CGM is FASCINATING

Today, for instance:

  • I ate skyr with paleo cereal. No spike above 110.
  • Then I ate cauliflower and potatoes for lunch. Spike over 140.
  • Then I hate 80 grams of protein with chicken, low carb, no spike
  • And then I ate gelato from Venchi, medium the spike was below 120!

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Holy Spikes CGM

Some general observations

Drinking beer on empty stomach (guinness) and cosmopolitan SPIKED the cgm. above the number I want

It took a day to get close to stabilization (oscilatory behavior)

But, heres even worse — acai bowl SPIKED THE SHIT OUT OF MY CGM HOLY SHIT. My cgm was basically BEEPING.

Holy hell dude. Never again.

I have to be very careful about my diet.

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Attia Glucose

Peter Attia’s glucose framework is less about whether a number is technically “normal” and more about maintaining low average glucose, small post-meal excursions, and low variability.

His rough targets are: fasting glucose in the 80s, average glucose below 100 mg/dL, standard deviation below ~15 mg/dL, and very few—ideally no—excursions above 140 mg/dL. A single fasting reading matters less than the overall pattern, since sleep, stress, illness, cortisol, and the dawn phenomenon can temporarily raise glucose.

For meals, 140 mg/dL is better viewed as a ceiling than a target. A curve like 88 → 110 → 95 → 88 is preferable to 88 → 155 → 105 → 68, even if both produce a similar daily average. The first shows a modest rise and smooth recovery; the second shows high variability and a possible post-meal crash.

The drop after eating is not inherently bad. Glucose should return toward baseline. The concern is overshooting well below baseline, particularly after a large spike. Large post-meal dips may also correlate with greater hunger and subsequent food intake.

The simplest Attia-style summary is:

Low baseline → modest post-meal rise → smooth return to baseline.

MetricRough target
Fasting glucose~75–89 mg/dL
24-hour average<100 mg/dL
Standard deviation<15 mg/dL
Post-meal peaksPreferably well below 140 mg/dL
>140 excursionsVery rare or none

The goal is not merely low glucose. It is low, stable glucose with minimal swings.

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Correlation CGM and other things

Higher CGM average means lower insulin sensitivity.

Conceptually, among otherwise similar non-diabetic people:

  • CGM mean ~90 mg/dL would generally be more consistent with better insulin sensitivity.
  • CGM mean ~105–110 mg/dL may indicate poorer insulin sensitivity / greater compensatory insulin secretion.
  • The paper does not establish diagnostic cutoffs at those values.

https://pubmed.ncbi.nlm.nih.gov/41418028

Association of Insulin Resistance and Insulin Secretion Indices and Glucose Metrics From Continuous Glucose Monitoring in People With Obesity

Renata Belfort-DeAguiar 1 2, Catherine W Yeckel 3, Ahmed Elshafie 2 4, Ana Paula Comarella 5, Janice J Hwang 2 6

Affiliations Expand

Abstract

Objective: To investigate the relationship between free-living glucose metrics obtained with continuous glucose monitoring (CGM) and validated indices of insulin resistance and insulin secretion in individuals with obesity: OB(+T2D) or OB(-T2D) for with and without type 2 diabetes, respectively.

Research design and methods: Thirty-seven individuals (17 OB(+T2D) and 20 OB(-T2D) wore a CGM device and had a 2-h oral glucose tolerance test (OGTT). Of these, 27 also underwent a two-step hyperglycemic-euglycemic clamp. CGM metrics calculated with EasyGV software were correlated with indices of insulin secretion and insulin resistance from OGTT and clamp.

Results: CGM metrics, such as mean and glycemic variability indices, were higher in OB(+T2D) than in OB(-T2D) (P < 0.001). CGM mean inversely correlated with insulin resistance indices (insulin sensitivity index from OGTT and glucose infusion rate [GIR] from the clamp) when analyzing all participants together (GIR: r = -0.82, P < 0.001) or separately (P < 0.01). CGM mean negatively correlated with insulin secretion indices only when the two groups were analyzed together (P < 0.05). When analyzing each group separately, CGM mean positively correlated with insulin levels during the OGTT and hyperglycemic step of the clamp in the OB(-T2D), but not the OB(+T2) group.

Conclusions: Our findings suggest that CGM metrics, in particular, the simplest metric, CGM mean, was associated with the degree of insulin resistance. Further research is needed to determine whether CGM mean could be a tool to identify normal glucose-tolerant individuals with obesity potentially at risk for progressing to prediabetes and diabetes, and whether its convergence with increased glycemic variability can further contribute to risk prediction of glycemic disorders.

© 2025 by the American Diabetes Association.

