CGM Profile Non-Diabetic - Far more variable than you'd expect

[Ronancastled]

https://diabetespsychologymatters.com/2020/06/22/flat-lining/

Now it's a bit short on dietry info & compressed but attached is her Libre profile.

Have a read as it's short but this was my main takeaway.

 

[bulkbiker]

Talking about T1 and multiple correction doses not really relevant for T2's and as you say without dietary info we have no idea what caused the peaks.
Also no HbA1c from the subject simply the assumption that because she runs marathons she can't be on the diabetic spectrum?

 

[Mr_Pot]

Also no HbA1c from the subject simply the assumption that because she runs marathons she can't be on the diabetic spectrum?

However she does show an average glucose level of 4.7 mmol/L over the 24 hrs which is equivalent to an HbA1c of 26.3

 

[NicoleC1971]

It would be more interesting from a metabolic point of view to see her insulin levels but with diabetes the blood glucose levels are easy to measure so that gets focussed on where high and chronically elevated post meal insulin levels would be a good warning 10-15 years out of a type 2 diagnosis and the other metabolic disease that accompanies this.
Not knocking it because the hba1c doesn't tell a doctor as much as looking at the pattern here unless the person is very obviously diabetic.
I guess you would want a spike that quickly goes down if you have full insulin sensitivity and are very carb tolerant.
Lastly I don't think any type 1 is as good as the pancreas in giving micro correction doses or stopping insulin but the that kind of closed loop system should be here soon for the NHS.

 

[Tophat1900]

It's really hard to draw any conclusions based on all the missing data that has already been pointed out (Especially the person's insulin levels) and the fact this is just a 24hr profile of just one individual. There is also the issue of there is no proof that she does or doesn't have diabetes. Seems to be an assumption that she doesn't.

I do agree with the part you pointed out about time in range and monitoring expectations.

 

[gogobroom]

Interesting article -

I was advised in 2014 that I was prediabetic with a Hba1c of 42 - it has varied over the last few years between 42 and 45 - Having just recently been tested again at 45. I am athletic, not overweight, eat healthily and generally lower on carbs than most - I train 12 plus hours a week and compete in long distance running and triathlon events - I have in the past looked at my blood sugar levels with a glucose meter and generally it is my morning fasting that has been high, usually around the 6 to 7 - I decided to purchase a Freestyle Libre to see what was going on during the night - In my first week it showed that I had a couple of very low readings in the early hours followed by a rising reading to the usual highs when I woke. (I might upload a few of the daily graphs)

I am currently trying to research into the possibility that some endurance athletes have either fluctuating or high Blood sugars either naturally or due to their endurance fitness - theres not a great deal of information out there about it.

Any pointers in the direction of additional info or research would be great. Its a personal thing for me to find out what is going on with me. Unfortunately the info provided by my GP isnt great as they say I am prediabetic and should keep active, eat healthy etc and to be mindful - but I do this anyway and my Hba1c isnt improving and my morning levels are fairly constant.

 

[Nicole T]

It's really hard to draw any conclusions based on all the missing data that has already been pointed out (Especially the person's insulin levels) and the fact this is just a 24hr profile of just one individual. There is also the issue of there is no proof that she does or doesn't have diabetes. Seems to be an assumption that she doesn't.

I do agree with the part you pointed out about time in range and monitoring expectations.

Non-diabetic or simply undiagnosed? I suppose we'll never know. Spikes of up to 11 are possible in a non-diabetic after high carb intake, so if those peaks above 6 coincide with consuming carbs, there's nothing here that should ring alarm bells. The 4.7 mmol/L average would predict an HbA1c well below the threshold for diagnosing pre-diabetes.

I'd say this is either the chart of a non-diabetic, or someone who is managing their diabetes well. To the point of being in remission, if they're doing it without meds.

 

[Ronancastled]

I am currently trying to research into the possibility that some endurance athletes have either fluctuating or high Blood sugars either naturally or due to their endurance fitness - theres not a great deal of information out there about it.

https://twitter.com/DocRunner1/status/1163546529715621888/photo/1

There's a Twitter thread of a Doc who runs & noticed a sharp spike on his CGM.
Non-diabetic btw.

 

[Nicole T]

https://twitter.com/DocRunner1/status/1163546529715621888/photo/1

There's a Twitter thread of a Doc who runs & noticed a sharp spike on his CGM.
Non-diabetic btw.

I think this is just a body doing what it's meant to: it responds to heavy physical demands are being made of it, by making sure plenty of energy is available as sugar in the bloodstream.

While using Libre, I noticed that light exercise (pedalling my e-bike) tended to spike me quite badly, whereas more intense exercise (getting my pulse over 140 and breaking a sweat on my exercise bike) didn't. I suspect that, in both cases, my body responds to being exercised by releasing sugar. The intense exercise actually uses that sugar, whereas the light exercise doesn't, leaving an excess to accumulate.

Funnily enough, driving often seems to spike me in a similar way. As though my body is preparing for exercise, even though there's no significant physical exertion involved.

