Part 5: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: Beginning to Share My Data

2018.10.12 Low Carbohydrate and Low Carbon, Washington, DC USA 557
2018.10.12 Low Carbohydrate and Low Carbon, Washington, DC USA 557 (View on Flickr.com)

As I mentioned in part 1 of this series, a significant reason for me wearing a continuous glucose monitor (CGM) was to understand (a very small portion) what it might be like to have diabetes. I will never fully understand what it is like to have diabetes, and I know that. I do understand what it’s like to be a fat person in society, as I have been one previously. Also, when I speak of diabetes prevention, diabetes reversal, diabetes remission, I am speaking of Type 2 diabetes, which accounts for 90-95 % of the population living with diabetes. For people with Type 1, insulin is not optional and diabetes reversal or remission is not a possibility (for more on managing Type 1 Diabetes with nutrition, see this blog post: Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century )

I’ve had the opportunity to review the data output and trends from wearing a CGM with an endocrinologist (or two) – thank you – and I feel comfortable sharing some of my data.

The results are boring for a non-diabetic

As the image above shows, not much of a glucose response is elicited (in the average) when glucose regulation is normal, and especially on a low-carbohydrate, healthy-fat diet. It is amazing what our bodies are capable of when you can see it happening real time.

This is not where the data is interesting, though.

Understanding how high carbohydrate meals are processed

This image shows what happened when I somewhat accidentally ate a small carbohydrate load on an empty stomach, after exercise, while otherwise fat-adapted.

These results can’t really be interpreted in the context of a person eating the Standard American Diet (SAD) because their ongoing circulating insulin levels may be much higher (constantly dealing with high glucose loads) and will change the way they react to cookies in this way.

2018.10.07 Low Carb and Low Carbon 550
2018.10.07 Low Carb and Low Carbon 550 (View on Flickr.com)

I would say don’t try this at home – the hypoglycemia down to 40 mg/dl is probably not the greatest state to be in (and it was asymptomatic, interestingly), and I reminder that for someone that has Type 1 diabetes and does not produce insulin, this level of plasma glucose can be life threatening.

I’m looking up relevant literature and will post more trend data and information from experiments that have been done to date.

It’s still impressive that before this era we really haven’t known for sure how humans regulate their plasma glucose in a comprehensive way, and yet we know that the dysregulation of glucose is responsible for so much suffering globally – 12% of the US adult population and heading toward 30%.

Is there a place where people can donate their CGM data for better analytics?

This is the question I’m asking. N of 1 experiments are great for stimulating curiosity in how the body works; they are not great in teaching ourselves what’s normal. If anyone knows of a place where this is happening in a conflict-free, not-selling-data-or-profiting-from-it-inappropriately way (the big catch), let me know in the comments.

Disclaimer and this is not a promotion of CGM-for-all

I’ve been asked directly or indirectly recently if I am advocating CGM-for-all. I am not, and definitely not with the current profile of devices available. This could change dramatically if CGM is more universally available (see blog posts above).

Reminder of my statement of independence and no conflict-of-interest:

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

Thanks for Publishing my Photograph, in Legislation intended to end sharp rent increases lands in the DC Council – Greater Greater Washington

2016.05.28 DC People and Places 05219
2016.05.28 DC People and Places 05219 (View on Flickr.com)

Thanks for using my photograph in this piece by @jonsteingart for @ggwash.

It’s a photograph of the U Street corridor featuring Washington, DC’s tallest mural, produced by @AniekenReloaded.

For more information about the mural:

A man afraid of heights is painting the tallest mural in D.C. – The Washington Post

Tenants could be spared from larger-than-expected rent increases under new legislation the DC Council is considering. Councilmember Anita Bonds (D-At Large) introduced a pair of bills that would update how rent increases are determined under the city’s rent control law.

Source: Legislation intended to end sharp rent increases lands in the DC Council – Greater Greater Washington

Thanks for Publishing my Photograph, in After 32 Years, The D.C. Government Is Taking Over The High Heel Race: DCist

2015 High Heel Race Dupont Circle Washington DC USA 00095
2015 High Heel Race Dupont Circle Washington DC USA 00095 (View on Flickr.com)

Thanks for publishing my photograph, @DCist.

It was taken during one of my (or my) favorite event in Washington, the annual high heel race.This photograph features our current Mayor Muriel Bowser (@MayorBowser).

Enjoy.

The campy event has gone from subversive to city-sponsored.

Source: After 32 Years, The D.C. Government Is Taking Over The High Heel Race: DCist

Thanks for Publishing my Photograph, in Events: Give a gigabit of your love (and creativity) to DC – Greater Greater Washington

FunkParade DC  40861
FunkParade DC 40861 (View on Flickr.com)

Thanks for publishing my photograph, @ggwash.

It was taken in 2014, several cameras ago, at probably the very first DC Funk Parade (@FunkParade)

Win money for an app focused city mobility and the environment, hear how to make commutes sustainable at GGWash’s panel, learn about changes to Bethesda’s bikeways, sit down at the green business roundtable, and more in this week’s events.

