Dr. Penny Figtree - 'Continuous Glucose Monitors in Healthy People'
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- เผยแพร่เมื่อ 4 ก.ค. 2024
- Dr Penny Figtree graduated from the University of Sydney in 1993 with first class honours. With over 20 years in general practice she has now decided to focus on weight loss and diabetes.
This decision was made after seeing the power of a low carbohydrate diet to help people lose weight and for some to even reverse diabetes. Dr Figtree had previously tried to help patients using various diets such as low fat diets, Optifast, the 5:2 fast but nothing really worked. In the end she would just say “as long as you are not gaining weight then that’s great”. Then Dr. Figtree read a book called “Always Hungry” By Professor David Ludwig where he explained the INSULIN CARBOHYDRATE MODEL OF OBESITY.
Dr. Figtree has now been practising low carb medicine for several years. She describes this as the most rewarding part of her career, stopping medications and patients feeling well.
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I diagnosed with T2D in 1996 like my father. In 2021 I was on 7 meds including 2 insulins. With help of CGM I found out the best food for my body. Lost 52lbs and cut all meds and don’t wanna kill my self anymore. I call it digital consciousness.
Great topic. So many “concerns” in the comments that “CGMs should not be used by healthy people.” Why? A) expensive B) might cause anxiety C) imprecise D) vendor says not indicated for use by healthy people. Let’s take a look.
A) Expensive. Cost is a matter of context. The cost of managing chronic metabolic diseases with drugs dwarfs the cost of a CGM. Monitoring blood sugar offers an opportunity for prevention by learning how specific foods or eating styles impact an individual’s blood sugar.
B) Anxiety. The key to all medical monitoring is education. If anxiety is an issue, it is only due to inadequate education. That’s on the medical community, not on the patients. When someone understands the possible scenarios they might experience, and how those scenarios play out through follow-up, they are much less prone to misconstrue the data. Yes, that subset of people who are particularly emotionally sensitive are more prone to anxiety. But again, that’s not on them, but on our educational resources.
C) Precision. CGMs are subject to three general measurement issues. A bad sensor needs to be returned. Poor attachment or inadequate protection (eg during sleep or physical activity) needs to be addressed through education and experimenting with improved location/protection. Random measurement error is, as Dr Figtree explains, inherent in the technology but generally has little to no impact on interpretive value over a period of weeks to months. The data obtained reliably inform the intended learning, “how do the foods I eat and my activities affect my blood sugar?”
D) Vendor recommendations clarify the original target market. Use by non-diabetics is not prohibited. Nor should it be. Actual physical risks of use are essentially nil. Use of a CGM differs in no real way from wearing a smart watch. It’s simply a live stream of information about your body. Whether the vendor intended it for one group of people or another is frankly irrelevant from the perspective of its intrinsic functionality.
Look, ban cigarettes if you feel compelled to save lives, but you cannot argue that a ban on CGMs will save lives. Quite the opposite, in fact.
I would rather patients monitor and adjust early rather than force them to wait until they reach a diagnosis. That WILL prevent avoidable suffering, save needless cost, and, in the long run, extend lives.
I did this 3 weeks ago using the Free Style Libre 2 CGM for 14 days and saw that I had episodes glucose dips while I slept. I thought I was healthy but found out I had to make more lifestyle modifications to level my glucose readings. It was a very interesting experiment. Definitely recommend for anyone who's interested in understanding the impact of food.
I was the same, I know now, without the CGM, when a hypo wakes me during the night. Been able to make some great changes after using the dexcom for 6 weeks. So cool. I would use it for the rest of my life if I could afford it, unless your sick, there's no subsidy in AU
Night time glucose drops, eating increases due to carb intake, recovery of level is more important. Type 1 diabetes no insulin glucose really goes up, no intake you can go really low like 2. That being said free style was so unreliable there was days that had no reads. I use strips because I have to know. Eat well exercise stay healthy all the best
I've been wearing one for 12 months (Freestyle Libre 2) and it's been a complete eye opening experience to food choices. I have a parent who is Type 2 so I know that there is a genetic predisposition for carbohydrate intolerance/insulin resistance. I'd recommend it as well to anyone, however it is not a cheap option for most. Additionally, it's a hard sell to your doctor when they run your fasting glucose and your in the "normal range"... while said glucose test is literally a snap shot of your overall metabolic health.
