I found this long (2+ hours) YouTube video entertaining and stimulating. Dr. Paul Saladino interviews Registered Dietitian Kara Collier in depth about their own CGM traces as well as the connection to various eating styles. Kara is an omnivore who favors a “ketogenic cycling” style of eating while Paul has been eating strictly carnivore for a few years but has recently added honey to his regimen.
Be forewarned that their views of “normal glucose curves” may discourage people who live with diabetes (“a fasting blood glucose of 120 [6.7] is abnormally high”) but their education and personal experience shed an interesting light on this game we’re all forced to play.
Kara and Paul both started out their medical careers trained by “keepers of the status quo” but following several years of exposure to medical mainstream practice, began to search for a better understanding of how the glucose metabolism actually works. Each has worn CGMs for extended periods and they comment on what surprised them about their own glucose metabolism.
We’ve often talked here about what a normal CGM trace looks like and this video provides many examples of that. After watching this long video (consider watching it over a 2-3 day period), I think that all dietitians and endocrinologists should be required to wear a CGM for at least 90 days as part of their training and credential. That experience would go a long way to minimize some of the gob-smacking advice we people with diabetes sometimes hear from the credentialed class.
Both Paul and Kara are incredibly well informed about the human glucose metabolism and their individual personal CGM experience has opened their eyes in a way that previously only people with diabetes experienced.
I don’t expect a wide group of people to watch and comment on this but I truly think it’s entertaining and valuable. I look forward to the comments, if any. Enjoy!
What surprised me is all the small-timescale gyrations going on in both the Kara and Paul CGM data as well as what they showed as “abnormal” presumably T2 but maybe not diagnosed yet data from medical journals.
All those pancreases are working hard not just making insulin, but also other counter-regulatory hormones, in ways that mine simply doesn’t. Even the “abnormal” CGM traces presumably from prediabetics or not-yet-diagnosed diabetics show gyrations that indicate the pancreas is working dang hard.
I think they were using a Libre glucose sensor and it makes me wonder if some of the jumpy trace might be attributed to the display software. I know that the Dexcom G6 that I wear actually uses a smoothing algorithm for the display.
I think all the CGM displays have some amount of smoothing/filtering going on, (unless you are in special raw mode), yes.
But still even the “glucose intolerant” CGM traces they show, I can see the that the pancreas is trying to move things in the right direction. I don’t think anyone in that long youtube video had or showed a T1 CGM trace? Which is what I’m more used to seeing for sure.
So far I have watched half of this video. First of all, I was happy that the doctor is enthusiastic about farmed meat and actually cares about the animals he eats. It doesn’t sound like he just buys meat without thinking about how most animals are tortured before they make it to one’s dinner plate. It also sounds like he was being thoughtful about how eating so much meat affects our planet.
I ate 30 carbs a day for 11 yrs. My body was failing me by the time I quit the diet. I was in really bad shape although my A1c numbers stayed between 4.6 and 5.2. My HDL was very high and my Trigs were very low. My LDL was high. Maybe if I had cycled in and out of the diet, I would have done better. My body started healing when I gave up dairy and went on a low fat vegan diet, while doing lots of exercise, I feel very good at almost 70 yrs of age. I ate very little processed food on both diets. My blood pressure was too low on the keto type diet and too high on the vegan diet. Most folks eating low fat plant based diets have normal BP, but I don’t.
It sounds like Cyrus and Robby from Mastering Diabetes might have helped change the doctor’s mind when it comes to carbs being bad. I want to listen to the conversation they had with each other. The Mastering Diabetes woe is wonderful for lowering insulin resistance.
Another thought I had is that I hope the presenters don’t want everybody wearing CGM’s. I think it would be great for people who are not metabolically healthy, but being such a narcissistic society, I would hate to see everybody being more interested in their results, than in the world around them. I can also see that it could cause another split between the haves and have nots. Hopefully CGM’s would be used for educational reasons only and not used by heathy people for any length of time.
That comment caught my ear, too. I found that other conversation and listened to that as well. While the tone was refreshingly respectful, the conversation was provocative and interesting to me but I hesitated to post and write about here since I think many of us, especially in the US-pandemic environment, are over-dosed with controversy in this political season.
I appreciate your watching the video with an open mind, Marilyn.