Source: Events: Give a gigabit of your love (and creativity) to DC – Greater Greater Washington

Thanks for Publishing my Photo, in Morning Roundup:  DCist

2018.10.08 DC People and Places, Washington, DC USA 06523
2018.10.08 DC People and Places, Washington, DC USA 06523 (View on Flickr.com)

Thank you for publishing my photograph, @DCist.

It’s of the upcoming The Meatball Shop (@Meatballers) coming to 14th Street Northwest, Washington, DC. Metabolic health is “in.”

Plus, this is how much area university presidents make, there may still be slowing on the Red Line, and more news.

Source: Morning Roundup: Metro Inspector Gets Job Back After Being Fired For Falsifying Reports: DCist

Part 4: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: Unexpected use – CGM to eliminate fatphobia and homophobia (it’s not what you preach, it’s what you tolerate)

2018.05 Low Carb and Low Carbon - Ted Eytan MD-548
2018.05 Low Carb and Low Carbon – Ted Eytan MD-548 (View on Flickr.com)

As I mentioned in part 1 of this series, a significant reason for me wearing a continuous glucose monitor (CGM) was to understand (a very small portion) what it might be like to have diabetes. I will never fully understand what it is like to have diabetes, and I know that.

I do understand what it’s like to be a fat person in society, as I have been one previously.

I also understand what it is like to be a minority in society and the different ways bias creeps into our lives, which is why this comment, added to my part 2 post impressed and surprised me:

Many gay men seem obsessed about their weight vs their health. You don’t need a glucose monitor if you aren’t diabetic. BTW Didn’t Dr Atikins die over-weight and from heart diseas (sic) ?“BrianAH”

CGM as a revealer of fatphobia and even homophobia

Because it’s not what you preach, it’s what you tolerate, and I don’t tolerate homophobia, I responded with the following:

Brian,

Thanks for stopping by and for the dialogue. I’ll take these one by one:

1. Many gay men also happen to be physicians (or I should say, many physicians also happen to be gay) interested in the health of the people they serve. Your statement doesn’t have evidence to back it up and is a little judgement and bias-tinged, don’t you think?

2. Did you read my “Why” post prior to this one? Here it is . If 55% of the population of California is insulin resistant, and the overwhelming majority don’t know it, 50% of them will progress to fulminant diabetes, what we think is needed may change. Hence this work. See this study for more information about CGM insights

3. No. He died from an intracranial hemorrhage from a fall.

Hope this adds clarity thanks for stopping by, happy to entertain other questions,

TedSource

Fatphobia and Homophobia/Transphobia are the only remaining prejudices accepted in medicine

This is fascinating to me because it parallels exactly what research has found in the explicit (endorsed) values of surveyed medical students

Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on Flickr.com)

How CGM could be a part of the solution of eliminating bias

I often hear physicians and professionals in the diabetes space talk about losing weight as the primary goal in management, almost to the exception of overall metabolic health.

The problem this creates in our patients are extreme feelings of disempowerment and labels that feed into the explicit biases above. I happen to know several people who would be considered overweight and have reversed their diabetes, from HbA1c’s in the 11’s to the 5’s. Are we to tell them that their primary goal is to lose weight, or is it to eliminate insulin and glucose toxicity?

Would we be happier if they were thin, hyperinsulinemic and glycotoxic? I don’t think so.

View this post on Instagram

#DataOverDogma #EmbraceCuriosity #MetabolicHealth #FMRevolution #Ketofest @2KetoDudes if someone knows something I don’t, I want to learn (HbA1c’s from 11.2 -> 5.2) ✌️🌎🕊

A post shared by Ted Eytan (@tedeytan) on

For an incredible example of what this philosophy (“lose weight, eat less, exercise more”) may have done to a generation of girls, boys, men, and women, listen to this podcast hosted by @Daisy_Ketowoman featuring dietician @TurtonJessica, it may burn a hole in your sole when listen to the story of eating disorders created by the health system that promotes this approach so vigorously:

With the data (finally) to understand both the status of metabolic health and its determinants (“eat this, not that”), it’s possible we can get away from things like fat shaming based on appearance only.

With regard to the homophobic nature of the comment above, I’m glad it came to this space; I never would have made the connection between the anti-human things that some people think and how something that gives us knowledge about how our bodies work makes such comments meaningless.

More validation that my generation of physicians came to health care to change everything. I love this century 🙂 .

Disclaimer and this is not a promotion of CGM-for-all

I’ve been asked directly or indirectly recently if I am advocating CGM-for-all. I am not, and definitely not with the current profile of devices available. This could change dramatically if CGM is more universally available (see blog posts above).

Reminder of my statement of independence and no conflict-of-interest:

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

Part 3: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: What’s Normal?

2018.05 Low Carb and Low Carbon - Ted Eytan MD.001-546
2018.05 Low Carb and Low Carbon – Ted Eytan MD.001-546 (View on Flickr.com)

I have been analyzing data from the Continuous Glucose Monitor (CGM) experience I’ve been having (see these posts for more: Why I decided to wear a continuous glucose monitor as a non-diabetic physician , and Part 2: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: The Experience) and I had run into a problem – I couldn’t find any data on what’s physiologically “normal”.

