What does a 'Freestyle Libre' graph look like for a non-diabetic

Begonia · Oct 10, 2017

I've seen lots of graphs showing 'normal' response to meals etc., but just wondering how much variation in BG a non-diabetic person would see throughout a 24 hour period. For example:

Does the BG level run lower throughout the night and by how much
What happens during the 'waking up' and getting moving period
What happens during various levels of exercise (any change going for a walk vs major session in gym)
How much change would be seen with 'stress' (eg during a major presentation or even just a busy period)

I suspect this would vary a lot between people, but does anyone have any examples ?

Mbaker · Oct 10, 2017

I think in a modern diabesity environment the figures would br surprising. There would be bound to be age differences as our internals become less efficent.

Ideally the insulin levels would be a key measurement.

Deleted Account · Oct 10, 2017

Didn't @CherryAA do a test recently with one of her non-diabetic friends?
(Sorry CherryAA if my memory is making things up.)

Diabeticliberty · Oct 10, 2017

I would hope it to look like a really well controlled diabetic. If it doesn't then there is little hope for any of us and I believe that there are wheelbarrow loads of hope for us all

CherryAA · Oct 10, 2017

Begonia said:
I've seen lots of graphs showing 'normal' response to meals etc., but just wondering how much variation in BG a non-diabetic person would see throughout a 24 hour period. For example:

Does the BG level run lower throughout the night and by how much
What happens during the 'waking up' and getting moving period
What happens during various levels of exercise (any change going for a walk vs major session in gym)
How much change would be seen with 'stress' (eg during a major presentation or even just a busy period)

I suspect this would vary a lot between people, but does anyone have any examples ?

Hi. I do have a non diabetic friend who has worn one of these. she is 27, with a BMI of 27 . Having worn one for a few days we both concluded that whilst she may not be pre-diabetic as such she is on the path because she has quite severe responses to sweet things . I enclose the chart we did showing what happened when she ate a tiny peice of sugar comparing that to what happened when she did a full rapilose OGTT test also comparing that to the Kraft curves and @bulkbiker and I

I then enclose the libre chart for that same day.
The top line shows her figures for that day, we switched over in the evening. so the bottom line is me.

You can clearly see that the big difference is she has no sign whatsoever of a liver dump . She is also LCHF so she does not have any food spikes just like me (apart from the ginger ) . She jogs to work - no reaction, She does a fairly stressful job during the day - no reaction . The previous days when she was wearing it showed exactly the same picture, a spike for the OGTT test, a spike for a packet of dorritos. otherwise rock solid.

In terms of the 24/7 libre readings, unfortunately the libre she was using packed up after a few days and would no longer be charged so I can no longer show you the pictures of this for all the days she wore it .

Various studies which I have posted about in the past show that for a true non diabetic person 91% of all responses will be under 6.7mmol, and 99% of the time under 7.8%. I.e. even though the NHS test doesn't worry if a non fasting reading is upto 11 in practise that really shouldn't happen which is why we both think that despite the " normal " readings - she probably already does have elevated insulin levels and she is at " early stage" diabetic by Kraft definitions just diagnosed 20 years early. As she has already bought into LCHF, I doubt that will translate into a problem .

I hope that helps answer your question.

CherryAA · Oct 10, 2017

Diabeticliberty said:
I would hope it to look like a really well controlled diabetic. If it doesn't then there is little hope for any of us and I believe that there are wheelbarrow loads of hope for us all

In practise , it pretty much does, I am only one year in and my hba1C was still 40 at this point - and my fasting insulin still high at 8.3 and my BMI still 31 - so still lots to play for !

kokhongw · Oct 10, 2017

My day 1 of putting on the Libre looks like that...

CherryAA · Oct 10, 2017

Mbaker said:
I think in a modern diabesity environment the figures would br surprising. There would be bound to be age differences as our internals become less efficent.

Ideally the insulin levels would be a key measurement.

Dr Unwin did a lovely presentation yesterday which should give massive hope to everyone no matter what age. I've enclosed it here.

There is one side showing improvements in Hba1C by age. His oldest patient is 87 years old and actually some of the biggest improvements in Hba1C on adopting a low carb diet came from those in their 80's . he didn't share the wieght loss chart, but said that the elderly also achieved the same benefit .

http://www.thefatemperor.com/blog/2...g-diabetes-and-obesity-with-science-bacpr2017

GrantGam · Oct 10, 2017

CherryAA said:
Hi. I do have a non diabetic friend who has worn one of these. she is 27, with a BMI of 27 . Having worn one for a few days we both concluded that whilst she may not be pre-diabetic as such she is on the path because she has quite severe responses to sweet things . I enclose the chart we did showing what happened when she ate a tiny peice of sugar comparing that to what happened when she did a full rapilose OGTT test also comparing that to the Kraft curves and @bulkbiker and I

I then enclose the libre chart for that same day.
The top line shows her figures for that day, we switched over in the evening. so the bottom line is me.

