentioning that in Canada, you do not require a
| prescription to get a CGM. However only the Abbot Freestyle Libre
| series is available here. It cost ~$100 and last 2 weeks.
|
| I've found it to be mostly accurate.
|
| Placing it on the back of the arm was always a problem for me, it
| was constantly getting knocked/pulled, and otherwise disturbed. I
| had to buy adhesive patches that covered the entire unit. I later
| discovered that another decent place to apply them in on my chest
| between my collar-bone and shoulder-joint but lower (towards the
| nipple). I always had decent reliability/accuracy there. It also
| hurt less (from the adhesive) then on the back of the arm.
|
| Having a CGM is amazing, and if you have medical coverage that
| will pay for it then you should get it.
| elevaet wrote:
| Can you give the elevator pitch on why someone should get one?
| UI_at_80x24 wrote:
| With a CGM you always can know what your instantaneous,
| average and trending blood glucose readings are. With a test-
| strip you know your instantaneous reading are. With a test
| strip, a pad of paper, a calculator, a calendar, a watch, and
| a good enough memory to take reading 100+ times a day you can
| get the same results.
|
| With the test strips, I measured myself AT MOST, 7 times a
| day. Often just once or twice.
|
| THAT is what makes them worthwhile. It keeps measuring so you
| don't have to.
|
| One helpful thing that I don't worry about: Low blood sugar
| alarms. Hypoglycemia is a real concern, and just as serious
| as hyperglycemia. A CGM will alter you when your sugar gets
| too high OR too low.
|
| I'm poor. I can't afford a CGM anymore. So I have been going
| months now without measuring. Because I keep forgetting. A
| CGM doesn't have that limitation.
|
| I was really hoping that Apple was going to announce a CGM. I
| avoid the Apple ecosystem, but I would have invested in that.
| cooldevguy wrote:
| I am diabetic type 2 and I've used the Abbot Freestyle Libre 2
| for a few years now. You don't need a prescription in Mexico to
| get it, but it is expensive ($1548 MXN ~= $91 USD). The data you
| get is pretty interesting but at least on my experience, the
| difference between readings from the CGM and actual blood test
| can vary from 10 ~ 40 mg/dL so you have to have that in mind.
| However it was really helpful to discover that, while I'm pretty
| active since a few years ago it was troubling for me to wake up
| on readings over 140 mg/dL which thanks to this turned out to be
| just that my body does it naturally and my blood sugar spikes
| while asleep and an hour or so before I wake up, which my
| endocrinologist just attributes to my body getting ready to work
| out.
|
| Even as an experiment, I'd say most people should get one just to
| understand their bodies, and their specific responses to certain
| foods, once in a while.
| NoPicklez wrote:
| These are so interesting and not just for diabetics who benefit
| from them the most.
|
| Top athletes have been using them for exercise to make sure their
| blood sugar remains in the correct ranges.
|
| But Diabetics are using them to help identify how particular
| foods impact their blood sugar levels (obviously). The reason
| being is that whilst some foods might be considered high/low in
| sugar, each of us reacts differently in how we absorb those foods
| or drinks. So a bagel you eat might not spike your blood sugar
| like someone else, or conversely it does. You can then correlate
| that spike or reduction in blood glucose with how you're feeling
| throughout the day, how your blood sugar levels impact exercise.
|
| Also it allows you to see how combinations of foods and the order
| that you eat them in impacts blood sugar. If you eat a chunk of
| white rice without any fibre you might find it spikes, if you
| each a bunch of vegetables in the bowl before hand you might find
| it doesn't rise as high or give you a steadier release of blood
| sugar.
|
| I'd use one for a few months just to see how foods impact my
| blood sugar and how I can make different choices. It's one thing
| to interpret a label, but it's another to see it's impact on your
| body in real time.
| briandw wrote:
| I did this for fun using the veri.co service. It was interesting
| how little my diet immediately affected my blood sugar. Non diet
| things were much bigger. Do hard exercise -> spike. Take a hot
| shower -> spike. Fast for 48 hours -> blood sugar still rises in
| the morning.
|
| Walking was by far the most effective way to keep blood sugar
| down after a meal.
