CGM data question

[frankiesfriend]

Hi everyone...I am seeking some insight from experienced users of continuous glucose monitors.

I have been using a Freestyle LIbre continuous glucose monitor for almost a month (my available time using it is nearly up). My blood (actually interstitial) glucose numbers have generally been good. Fasting glucose is in the 80's, rising after meals to between 95-120, and my overall average glucose is 89. However, I have noted that the CGM shows "low glucose events" while I am sleeping. I understand that a "low glucose event" is a reading of blood sugar under 70. Most of these have occurred in the early morning, maybe 5 - 6am, possibly during REM sleep, but a few have occurred between midnight and 3am. I usually fast around 15 hours, and generally have entered very mild ketosis of 0.5-0.6 by the morning, although I do not eat a ketogenic diet. For those of you who use a CGM, do you see low glucose events, and if so, do you change anything about your diet to try to eliminate these?

By the way, most of the research I have sought about "low glucose events" or "low blood sugar" return results for studies of diabetics who have poorly matched insulin to food intake. For them, a low glucose event can be very dangerous because the blood glucose can go to extreme lows. Some studies performed in the 90's using healthy, young non-diabetic subjects and monitoring multiple blood biomarkers have indicated that a healthy steady-state blood glucose during sleep would be in the mid-90's. My overnight average is 79. I think I am healthy, but not young (I am 71) so I don't have a good comparison, but I suspect that healthy blood sugar doesn't change much as one ages. Or does it?

Thank you for any information you might share!

[Tincup]

Hi everyone...I am seeking some insight from experienced users of continuous glucose monitors.

For those of you who use a CGM, do you see low glucose events, and if so, do you change anything about your diet to try to eliminate these?

In 2017, I did nineteen cycles of fasting 5 consecutive days out of every 14 (being weight stable when looking at the beginning of each cycle to the beginning of the next). I don't recall if I wore a CGM during any of those, though I have used the Freestyle. The last few days of a fast, my glucose would commonly be in the low 50's. One afternoon I checked and had 32. To make a point, I went to the gym and set PR's on my lifts. (by the way, my numbers are in mg/dL, for readers outside the US, divide by 18 to get mmol/L) I'm 66, I climb with an MD neurologist. When I told him this story, he said the only people he'd seen in the 30's were comatose. I said they obviously weren't adapted. By the way, when my glucose is in the 50's, my serum ketones are in the 5-8 mmol/L range.

George Cahill was a Harvard Prof & MD. He did fasting research in the 1960's and later. Dr. Mary Newport has accumulated a number of his papers on the topic. See here. One time they fasted obese seminary students for 40 days. Then gave them injected insulin. Their average glucose was 18 and one guy was 9, with no cognitive issues.

My point - if you are adapted, and you are, then there is no issue with low glucose. As your glucose drops, your ketones will rise and your brain will be fed. For other readers, if you are Type 1 diabetic or taking diabetic meds, then my answer doesn't apply without talking to your doctor. The meds can force your glucose low and be a problem. Also may be an issue for those who are not adapted, as they won't make ketones and the brain will go low on fuel.

By the way, I make sure no alarm will sound if I'm lower than 70 if wearing a CGM, I don't want to wake up for that!

[xactly]

I was keto-adapted and also fasting when I went to the Mayo Clinic for a routine colonscopy two years ago. My PCP ordered my annual blood tests before the procedure to be efficient with my time. A team of three medical staff bolted into my room before the colonoscopy started and informed me that my glucose was 37 mg/Dl. They were shocked that I was speaking and functioning normally. None of them had ever seen anyone with blood glucose that low who was not in serious distress. Of course, they administered glucose through an IV because they wouldn't start the colonoscopy I was at least 70. I took readings at home for several days afterward and confirmed for myself that my blood glucose was often less than 70, but I felt fine.

[frankiesfriend]

Hi everyone...I am seeking some insight from experienced users of continuous glucose monitors.

For those of you who use a CGM, do you see low glucose events, and if so, do you change anything about your diet to try to eliminate these?

My point - if you are adapted, and you are, then there is no issue with low glucose. As your glucose drops, your ketones will rise and your brain will be fed. For other readers, if you are Type 1 diabetic or taking diabetic meds, then my answer doesn't apply without talking to your doctor. The meds can force your glucose low and be a problem. Also may be an issue for those who are not adapted, as they won't make ketones and the brain will go low on fuel.