 

[Gabriel37]

Interesting article -

I was advised in 2014 that I was prediabetic with a Hba1c of 42 - it has varied over the last few years between 42 and 45 - Having just recently been tested again at 45. I am athletic, not overweight, eat healthily and generally lower on carbs than most - I train 12 plus hours a week and compete in long distance running and triathlon events - I have in the past looked at my blood sugar levels with a glucose meter and generally it is my morning fasting that has been high, usually around the 6 to 7 - I decided to purchase a Freestyle Libre to see what was going on during the night - In my first week it showed that I had a couple of very low readings in the early hours followed by a rising reading to the usual highs when I woke. (I might upload a few of the daily graphs)

I am currently trying to research into the possibility that some endurance athletes have either fluctuating or high Blood sugars either naturally or due to their endurance fitness - theres not a great deal of information out there about it.

Any pointers in the direction of additional info or research would be great. Its a personal thing for me to find out what is going on with me. Unfortunately the info provided by my GP isnt great as they say I am prediabetic and should keep active, eat healthy etc and to be mindful - but I do this anyway and my Hba1c isnt improving and my morning levels are fairly constant.

 

[Gabriel37]

Im quite active as well ,a few extra kg ,i lift heavy,i do 30 min cardio every day ,more or less, do not take sugar,very healthy diet,always get my vitamins and minerals etc ,started to wee alot and drink water like 8-10l a day ,got back from gp as a type 2 ,the only think that goes to my mind is all thouse supplements that rises HGH levels ,made me insulin resistence , if you take any Sarms,GH suplements ,stop !!

 

[Gabriel37]

I think this is just a body doing what it's meant to: it responds to heavy physical demands are being made of it, by making sure plenty of energy is available as sugar in the bloodstream.

While using Libre, I noticed that light exercise (pedalling my e-bike) tended to spike me quite badly, whereas more intense exercise (getting my pulse over 140 and breaking a sweat on my exercise bike) didn't. I suspect that, in both cases, my body responds to being exercised by releasing sugar. The intense exercise actually uses that sugar, whereas the light exercise doesn't, leaving an excess to accumulate.

Funnily enough, driving often seems to spike me in a similar way. As though my body is preparing for exercise, even though there's no significant physical exertion involved.

I get the same thing ,spike when i lift,at the end of program when i go on tredmill or bike drops betwen 20-22

 

[In Response]

I tend to think my partner is a good example of someone without diabetes and is reasonably fit with no known medical conditions.
Every so often we prick his finger. There’s rarely any rhyme or reason about when we do it. It it usually when sitting still on the sofa. It could be 30 minutes after eating or it could be a few hours. Most of the time (I would pretty much say, 9 times out of 10), his reading is 5.2 or 5.3. There have been a few exceptions.
- a fasted morning reading after walking up a hill was 3.9.
- he often partakes is indoor cycling, usually with the Zwift app which replicates hills through increased resistance. He is pretty bad at fuelling during long rides. On one occasion, he “bonked” (ran out of fuel). He felt shaky and had to get off the bike to lie down. After 30 minutes, he started to feel better and took a BG reading. By then, he had “recovered” to 2.9. This is an example I will often give when someone suggests someone without diabetes (or RH) is unlikely to hypo.
- whilst he enjoys sweet food, he is no a sugarholic and often comments on something being too sweet. Recently, he overindulged in French toast - 3 slices coasted in caramel sauce, with maple syrup poured over and served with caramelised pear. Unusually, he thoroughly enjoyed it but felt it was the sweetest thing he remembered ever eating. Thirty minutes after the last mouthful, his reading was 6.7. The highest he has ever seen but not high for us.

After a typical Christmas, he is planning to get back on the bike (using the Zwift app so he doesn’t have to worry about the weather) in the New Year. He is considering using one of my spare Libre sensors (I self fund a different CGM so don’t feel guilty about using one I get on prescription) for a couple of weeks which could be very interesting (taking into consideration the limitations of all CGMs).

 

[KennyA]

No-one seems to have done all that much research on what "normal" looks like as shown by CGM - the attached is an exception.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals

This study investigated continuous glucose profiles in nondiabetic subjects.Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content (50 ...

www.ncbi.nlm.nih.gov

 

[Gabriel37]

I get the same thing ,spike when i lift,at the end of program when i go on tredmill or bike drops betwen 20-22

I thing i got it ,exercies without breakfast ,heavy lifting ,shoulders +abs 45 min /40 min tread mill afterwords ,started execise around 9 finish around 11:45 ,i think ,without eating liver starts producing sugar when you lift heavy ,and consume that sugar very fast when cardio ,so i think best is to have breakfast ,not to creazy with carbs (max 15 g my case ) wait 40-50min then exercise ,any thoughts anybody ?!?

 

[aylalake]

No-one seems to have done all that much research on what "normal" looks like as shown by CGM - the attached is an exception.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals

This study investigated continuous glucose profiles in nondiabetic subjects.Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content (50 ...

www.ncbi.nlm.nih.gov

The Zoe Study has done extensive research into nutrition recently which is how I came to use the Libre. My non-diabetic daughter was a guinea pig and her results were astonishing. She encouraged me to get one and I have done so ever since.

Continuous Glucose Monitoring (CGM) System - ZOE

Understand in real-time how your blood sugar responds to food, exercise, stress, and sleep with ZOE’s continuous glucose monitor via clinical trial.

zoe.com