|
| Most of what I ate didn't cause a problem. However tend avoid
| sugar and carbs. The worst offender was a PB&J sandwich. That was
| surprising.
| int_19h wrote:
| Both peanut butter and jelly have lots of sugar in them. Modern
| supermarket bread (in US) usually does, as well, and the carbs
| in it also turn into sugar quite readily right in your mouth.
| eep_social wrote:
| > hot shower -> spike
|
| Assuming this was a Libre, this is likely reader inaccuracy
| that does not reflect an actual blood glucose event.
| briandw wrote:
| That makes sense and I was wondering if it might be related
| to the device temp. I should have tried putting a hot pack on
| the sensor to validate.
| jesprenj wrote:
| For having participated in a study, they installed an Abott
| FreeStyle Libre 2 sensor on me for 14 days. I could get minute
| readings, which is not possible with either the hardware reader
| nor the official app, using the almost entirely FOSS android app
| Juggluco.
|
| Another FOSS web tool is Nightscout -- it generates reports and
| live graphs from data gathered from your CGM via for example
| Juggluco. My instance is at http://sladkor.4a.si. My sensor
| expired, so there's no more live data.
|
| glucometerutils is an interesting repo for downloading stored
| data from hardware readers etc. Abott encrypted the Libre 2 USB
| communication to force users to use their proprietary software,
| but hackers managed to extract keys.
|
| http://juggluco.nl http://nightscout.github.io
| https://github.com/glucometers-tech/glucometerutils
| http://ni.4a.si./anonymous/freestyle-keys/tree/freestyle_key...
| 99112000 wrote:
| I got some FreeStyle Abotts for anyone who wants to hack away at
| them. Rumor has it Dexcom is cheaper in bulk than Abotts and they
| are losing hospitals as customers.
| davidthewatson wrote:
| I'm happy for those who have been helped by these devices.
|
| The FDA approval is only a revelation to the extent that the
| hidden truth of the extant prescription CGM market is poor data
| veracity combined with high catastrophic failure of the devices
| under manufacturer warranty in some patients.
|
| It's difficult to know for sure the size of the patient cohort
| impacted here since these numbers are not made public. If the
| market functioned transparently, this knowledge would be of great
| benefit to consumers.
|
| Given the proprietary nature of these organizations, and the fact
| that they spend lots of money on lobbyists and lawyers to
| maintain the status quo, I'm not expecting this to get better, at
| least in the United States. This leaves the hope that the EU or
| elsewhere may be more aggressive in regulation, as they have
| demonstrated recently around Apple and Google.
|
| LSS: there's a ton of room for competition, cooperation, and
| innovation in CGM's and their slowly evolving ecosystem of
| software, smart phones, and smart watches, particularly in open
| source where hacks frequently work around the proprietary
| limitations in software, i.e. information devices that have
| little to do with telling time save for putting a date/time stamp
| on their event stream which is nowhere near the 5 V's of big data
| in volume, velocity, or veracity.
|
| The two leaders in the space, Dexcom and Abbott both fail at a
| high rate with some individuals, such as me. Turns out that at
| the edges, adipose tissue and its interstitial fluid are a poor
| proxy to plasma blood glucose in some individuals. This is likely
| due to fluctuations in the composition of that tissue during
| times of fasting: exercise and sleep.
|
| Sadly, the price of admission for my family has been high given
| that no one has slept normally for five years with the screeching
| alarms nightly at 3 AM, which are not adequately configurable.
| The design failure here is clearly driven by liability.
|
| It's worth considering that the brain's default mode network
| (DMN) is impacted by glycemia. This has been demonstrated via an
| fMRI lab at Harvard via Nicolas Bolo, et al using a small cohort
| of diabetics.
|
| The leap from there to what families of diabetics have known
| intuitively for decades may be phenomenological, but it isn't
| difficult.
|
| Put simply: diabetic mood swings may not give rise to psychosis,
| but the mood dynamics of glycemia have been clear for almost as
| long: a spectrum from hypomania or nightmares induced by
| hypoglycemia to hyper compulsivity or depression induced by
| hyperglycemia.
