Neat to see what other people's priors are, on this.
I'll note that even basic physics has that problem. Try explaining to a 5th grader why a feather would fly in the same arc that a rock will take, if there was no air.
I don't think anybody was expecting to be surprised by this study. In practice, most science is pretty boring and rarely breaks expectations. But being unsurprising does not mean it's not worth doing. A lot of studies are simply validating expected outcomes and providing foundational data points for future studies to refer back to. For example, a future study might use this study to justify funding ("as shown in Study 2025.abcd, glucose is highly variable... we propose to further study this by controlling for ... which will help us understand the influence of ..." etc etc).
My wife is T1D and this is infuriating for her.
She’ll think that she’s cracked it, and then the next day, with the same meal at the same time, her sugar levels go high.
Her words: there is nothing else where you have studied for over 30 years and STILL feel like you know nothing.
It is incredibly demoralising for her sometimes - especially when she’s suffering also from a high/low sugar level. I have the upmost respect for anyone having to do the amount of work, to get to zero (sometimes).
I do keto diet long term but for other reasons, often the epilepsy version where it's more strict and higher fat.
there are plenty of good reasons we eat carbs (especially complex carbs, plus trying to avoid processed stuff); as a diabetic you just have to prepare ahead of time. it sucks, but honestly, as a 20+ year T1D, not eating cake sucks more than having to plan to eat cake :)
For example, AAPS has since version 3.2 dynamic IFS. ( https://androidaps.readthedocs.io/en/latest/DailyLifeWithAap... )
For me this works quite well
Assumption: Medical professionals are trained to use Evidence Based Medicine (EBM).
One might assume that EBM means something specific, and I'm sure it does, but that specific thing is different for different people.
One thing that EBM sometimes means is: common sense is no substitute for evidence. There are uncountable times that common sense has been wrong in the medical context.
So, you have a lot of people commenting here that this is obvious common sense, but many medical professionals will pull out a reference chart of caloric content and glycemic index and say "look at the evidence".
So, it is very useful to do studies that bring evidence to common sense.
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My other pet peeve with EBM is that it does a poor job of understanding that different interventions work for different people - it is time consuming and expensive to do that kind of investigation, thus some/many medical professionals do not understand or believe it.
This comment is intended as a critique, not a dismissal.
Such tools also enable studies that can be done at a scale and cost level that is reasonable and can push forward the communal knowledge base.
The problem with studying humans is, roughly, the central limit theorem doesnt work: properties of biological and social systems do not have well-behaved statistics. So all this t-test pseudoscience can be a great misdirection, and common sense more reliable.
In the case where effect sizes are small and the data generating process "chaotic", assumptions of the opposite can be more dangerous than giving up on science and adopting "circumstantial humility". (Consider eg., that common sense is very weakly correlated across its practicioners, but "science" forces often pathological correlations on how people are treated -- which can signficantly mangify the harm).
Citation needed?
I don't know what would lead to that conclusion. And it would seem to run counter to the entire history of the field of psychology, for example.
Psychology is the field that is most hit with replication failures and has a slew of unintuitive results that turn out to be malpractice.
You have this about everything, everywhere. It's a pet peeve how much stuff people will attribute to "common sense" so they can do the internet "I'm superior" thing.
"Wear sunscreen, it's just common sense". No it isn't. We evolved on Earth under the sun, we feel good when going out in the sun, it's bright and beautiful. Rubbing petrochemical distillate or industrially processed plant extract on your skin so the invisible light discovered in 1801 doesn't denature the invisible DNA discovered in 1869 is not common sense it's learned behaviour. Nothing much about Science is common sense, it took thousands of years from the dawn of Civilization until the Enlightenment era and still people can go through years of education and then choose to believe what we want to believe instead of what the evidence shows.
'Common Sense' is that the world is simple, designed for a purpose by a human-like mind one or two levels up from us on the power scale, and inhabited by life-like energies and spirits, some of them malevolent. Common Sense is that things which didn't happen today or yesterday will probably never happen. Common Sense is that things which happen together cause each other; if the relative comes to town and the crop fails then they are bad luck, if the relative comes to town and the baby is born healthy then they are good luck.
Why would it be any kind of 'common sense' - 'sound judgement not based on any specialised knowledge' - that glucose (1747) response differs for the same meal if you need a continuous glucose monitor (FDA approved in 1999) to find that out?!
Another thing I've noticed is that if I eat a very rice-heavy meal, my blood sugar levels may rise throughout the night. I don't think this is insulin-resistance but rather my body digesting the rice. You can't expect the body to digest all the rice in 2 hours, can you, there certainly must be parts that are protected from the stomach acid until much later in the digestion process. So that feeds into the high blood sugar levels overnight in my opinion.
I think if anything, CGMs have opened up the idea of what diabetes really is and how different bodies handle blood sugar. I think I'm borderline T2D, not full-on T2D despite what my doctor says, and I've started wondering if my blood sugar has always been high, but normal for me. On average it's about 120 mg/dL, but I do see my body react properly to new sources of blood sugar and drive it back to "normal" levels, so the idea that I have insulin resistance doesn't make sense to me.
I think you could have a point at around 100-105 baseline but 120 seems too high.
Type 2 "resistance" is about the quality of the response to high glucose levels, not the complete lack of a response to them. There shouldn't be a long buildup overnight in that scenario for a person without insulin resistance/deficiency and still having a measurable insulin response is normal/expected of all but the worst Type 2 diabetics. Yes, you're still digesting, but in individuals without diabetes the blood sugar peak occurs (and ends) well before digestion is finished because influxes of carbs can still be effectively managed by the insulin alone rather than by the lack of additional carbs to digest. If it were just that one's digestion were a lot slower than a normal persons then it should still result in a lower, but still quickly managed to baseline, peak.
You may well actually be prediabetic though, it just depends on the specific numbers for A1C/average & peaks combined over time and not the presence of a response itself. The recommendations between higher side prediabetic and lower side type II diabetic shouldn't be all that different in the end anyways though.
Just to clarify - A1C is itself an easily-measured proxy for diabetes mellitus, but it's itself a heuristic. There are groups for whom it is known that the "standard" A1C range is actually incorrect, because of confounding factors that affect the A1C measurement but are unrelated to the metabolic dysfunction or general sugar levels.
Your point is correct, though, that what OP is describing is consistent with diabetes, and the actual clinical recommendations for prediabetes and Type II diabetes are often the same, at least in the early stages.
Typically the glucose level in the interstitial fluid takes longer to respond to your food intake, and the GCMs measure that instead of the blood glucose level.
I'm a type 1 and my blood glucose can response can vary wildly. Sometimes it can spike quickly (15-30 minutes), other times it can take 2, 3, or even 4 hours. The reverse is also true, in that insulin can sometimes effect me quickly, and sometimes it can take effect 3+ hours later. In general, when having a big meal, I'll take a "fairly large" amount of insulin, but not enough for the entire meal; then I'll take more[1] when my blood starts increasing into 200+ range. Otherwise, I risk it dropping because the insulin was having a "fast" day but the food was "slow".
My endo finds it weird, but we've gone over specific cases of it, including exactly what I ate, when, and what the CGM history for the day looked like. I'm just defective :)
[1] Note I'm not talking about reactively taking more insulin after the "right" amount turned out not to be enough (which is generally a bad idea). Rather, I'm talking about splitting what I know to be about the right amount... into 2 different doses.
msarrel•2d ago
jzacharia•3h ago
nradov•1h ago