You can clearly see that the big difference is she has no sign whatsoever of a liver dump . She is also LCHF so she does not have any food spikes just like me (apart from the ginger ) . She jogs to work - no reaction, She does a fairly stressful job during the day - no reaction . The previous days when she was wearing it showed exactly the same picture, a spike for the OGTT test, a spike for a packet of dorritos. otherwise rock solid.

In terms of the 24/7 libre readings, unfortunately the libre she was using packed up after a few days and would no longer be charged so I can no longer show you the pictures of this for all the days she wore it .

Various studies which I have posted about in the past show that for a true non diabetic person 91% of all responses will be under 6.7mmol, and 99% of the time under 7.8%. I.e. even though the NHS test doesn't worry if a non fasting reading is upto 11 in practise that really shouldn't happen which is why we both think that despite the " normal " readings - she probably already does have elevated insulin levels and she is at " early stage" diabetic by Kraft definitions just diagnosed 20 years early. As she has already bought into LCHF, I doubt that will translate into a problem .

I hope that helps answer your question.

If your mate never ate a minimum of 150g CHO, for at least three days leading up the the "dorritis and OGTT" - then the findings are more or less useless, nearly interesting - but useless.

She's likely experiencing physiological insulin resistance, as part of her LCHF endeavours. And an OGTT and bag of carb rich crisps demonstrate nothing more than a shock to the system.

In answer to the OP, @Begonia, spikes are normal in non-diabetic's - and using CGM's of flash monitors like the Libre will show that. I have evidence in a book I own "Pumping Insulin" by John Walsh and Ruth Roberts, although to post a copy of the diabetic vs non-diabetic BG trends would probably be an infringement of copyright laws...

We all have BG spikes on a normal diet. It's how quickly we get back within range which is critical. It's also critical to be getting sufficient amounts of exercise and to not be overweight or obese.

kokhongw · Oct 10, 2017

Jenny Ruhl wrote an informative blog comparing the spikes of normal vs those with impaired glucose tolerance...

http://www.phlaunt.com/diabetes/16422495.php

Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugars of truly normal people are:

Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.

Most normal people are under 100 mg/dl (5.5 mmol/L) two hours after eating.
This is demonstrated by the graph at the top of this page, which shows the blood sugars measured during a study where normal people had their blood sugar sampled every few minutes after eating a high carbohydrate meal.

kokhongw · Oct 10, 2017

This is a separate 2013 study from China...note that the spikes for those who normal glucose tolerance did not exceed 6.5 mmol/L.

Effects of Different Proportion of Carbohydrate in Breakfast on Postprandial Glucose Excursion in Normal Glucose Tolerance and Impaired Glucose Regulation Subjects
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709592/pdf/dia.2012.0305.pdf

Glucose responses of foods are classified based on their GI and GL. Although protein and fat can affect postprandial glucose responses, variance of the postprandial glucose and insulin responses are mainly explained by the amount and GI of carbohydrate in meals.20 But, the GI does not take into account the amount of carbohydrate actually consumed, and the estimation of the GI of a mixed meal by calculation is comparatively complex and imprecise.10 Therefore, postprandial glucose fluctuations are mainly determined by the amount or proportion of carbohydrate in meals. We found that not only in the NGT but also in the IGR groups, glucose variability presented to an increasing degree from the LC to the MC to the HC meals. This indicated that a low proportion of carbohydrate in meals rich in protein and fat produced a blunt glucose response. The result was consistent with other studies.13,21

Begonia · Oct 10, 2017

Thanks for all your responses. @CherryAA your friend does indeed keep very level throughout the 24 hours apart from the sugar spike. I'm also really interested in your graph @kokhongw. Looks like you go lower overnight and also quite a dip at 7pm prior to dinner. Would that be caused by exercise maybe ?

kokhongw · Oct 10, 2017

Begonia said:
. Would that be caused by exercise maybe ?

No...that's simply the body running out of glucose...but because I have been eating fatty meat...there was no sense of intense hunger. Quite different physiological response when the dip is a result of a high carb meal...

The following graph shows a large dip after lunch...that needed teatime snack to correct...followed by dinner...resulting in elevated night time glucose (above 5.5 mmol) all thru the night.

Bluetit1802 · Oct 10, 2017

Begonia said:
Thanks for all your responses. @CherryAA your friend does indeed keep very level throughout the 24 hours apart from the sugar spike. I'm also really interested in your graph @kokhongw. Looks like you go lower overnight and also quite a dip at 7pm prior to dinner. Would that be caused by exercise maybe ?

We all go lower overnight, although how low depends on how well you are doing generally. We need very little glucose at night so hormones and the liver slow down. The pancreas secretes small amounts of insulin like a drip feed to attempt to keep levels stable and keep the brain and red blood cells supplied with glucose. Also, our pre-evening meal levels are most often the lowest of the day unless we spend the afternoon snacking, whether we exercise or not.

