I highly recommend getting a continuous glucose monitor and wearing it for at least a few weeks. I was able to find a model at about $35/week, which required a prescription (US).
You can quickly get a good idea about how different foods and exercises affect your blood glucose. For me it was fun and motivating. It's helped a lot to put my diabetes into complete remission. The improvement in my daily quality of life is not subtle.
Since an improvement in your insulin levels can easily add healthy years to your life, it's worth doing even if you have no diagnosis of (pre)diabetes.
This. If you are in the US, you want a Freestyle Libre 2, which costs what you state, with coupons: $35/week
In the European Union, the Freestyle Libre 3 is available and is far better technology than the Freestyle Libre 2, for a variety of reasons. This also does not require a prescription in Europe. Because I cannot get a Freestyle Libre 3 in Croatia, I order the Freestyle Libre 3 from Abbott Diabetes Care in Germany, without a prescription using a German mail forwarding service (I personally use myGermany). You can ship to the USA using this method. The pricing is also regulated by the German government, so the price of the sensor is reasonable.
I actually use 2 glucose sensors in tandem: a Freestyle Libre 3 and a Dexcom G6. The Freestyle Libre technology is better than the Dexcom. It is also, way, way, cheaper.
While these articles were for older iterations of the Dexcom
and Freestyle Libre, they are still very applicable. [1] [2] [3]
I use the Dexcom because it connects to my Tandem t:slim x2 insulin pump and it creates an “artificial pancreas”. It automatically manages my blood glucose, with very little effort. I can get a 6.2 or 6.3 A1c with almost no effort, using only the Dexcom G6 sensor (no Freestyle Libre 2|3 sensor use), and I have an profoundly messed up digestive tract, that really should profoundly mess up my blood glucose values.
Anyways, the Freestyle Libre updates more frequently (1 minute versus 5 minutes) and responds to changes in blood glucose faster than the Dexcom, so I can take action and dose insulin much faster.
With the Freestyle Libre 3, used in tandem with my Tandem t:slim x2 insulin pump using artificial pancreas technology via the Dexcom, my A1c hovers around a 4.9 or 4.8.
Really interesting. Thanks for sharing your experience!
In Australia we only have access to the Libre 1. Which is both frustrating as I’d like my girlfriend to have the ease of the Libre 2/3 (bluetooth etc) but it’s tolerable given the more open nature of the first iteration where we double the function life - essentially halving the high cost.
I’m looking at grabbing a Bubble glucose monitor (https://www.bubblan.org/) that adds bluetooth functionality to the Libre 1 amongst other monitoring etc.
Have you looked into OpenAPS / AndroidAPS to move away from the Dexcom? Still learning so this may be an overly simplistic question.
I'm very interested in the Freestyle Libre 3 and the order-from-Germany approach. They don't list the model on their website yet: https://www.freestylelibre.de/libre/produkte.html so I can't check the price.
Can you call on the phone and order? Also how does it work about shipping internationally? Do they ship to Croatia or do you need to ship to a DE address first, then FWD to Croatia. Contact info in profile. If you can send me any info or tips, I would greatly appreciate.
I've heard Freestyle Libre, and most portable models, is not very accurate.
Freestyle Libre has the additional feature of continuity, which IMO, is likely to be more inaccurate (generally portable models take a blood drop and give one reading, i.e., are not continuous monitors).
It’s static (blood glucose testing) sampling versus dynamic (continuous glucose monitoring via interstitial fluid) sampling. The best comparison is that it is like a picture (static sampling) versus a movie (dynamic sampling). It makes a huge difference: you can actually prevent blood glucose fluctuations, blood glucose lows/highs, with a continuous glucose monitor. With a blood glucose meter, at least with type 1 diabetes, you really only can take action after the blood glucose (static sample) is taken, and you really cannot use informed insight moment to moment to prevent things.