Well, I just finished the second half of this presentation. I found some of it quite humorous. The doctor acted like he had been eating a keto diet for years. No, I am sorry, but two years is no time at all. I would like to talk with him in 10,20 or 30 years and see what his thoughts are. When I was eating 30 carbs daily, at the two year mark I would have been agreeing with him wholeheartedly, but after more than a decade of eating that way, I now strongly disagree with him. His enthusiasm is entertaining though.
I now eat almost 300 carbs daily, and I eat a ton of fiber. I am never bloated, too full, nor do I have problems with gas. When eating 30 carbs a day I was constipated and had to take a supplement daily just to go to the bathroom maybe 3 times a week. Now that is a problem of the past. I no longer hold on to my food at all. I feel good.
I realize that both the presenters are both non diabetic, but it was interesting to see their glucose results. I too have my best days when my fasting blood sugar is 70-90. It just starts the day out right. Unlike them, I am less insulin resistant at night, and my night levels are usually flatter than the doctors. My levels do rise about 4:00 am though and I often have to give a unit of insulin around 5:30.
I was appalled that the cardiologist who was a vegan, knew so little about nutrition. So many nurses and doctors eat really bad diets.
Oh, I also noticed that the doctor was not concerned that his glucose level appeared to at times drop a bit below 70. It is very normal for me to drop to 65.
Just my thoughts for what they are worth. Our bodies are all so different. Tomorrow I will see if I can find his conversation with Robby and Cyrus from Mastering Diabetes.
I think the important thing for each of us regarding diet is feeling well. Since we diverge on diet choices, I do like to emphasize where we agree. We both like to eat whole foods and avoid processed carbohydrates. Neither of us likes to combine high fat and high carbohydrate in what we eat, aka the Standard American Diet.
I don’t think it is abnormal for non-diabetics to drop below 70 in the early morning hours. My personal threshold for beginning to observe counter regulatory effects begin at 65.
I share the follow-on benefits of waking up between 70-90. I fight a bout of insulin resistance in the morning hours after I wake up and before I eat my first meal mid-day. To fight this, I usually inhale one or two 4-unit doses of Afrezza. Those doses are annotated on this chart as 2U dots on the glucose line around 7 am and 9:30 am. I took each dose when my glucose hit the 120 threshold. It worked fairly well as my glucose fell and sustained in the sub-90 range.
The blue graphic is my Loop-controlled basal rate. For reference, the dashed lines bracketing the glucose trace are 65, below and 120, above.
I really wish that I could use Afrezza or Fiasp, because I would really like to use a faster working insulin. Fiasp worked at first, but soon it was like injecting water. I think I have some that hasn’t expired, so I could try it again, but I don’t like to take a chance that it won’t work. I forgot to give a shot before lunch the other day, and paid for it for hours.
I agree that we both do ourselves a lot of good by not eating processed food or fatty carbs.
How quickly does Afrezza work for you? I might take the breathing test again, if I ever have another in person doctor’s appointment.
I usually see evidence of Afrezza action, a falling BG or a rising line that flattens out, within 15 minutes or so. The graph above is a good picture of that with falling lines about 15 minutes after inhalation.
So, if you account for the CGM lag-time the effect is fairly close to immediate. I’ve been using Afrezza almost every day for over five years now. I could get by without it but it improves the quality of my life.
When I forget to dose for a meal, I just inhale a four-unit cartridge of Afrezza at meal-time and then combine that with a pump-delivered bolus dose to correct for the forgotten prebolus.
Thanks for posting that podcast. I thought it was very informative. Its funny you mention afrezza since the inventor of the CGM was also the inventor of afrezza, Al Mann. After seeing the CGM results of existing insulins, Al saw they were too slow to deal with the PPG excursions. So now thanks to the CGM we have afrezza.
I have been waiting for the diet community to pickup on the use of CGM technology. I talked with American University last year about incorporating it into their dietary program but I think they thought I was nuts. I don’t believe Virta Health or GoLo are using it yet. Maybe others are. It was nice to see Nutrisense is.
Its hard to say from the video but I got the sense the Nutrisense team does not fully appreciate the loss of first phase insulin release in early T2s. They may benefit incorporating afrezza into their program for some clients in addition to the dietary changes. Maybe someone like a VDex could help them out.
My recommendation in watching the video is to skip past the long discussions on raw honey and fiber as it will save some time.
I knew Al Mann was the founder of MiniMed, an early manufacturer of insulin pumps. Did you mean insulin pump instead of CGM?
