Chapter 1: What is the significance of blood sugar tracking?
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It's a simple recurring donation that gets you perks to NPR's podcasts. Join us at plus.npr.org. Thank you again for your support. All right, let's get on to the show. You're listening to Shortwave. Tis the season of eating. I'm joined by health correspondent Ping Huang. Hey, Ping. Hey, Emily. We want to invite you on the show to talk about your experience with a continuous glucose monitor.
Mm-hmm. CGM, what prompted you to start wearing one?
Yeah. So I've been pre-diabetic for a few years now, like on and off. And most recently, it's been mostly on. And I saw that they got approved for overly counteruse last year. So a few months ago, I decided to try one.
Yeah, and I know that prediabetes is really common in the U.S. Around one in three adults have it, but not everybody knows they're prediabetic.
Right, yeah. I mean, being prediabetic basically means clinically that a person's glucose levels are higher than people without diabetes. Mm-hmm. but not quite in the diabetic range.
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Chapter 2: How does a continuous glucose monitor work?
I remember having to draw from memory the Krebs cycle in freshman biology class, and it was all about how the mitochondria convert glucose to usable energy to ATP.
You remember many details of that. I'm impressed. But we get our ATP from glucose. We can get ATP from fat and other things, but glucose is ultimately the main currency.
Okay. Glucose is the thing we're after for energy. So How does it get stored in our bodies?
So each cell can store some glucose and some cells can store a lot more glucose, like your muscles that need a lot of glucose because they're the ones moving your body. And we store that in the form of glycogen. And then your liver is actually the organ that stores extra glucose to share later.
And when you are not eating, like when you're sleeping at night, the liver will give out glucose to the rest of the body so that we have glucose all the time.
Okay. And I know that part of what's happening with like glucose uptake, like the cells sucking in that glucose involves this hormone called insulin. What's insulin doing?
So hormones are just chemical messengers in the body. Insulin comes from a specific cell in the pancreas called And insulin goes throughout your body and allows cells to actually take up the glucose into the cell. So imagine your cell is a house and it has a door. But in order for the glucose to go into the house, it needs the key. So you use the key to open the door. The key is insulin.
So if you don't have insulin, that doesn't happen and there's a problem.
And we all know how frustrating it is to get locked out of the house. you know, when you're just at the door and all you need is that dang key. Yeah, and humans, when you lock those insulin keys, it looks like diabetes. Type 1 diabetes means the body does not produce insulin, so people take insulin medication, whereas Type 2 diabetes means the body has more insulin resistance. What is that?
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Chapter 3: What are the implications of being prediabetic?
It is a combination of insulin resistance and some insulin deficiency. So insulin resistance means that the insulin's there, the keys are there, but you need like five keys to open the door instead of just one key because the one key is not strong enough. And so your body has to make extra insulin In order to do insulin's job.
And then over time, one can say that the cells that make insulin get exhausted, they start to die and are non-functional. And so you have actually then a decline in insulin production. So you have both a resistance to insulin and also just not enough insulin.
So I have two family members with type 2 diabetes and... They were always talking about their blood sugar. Like, I got to watch my blood sugar. And when I was a child, I just thought my grandpa's blood basically was made of cookies. But what is blood sugar? And why is that pertinent to diabetes? Yeah.
So when we say blood sugar, it's just our casual way of saying blood glucose.
Okay, so before glucose gets stored, it travels through our bloodstream?
Yeah, because it's the sugar in the blood. And blood glucose has a healthy range. So in people without diabetes, blood glucose can range anywhere from as low as maybe 60 milligrams per deciliter of blood up to maybe about 140 after a meal. milligrams per deciliter of blood. And having glucose concentrations above that and below that can be problematic. So we do want it in that healthy range.
Can you expand more on what can happen if the body spends a lot of time above and also below that?
Yeah, so the glucose is actually not getting into the cells where they're needed. And so instead, they're still in circulation. They're still in the blood. The blood is like the highway of the body. It's trying to deliver lots of different things to all parts of your body, including glucose. And so when that happens, actually, the blood vessels can get damaged over time.
It's like damaging the roads, right? And this is essentially the root of the diabetes complications. So we have some very vulnerable vessels in our eyes, in our kidneys that supply the nerves and like our feet. And those get damaged early. And then you can get damage to bigger vessels, to our heart and to our brain. So it's the vessel complications of diabetes that are what we want to prevent.
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Chapter 4: How can a CGM help manage prediabetes?
And so when you exercise, instead of five keys needed to open the door,
You may only need three. And Sarah, what about time of day? Does time of day impact blood sugar? Especially when you're eating foods that are high in glucose?
Everyone tends to be more resistant to insulin in the morning hours. And that's because of the other hormones that are circulating in the morning that are helping you to get up and get ready for the day.
Gotcha. Okay.
So when people have diabetes, they're number one, more insulin resistant in the morning, naturally. And then if they eat a big carbohydrate meal in the morning, it's kind of like a double whammy for the system. And so their glucose levels may go higher than they want.
Okay, for all of us, diabetic or not, what are your top tips for keeping blood sugar in a healthy range? Especially heading into the holidays.
Okay, my big message for the holidays is don't worry about the holidays. If you really wanted to focus on your health, I would say focus on the other 350 days of the year. And, you know, don't torture yourself during the holidays.
Just enjoy the delicious season.
Indulge in the holidays and maybe try not to indulge so much when it's not the holidays. That should be the message.
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