|
| I'm not certain that a researcher or clinician like Bolo exists
| to put data behind these glycemic mood associations, but
| speculatively, the relationship is clear to me from a subjective
| metacognition perspective, as someone who's been T1D for ~50
| years and also has an HbA1c below the diagnostic threshold for
| T1D and routinely stays functional with accurate plasma BG < 50
| and shows no signs of cognitive impairment accruing to these
| brain states after various neurology studies.
|
| It's worth noting that hypoglycemia itself is a dynamic range,
| not a constant, and is frequently lower for people who have eaten
| or trained on the ketogenic spectrum, i.e. ultra marathon runners
| like Zach Bitter.
|
| My experience has been that the feelings associated with
| hypoglycemia can be paradoxically awful at BG=80 and no problem
| at BG=40. If you've never eaten a half gallon of ice cream
| yourself with no signs of obesity, then you may not understand
| the zen state it takes to overcome this "beyond hunger" that's
| immediately familiar to any experienced diabetic on earth, while
| recognizing that that problem does not occur naturally with the
| disease. It's the result of insulin overdose, carbohydrate under-
| supply, or both.
|
| FWIW, Microdosing carbohydrate may be key.
|
| I believe the first use of the term in science was actually in
| glucagon, IIRC, i.e. the need for yet another syringe of glucagon
| in emergent insulin pumps that would go beyond the current crop
| of devices that are near autonomy, but may inadvertently overdose
| or underdose the patient due to the poor veracity of CGM sensors
| across the board and the hybrid closed loop devices which dose
| based on CGM which may be demonstrably inaccurate on occasion to
| the tune of several hundred points off high and low.
|
| I have n-of-1 empirical evidence of this given the fact that I
| wore several insulin pumps for twenty five years and used
| multiple CGMs over that time, some concurrently. All were what we
| call, "shipping the prototype". Fortunately, beyond Therac 25,
| that was not an option in other medical device markets; certainly
| not those under FDA oversight.
| henrikberggren wrote:
| I've been wearing one for 6 years straight and wrote a post back
| in 2018 when I first got one. As someone who lives with Type 1
| diabetes its been one of the absolute biggest game changers for
| my health
|
| https://blog.steady.health/the-wearable-that-changed-my-life...
|
| I also started a company focused on CGMs which was too early and
| didn't work. Maybe its time to try again? :)
| squirrel6 wrote:
| I have been doing CGM for 7 months now and the learning has been
| invaluable. My metrics were never in the danger zone but I feel
| like I've learned so much about how many different factors play
| into insulin resistance and have managed to build much healthier
| habits over time.
| patsplat wrote:
| I just heard about a related device from a family member who is
| an endocrinologist.
|
| https://www.fda.gov/news-events/press-announcements/fda-clea...
|
| First off, he had discomfort with the study methodology. Didn't
| go into details, but was surprised that the FDA was less
| conservative than himself in this case.
|
| Secondly, it has been common in his practice for someone to have
| an unusual event. Someone does something out of the ordinary,
| they have an unusual circumstances, they don't adjust their
| treatment, and something goes wrong.
|
| His question was -- does the device have a reset button? Is there
| a way to restart the management and learning? The answer is no --
| the device will learn! But there's no way for the patient or the
| physician to adjust the treatment. So his answer is -- he would
| never recommend this device, not the way it's currently setup.
| It's opaque and there's no means for a person to influence the
| device's learning.
| TylerE wrote:
| This is just monitoring, not a pump. There is no learning or
| tuning or dosing. If it's anything like the Freestyle I wore
| for a while there's a self calibration process that takes a
| couple hours, but that's per-sensor, and those get changed out
| every two weeks.
| patsplat wrote:
| You are correct, I think he was talking about a different
| device:
|
| https://www.fda.gov/news-events/press-announcements/fda-
| clea...
| TylerE wrote:
| I will point out the obvious tensions between these
| legitimate concerns and the usual HN "we demand full
| unfettered access to all the firmware knobs all the time"
| groupthink.
| xattt wrote:
| > But there's no way for the patient or the physician to adjust
| the treatment.