Thank you Tincup...this is very helpful.

[frankiesfriend]

I was keto-adapted and also fasting when I went to the Mayo Clinic for a routine colonscopy two years ago. My PCP ordered my annual blood tests before the procedure to be efficient with my time. A team of three medical staff bolted into my room before the colonoscopy started and informed me that my glucose was 37 mg/Dl. They were shocked that I was speaking and functioning normally. None of them had ever seen anyone with blood glucose that low who was not in serious distress. Of course, they administered glucose through an IV because they wouldn't start the colonoscopy I was at least 70. I took readings at home for several days afterward and confirmed for myself that my blood glucose was often less than 70, but I felt fine.

Thank you for sharing your experience. My acupuncture practitioner suggested that my blood sugar is unstable, indicating prediabetes. About a eighteen months ago, labs showed no insulin resistance and I have never had high blood sugar readings I also have high HDL and low triglycerides. Nonetheless, she suggested that I would sleep better if I ate a teaspoon of honey in the middle of the night. I am not enthusiastic about eating at night, but I know that sleep is incredibly important, so I don't want to dismiss her implication that low blood sugar is interfering with restful sleep which doesn't come easily to me.

[Tincup]

Nonetheless, she suggested that I would sleep better if I ate a teaspoon of honey in the middle of the night. I am not enthusiastic about eating at night, but I know that sleep is incredibly important, so I don't want to dismiss her implication that low blood sugar is interfering with restful sleep which doesn't come easily to me.

Certainly wouldn't hurt trying this for a few nights and seeing what happens to your sleep.

[circular]

Thank you for sharing your experience. My acupuncture practitioner suggested that my blood sugar is unstable, indicating prediabetes. About a eighteen months ago, labs showed no insulin resistance and I have never had high blood sugar readings I also have high HDL and low triglycerides. Nonetheless, she suggested that I would sleep better if I ate a teaspoon of honey in the middle of the night. I am not enthusiastic about eating at night, but I know that sleep is incredibly important, so I don't want to dismiss her implication that low blood sugar is interfering with restful sleep which doesn't come easily to me.

I have good insulin, glucose, and cardio labs as well, but I still sometimes have issues with hunger at night, either during the evening before bed or during the night, whether I'm in ketosis or not. In Rhonda Patrick's genomic report I have FTO rs9939609 (A;T) which she says, 'has been associated with an intermediate increased risk of obesity and type 2 diabetes due to high production of ghrelin'. I'm not obese and I don't have type 2 diabetes, but I have seemed to have high ghrelin levels for years. It seems worse when I'm under a lot of stress and/or exercising even a modest amount, though it is true hunger. I've never been an emotional eater. My ghrelin, however, isn't constant and I'm not a snacker. I do get full fast, so it might have nothing to do with FTO and just be that I can't eat as many calories in one meal as others.

When I get hungry during the night I often lie awake until it goes way and finally fall back asleep. I'm then happy I got the longer fast in, but not sleeping well is a huge price to pay. My husband tells me to prioritize the sleep, so sometimes I do that and just get up and eat something and then go back to bed and sleep late. Now that I write about this, I think it's probably better to get up and eat something easy to digest and then get the sleep.

I usually first drink a huge glass of water I keep in the bathroom and then go back to bed. Often the hunger goes away and I'll then fall asleep. It's only if that doesn't work that I eat something.

But I often feel like I just can get my body to behave according to all the rules that seem to come easily to others. It's very frustrating, and actually it may all be down to stress mucking everythin up since it's been chronically very high for over ten years now.

I think the only insulin measurement I haven't done, besides CGM (which measures glucose but not insulin), is the two hours post meal insulin measurement, but all the more conventional ones are good and I can easily go in and out of ketosis.

[frankiesfriend]

Now that I write about this, I think it's probably better to get up and eat something easy to digest and then get the sleep.

But I often feel like I just can get my body to behave according to all the rules that seem to come easily to others. It's very frustrating, and actually it may all be down to stress mucking everythin up since it's been chronically very high for over ten years now.

I think the only insulin measurement I haven't done, besides CGM (which measures glucose but not insulin), is the two hours post meal insulin measurement, but all the more conventional ones are good and I can easily go in and out of ketosis.

