The DOC is plagued with poor info on what normal blood glucose patterns look like in non diabetics. EG Bernstein and his thousands of followers claiming that all non diabetics have bg of 83 all the time.
Interestingly it’s a subject quite poorly studied so I am glad any time I see real data on the subject like this.
Yes, although this data like other similar papers shows the amazing job the body does at keeping non-diabetics in a normal blood sugar range for all but 20-30 minutes a day. Pretty cool system when it works like it should.
I don’t think any paper ever has vindicated Bernstein and his ilk on this issue. Do they have any evidence to back up Bernstein’s 83 claim other than his anecdotes? The whole story how he determined that 83 is the holy grail sounds implausible. Besides, even if he were right about it, that wouldn’t necessarily mean that pursuing a constant BG of 83 has any meaningful clinical benefit compared to an average BG of e.g. 110.
I think the troubling part of Bernstein is the loud and “cult like” adherence some of his more devout followers bring. i.e. this is the only way, when we know there are others that work as well. While I do think many people are better able to manage themselves using his methods, and he certainly has helped people. I find anyone who isn’t able to look at and discuss alternatives frustrating, and therefore not to my preference.
I have no problem with berenstein methods of eating very low carb, and of course it does reduce blood sugar fluctuation in diabetics and non diabetics alike… But I do have a problem with absurd proclamations like non diabetic blood sugar is 83 all the time without exception when anyone with any common sense knows that’s not the case… but then his tens of thousands of online flunkies chant it over and over while banging drums and shout down anyone who knows anything… it is very cult like
Right. His ideas can’t all be rubbish, but the absurd claims are really off-putting.
Does he actually have that many followers or are there just a few loudmouth prophets?
There are numerous groups on Facebook and probably other forums with thousands of members. Some of Bernstein’s recommendations are helpful, but some are just nonsense.
This study is really useful for me at the moment. My dad is concerned about his blood sugar, because he got an A1c approaching 6.0% and is worried about it progressing to pre-diabetes. I suggested he buy a Libre sensor and use the two week period to experiment with food and see if he has a problem and/or if he should eat a lower-carb diet. I was wondering what number I should give him for a threshold to be concerned about, as I’ve already told him that spiking somewhat after meals is normal. So I will pass on this study. (I do think this study does seem to include some people with pre-diabetes, if they have an A1c of >6.0% and are hitting >11.1 mmol/L after meals, so I’m not sure I’d consider that optimal; but certainly briefly hitting >7.8 mmol/L seems totally normal, and even outside the Bernstein followers, there are plenty who claim that damage begins once you hit that number…)
The fact that that they are using CGM could mean the minutes they are seeing is extremely inaccurate. A non-diabetic is essentially doing IV injections all the time, so the CGM would be incredibly inaccurate, it would never pick up the extent of the spike. The body can correct it and bring it down before the CGM ever sees it, or without it capturing the actual minutes.
I can do this as a demo sometime. Like drink a Coke, show a BG reading, do an IV injection to correct it, and show how the CGM never sees how high it really went.
An experiment where you stick a CGM on a research participant and send them home and they have to do occasional BG checks is easy to do (preprandial, 90 min postprandial, pre-bedtime and 03:00 hours, according to the experiment).
A much more accurate experiment, where the research participant gets a BG reading every 5-15 minutes, would cost much more. It would irritate the participants enough where you’d need to reimburse them a lot more.
Another factor in this experiment - for the CGM, they used Medtronic! 
I think the issue I would look at is if and how long he stays above 200 (11), if he doesn’t venture above that for more than a few (30?) minutes a day, I wouldn’t be inclined to change much. If he does, then I would be looking hard at my diet.
Ok. that’s HILARIOUS! Talk about BAD data. I think that “CGM” shouldn’t be allowed to call itself that with all the calibrations it needs on a daily basis!
Personally, the few times I have made an effort to employ Berstains suggestions (and they are more than just suggestions.), I have ended up with horrible results. And I loath being proselytized to.
I share your feelings completely. as I said, “proselytizing.”
I’d like them to reanalyze their data and just include the those participants with A1c less than 5.7%. In the US 5.7-6.5% is considered prediabetes. The Medtronic guardian is quite accurate when calibrated 4x daily, which would have been easy since they were checking BG 7 x daily if I recall. Thanks for posting, Sam.
Interesting article, and I wonder if anything more rigorous has come out since it was published in 2010. E.g., the authors indicate they could have gone further toward eliminating any possibility that the participants were IGT.
It’s remarkable to me how little is actually done on studying what’s normal, BG-wise. Which segues to the fact that this one raises some questions for me about a bugaboo I’ve had for a while about this term “pre-diabitic.” I can’t seem to shake off the feeling there’s something of the odor of medical-fad around it. I’ve had not a few friends in recent years panicked about hearing “pre-diabetic” from their pcp when they showed a BG of, like, 114 in a routine blood draw. “Hey, Bill, you know about this stuff, am I gonna die???” (Slight exaggeration). But it bugs me. I LOVE seeing 114. Heck, after certain meals I’m slapping myself on the back for anything under 160. So what exactly is this pre-diabetic thing about, especially when it seems like a snap diagnosis based on a single datum in a single test. The OP article seems to indicate that these kinds of spikes, taken in isolation, are nothing to be concerned about, which is what I’ve been saying to people, recently my younger sister. “You need more testing to know whether this means anything!”
And then it feeds into the national health statistics, which is another thing. Given how non-specialists continue to reflexively (mis)diagnose T1 adults as T2 because they’re “too old to have T1,” I gotta wonder at what degree of competence is underlying this “pre-diabetic” thing, which if anything is more amorphous. You keep hearing things like, “By 2025, half of all Americans will be diabetic or pre-diabetic,” and that little “or pre-diabetic” is a parenthetical clause you could drive a truckload of pharmaceuticals through, seems to me. I mean, there’s no harm for most people to lose weight and get more exercise, and I read that Metformin has benefits unrelated to diabetes, but if they’re flinging “pre-diabetic” around as just kind of a scare tactic it’s not really ethical. Not to mention skewing the national health statistics in a weird way. I’d like to believe otherwise, but there is a huge shitpile of money that wants that statistic to keep heading up.
Well I think the pre-diabetes is a bit of a reach, since it only denotes someone who has an increased risk of developing diabetes. But the medical societies do struggle to reach patients and so oversimplify things if they think they can get patients to take action. I don’t think of this as a pharma thing, but rather a medical society thing and the lack of high quality research most people are willing to undertake.
There is a pretty good write-up on what Pre-diabetes is at Joslin:
https://www.joslin.org/patient-care/diabetes-education/diabetes-learning-center/what-pre-diabetes
I am assuming the IGT test is a bit underutlized.
I wanted to demonstrate why using a CGM to show “normal” non-diabetic BG patterns is kind of ridiculous.
Here are 3 pictures that illustrate it well.
IV injection…
The Dexcom never had a clue.
That’s only illustrating the point that they’re more volatile than a cgm can track…