@@OnzaRaybone
This six weeks did you do with one sensor?
I did this more than a year ago out of curiosity - had trouble getting it in Oz without being diabetic. Paid full price online, no govt subsidy, for Freestyle libre - they sent it out, then were upset when they realised. Things seem to be changing, thank goodness. It was so paternalistic. Citizens not allowed to know stuff without a doc in charge - even highly informed and motivated patients. Luckily I have a great doc who was interested - but many are threatened.
Great talk. If insulin levels are what we really need to watch, who's going to develop a continuous insulin monitor?
We should focus on GKI not insulin except in the case of diabetes.
Low GKI values indicate good health. People with low GKI have normal blood sugar. You will make both glucose and ketone at the same time just not as much glucose since you have the ketone.
It is a truly beautiful system when we do not eat sugar and starch then we are washed in an optimal glucose-ketone fuel mix totally controlled.
We do not need to monitor insulin when we eat zero carbs.
Insulin is needed to process any glucose eg the natural sugars in berries or carbs.
When the body can't use Insulin properly then u are Insulin resistant aka type 2 diabetes.
It’s coming!
Maintaining good metabolic health may seem to be a journey of a thousand miles but is as easy as avoiding refined carbs, sugars, seed oils and adding with any amount of active lifestyle. You will gain traction as you see positive results.
I wore a CGM for 10 days last month. Same effect as you had with the bowl of oatmeal. Great video. Thank you!
Figtree - what a beautiful name!
Such an easy to understand talk. I no have a name for what I used to experience in the days when I ate oats for breakfast.....Reactive Hypoglycaemia. I used to get to around 11.30 each day and have uncontrollable fits of wretching. I felt terrible and needed to eat something. Since going low carb those symptoms have never occurred
Wow! Such timing, just a couple days after finishing my own low carb, CGM experiment.
My blood sugar was often in the red/low, & I always felt perfectly fine. Though I admit that seeing it like that a lot did cause me some amount of worry… In the end I figured that this was probably just previous programming causing me to doubt myself, & to doubt my lack of any negative symptoms.
My body feels & looks better without all those crappy carbs 🥩🍗🍖🥚♥️💪🏻
Thank you for clarifying this for us, it helps a lot 🙏🏻✨
"heathy" people. For now Im done with my CGM (Libre 3), due to its huge inaccuracy (way low or way high deviation from a finger prick). Granted one day they will be much better. With my insurance I I paid $75 for two. Previously Type 2. Will low carb and eating right, I got into the low 5's A1c. In the states you have to have a prescription. Think about that, you need permission to monitor your blood. Insane! Made me furious. They should be OTC and would probably cost $10 each. It did help me see the need to strip bread and other toxic carbs out of my diet.
see at 5:57
She explains in the video why there is a discrepancy.
The trouble with an A1C if your eating a healthy diet ie low carbs, carnivore, your red blood cells can live longer therefore collect more sugar over time and so give you a higher reading.
After 3 weeks on keto diet it was an enlightening experience. Every food i ate during these 2 weeks was good. All days - perfectly flat graphs. One single spike to 106 mg/dl during this time. Average 88 mg/dl. I also wanted to see what's going on during my 48h fasting I do every week. All fine. I wish they could make these sensors dual purpose for monitoring glucose and ketones, it'd be cool. I'm not a doctor, I'm an engineer, but my both parents died because of how well the system cared for their T2D. It's worth to be aware and the software is smart enough these days so CGMs should be for everyone. And I think you (doctors) would lose some of your patients, not because they die, but because they don't need your help anymore 😊
so sad that the great bulk of doctors have sold out to the medical industrial complex, more concerned with maintaining the profitable status quo, both for them and their employers, at the expense of patient health.