Last year, I did experience about six months of 7-7.5 hours/night of pretty solid, refreshing sleep. This occurred when I started taking a very small dose of medical marijuana THC indica strain added to the low dose of melatonin I have been taking for a long time. Research on the effects of THC on cognition give mixed negative/positive results, but most of the negative results seem to occur in adolescents with long term high dose use. Ultra-low doses appear to mostly be beneficial. However, I became worried because I gained about five pounds and could not seem to lose it, and I was already trying to lose five pounds before I began taking it, and I was worried that my cholesterol would go up. Although I can't be sure that the THC caused the weight gain, now I am not taking it, and my sleep maintenance problems have returned. I took the THC right before bedtime, and given the low dose I was taking, I had no hangover effect. It (the indica strain) was just calming. I am very sensitive to all medications, so a vial of THC oil that might supply another person one month would provide at least three for me.

Regarding my current sleep issues, I might try a small amount of honey or something else at night to see if it helps me sleep better. I do believe that is important, but I was pretty happy with my blood sugar readings and also having some ketones on board for a few hours in the morning.

[circular]

Last year, I did experience about six months of 7-7.5 hours/night of pretty solid, refreshing sleep. This occurred when I started taking a very small dose of medical marijuana THC indica strain added to the low dose of melatonin I have been taking for a long time. Research on the effects of THC on cognition give mixed negative/positive results, but most of the negative results seem to occur in adolescents with long term high dose use. Ultra-low doses appear to mostly be beneficial. However, I became worried because I gained about five pounds and could not seem to lose it, and I was already trying to lose five pounds before I began taking it, and I was worried that my cholesterol would go up. Although I can't be sure that the THC caused the weight gain, now I am not taking it, and my sleep maintenance problems have returned. I took the THC right before bedtime, and given the low dose I was taking, I had no hangover effect. It (the indica strain) was just calming. I am very sensitive to all medications, so a vial of THC oil that might supply another person one month would provide at least three for me.

Regarding my current sleep issues, I might try a small amount of honey or something else at night to see if it helps me sleep better. I do believe that is important, but I was pretty happy with my blood sugar readings and also having some ketones on board for a few hours in the morning.

I am also really sensitive to medications and supplements. I have a friend who swears by her THC before bed, and she does sound like a different person since using it. She's taking something with 100 mg THC and 2 mg CBD. I'm interested in knowing how many mg of THC you're taking.

I also have long periods without sleep issues. The hunger affecting my sleep is definately exacerbated by stress, but I know people who sleep soundly even when they're under huge amounts of stress, so I should be able to not deal with this.

[frankiesfriend]

I am also really sensitive to medications and supplements. I have a friend who swears by her THC before bed, and she does sound like a different person since using it. She's taking something with 100 mg THC and 2 mg CBD. I'm interested in knowing how many mg of THC you're taking.

I also have long periods without sleep issues. The hunger affecting my sleep is definately exacerbated by stress, but I know people who sleep soundly even when they're under huge amounts of stress, so I should be able to not deal with this.

I was taking about 5-6 drops of a formulation of 40 mg/ml THC, yielding about 4 mg THC with less than 0.4 mg CBD of the indica strain. I was already taking it when I listened to an interview with Dr. Mikhail Kogan regarding his extensive recommendations of medical marijuana in his medical practice for all kinds of conditions. I ordered his book, but have leant it to a friend so I don't have his specific recommendations in front of me. I did read either in his book or in some scientific studies of the impact of THC and CBD on sleep that CBD in small amounts is stimulatory and that it requires large amounts (which are expensive) if using CBD for sleep. However, THC is sleep inducing in small amounts. Once again, I think it is important to use the indica strain and start with a low dose.

I took it at bedtime along with a 2mg extended release melatonin formulation, which I still take. I would awaken one time each night for a trip to the bathroom and then go right back to sleep until morning. If taking a small dose, I had no sense of being high or unsteady.

In Florida, one must get a state license and see a medical marijuana doctor. It costs around $300, and requires two visits/year to the doctor to continue the prescription. With the license in hand, one can go into a medical marijuana dispensary and buy any amount of anything, no questions asked, even products that are clearly designed to induce a high. The "Budspersons" - not the doctors - guide you in selection of your product. There are gummies, tinctures, oils and smokables. In Florida, there is no legal way to sample any of these products, but I hope that in your state, you can find a way to do that!