CGM
- His is average is about 90. STD is about 10. Peak is 100, low is 77?!?
- So it is mostly flat
- He has measured 5.1 to 5.8 in his A1C. He thinks its usually in the low 5s.
Big points
- Lower is better. 5.1 is better than 5.5 (both are “normal”)
- Lower variability is better. std of 10 is better than std of 20
- Minimize the peak – Never above 140.
Lower is better
- All cause mortality is better.
Variability
Most labs consider a HOMA-IR below 2.0 to be normal, but Peter wants to see below 1.0
asting glucose multiplied by fasting insulin divided by 405f
What’s wrong with peak glucose levels? Why would that be problematic?
- Bob looked at the literature and was actually kind of surprised by some of the results that he saw there just acutely
- Let’s say, for instance, that you did one bad meal a day and you just had a spike and then it goes away, but overall maybe your average glucose looks fine — so why WOULD that be a problem?
- Some of the studies would look at the endothelial function during periods of hyperglycemia
- There are actually a bunch of replicated experiments like this that they would look at oral glucose tolerance tests
-In one case they actually did a glucose infusion
- They looked at healthy nondiabetic individuals in these studies, and they basically found endothelial dysfunction
- it’s flow mediated dilation is how they assess it, but they found it again and again
- if that’s the case that those glucose peaks could have accelerated the development of atherosclerosis, even in those with normal glucose tolerance in those people
- This population that with something that maybe we’re not seeing or we’re missing in general “healthy” nondiabetics
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