I'm a healthy, lean 61 yo F, eating meat forward low carb, though also consume whole grains (organically sourced, heritage) - 99% of what I consume I make from scratch. I display no symptoms of high or low blood sugar. I'd like to continue this path of health and I believe a CGM, worn once or twice a year to gather N=1 data is valuable. I don't see anything unethical about doing so -- if anything, a Doctor saying it is makes me wonder at their bias and motivations -- 'don't help healthy or even borderline (and undiagnosed) people take charge of their health or I'll go broke' -- Having the education of how to interpret etc. by Dr. Figtree is vital.
I used CGM for five years, the sensor failure rate was approx. 50%in my experience and opinion. I personally won't use them due to a total lack of reliability. But nice bobble at 90$ for 14 days but probably less, that's if it works.
Thank you for posting this terrific presentation. I am a healthy 55yo woman who has wondered if I could learn something from wearing a CGM, or whether it would be a case of 'a little info is a dangerous thing'. This talk has provided some baseline to interpret the numbers a CGM will give me. Waving hello from 🇨🇦
Why are they so expensive...it should be for everyone....
Hang on... then people will not eat a bad diet..if you know how much bad food is out there...
I use them with my keto diet, to make sure how things affect my glucose levels. It has been very enlightening. I don't think it will make much difference in the long term. In the US, the attitude is don't change your diet, just use a GLP-1and/or if you have diabetes, just use more insulin with your high carb diet. Very true about the cheat days causing extreme glucose rise. Had a piece of cake on my birthday, you would think I had become diabetic for the next few hours. My pancreas was not at all ready for all the sugar.
You nailed it!
Gotta spend the big money on arms and surveillance. Homo sapiens aren’t evolving into termites fast enough.
@@user-rz3ue5iz7y. By eating keto/low carb or carnivore are we in danger of making our pancreas redundant if it struggles to cope when we do have a piece of that birthday cake?
That was a great lecture, thank you. 😊
I tried with the Freestyle 2 (given for free as trial) and 3. There are TH-camrs reviewing them, if you need guidance between various types.
I'm not diabetic but in a continuous struggle with body weight. I've learned some interesting things, wearing them during December's holiday feasting. For example, a bad meal (hypercaloric and high carb) can cause blood sugar spikes and lows even 12 hours later i.e. it takes at least a 16 hours fast to clear the "damage". Funny also how physical activity, even in fasted condition, causes glucose to rise, as dr. Figtree says at 6:30. Never had low episodes because of too much training in fasted condition, I guess this is a sign that I am quite well fat-adapted. OTOH, if I stick to my routine of IF and LC, then glucose monitoring becomes kind of boring/useless, days on end between 80 and 110, with the maximum around 7AM. To be noted, almost always (even in ultra-steady state) the CGM would read 8-12% less than the finger stick (I used them for calibration).
They are expensive like hell (5€/day) but I think they should be used by non-diabetic people too, at least occasionally, along with HOMA-IR testing, to spot insulin resistance early on and to learn how food and activity affects blood sugar.
Isn't it insane how long the elevated glucose remains after consumption of carbs/sugars? In the states for Christmas I allowed myself more carbs and sugars than usual and it seemed like I had elevated glucose for literally 3 days afterwards... and that was with going back on plan with my Intermittent fasting and exercise and low Carb/Keto...
I don't' know how the average person does a diet like the SAD on a daily basis and doesn't' bat an eye... yikes..
The manufacturer of the Freestyle says they are not indicated for use in non-diabetics. The facts you state after using them are facts you don't need to use a continuous glucose monitor to determine. You need to use a CGM to monitor your blood sugars that aren't controlled by your own body, as a diabetic's body won't regulate the sugars in a well-known method... 🤷🏻♂️🤯
Very informative. Thanks! 👍
Thanks for educating instead of chastising ❤
I've gotten exercise induced hypoglycemia a few times. It's awful! If I didn't know where it came from, getting that feeling sprung on me out of nowhere would be bad for my mental health. If people get that effect from eating the wrong foods, I can totally see how a CGM could help.
