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Blood glucose levels affect lots of health functions. Diabetes represents an extreme end of the spectrum where the body's ability to regulate these fluctuations fails, but just because your body can get your levels in control eventually doesn't mean you won't suffer from the negative effects of it needing to do so.

Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out.

Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.

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sample of 1, but yeah changing my diet (very low sugar, more veggies) did alter my health visibly and rapidly. to the point that if I eat something too sweet too fast i have a very mild headache soon after, my system readjusted to not seek levels i grew up with
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fwiw...

if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail.

other signs of digestive problems in this area may include:

- a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like)

- feeling generally flushed and hot after eating food (more histamine!)

- waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine)

- often having an upset stomach, and lots of stomach acid

- increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge)

- generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters)

- serious nasal congestion contributing to sleep apnea, and extreme fatigue

now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them!

(and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)

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> it's also the sort of condition that might sometimes has an instant miracle cure

I assume that by this you mean figuring out some kind of dietary restriction?

I also struggle with a lot of those things (also ADHD) plus other inflammation-related issues (ezcema), and noticed a very specific pattern of fatigue during the day that improves at night. It's hard to tell what might be effective or not since keeping stability in my routine is a struggle, but I've mostly came up empty on explanations/solutions so far.

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Woah. I have ADHD and most of these symptoms.
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What happens is you lose carb tolerance if you don't take them regularly.

I had really high carb tolerance but doing keto for many years has plummeted it and I'm very sensitive now (can still train it). Another example doing keto for many years you also have lower alcohol tolerance.

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Do you think CGM + alerting is a good solution for this compared with just, like, low-dose GLP-1s?
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Recall that GLP-1s were originally designed as next-generation long acting insulin modulators; they're a form of passive control. The CGM gives you data to act on, or at the very least observe. I find, from my experience wearing them as a person without diabetes, they give really interesting insights into my own life by giving numbers to stressful moments, which can be good insight to have. That's called stress induced hyperglycemia. Everyone has a unique and continuously evolving glucose system, so YMMV.
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I am confident that blood glucose has a lot to do with mood regulation as well.

Having been diagnosed with bipolar since 1997, when I began mainlining insulin last year I immediately took notice of how calm and docile I became. I have anger issues and taking insulin turned me into a lamb. I also immediately began sleeping peacefully and restfully, which had been elusive for a decade.

I currently take a calcium channel blocker for hypertension, and Metformin for the glucose, and I monitor with Stelo. But I would give anything for that calming effect of fast-acting insulin.

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Cardiac surgery, burn units, ICU, neuro come to mind. All have been studied to show mortality and complications improvements with AGC, but unfortunately the commercial technology has not materialized yet.
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Why is a hospital setting so different that AGC can not be used? Or is the temporary use of such not yet approved?
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Drug interference (with the sensor chemistry) and perfusion (which the sensor needs to function) are two major problems that a hospital presents that are not present in ambulatory (outside the hospital) use. Also the FDA has not approved any systems yet; the software is actually quite difficult to get right.
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I’m willing to bet we can see longevity improvements from better blood sugar control. Not 100% certain but extremely likely, this would include potential heart attack and dementia reduction…
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IMO blood sugar is too simple and focused on because of ease of measurement. Someone can have rollercoaster blood sugar and be far more metabolically healthier than someone with low and steady blood sugar. Continious insulin and cortisol monitors are far more interesting IMO
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This has been tested actually. A clinical trial looking at tight blood sugar regulation was aborted after it resulted in multiple cardiac events.
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That's not a fair representation of what happened. That study was going for _aggressive_ control - beyond what any normal person would do. They were combining multiple drugs to force blood sugar down rapidly, including right after meals (when it _should_ be going up).

Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks.

From the AI

> The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.

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I'll be showing my bias here, but you're probably referring to NICE-SUGAR, which I think suffered mainly from having a pretty uninspired control algorithm. We built and simulated it and several other clinical protocols and it had the widest spread of performance, but it lost a ton of points to hypoglycemia performance, which is where you get into increasing mortality. The NICE-SUGAR protocol [1] has no notion of weight based dosing, and even has some completely missed edge cases. There have been similar studies in Japan with a better algorithm and they showed the expected benefits.

[1] - https://www.glycemiccontrol.net/NICE/StudyDesign/NiceALGORIT...