The continuous glucose monitors tend to be pretty accurate. The Mean Absolute Relative Difference (MARD) for the ascribed devices:
Freestyle Libre 3: 9.2% (in adults)
Freestyle Libre 2: 9.2% (in adults)
Dexcom G6: 9.0% (in adults)
Also, I regularly test my blood glucose using finger sticks whenever I need to take a fairly large insulin dose and there is a large amount uncertainty of where I may possibly be (such as when my two sensors have a big discrepancy, and especially when my blood glucose is fluctuating). For that, I use Freestyle Lite blood glucose test strips.
About 1 in 25 to 1 in 30 Freestyle Lite test strips I use is about 50 mg/dL off, despite me using proper testing technique, which is quite significant, since my blood glucose values are very tightly managed. It is obvious when it happens, looking at the Freestyle Libre 3 graph, and the Freestyle Libre 3 in this case keeps me from overdosing and causing a serious low.
You can also play with the data directly using open source projects like nightscout. I used that to convert a days worth of glucose data into sound :) https://dddiaz.com/post/glucose-sound/
> Since an improvement in your insulin levels can easily add healthy years to your life, it's worth doing even if you have no diagnosis of (pre)diabetes.
Proof that healthy people benefit from caring about something that isn't broken?
In this study it looks like the hazard ratio is at its lowest at about 80 mg/dL. So maybe if you're at that level lowering your glucose/insulin levels won't help.
I'd love to see what my insulin levels do throughout the day. I have a lot of issues which feel like they're blood sugar related(extreme fatigue after meals, "brain fog", low energy, sleepy all the time but my apnea and nighttime SpO2 is fine, bouts of feeling hypoglycemic), but every time I've checked my glucose levels they're normal. I suspect I am becoming insulin resistant but I'm not sure.
Things seemed to really go downhill after I tried intermittent fasting(16/8).
I feel like there is a weird viral component to this but I'm not sold on that theory. A lot of my problems(apnea, brain fog, worsening attention span) happened when I got divorced. I try to avoid jumping to an unsubstantiated and fringe interpretation, but I do wonder if this is all neuroinflammation from HPV or something. Up until my divorce I had 2 partners. Then again, the stress of the divorce didn't help.
After research indicated that stress can alter DNA on the fly, I became more inclined to consider physio/enviro factors together, instead of allowing one to exclude the other.
Usually a half a cup of fairly weak, instant espresso. Lately I've been increasing it but it doesn't do anything. I'm generally sensitive to caffeine so I drink my usual half-cup over 4-5 hours and sometimes fail to finish it. My genetics indicate I'm a fast metabolizer of caffeine.
Living with diabetes is about decision making. CGMs help some people make better decisions. I’m glad it worked for you.
I’m curious as to what you mean by “remission.” Aren’t you simply making better decisions now which is reflected in your A1C and blood glucose numbers?
I just mean that my A1c is at 5.3% and fasting blood glucose around 85 mg/dL, below the prediabetic range. Yes, that's because of daily decisions. If I ate one pizza I'd get symptoms again.
Exercise tends to reduce my baseline glucose, but on the next day. I do best on a very low carb diet, getting most of my energy from fat. It's obvious to me that not everyone is like this. That's why a CGM helps so much. There is no good one-size-fits-all advice, but the CGM lets you develop a bespoke profile.
Just out of curiosity, since it's the other end of the diet extremism: Have you tried an all complex carbs (so no sugar, no broken free carbs), low fat diet?
Are you concerned about other health parameters with your low carb diet? Like high IGF-1 or blood vessel and digestive health?
Yes, I was deeply into the McDougall Program, even went to the week long training. I lost a bunch of weight on it. Then it seems that my body adapted and without changing the ingredients, my appetite returned, and so did the weight.
Something similar happened to me with a low carb paleo diet years later. I've had to become more extreme to succeed. But I think that's because of the damage I've done to my own metabolism with a fork and spoon, and isn't true for most people.
Most people, I think, would benefit greatly from changing to a complex carb diet from a Standard American Diet.
You can also just get regular testing kit on Amazon for $30 that comes with a lancer, test strips, and monitoring device. I bought one recently precisely after reading a headline like this to keep an eye on myself.
