research article from 2018: Continuous glucose monitoring can disclose glucose fluctuation in advanced Parkinsonian syndromes

[Rhyothemis]

here's the link to the full article -

ncbi.nlm.nih.gov/pmc/articl...

A small study of non-diabetic elderly people with advanced MSA, PD, progressive supranuclear palsy & dementia with Lewy bodies used continuous glucose monitoring to track glucose [blood sugar] levels.

They found very low levels during the night ("4 of them reached recordable limit of 40 mg/dL" - 2.2 mmol/L ; that's extremely, dangerously low) and abnormally large spikes after meals.

~

If you have used a CGM, have you noticed similar patterns?

[Rhyothemis]

Here's a YouTube video that discusses normal and optimal glucose levels in non-diabetic healthy people:

youtu.be/vZbgTzDxBFg(Not working as expected?)

Hypoglycemia metrics in non-diabetics (n=153) - slide from conference presentation:

doi.org/10.1210/jc.2018-02763

hypoglycemia metrics in non-diabetics - slide from conference presentation

[Rhyothemis]

Here are some screenshots from my ambulatory glucose profile [AGP] report. Lots of hypos. I have not been diagnosed w/ PD or other Parkinsonian syndrome. My father had MSA, which is not supposed to be hereditary. I have dysautonomia issues. I don't have symptoms of the hypos -could be unawareness due to damage to ANS.

chart of glucose vs hour of day, lots of hypoglycemia episodes from 12 am to 12 pm

[Rhyothemis in reply to Rhyothemis]

more AGP data

glucose report showing 12 % of time less than 70 mg/dL and 2% less than 54 mg/dL

[Fumaniron]

When wearing a CGM, it was eye opening. I'd bottom out in the 50's during many evenings. Unexpected causes causes of spikes were various stressors and foods (sweet potatoes)

[Rhyothemis in reply to Fumaniron]

Thanks for responding!

Sweet potatoes caused me huge spikes, too. Also fruits (apple, orange, mango), but not as bad. Buckwheat does not cause much increase at all, despite being high carb.

But the lows are concerning, & I don;t seem to be able to do much about it. I did notice my worst night was when I took melatonin (only 300 micrograms, controlled release) - I was hoping it would help!

I'm assuming you have been diagnosed w/ PD.

I'm thinking the hypos start early in disease process. I think its weird there have not been any large CGM studies on pw/ PD at different stages.

[AkunaMatata in reply to Rhyothemis]

I agree 100% Rhyothemis ; I'm surprised they didn't even give CGM to participants in the exenatide trial. Come on, it's a diabetic drug; how come they don't track blood glucose levels?!

Besides decreasing sugar levels, GLP1 agonists (exenatide, lixisenatide, etc.) also seem to reduce hypoglycemia and glycemic variability in general: "Although it would be thought that increasing GLP-1 would be counterintuitive and worsen postprandial hypoglycemia, it appears that this class of drugs could reduce the frequency of episodes [(9, 38, 39)]. One theory is that the medication occupies the GLP-1 receptor, keeping a more consistent level and thereby blocking the excessive peak of postprandial endogenous GLP-1 from accessing the receptor. By the aforementioned actions, the medication could thereby prevent the excessive peak of endogenous insulin, reduce glycemic variability, and, ultimately, reduce postprandial hypoglycemia" (The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review, 2022: onlinelibrary.wiley.com/doi...

If you have high glycemic variability (both high peaks and hypos, especially at night), then your Hb A1c (kind of equivalent to the average glucose level over the past few weeks) is normal. Hb A1c is the most common metric to diagnose diabetes. So people with high glycemic variability go unnoticed.

Hypoglycemia has many short-term neurological symptoms (you recover quickly after absorbing glucose), such as tiredness, confusion, difficulty speaking, sweating, tremors, depression, irritability, etc.

en.wikipedia.org/wiki/Hypog...

en.wikipedia.org/wiki/Neuro...

But what about the long-term effects? If for decades you have these untreated big highs and lows, could it damage your blood vessels, for instance?

[alexask in reply to Fumaniron]

You sometimes need to be a little careful about cgm readings - they can exaggerate the highs and lows.

[Rhyothemis in reply to alexask]

I've done finger sticks to check functioning of the sensor. It's accurate when my glucose is stable (within 6 pts) at around 86. I've not yet checked it at night during a hypo - I'm not sure if I can since it seems as soon as I start waking up (not just in AM during dawn effect, but in the middle of the night) glucose goes up. I know laying on the sensor can depress readings but I'm pretty sure most of the time that is not the issue. This morning I woke w/ my sensor arm 'asleep' (circulation cut off) and the reading was low & went up when circulation was restored. But that's the first time I've had my arm 'go to sleep' when wearing it.

I'm not sure how to rule out effect of position, though. I had floated the idea of filming me sleeping w/ an IR camera - my husband did not seem keen on the idea & the camera would cost at least $100.

[AkunaMatata in reply to Rhyothemis]

Rhyothemis Which CGM are you using? Early models were not super accurate as alexask said, but the recent ones (Freestyle Libre 3 and Dexcom G7) are extremely accurate (and don't require frequent scanning). So I wouldn't be too much worried about the accuracy. Especially as you're looking at the general trends and not specific data points.

In any case, you're comparing your trends to CGM data available in papers. They used similar, if not identical, devices, so it should be okay.