PubMed Disclaimer

Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

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References

    1. Cameron NA, Petito LC, McCabe M, et al. Quantifying the sex-race/ethnicity-specific burden of obesity on incident diabetes mellitus in the United States, 2001 to 2016: MESA and NHANES. J Am Heart Assoc 2021;10:e018799. – PMC – PubMed
    1. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes 2009;58:773–795 – PMC – PubMed
    1. Polonsky KS, Given BD, Van Cauter E. Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects. J Clin Invest 1988;81:442–448 – PMC – PubMed
    1. Hron BM, Ebbeling CB, Feldman HA, Ludwig DS. Relationship of insulin dynamics to body composition and resting energy expenditure following weight loss. Obesity (Silver Spring) 2015;23:2216–2222 – PMC – PubMed
    1. Thomas MK, Nikooienejad A, Bray R, et al. Dual GIP and GLP-1 receptor agonist tirzepatide improves beta-cell function and insulin sensitivity in type 2 diabetes. J Clin Endocrinol Metab 2021;106:388–396 – PMC – PubMed
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Proof of devotion

Addiction is proof that you are capable of intense devotion. You just serve a false God.

I have an addictive personality. I can be devoted for that reason. And now I am sensing that I am becoming more devoted to my own health.

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Loosing weight in a busy city

I will loose weight in the busy city. I will accomplish this.

Done.

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While you can, you will.

It is a privilege to be able to run. To be able to build my body. I have feet, arms, legs. I am healthy enough to do it.

I will lift weights until I cannot.

I will do cardio until I cannot.

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Stanford Stagnation

how to get UNSTUCK in a rut

  1. What am I avoiding?
  2. Where do I start?
  3. How do I win TODAY? Three things to focus on today.
  4. What habits are interfering with where I want to go.

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How to empty the mind

Warning: Once you see this monk’s 3-minute demonstration on “how to stop thinking,” you can’t unsee it.

Ajahn Brahm says:

“Your mind never actually stops. It just fills every gap you fail to notice.”

His demonstration works because he exploits something neuroscience has quietly confirmed for years that “the thinking mind cannot generate thought and pay full attention at the same time.”

Attention and cognition compete for the same neural real estate. When one runs at full volume, the other goes quiet.

Most people never experience mental silence because they’ve never once given attention anything to fully occupy it with.

What Brahm does in those 3 minutes is deceptively simple.

He asks you to listen to the gaps between his words.

The silence between syllables. The pause between sentences. And the moment you shift your attention to those gaps, your internal narrator goes quiet.

The reason is you directed your awareness with such precision that it fully engaged your attention and left no room for extra commentary.

Meditation traditions have circled this insight for 2,500 years.

The Pali term for mental chatter is prapañca.
Transaltion: Conceptual proliferation.

One thought spawns another, which spawns three more, and within seconds you’re rehearsing an argument from 2014.

Brahm’s technique interrupts the mechanism at its source. You cannot proliferate thought while genuinely tracking silence, because silence has no content for the mind to grab onto and multiply.

This is why most meditation instruction fails people. They’re told to “clear the mind,” which is like being told not to think of a polar bear. The very act of trying activates the machinery it’s supposed to silence. Brahm inverts the entire approach.

Instead of asking you to stop, he asks to divert your attention somewhere so refined to rest that stopping happens on its own, as a side effect.

There’s a deeper reason this demonstration hits so hard.

Modern life has trained our nervous systems to treat silence as a threat that must be filled with a podcast, a scroll, a snack, a plan.

We’ve forgotten that silence is the medium consciousness actually rests in. Sound is the interruption. It’s not the other way around.

Once you experience even 5 seconds of genuine internal quiet, your relationship with your own thoughts permanently shifts. You stop believing every mental voice is you. You start noticing there’s a witness underneath the chatter that was never anxious to begin with.

Please throw in your thoughts on this.

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Peter Attia’s take on CGM’s


CGM

  • His is average is about 90. STD is about 10. Peak is 100, low is 77?!?
  • So it is mostly flat

  • He has measured 5.1 to 5.8 in his A1C. He thinks its usually in the low 5s.

Big points

  • Lower is better. 5.1 is better than 5.5 (both are “normal”)
  • Lower variability is better. std of 10 is better than std of 20
  • Minimize the peak – Never above 140.

Lower is better

  • All cause mortality is better.

Variability

Most labs consider a HOMA-IR below 2.0 to be normal, but Peter wants to see below 1.0

asting glucose multiplied by fasting insulin divided by 405f


What’s wrong with peak glucose levels? Why would that be problematic?

  • Bob looked at the literature and was actually kind of surprised by some of the results that he saw there just acutely
  • Let’s say, for instance, that you did one bad meal a day and you just had a spike and then it goes away, but overall maybe your average glucose looks fine — so why WOULD that be a problem?
  • Some of the studies would look at the endothelial function during periods of hyperglycemia 
  • There are actually a bunch of replicated experiments like this that they would look at oral glucose tolerance tests

-In one case they actually did a glucose infusion

  • They looked at healthy nondiabetic individuals in these studies, and they basically found endothelial dysfunction
  • it’s flow mediated dilation is how they assess it, but they found it again and again
  • if that’s the case that those glucose peaks could have accelerated the development of atherosclerosis, even in those with normal glucose tolerance in those people
  • This population that with something that maybe we’re not seeing or we’re missing in general “healthy” nondiabetics
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