Drs. Baraki and Feigenbaum discuss continuous glucose monitors in health, sport, and beyond; exploring glucose levels in athletes, blood sugar management in hospitalized patients, variability in medical testing, diabetes diagnosis, continuous glucose monitoring in obesity and athletic performance, and the use of continuous glucose monitors in healthy individuals.
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Quick takeaways
Maintaining blood sugar levels below 180 mg/dL is crucial to avoid health complications.
Continuous glucose monitors offer a non-invasive method to track blood sugar levels accurately.
Hypoglycemia can range from mild to severe, with severe cases requiring immediate medical attention.
The use of continuous glucose monitors in healthy individuals for health and performance benefits is controversial.
Deep dives
Normal Blood Sugar Response to Meals in Healthy Individuals
In healthy individuals, blood sugar after meals typically runs in the 100 to 140 milligrams per deciliter range. Studies show that peak blood sugar levels after meals are below 140 milligrams per deciliter in around 99% of individuals. The time to peak blood sugar after meals is typically about 40 to 50 minutes. Factors like meal composition affect blood sugar with higher protein, fat, and dietary fiber content slowing down the release of sugar into the blood.
Defining High Blood Sugar Levels and Renal Splay
Blood sugar levels greater than 180 milligrams per deciliter are considered high and potentially problematic. This level is associated with the renal threshold where kidneys can't reabsorb all the glucose, leading to glucose spilling into the urine. Glycomark test, measuring one five anhydroglucitol, indicates regular excursions above 180 and correlates with diabetes complications, cardiovascular events, and cancer mortality. Low one five AG levels suggest frequent spikes of blood sugar above 180.
Significance of High Blood Sugar and Complications
Blood sugar levels exceeding 180 milligrams per deciliter can lead to unwanted outcomes, correlating with diabetes complications, cardiovascular events, and other negative health impacts. Excessively high blood sugar values, especially those that exceed the renal threshold and lead to glucose spilling into the urine, are associated with increased risks of various health issues. Monitoring blood sugar levels and aiming to keep them within a normal range is crucial to prevent such complications.
Signs and Dangers of Low Blood Sugar
Low blood sugar, or hypoglycemia, can be categorized based on glucose levels and symptoms into mild, moderate, and severe states. Mild hypoglycemia is in the 54 to 70 milligrams per deciliter range, moderate hypoglycemia is below 54 milligrams per deciliter, and severe hypoglycemia indicates cognitive impairment requiring external help and is below 54 milligrams per deciliter. Severe hypoglycemia requires immediate attention and medical intervention.
Continuous Glucose Monitoring Systems: How They Function
Continuous glucose monitoring systems have been developed to overcome the limitations of self-monitored blood glucose levels obtained through finger pricks. These systems are worn on the body and constantly measure glucose levels in the interstitial fluid of subcutaneous tissue. This method provides a proxy for blood sugar concentration without the need for repeated finger pricks and is considered reliable and accurate for obtaining consistent blood sugar measurements.
Accuracy and Performance Evaluation of Continuous Glucose Monitoring Systems
The accuracy and performance of continuous glucose monitoring systems are evaluated by comparing them to actual blood glucose tests. These comparisons aim to determine the precision of the entire system, including the sensor and proprietary algorithms used. While advancements have improved accuracy over the years, different devices may vary in accuracy, especially in hypoglycemic or hyperglycemic states. Studies have shown differences in accuracy levels, particularly in individuals with diabetes, but more research is needed to assess their accuracy in healthy individuals and during dynamic events such as exercise.
Utility of Continuous Glucose Monitoring in Healthy Individuals and Athletes
The use of continuous glucose monitoring in healthy individuals and athletes remains a topic of debate. Current guidelines do not provide specific recommendations for using these systems in individuals without diabetes or impaired glucose metabolism. While these devices may offer insights into dietary choices and exercise adherence, their impact on weight loss, disease prevention, and performance outcomes is inconclusive. Potential risks include driving disordered eating patterns and increased focus on blood glucose values, without clear evidence of significant benefits in healthy populations.
On this week's podcast, Drs. Baraki and Feigenbaum discuss continuous glucose monitors and their applications in health, sport, and beyond.
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