My doctor was happy to give me a prescription for the cost of an office visit. I've heard that's generally the case. The only reason not to provide them OTC seems to me to be an outrageous and harmful paternalism.
https://www.nutrisense.io can send you CGMs without a prescription, but isn't available yet to diabetics for that reason. There's an online evaluation. It's far more expensive than just the Freestyle Libre CGM they provide, but their app is far better, and the price comes with a decent consulting service.
"Prediabetes" is a nice euphemism for being fat that helpfully reminds people directly of the danger of being overweight.
You can improve your health/diabetic markers by experimenting with any or all of the following things:
1) Intermittent fasting: reduce your daily period of eating to a 6 or 8 hour window. 16/8 or 18/6. The number of hours without food or sugar or cream or diet pop versus the window of hours that you're allowed to eat during.
2) Water Fasting: Skipping food altogether. For example, a 32 hour fast. Eat dinner, then go the entire next day without food, and then eat breakfast. Regularly doing a 32 hour fast once a week can be incredibly effective. Or do a longer fast once every few months.
3) Low carb (< 20 grams), medium protein, high fat diet. Keto diet.
Why do these things help? Adult onset diabetes generally traces back to insulin sensitivity, and too much insulin in the body. Reducing the amount of insulin in your veins, reducing the insulin spikes, etc all help the body recover back to health.
Highly recommend checking Dr Jason Fung's youtube videos or book.
No, "skinny fat" is actually detrimental, as your body doesn't handle excess energy well. Your body then stores fat in-between your organs as visceral fat, which is the "I don't know where to put this" kind of panic. The visceral fat is what's really indication of health problems (the "fat fat" people get it too ofc), where subcutaneous fat isn't as unhealthy.
Fructose intake (making up at least half the sugars in most sugar sweeteners) isn't metabolized like glucose, with a delicate and specialized load response and processing. It's metabolized like alcohol in the liver and then directly converted to fat, then shoved into the blood stream. Fructose is the reason why you increasingly see non-alcoholics with "alcoholic" fatty liver.
Now, when you eat an apple, the fructose content doesn't hurt you (unless your digestive system gets issues with it), because it's processed slowly, has to be broken out of the fiber matrix and is partially broken down by bacteria. However, blending the same apple, the fructose will overload your system all the same as drinking fructose water. Btw. many "healthy sugars" actually have a worse fru:glu ratio than table sugar, e.g. agave syrup or honey.
I should probably do the same. It frustrates me to no end that everything is always about weight. Weight I imagine merely a correlating factor, and while certainly bad, isn't the full story. My assumption is that people who eat poorly are somewhere on the insulin resistance spectrum and that includes many negative health impacts, regardless of weight.
Curious - do you pay for your blood glucose and A1c checks out of pocket?
I'm one of the many folks who experience strong flu like symptoms during fasting. I used to fast 1x-4x a month for a decade or so and it never improved. Productivity was impossible; I just wrote-off the entire day.
In Canada, our CGM's are over the counter, which is pretty cool...you can get the Freestyle Libre or Dexcom CGMs right from the pharmacy without a prescription
I’m in Australia we unfortunately mimic the US when it comes to many health ailments - my girlfriend has T1 diabetes.
I am offended with the intentionally slow roll when it comes to artificial pancreas solution development... moreso, the regulatory hurdles these products are being held up in.
That said, there is a willing hacker community around CGM solutions that can be dove into that yields pretty awesome results in function and hip pocket savings.
This isn't T1 though they're talking about. It's T2. And 80% of people with T2 diabetes who are also obese and overweight would be asymptomatic if they got themselves down to a proper weight.
On the plus side, your country has some great scientists that are making some progress in changing your governments stance on health, albeit very slowly which I think speaks to your point about hurdles. One of my favorite Youtube channels is "Low Carb Down Under" and they often have great scientists speaking on these topics. [1]
I think probably "moral" in the sense that it's not considered your fault to have type 1 diabetes. Type 2 is brought on by poor diet and exercise so it is the "immoral" version.