I wear a dexacom g6 you can calibrate it with a finger stick test and it learns and adjusts to you. Its fantastic to learn how my blood sugar reacts to different foods.
(Type 2 on meds and eat low carb with chronic illnesses)
With 3 daily finger sticks, each day of the last 3+ years, I have pretty much figured out why/when my BG rises and falls. Still, a CGM would be nice for a few weeks. However, unlike Australia, it's still a $ making racket here in USA: need a doc's "prescription", and often a "health coach" actively involved in order to obtain a CGM, and both of those cost big $, in addition to price of the CGM. So I will just wait till the racket has ran its course, then get a CGM off the shelf at Walmart, same place other diabetes supplies are now available nowadays, at reasonable prices.
It's only subsidised for type 1 or if you take insulin here in Aus.
I'm type 2 and use one but I have to pay full price. But its vital to me my medication can drop my blood sugar low (hypo) but due to my health conditions the warnings of a low are the same as other conditions so I can miss it.
She said there is a massive discount atm $15 or $32.10 for 14 days at this time is awesome. Pick it up before it goes back to full price again.
I am healthy, BMI 22, maintained moderate ketosis for almost 2 years now. I wear a CGM to simply see my individual reaction to foods and combinations of foods. The Glycemic Index is based on very weak science and for the aggregate.
Wait .. After Drs Berry, Baker, Salad-ino we now have a Dr Figtree as well? Who is making this s* up? It's about time for Dr Ribeye to enter the low carb realms. 😁
😂
🤣
It's drawing a long bow, but there's also Dr Chaff-ee, as in horsefeed ... 😏
subsidised CGM for type 1 but not for T2 insulin dependent who are basically a type 1
Great rebuttal @ketolomics. Any thoughts about the underlying reasons why there would be public opposition to “healthy individuals” from monitoring their food intake and the impact it may have on their insulin levels?
My experience with Freestyle Libre is very poor quality control. Too many break when applied and, particularly, consistently read too low. Between a 20% ERROR RATE (!!! utterly irresponsible) , faulty sensors and the ones that dont apply properly ... i wouldnt recommend them to anyone until they fix the problem
Low blood sugar at night. I awake with my dawn phenomenon 3:00 am. I’m hungry. I wore a cgm and yes my blood sugar drops at night while I’m sleeping. I have had sever reactive hypoglycemia most of my life but I started low carb a year ago. I eat paleo ketogenic diet; Strict for 8 months. I am not diabetic I see an endocrinologist and have been referred for tumor evaluation on my pancreas. My A1c is 4.9. I do or at least did have a metabolic disorder. Skin darkening around neck and groin. Skin tags, mental health disorder( pmdd) reversed with paleo keto diet. But now I am having these low blood sugars at night. Cgm revealed them. I am going to to try eating some protein and fat right before bed.
Is this discount only on the freestyle libre website? I cant see any results of that price from pharmacies when I search
Is an NDSS card required in to gain the subsidy when purchasing the CGM's?
Convinced me and I am watching from Bangkok. Here there a gazillion Chinese and Indian knock offs with the UltraHuman ring very popular because of its app- its all about the trends as Doctor Penny said.
Is there a puplication where the plots of the CGMs of the trial of Nick Norwitz are illustrated?
In this study: "Metabolic Health Immersion for Medical Education: A Pilot Program with Continuous Glucose Monitors in Medical and Dental Students" there are none.
Need an insulin monitor. Do I need a prescription for aCGM?? Can I get around this?
What makes you think that old people like me aren't healthy? I'm close but not quite. But older people are sometimes much healthier than the super young.