I think the body builder and active athlete community is where the cgm sales are starting to rise. To be fair, this is also a group of people interested in eating well to complement their workouts. It makes sense that some in this group would be curious about realtime glucose monitors and then exploit that metabolic knowledge to benefit their fitness goals.
Welcome back, by the way. I remember that you’re a fan of Afrezza. It’s an amazing tool!
Al did not invent the insulin pump but rather perfected it at MiniMed which became the first commercial pump. At the time most companies gave up their pump development activities after a number of deaths during trials. Minimed was then sold to Medtronic.
Al was trying to develop the first artificial pancreas at MiniMed and inventing the CGM was the first step. Yes, Al invented the CGM. Kevin Sayer who is now the CEO of Dexcom was Al’s accountant at MiniMed.
Al came to realize the artificial pancreas was limited by the speed of action of the insulin and knew the AP limitation was not the algorithms but rather the insulin. In search for a faster insulin he worked with Sol Steiner to invent afrezza. We see it today where the best control with the APs is to bolus with afrezza.
Once he had afrezza he saw little need for the AP. He believed T1s would transition to a simple patch pump and afrezza at meal time. However, with the CGM he started to really understand early onset T2 and believed if T2s started using afrezza as step 1 and not go through the current SoC “treat to fail” protocol of metformin, TZDs, SGLT2s, etc. T2 progression could be stopped and in some cases reversed.
I am really excited to see companies like Nutrisense starting to pop up using CGMs in the diet space for the reasons demonstrated in the podcast. As Nutrisense mentions on their website a big limitation right now is the cost of CGMs.
By now I was hoping guys like Tim Cook had a non-invasive CGM integrated into something like the Apple watch. When that happens and the average Joe can see whats going on at meals, when taking metformin, SGLT2s etc maybe Al’s afrezza will get a second look by the medical community. As the lady said in the podcast “data over dogma”.
BTW - some of those body builders who are using insulin as a dietary supplement have discovered the speed of action of afrezza and its benefits.
When I worked in the medical field, I thought I knew something about diabetes… until I got it myself. LOL… I did have pre diabetes for years but tolerated carbs very well. Now, I am not so sure about some of the dietary guidelines we proposed to patients. We recommended 45 g of carbs per meal. Ouch! Personally, at this point in time, I’d never get my blood sugars under control with that, even exercising an hour a day. I am very lucky to have a super smart and sweet Endo. He does not judge and doesn’t have outrageous opinions. The CGM has been an invaluable tool for me as well. I don’t mean to take away anything from medical folks but when you experience the emotions of having your life revolve around blood sugars, then you “understand” it. It’s very different when it becomes personal.
I wouldn’t be able to eat 45 carbs a meal either if I ate fat. Lowering fat content down to 10 to 15 % of one’s diet greatly lowers insulin resistance. I can now eat close to 100 carbs a meal with no problem as long as I exercise 1/2 an hr after breakfast and lunch. I use 0 to 5 more total units of insulin than when eating 30 carbs daily.
Glad that is working for you Marilyn!!! Can you eat good fats like olive oil without it affecting your sugars?? I’ve always enjoyed carbs and veggies much more than meat! I always followed a lower fat diet, never ate fast food, etc… Last week,( for another reason), I started taking choline and to my surprise it dramatically reduced my blood sugars. I think it affected my insulin resistance and liver function. A very welcome surprise. Now, I can tolerate carbs better and my fasting and between meals are much lower. I think my A1c is going to drop into the low 6’s. Fingers crossed!!!
That’s great Jean! Maybe I will try choline. No, I don’t use oil of any kind. I have a bit of walnut with my oats groats and fruit every morning, and a bit of avocado with dinner, but I don’t use any form of oil. If vegetables need browning, I use broth.
Wow, that is really low fat! Is your cholesterol low???
I am using the Thorne brand at 420 mgs. I try to use a company that does 3rd party testing on their supplements. I have so many side effects from meds, it’s unusual for me to find something that agrees with my system. I hope it lasts. I will talk to my Endo about it in a few weeks to make sure he’s ok with it.
Most type 1’s and 2’s can get off several meds because of this woe. Perhaps because of having diabetes for so many decades, I still have fairly high LDL. My triglycerides are minimal. Last time I had my LDL checked, which was last Jan, my LDL was about 114. I can not take statins or injectables.