Since that time, I’ve consulted with two endocrinologists (thank you!) who have generally confirmed this problem, and also that what I’m seeing for myself is expected physiology, so I’ll begin sharing some of my findings, including the experience pictured above.

Glucose/Fat/Industrial Oil Challenge for a Fat Adapted Individual

As is pictured above, I had several bites of the dessert above, about 30 minutes after my standard diet, low carbohydrate/healthy fat, with the results pictured in the lower right corner. Essentially not much of a glucose rise at all. This was expected and also not-expected because I’ve been told that a person who’s fat adapted and has a lower basal insulin secretion could have a disproportional rise to a glucose challenge. On the other hand, there was probably enough fat in the meal above to impact things.

Finally a study of what CGM shows in a group of normal individuals

This is what gives me the confidence to share what I am beginning to share. Incredible that only until 2018 have we been able to really explain how the human body manages glucose throughout the day.

See: Virtual Meeting | EASD

Disclaimer and this is not a promotion of CGM-for-all

I’ve been asked directly or indirectly recently if I am advocating CGM-for-all. I am not, and definitely not with the current profile of devices available. This could change dramatically if CGM is more universally available (see blog posts above).

Reminder of my statement of independence and no conflict-of-interest:

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

If this is not a promotion of CGM-for-all, what is it?

It is:

  • Promotion of CGM for people charged with serving other humans to understand their own physiology so that they can be better servant leaders
  • Promotion of understanding of the role of non-pharmacologic, nutritional approaches to preventing, reversing, and potentially pre-empting diabetes. I don’t think there’s any argument that eliminating this condition with real food rather than pharmaceuticals is ideal. If there is, I’d love to hear it 🙂 .
  • Promotion of CGM to reduce and eliminate bias in the health care system – a fascinating other use that I did not discover until I started sharing my experience. I’ll post separately on that.

Any questions/comments, feel free to leave them in the comments, as usual.

Thanks for Publishing my Photos, in Can One Person Really Change the World? – It Starts with a Step: Walking for a Better World 

2018.01.11 DC People and Places 2125
2018.01.11 DC People and Places 2125 (View on Flickr.com)

Thank you for publishing my photos in this wonderful essay about placemaking, by (now book) author Clara Cecil.

2018.01.11 DC People and Places  98
2018.01.11 DC People and Places 98 (View on Flickr.com)

I love the meaning attached to something that I do every day without thinking about it:

Ted, an avid photographer, decided to start taking a picture every day on the way to work to capture a physical representation of his daily commute. When Ted started looking back at each of the commute photos, what initially had seemed to be a monotonous daily routine took on a new degree of meaning.

He no longer only noticed the same static concrete sidewalks and office buildings he passed by every day. While he had thought that the urban landscape itself was the central character of the city, he recognized that the city forms the backdrop while everything else occurring in and around the city composes the foreground.

In a nutshell, it’s true, I <3 DC. Enjoy the photos.

A person will take an average of 216,262,500 steps in their lifetime.

Source: Can One Person Really Change the World? – It Starts with a Step: Walking for a Better World – Medium

Photo Friday: Cracking open a new Continuous Glucose Monitor sensor

2018.09.26 Continuous Glucose Monitoring, Washington, DC USA 1695
2018.09.26 Continuous Glucose Monitoring, Washington, DC USA 1695 (View on Flickr.com)

This week’s photograph was taken in Washington, DC (of course). I also used it as part of the 7 day life in Black and White Photo challenge.

It’s a new Continuous Glucose Monitor (CGM) sensor. My second one. It will monitor interstitial glucose concentrations for 10 days.

I believe I’m ready to conduct some mini-experiments on glucose regulation. I keep finding in conversation that there is very little known about what normal patterns of glucose regulation are. Am I right about this? If you have feedback, let me know in the comments.

For more on my experience, check out these posts

And, a reminder of the disclaimer/disclosure. Conflict free is the way to be.

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

Thanks for Using my Photo WAMU and DCist, in Update: Catholic University Suspends Social Work Dean …

2017.02.12 Brookland, Washington, DC USA  00702
2017.02.12 Brookland, Washington, DC USA 00702 (View on Flickr.com)

Thanks for using my photo, @DCist. Its sibling media outlet, @wamu885, used the same photograph for a slightly different story (see below).

The photograph was taken under different conditions, in the exploration of the Brookland Neighborhood in Washington, DC (of course).

It’s worth linking to that experience here, to remind that for every square millimeter of trying times in our nation’s capital, there are 1,000’s more of the stories of leadership and the future being born. Enjoy.

Photo Friday: Brookland, Washington, DC USA – An amazing journey through American History

Social work students are planning to protest and demand his resignation on Monday.

Source: Update: Catholic University Suspends Social Work Dean Who Disparaged Kavanaugh Accuser On Twitter: DCist


Catholic U. President Says His Instinct On Abusive Priests Is 'Go After Them With A Baseball Bat' | WAMU