CGM is extremely useful to wear it at least once, especially during holidays. I have my CGM results saved along with exact list of everything that was eaten during the time (MyFitnessPal/Cronometer log). With this I found out my 24h average is 90 mg/dL and that it stays within normal range for the 95% of the time. I do have expected spikes when I eat 80-100g oats (30 minutes to peak and 30 minutes back to normal, without overshoot, does not dip). My night glucose is flat and no morning spike before breakfast. Glucose goes up at the beginning of exercise. Glucose response is lower if the same oats shake is taken during weightlifting. But eating "holidays" food with a piece of cake does bring glucose up close to 200 and makes it stay there for 2 hours before it went back to 100mg/dL (even that it was still within daily calorie limit). I can only imagine someone eating junk/sweets often and daily, glucose must be elevated all the time.
@KrzysztofCygan
Did you eat that cake (200g? 80g carbs?) only with coffee or in compagnionship with other food?
There is an known effect, when you eat protein with carbs than the spike is about 25% lower, did you test this?
Also doing some walk or movement can lower the spike substancially (insulin independent glucose intake from the muscles).
They do ask a couple of questions over the counter but I just lied 😅
Dr. Bikman should address why glucose spikes is lower when protein is mixed with carbs. Insulin response is much higher? I think so from his earlier lecture. So is mixing protein with carbs? Probably not.
What about people who are pumping out a ton of insulin causing blood sugar readings to appear normal. Or will the glucose monitor pick up the pre insulin glucose spike?
If you are in the phase, where your body can realize a normal blood glucose level, but with skyrocket high insulin, you will not dectect that with CGM. You cannot detect that with OGTT either.
You need therefor a Kraft OGTT +insulin test. Which was developed some decades ago ( Kraft JR. Detection of diabetes mellitus in situ (occult diabetes). Lab Med 1975) and is still not standard in medical circles around the globe.
With that test you could check if you are prediabetic.
Do you suggest, that there is all the time a detectable Spike (maybe not with CGM cz it measures every minute), when you are prediabetic?
Check that your phone is compatible. Mine isn't.
Both 2 and 3 Have readers now.
I can only find free trial for 14 days on the British web site. Which is not the same as buying at a low price.
One comment about CGM: RTFM. I didn't. Some of them get completely thrown of, show way to high values, when you supplement with Vitamin C. You have to stop that couple days before applying the device.
Secondly we get to see Dr. Figtree CGM data, I assume. It looks like it^s mostly around 5 mmol/l. What am I missing here? isn't that a tad high as a baseline which should be 4.5 or lower? (70-80 mg/dl range)?
CGM's are great if you want to learn. But if you're not into the minutia of health then just eat a clean carnivore diet.
7 days without beef makes one weak.
great idea just to get a base line profile of what is going on when you eat, expensive but not horrifically so $110/14 = $7.85 a day so less than 2 takeaway coffee's or 1 beer
I used glucose monitor, but it was useless since I am using sauna and cold plunges. I just wasted money, they would last only few days with this temperature range.
Accuracy of cgm is big issue
I don't have T2D but based on family history, I'm highly susceptible to developing it without gaining much weight. We're a family of skinny diabetics. I switched to a LCHF way of eating over 8 years ago for this reason; however, I'm now in menopause and I certainly notice an unpleasant difference in how and where excess weight accumulates. I haven't yet tried a CGM but would like to, just to learn which foods affect ME. The outrage over CGMs for nondiabetics seems akin to saying that people shouldn't bother with a smoke detector until flames are present. Knowing which foods cause a big rise in BG and insulin, especially for someone like me whose diet is generally very low-carb but who occasionally splurges on things most people would consider "keto" (e.g., nuts, dairy).
I love my CGM! Everyone should have one 😂. Problem is insurance wont cover cost unless you're diagnosed diabetic. Not even 'pre'. Funny thing, the PPO insurance I had thru my employer paid for it. Medicare will not unless diabetic. You can work work with your pharmacy to find discounts. Currently I pay $90 for 1 month which is 2 devices. But what i don't get is, if I'm paying out of pocket why do I need a scrip? It's not a drug its a device...
