I bought a continuous glucose monitor a while ago thinking it could be interesting to try. @TamaraRC 's post has inspired to me to finally put it on. Here's a trace from when I had 5 pieces of a medium pizza yesterday evening (peak on the right): and a relative of mine eating exactly the same at the same time: In my case the peak extends into what the app describes as the 'elevated' range, I think it peaked at something like 11.7mmol/L. Supposedly 2 hours after eating glucose levels should return to below 7.7mmol/L. Mine were over 9mmol/L at 2 hours and didn't dip below that until over 3 hours later. According to some online health websites this would place me firmly into a 'prediabetic' category. I don't really know how to interpret these data so I'm not really sure if it's actually something that's abnormal or is actually very typical. I want to try this again after eating a big sugary desert, but I'm a bit concerned to do that because when I've eaten sweet food in the past it sometimes makes me feel quite ill. @Jonathan Edwards in your experience do you know if this is in any way unusual? There's been a few studies now arguing insulin resistance in ME (some mentioned in @TamaraRC 's video), I might put them together in this thread at some point to compare.
I've always reacted badly to simple carbs since getting ill, so I find this an interesting idea. Trouble is, the sensors only last a couple of weeks and they're very expensive, so they're not easily accessible. I know my long term blood glucose pattern's okay because I have regular HbA1c tests—probably more than average for a non-diabetic. I need regular blood tests anyway, I'm middle aged and at the top of the notional healthy BMI range, so they sometimes add a couple of other routine screenings to the lab form. They've all been fine.
The "pizza graph" from @chillier is similar to what I also get from for example eating a pizza. Actually I did test my blood glucose levels few days ago before and afer eating a pizza. Before it was 5.5mmol/L. 30 minutes after it was 8.1mmol/L. 90 minutes after it was 11.9mmol/L. Didn't take more tests because I started to feel better and thus it was obvious that the levels were going back down. In the past I've also noticed that at times I have the so called reactive hypoglycemia also. Sometimes 2-3 hours from meal my glucose level drops to around 3.5mmol/L also (causing different kind of symptoms) instead of stabilising back to normal right away. I've also been "prediabetic" for over 15 years, though I believe that my situation has improved in the past years after I removed most of the foods that causes such large changes to my blood glucose level from my diet. And the same as @Kitty , my HbA1c has always been normal when tested. Last time it was even in the middle of the normal scale. As for the BMI, I'm in the low end, on the border of being underweight. No idea if this has anything to do with my ME symptoms, but I strongly suspect that there's at least some correlation. I don't have any medical background so I can only guess though. I'm not sure if on my case a continuous blood glucose monitor would show much while I'm on my safe diet.
I am just hypothesising and could be completely wrong but maybe it should be considered that the HbA1c might not fully capture certain forms of insulin resistance. The HbA1c test measures the average blood glucose levels over approximately the last 2-3 months by assessing the percentage of glycated hemoglobin in the blood. While it could detect insulin receptor resistance caused by diet and androgen imbalance, there are situations where HbA1c might fail to reflect underlying insulin resistance accurately. If a person has a genetic variant that causes prolonged or excessive insulin secretion from the pancreas, the persistent high levels of insulin could lead to insulin receptor resistance, particularly in tissues like muscle and liver. However, if this prolonged insulin secretion lowers glucose levels during fasting and at night, this might balance out daytime spikes in glucose resulting in an average glucose level that appears normal or near-normal. I am just hypothesising here, but it’s an interesting idea that the reason ME patients tests come back normal isn’t because there is nothing wrong but because the tests are not picking up on a problem. In cases of prolonged insulin secretion due to genetic variants, doing a fasting insulin test and also insulin tests at one, two and three hours after a OGTT could be a better indication of a problem. Would need a large study and comparison to healthy controls.
Pizza is not an ideal food to test your response because from what I understand the high fat content slows the digestion/absorption of the carbs & slows & prolongs the insulin response. It is a notoriously difficult food for Type 1 diabetics to dose for. Try a similar test with boiled sweets or a sweet fizzy drink and away from a meal so that you are looking at the response purely to carbs.
Mine was low fat. I made it 1/4 rye flour, 3/4 wheat flour. Tomato sauce, seafood and vegetable toppings. No cheese
You have managed to identify a subject on which I am totally ignorant. Maybe we should discuss insulin resistance a bit more. There must be some experts here. It came up on Chris Ponting's proteomics study for ME/CFS.
Here are some of the pieces of relevant literature that I am aware of: Beentjes and Ponting's recent preprint of blood factors in the UK biobank cohort. Many of the findings in the 'blood biochemistry' section are associated with insulin resistance including high(er) glucose, hba1c, and a high ratio of triglycerides to HDL cholesterol: In this paper we feel quite far away from the raw data and it's been fairly pointed out that the signal could be coming from issues of specificity within the cohort. We can at least get a feel of the raw data for Triglyceride to HDL cholesterol ratio and TyG (a composite score of triglycerides and glucose) from these cumulative density plots: The shift to the right of the curve for TyG for instance I think might suggest it's a population wide effect (whole normal distribution shifted to the right). Precision life's genetic study on the UK biobank. 1 of the 14 identified genes is the insulin receptor INSR. Others are plausibly linked to insulin resistance. ATP9A and USP6NL for example are both involved in recycling RTK type receptors (which INSR is) from endosomes back to the plasma membrane: This is from the same cohort as above so the same specificity concerns apply, however... It's replicated in Precision life's long covid genetic study
In Armstrong et al 2015's metabolomics study (n=34 patients n=25 controls) in ME the only significantly elevated metabolite they see in the blood is glucose (phenylalanine/glutamate/hypoxanthine significantly low): In Germain and Hanson 2022's 2 day CPET metabolomics study 1 of the 7 metabolites significant after multiple testing correction is 1,5 anhydroglucitol. (C = control, P = patient, left is total, middle female only, right male only) Low levels indicates that an individual has had a hyperglycemic event in the previous 2 weeks. The molecule is metabolically inert and contained in food, but resembles glucose in structure. it competes with glucose for reabsorption into the blood in the kidney, such that if glucose levels are high, blood levels of 1,5 anhydroglucitol decrease. In Hoel and Tronstadt 2021's metabolomics study they do not see high glucose levels, but do see high triglyceride levels. They also measure metabolism associated hormones and see high insulin, leptin and others:
ME patients can't utilize sugar and fats normally, are we surprised to find 'insuline resistance?' If you eat sugar, and your cells can't utilise it (for potentially a whole bunch of reasons) your BS will rise. Increased BS doesn't automatically indicate IR though, it also doesn't help that IR itself is poorly understood.
I would turn that on it's head . ME patients can't utilize glucose properly , which means the body has to workaround via either utilising fats, and / or protein. Protein break down seemingly affects insulin requirements - diabetics may have to dose higher insulin for a protein rich diet than for a keto one . Keto can put type 2 into remission for some. Tagging @mariovitali , as liver has a key role in all these scenarios .