Though I think the science on what drives hunger cravings and "willpower" and fat storage this leading to obesity is still in its infancy.
How many of these are due to unhealthy American Diets and how many of them can easily be cured by a simple whole foods plant based diet.
There are so many reports coming out now that diet (mostly a whole foods plant based diet) can reverse diabetes and that too in a short time. People heal faster when they remove the root cause of the problem. (bad diet)
There seems to be many reported ways to reduce Diabetes Type 2 issues. Most of them involve the reduction of insulin related foods. Carnivore, Keto, Vegetarian etc (without processed grains), and of course caloric restriction/control via IF.
Personally my preferences involve eating meat, and Keto was exception good at reducing my blood sugar, and many other medical issues such as hypertension. I did think about going vegetarian, but it just doesn't suit my situation.
Why do you have to diminish your otherwise good comment by advocating for something that is clearly just your own belief? There is nothing special about a whole foods plant based diet, except that it is like infinitely more healthy than the standard American "diet" (or you could also call it "slow and painful way to die").
The problem is that vegan or vegetarian diets will scare away many people for no good reason.
But yeah in general I agree. It's pretty amusing how the HN crowd talks about measuring and temporary fixes like "intermittent fasting" but not at all about actually ending the poisoning by food... Yeah sure, you can do all sorts of stuff to prolong your life while stuffing yourself with poison. However the most effective way is still not to eat the god damn poison in the first place. But hey, then there would also be no engineering problem to solve and no products to sell, right?
Intermittent fasting(16/8) was the start of what seem to be blood sugar related issues for me. Ever since I tried it, I get insanely tired after a meal. I had bouts of hypoglycemia as a kid, but that resolved until after trying IF. Now my blood sugar regulation seems wonky. My fatigue is worse since then as well. I've checked my glucose levels when the fatigue hits and they're fine(<120mg/dL). IF didn't have an effect on my weight either.
Same, on almost all counts. Two things helped: add a 1-2 hr (moderately intense, definitely sweating) bike ride at end of fast time, shower, cook, eat SLOWLY. Like slowly enough you could carry on a phone conversation without being rude. Heck, try a phone call quite literally, it’s not like we’re going to HHs nowadays!
Limit your fasting coffee intake as well or part of it could be caffeine/sleep crash.
My A1C is reasonable, despite my rather high carbohydrate intake. Due to a metabolic disorder, I'm supposed to be on a carb-heavy diet, and when I get seriously ill, one of the recommendations is a truly shocking amount of glucose. If anyone should be near diabetes, it should be me.
And yet my friends, with more reasonable diets, tend toward diabetes or near it. I'm rather afraid for my friends.
In a plea for accuracy, can we be specific about which type of Diabetes we are talking about? They are _very_ different, both in how they are caused and how they are managed.
The number refers to both, but type 2 is the overwhelming majority of them (and 100% of the prediabetes, which is the by far most of that 100M).
Type 2 is the one that can be prevented (in most cases) by diet and exercise. This article is warning that we're failing at that, by very large amounts.
Type 1 is still a large problem, but a small fraction of this problem, about 1%. You could exclude them from this number without substantially altering it.
Saw this submission yesterday that got no attention which claims seed oils (specifically Omega-6 fats) are the primary cause of diabetes (and other diseases):
I think Omega 6 fats contribute to heart disease and may also contribute to diabetes. It is one of the biggest changes in the Western diet over the past 100 years, we now eat 4x as many Omega 6s as Omega 3s and it used to be the exact opposite ratio. I notice when I'm on a keto diet (primarily sat fats and omega 3s), even my stool seems healthier. Many other benefits too.
You can quickly get a good idea about how different foods and exercises affect your blood glucose. For me it was fun and motivating. It's helped a lot to put my diabetes into complete remission. The improvement in my daily quality of life is not subtle.
Since an improvement in your insulin levels can easily add healthy years to your life, it's worth doing even if you have no diagnosis of (pre)diabetes.