I can reliably tell whenever my ketones are above 0.3. I can feel it 100%. 0.3 is where it is at for me. And whenever that is the case, my glucose is below 100. And that guarantees low insulin. If my glucose is below 100, and I feel great, my ketones are up. For me, whenever I feel like myself, I know that I am both in ketosis and have low blood-glucose. No meter required.
Hell, I can tell if my partner is in "ketosis" just by her telling me how she feels. And she doesn't eat ketogenic. She just sometimes eats stuff pushing her into the 0.2-0.3 range, and it is noticeable. Whenever she tells me that she isn't hungry, but her last meal was sooo long ago, and she feels good, I know. And we've tested that quite a few times.
I don't buy the 0.5 threshold for ketosis. There are significant changes in feeling and well-being at much lower levels.
FYI: Freestyle is not indicated for use in non-diabetics, as stated by the company that makes them.
We use many medicines off label routinely in medicine. For example anti epilepsy medications in psychiatry, semaglutide was initially approved for type 2 diabetes but was widely used for obesity. Countless examples used in every day practice.
If you are in ketosis will 5 grams of carbs in cofee with milk spike blood sugar and take you out of ketosis?
No. If you're really curious they also make continuous ketone monitors.
I did this for a short period and began to feel worse so I ditched it.
worse than that... it'll send you to an early grave
I'm not young but I must be pretty healthy. My glucose is typically quite low.
One issue is that the definition of 'healthy' isn't precise. It's usually just done by eye.
Saying people shouldn't use CGM's if they are healthy is like saying thermometers should not be used by people who don't have a fever.
I get it. But, I'm definitely not going to wear this 24/7. Keep it for someone else.
Anybody intolerant to coffee and chocolate (skin rash, insomnia) while on low carb diet? No way to regain tolerance? Thank you.
No no no don’t worry about us CGMUsers, we just want to see the data of ourselves. Many of us just discovered that the MDs and nutritionists don’t know much about blood glucose and it’s ups and down, they are on the brink of being completely useless with their nutrition guidelines, they are mostly just laughable. We do our own research, we talk to each other, we experiment with cold exposure and meat and salad and fasted runs and no breakfast…and so much more. We also read books and papers from pubmed. In real life we are technicians or accountants or pilots or scientists, yet we are treated as 5 year olds by MDs, we are not stupid little children we understand a lot more about nutrition than what nutritionists can imagine, we leave them behind because they are nearly useless sorry to say 👋
why can't we just measure insulin. Imagine a continuous Insulin monitor?
It’s coming soon!
“Strike me down, and I will become more powerful than you could possibly imagine.”
- Dr. Penny Figtree
Do you think a people Have money fór sensors in this time of crisis😂, expensive , nobody want to pay IT if youre not diabetic already, i think Its a must fór some people .....
Not everyone is poor, mate. Lots of people spend more than this at Starbucks every day.
Waste of money if you are strictly carnivore and eat zero carbs.
True, though it's good data if you collaborate with your doctor.
Eat a Proper Human Diet and skip the doctors and the monitors and feel good. I only watch these vids because I love to hear their Aussie accents
So expensive and not going to help healthy people except make them nervous.
Sorry, but I’m not sure about these increasingly “trendy” plastic devices (for those who are not diabetic). Yes, they are a vital, life-changing advance for those whose lives depend upon them. But those fortunate enough to be able to buy them as a “healthy lifestyle choice” may only gain more obsessive “self-checking behaviours” leading to nothing better than long-term health anxiety. Easy for those who are profiting from promoting them (via the wealthy health-conscious) to say that they stave-off cardiovascular disease etc. Really?
⁸😮😮
What a waste using these on non diabetics! They are meant for people who need them!
I mean... I'm on keto, some of us also want to track, you know? I accidentally ate too many carbs a few times, for example (unkowingly)
Not accurate at all.