CherryAA · Oct 10, 2017

GrantGam said:
If your mate never ate a minimum of 150g CHO, for at least three days leading up the the "dorritis and OGTT" - then the findings are more or less useless, nearly interesting - but useless.

She's likely experiencing physiological insulin resistance, as part of her LCHF endeavours. And an OGTT and bag of carb rich crisps demonstrate nothing more than a shock to the system.

Interestingly both @bulkbiker and I recorded very similar OGTT results, he not having carb loaded, I did. I guess when I do te next one, where I have no intention of carb loading, I will find out what the difference a shock to the system does to me !
yes spikes are normal, however the 99% of the time data under 7.8 mmol does come from studies of the subject.

The poster did not ask particularly about spikes, she has seen those before, instead she asked about overnight and morning liver dump - the graphs showed that, I only mentioned the spikes because they are clear on the relevant documents.

GrantGam said:
If your mate never ate a minimum of 150g CHO, for at least three days leading up the the "dorritis and OGTT" - then the findings are more or less useless, nearly interesting - but useless.

She's likely experiencing physiological insulin resistance, as part of her LCHF endeavours. And an OGTT and bag of carb rich crisps demonstrate nothing more than a shock to the system.

In answer to the OP, @Begonia, spikes are normal in non-diabetic's - and using CGM's of flash monitors like the Libre will show that. I have evidence in a book I own "Pumping Insulin" by John Walsh and Ruth Roberts, although to post a copy of the diabetic vs non-diabetic BG trends would probably be an infringement of copyright laws...

We all have BG spikes on a normal diet. It's how quickly we get back within range which is critical. It's also critical to be getting sufficient amounts of exercise and to not be overweight or obese.

I'm sorry but I dont' agree, I don't think her spike should not go beyond 7.8 mmol. but we can agree to diffeR!

GrantGam · Oct 10, 2017

CherryAA said:
I don't think her spike should not go beyond 7.8 mmol

So technically you agree with my point, or you've made a mess of your grammar when writing your reply?

Bluetit1802 · Oct 10, 2017

CherryAA said:
I'm sorry but I dont' agree, I don't think her spike should not go beyond 7.8 mmol. but we can agree to diffeR!

What was Kraft's criteria for eating prior to an OGTT for his experiments/research?

Last meal effect does make a lot of difference if eating low carb. I absolutely know this from my own experiences, and presumably so do the powers that be when dishing out instructions about eating >150g carbs for 3 days prior to official tests.

CherryAA · Oct 10, 2017

GrantGam said:
So technically you agree with my point, or you've made a mess of your grammar when writing your reply?

ha yeh my grammar is rubbish sorry to be clear - no I don't think it should go beyond 7.8 !
I doubt there is enough of a sample out there of people doing OGTT whilst also being LCHF, though happy to be shown wrong if there is !

GrantGam · Oct 10, 2017

CherryAA said:
ha yeh my grammar is rubbish sorry to be clear - no I don't think it should go beyond 7.8 !
I doubt there is enough of a sample out there of people doing OGTT whilst also being LCHF, though happy to be shown wrong if there is !

It's not about being proved wrong really, I think it's quite accepted to have a fairly poor BG response to eating carbs when you've not been eating many in the days, weeks, months or even years prior. This is why the medical profession have you eat a moderate amount (150g for a minimum of three days) prior to an OGTT.

See it this way, if you sat down for a week solid and never used your legs - then tried to run 10 miles; would you expect that run to be a true representation of your potential abilities? The same is true when you expect your pancreas to respond to carbs when it's virtually only trickled basal right up until the point when you scare it to death with an OGTT. It's caught off guard.

That's a dumbed down analogy on how I interpret NICE's guidelines of a moderate carb consumption a few days prior to the OGTT. At least certainly wrt to deeming someone diabetic or not.

Robbity · Oct 11, 2017

@Begonia: just for comparison because I thought my "well controlled" diabetic graph looked somewhat similar to Cherry's friend's spike; this is from my Libre when I had a very weird turn & my husband mistakenly decided I was having a hypo, so I got fed 4 tea spoons of sugar in warn water (approx 17g carbs) which caused the rise. The graph's time divisions are in 2 hourly segments, which suggests that the spike start to finish was of similar duration. The actual rise would appear to have been just over 3mmol/l as it started from the top of my 4.5-6.5 target range...though I think it might look a lot worse?

I'm on a very low carb/ketogenic diet, and my levels at that time were pretty stable and flat.

Robbity

PS Regarding Cherry's comment about lack of liver dumps, I don't normally see any when I'm keeping closely to my diet, and believe that when my body is happily burning fat, there's probably little or no need for my liver to have to intervene with a dose of glucose.

What does a 'Freestyle Libre' graph look like for a non-diabetic

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