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Nonsense, you can fast or live in ketosis for years without any adverse consequences.
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Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe
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They are specifically relevant to trying to enter a fasted state.

The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight).

Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).

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whether or not (say) that coffee you just drank took you out of the fasted state

A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state.

Now, if you're talking about a cup of flavoured milk, that's a different question...

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I think I drink coffee but I really drink lattes…
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Adding any amount of milk to a coffee adds carbs. And a large number of people add _some_ amount of milk.
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An 8oz serving of milk (236 ml) has 12 g of carbohydrate.

People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g.

That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.

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Preventive medicine is a bit one. If your fitness watch could measure blood glucose, I think it would be a ton more impactful in terms of health outcomes.
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In what way? Nondiabetic folks self regular glucose just fine on their own.
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Diabetes (as with much else) is a continuum. Many people are prediabetic, or experience periods of high or low blood sugar.

There are also multiple types of diabetes, not just the generally-known Type I / II split, but gestational (affecting pregnant women), Type 5, malnutrition-related, and others. (See Wikipedia for a listing: <https://en.wikipedia.org/wiki/Diabetes#Types>.)

Other factors can also influence blood sugars, including infections, physical activity, and stress.

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That's what I thought too, until I got my last bloodwork results and started wearing one of the OTC continuous glucose monitors.

That device helped a lot to switch diet habits.

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Can you be specific about what your bloodwork results showed and what special insights your CGM gave you and what behavioural changes it led to?

My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary

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Seeing just how much rice can impact your blood sugar is eye opening. Sticking to a "half the normal amount" of rice when eating Indian/Asian food can help a lot with blood sugar. And keeping blood sugar in check _seems_ to have a fair amount of researching backing up the idea that it's healthier and makes you feel better
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Sure it impacts it. But what does that matter? Your body is very efficient as self regulating
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> Your body is very efficient as self regulating

Yet the mind of most people is terrible at that, we love to overeat our body regulations.

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For sure it's going to depend on the person, but I bet a lot of the hacker news crowd here appreciates observability and metrics.

In software we're wiring up stuff with prometheus and making grafana dashboards and changing code and configuration based on what we see happening. CGMs in a way give you insight into one aspect of your body and diet.

I've been trying Lingo, and it's been super-interesting to see in almost realtime how your body reacts to different foods. Sure you read all the time about "watch your carbs..." or "don't eat so much sugar", but it's hard to know how seriously to take that advice.

It's a whole different thing though when you eat one thing for a snack and see a big spike in a graph on your phone, and eat a different thing the next day and see hardly any change at all. It makes it much easier to rationalize your food choices.

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I did it for a month and learned what kinds of things led to spikes and what did not and it wasn’t always obvious without the monitor.
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My story is: I had a really bad crash after eating a chocolate, which never happened before. That prompted the bloodwork, which shown that A1c was not where it's supposed to be.

I bought CGM myself, without any doctor's input. Didn't know they exist before reading some selfhelp book which my wife found.

Echoing another poster, it's eye opening how some of the foods you'd never think of, are spiking glucose levels.

Overall, after both me and my wife adjusted diet, much better energy through the day, no crashes.

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In the same way a step counter encourages people to walk more, a glucose monitor on your watch could discourage you from eating that extra donut
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Does a step counter do that? All studies I've seen say they don't cause people to adapt their behavior
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This study says otherwise: https://med.stanford.edu/news/all-news/2007/11/pedometers-he...

Even if it doesn’t increase steps on average, it will absolutely still work with someone who’s self-motivated and not just looking for a quick fix.

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Also rare genetic issues like GSDs and FAODs may benefit immensely from dual glucose and ketone metering. Next we need potassium and magnesium meters and that will benefit the people with rare renal wasting syndromes like Gitelman and Bartters
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Metabolic psychiatry is rising, though very slowly. You do "epilepsy keto diet", and may work in bipolar/schizophrenia (need GKI 1-2, it's not keto for weight loss). But you don't need the continuous monitor, normal ketone monitor is fine, because the food list is very narrow.

The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.

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"management" is the key word. Early diagnosis might help a lot not just with T1 but also T2.

Early diagnosis would save a lot of pain and suffering... and money.

I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan.

Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis.

If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable.

Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario.

IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.

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Metabolism, and the endocrine system in general, is very responsive to physical activity. Even in athletes, glucose can have significant ups and downs when it gets intense.

It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.

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