#78 - Food, exercise and glucose "spikes": should everyone wear a CGM? Glucose spikes are normal physiology!! With Dr Guess and Prof Little

Dr Glenn McConell chats with Dr Nicola Guess from Oxford University, England and Professor Jonathan Little from the University of British Columbia, Canada. Nicola is a dietitian researcher with many years of expertise including the importance or otherwise of glucose “spikes” or excursions and the pros and cons of continuous glucose monitor use. Jonathan is an expert on exercise metabolism who is coming onto the podcast for the second time after speaking previously about keto diets and exercise. A major point is the difference between having chronically elevated blood glucose levels such as in diabetes (pathology) versus having normal increases in glucose ("spikes") in response to a meal. Also increases in glucose before and during very intense exercise is normal physiology and not a concern. There was also a clear message that the use of continuous glucose monitors (CGMs) have both pros and cons and that need to be considered. A very interesting chat. Twitter: @DrJonLittle
0:00. Introduction and welcome
3:20. What are glucose “spikes”/excursions
4:45. Hyperglycemia in diabetes is very different to “spikes”
6:20. Glucose spikes in type 2 diabetes
7:19. Why is chronically elevated glucose a problem?
12:20. Confusion about glucose levels 2hrs after a meal
15:29. Underlying insulin resistance the problem not spikes
19:08. Fasting glucose and insulin measures
21:10. Meal tests and oral glucose tolerance tests
24:55. Be careful not to make the underlying pathology worse
26:15. Keto diets: T2D, weight loss, exercise
32:10. Glucose even in diabetes is not as important as we think
35:00. Are CGMs useful?
38:30. Too much focus on glucose than more important things
41:00. CGMs very important for people with T1D
42:05. CGMs and anxiety
43:25. CGMs and higher cholesterol
44:00. Misunderstanding of pre-diabetes re CGMs
46:00. Metabolic flexibility
47:40. “Nervous normals”
49:42. Is how loses weight important?
53:41. What about CGMs in type 1 diabetes?
54:15. CGMs, diabetes, diet, behaviour change and exercise
57:40. Glucose metabolism during exercise
59:55. Exercise and insulin sensitivity
1:02:15. Effect of exercise on glucose spikes from a meal
1:04:10. Intense exercise can increase blood glucose levels
1:07:10. Normal to have elevated glucose after intense exercise
1:09:50. Influencers misinterpreting data re glucose spikes etc
1:12:10. Misunderstanding glucose cut offs
1:13:10. Takeaway messages etc
1:14:00. Weight loss diet strategies
1:17:50. Amino acids and insulin secretion
1:24:40. Should everyone use CGMs?
1:26:30. Keep it simple re diet and exercise
1:27:40. Outro
Inside Exercise brings to you the who's who of research in exercise metabolism, exercise physiology and exercise’s effects on health. With scientific rigor, these researchers discuss popular exercise topics while providing practical strategies for all.
The interviewer, Emeritus Professor Glenn McConell, has an international research profile following 30 years of Exercise Metabolism research experience while at The University of Melbourne, Ball State University, Monash University, the University of Copenhagen and Victoria University.
He has published over 120 peer reviewed journal articles and recently edited an Exercise Metabolism eBook written by world experts on 17 different topics (https://link.springer.com/book/10.1007/978-3-030-94305-9).
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Not medical advice