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This is why it made me upset to see this Doctor on TikTok telling people unless you have Diabetes, you don't need a glucose monitor and making fun of people who

This is why it made me upset to see this Doctor on TikTok telling people unless you have Diabetes, you don't need a glucose monitor and making fun of people who had one. Where is the harm in getting data on how your own body deals with glucose?

queuebert 3y ago
False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.
- eurleif 3y ago
  If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.
  - akira2501 3y ago
    If I'm not trained to correctly respond to the information then why should I believe that I'm going to?
    - mhb 3y ago
      You can learn?
      - akira2501 3y ago
        I can learn almost anything. So, I have to put values on what it is I'm learning, so I don't waste my time. My estimation is that learning how to interpret my health data so that I can spend a lot of time gathering and then continually interpreting that health data is not going to evince any additional value in my life.
  - queuebert 3y ago
    If you knew which signals were false positives, they'd be true negatives.
  - user_7832 3y ago
    > If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information. Not necessarily. Rohin Francis (Medlife crisis) has I think a video on overtesting, but for example, if you have a new technology that tests and suspects a tumor, which results in CT scans for patients, if millions of users use this tech there's a likely non-zero number of people who may get cancer from the CT exposure. "What about those who actually had the tumor?" Well it's possible that 99% of these cases would've been symptomatic anyway in a few more months. By explanation isn't the best, but over-medication is not a non-issue.
    - graeme 3y ago
      That's still the response though. You can simply say "Well, we expect an error rate of X with this new test, so in the absence of other risks factors we predict the actual odds of the condition are Y". Then you can decide whether a test makes sense or doesn't make sense, given the tradeoffs of radiation and cost vs. the risks of harm. In the real world, information absolutely can lead to harm, but it's still all in the response and how medicine and patients use information. But as information gets cheaper and more common we can develop ways of dealing with it. If it was difficult and expensive to test for fever you'd see people in the medical profession warning against it because it could lead to overreaction.
      - user_7832 3y ago
        I get your point, however I think there are a few confounding things. For a lot of people, if you get a positive result from a test that a doctor brushes off that's not going to go well. I'm very much in favor of more testing personally, there are almost certainly folks who're on SSRIs who'd benefit more from Vit D/Mg supplementation for example. Another thing I seem to remember in his video was that a tumor is not necessarily dangerous. Out of a hundred (say) tumors in a person's life, only maybe 5 are risky. But I'm paraphrasing this badly. Edit: https://www.youtube.com/watch?v=7kQk9-KLPfU https://www.youtube.com/watch?v=7kQk9-KLPfU is one of the videos, however I think he's talked about this more (likely on instagram or another video too).
- psychlops 3y ago
  What sort of risky false positives and interventions are you anticipating from knowing glucose levels?
- gtirloni 3y ago
  The unnecessary interventions are done by licensed doctors? Why?
  - queuebert 3y ago
    Doctors make mistakes. Procedures carry inherent risks, such as infection, allergies, blood clots, etc. Even driving to the doctor to discuss your blood glucose carries a risk of car accident. All of these are low probability events, but non-zero.
  - tetramer 3y ago
    You don't know if it's a false positive or not until you do further interventions. Realizing it's unnecessary is only evident in hindsight. E.g. CT scan shows an incidental, tiny lung nodule. You do a biopsy. Unfortunately, during the process of getting a biopsy, you develop a pneumothorax (an uncommon but well-known complication of a lung biopsy) and need a chest tube, hospitalization, etc. You get discharged and you're fine, but man, that wasn't fun. Biopsy comes back negative for cancer. Nodule goes away on its own with time. Edit: that being said, I'm excited about OTC CGMs! But the "data" we have in medicine is not as accurate as other fields and always subject to false positives/negatives.
    - unlikelytomato 3y ago
      the gap between cgm and a biopsy from a CT scan is vast. CGM is not enough to trigger any such intervention. Unnecessary interventions are absolutely a concern. A CGM is about as controversial as someone taking their own heart rate to help them calm down from panic attacks. Minimally invasive and nobody would base a dramatic intervention on this data alone.
      - tetramer 3y ago
        Sure. As I stated in my original comment, I'm excited about CGMs being widely available. The example in my comment was very specifically answering "why do doctors perform unnecessary interventions?".
    - 3y ago
- abletonlive 3y ago
  Dumb framework for dealing with incompetence. "I'm so incompetent that more data is going to lead to worse outcomes! So let me stick my head in the sand and not measure!" Imagine if any other profession operated under this framework: "Ehhh, if we inspect too hard we might make a repair on this airplane that will cause further damage, lets just not do the inspection"
  - queuebert 3y ago
    Do you think tearing apart a working airplane and putting it back together in order to inspect it between every flight is a safe practice? Did you see the 737 door plug accident? You are missing part of the picture here. And that part is not that everyone else is dumb but you.
    - abletonlive 3y ago
      > Do you think tearing apart a working airplane and putting it back together in order to inspect it between every flight is a safe practice? Do you think this is....the same thing as a continuous glucose monitor?
      - queuebert 3y ago
        Mathematically, yes. The probabilities involved are different, however.
deleted 3y ago
[deleted]
rockooooo 3y ago
There are downsides to over-medicating, even if your personal budget for health is ~unlimited. Nobody wants to be a false positive.
Aurornis 3y ago
> Where is the harm in getting data on how your own body deals with glucose? We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population. CGMs will often give an "estimated HbA1c" value based on statistics from the collected data. The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.
- crimsontech 3y ago
  At the age of 45 I had never had an HbA1c test. I found out I had T2 diabetes from getting a CGM as part of a health study I applied for, and seeing my blood glucose was at 22mmol (it should be under 10). I ordered a finger prick test kit from Amazon assuming the GCM was faulty but it wasn’t. After this I went to the doctors who confirmed with an HbA1c and put me on Metformin. It certainly should be part of routine checkups in my opinion, but I had never had more than blood pressure check and a weigh in from my doctor.
  - bialpio 3y ago
    Where are you based? I have it tested annually, but only after moving to USA (from Poland). I don't remember if I had such a test done earlier - I think I might have had it done as a part of screening for whether I'd be allowed to go scuba-diving or something else sports-related.
    - crimsontech 3y ago
      Sorry I should have mentioned that in the post. I’m in the UK, so National Health Service.
  - Aurornis 3y ago
    HbA1C has been checked by all of my primary care providers across several locations in the US. I also had an insurance provider who gave us a cash bonus if we had it tested (they paid) every year for a while. It’s surprising that some doctors aren’t checking it still.
akira2501 3y ago
> Where is the harm in getting data on how your own body deals with glucose? That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels. You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.