|
| This does not parse. This device is for patients that are
| managed with oral meds and not insulin. Yes, sulfonylureas
| carry some risk of hypoglycemia, but not as much as insulin
| proper and its fast- and slow-acting friends.
|
| If someone is on a pump, they sure as heck will be using
| prescribed equipment.
| jablongo wrote:
| This is great news for the healthcare system because it is going
| to drive down costs for people with diabetes who really need
| these things. Well done Dexcom!
|
| This OTC model limits the measurements to every 15 mins instead
| of every 5 for the prescription version; this will limit its
| ability to be integrated into open source automated insulin
| delivery systems. Not sure why they made this choice as the
| hardware looks the same as the Dexcom G7. In theory they could be
| doing it to increase battery life or allow for cheaper batteries
| to be used in the consumer version.
| ijustlovemath wrote:
| Glucose control is my particular area of expertise; if anyone has
| any questions about it, I'm happy to be a resource!
| arisbe__ wrote:
| This could lead to a large amount of helpful preliminary signals
| that eventually pan out into some new knowledge.
| nobrains wrote:
| A family member uses Abott Freestyle libre 2 CGM and buys it OTC.
| In UAE.
| AbstractH24 wrote:
| From what I understand, the next step after this is a device that
| continuously measures ketones as well.
|
| Very interested in that
| antirez wrote:
| I'll be that guy to say that if you don't have a diabete problem,
| you don't need a CGM: here in Italy there is this crazy fashion
| of wearing one if you are into sports or alike. It's much better
| to eat clean, check your weight, and don't care about your
| physiological parameters all the times.
| maxehmookau wrote:
| I'm gonna go against the grain here and say that I tried a CGM
| for a few months and found it fairly unhelpful. (I'm not
| diabetic.)
|
| Yeah, eating stuff that's bad for me caused a blood sugar spike
| and made me feel crummy. Eating healthier foods did not cause the
| same spike and I felt better.
|
| I didn't need to spend money to tell me that.
| komposit wrote:
| My son was diagnosed with diabetes about 4 weeks ago. The first
| two weeks we were measuring him through fingersticks multiple
| times daily. Now we have the cgm it has become so much easier to
| manage his condition.
|
| The interesting thing to observe is to see in real time the
| metabolic spectrum of the foods we consume. Liquid sugars cause
| glucose spikes within 6 minutes. Solid carbs 30-120 minutes
| depending on carb complexity etc. Proteins 3h+. Fats can be six
| hours or more.
|
| The thing is there are a variety of insulins available, some of
| which are rapid acting and others act more slowly. So to keep my
| son in range with multiple daily injections you are playing this
| game of giving him the right mix of foods where his carb
| digestion matches the profile of his rapid acting insulin.
|
| Pizza is an interesting case study. It is by far the most carb
| rich deal we've tried and it is almost impossible to manage. With
| so many carbs it's hard to get the insulin dosage right, and once
| he is high, once he is coming down from that the digestion of the
| fats kicks in and he remains high through the night.
|
| I think it would be a great thing for people to wear even just
| for a couple of weeks.
| phasetransition wrote:
| My 3 year old has type 1, and CGM has kept us out of the ER for
| surprise lows multiple times.
|
| It also has informed family diet change, in the direction of keto
| practices, that has compressed the baseline to high delta for our
| son.
|
| It's a relief to know that an OTC product exists as a backstop to
| our prescription CGMs.
| rapnie wrote:
| This article reminded me of a recent item on Dutch national news,
| about an artificial pancreas device for diabetis type 1
| sufferers.
|
| https://www.dutchnews.nl/2024/03/artificial-pancreas-offers-...
| JoeAltmaier wrote:
| Some of us can't be trusted with continuous stat reporting. I hit
| Update on HN often enough. I don't even wear a watch, I kept
| looking at it every twenty seconds and then realized I still
| didn't know what time it was, it was just a reflex.
|
| I learned to leave my phone someplace else, upstairs, wherever,
| just check it a couple times a day. Else I'd go crazy.
|
| I took the speedometer off my bike, I was looking at it more than
| the road.
|
| So I understand my limits and take steps to keep my self from
| compulsive behaviors. I guess(?) other people do better and can
| handle these things.
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