queuebert 3y ago

False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.

eurleif 3y ago
If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.
- akira2501 3y ago
  If I'm not trained to correctly respond to the information then why should I believe that I'm going to?
  - mhb 3y ago
    You can learn?
    - akira2501 3y ago
      I can learn almost anything. So, I have to put values on what it is I'm learning, so I don't waste my time. My estimation is that learning how to interpret my health data so that I can spend a lot of time gathering and then continually interpreting that health data is not going to evince any additional value in my life.
- queuebert 3y ago
  If you knew which signals were false positives, they'd be true negatives.
- user_7832 3y ago
  > If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information. Not necessarily. Rohin Francis (Medlife crisis) has I think a video on overtesting, but for example, if you have a new technology that tests and suspects a tumor, which results in CT scans for patients, if millions of users use this tech there's a likely non-zero number of people who may get cancer from the CT exposure. "What about those who actually had the tumor?" Well it's possible that 99% of these cases would've been symptomatic anyway in a few more months. By explanation isn't the best, but over-medication is not a non-issue.
  - graeme 3y ago
    That's still the response though. You can simply say "Well, we expect an error rate of X with this new test, so in the absence of other risks factors we predict the actual odds of the condition are Y". Then you can decide whether a test makes sense or doesn't make sense, given the tradeoffs of radiation and cost vs. the risks of harm. In the real world, information absolutely can lead to harm, but it's still all in the response and how medicine and patients use information. But as information gets cheaper and more common we can develop ways of dealing with it. If it was difficult and expensive to test for fever you'd see people in the medical profession warning against it because it could lead to overreaction.
    - user_7832 3y ago
      I get your point, however I think there are a few confounding things. For a lot of people, if you get a positive result from a test that a doctor brushes off that's not going to go well. I'm very much in favor of more testing personally, there are almost certainly folks who're on SSRIs who'd benefit more from Vit D/Mg supplementation for example. Another thing I seem to remember in his video was that a tumor is not necessarily dangerous. Out of a hundred (say) tumors in a person's life, only maybe 5 are risky. But I'm paraphrasing this badly. Edit: https://www.youtube.com/watch?v=7kQk9-KLPfU https://www.youtube.com/watch?v=7kQk9-KLPfU is one of the videos, however I think he's talked about this more (likely on instagram or another video too).
psychlops 3y ago
What sort of risky false positives and interventions are you anticipating from knowing glucose levels?
gtirloni 3y ago
The unnecessary interventions are done by licensed doctors? Why?
- queuebert 3y ago
  Doctors make mistakes. Procedures carry inherent risks, such as infection, allergies, blood clots, etc. Even driving to the doctor to discuss your blood glucose carries a risk of car accident. All of these are low probability events, but non-zero.
- tetramer 3y ago
  You don't know if it's a false positive or not until you do further interventions. Realizing it's unnecessary is only evident in hindsight. E.g. CT scan shows an incidental, tiny lung nodule. You do a biopsy. Unfortunately, during the process of getting a biopsy, you develop a pneumothorax (an uncommon but well-known complication of a lung biopsy) and need a chest tube, hospitalization, etc. You get discharged and you're fine, but man, that wasn't fun. Biopsy comes back negative for cancer. Nodule goes away on its own with time. Edit: that being said, I'm excited about OTC CGMs! But the "data" we have in medicine is not as accurate as other fields and always subject to false positives/negatives.
  - unlikelytomato 3y ago
    the gap between cgm and a biopsy from a CT scan is vast. CGM is not enough to trigger any such intervention. Unnecessary interventions are absolutely a concern. A CGM is about as controversial as someone taking their own heart rate to help them calm down from panic attacks. Minimally invasive and nobody would base a dramatic intervention on this data alone.
    - tetramer 3y ago
      Sure. As I stated in my original comment, I'm excited about CGMs being widely available. The example in my comment was very specifically answering "why do doctors perform unnecessary interventions?".
  - 3y ago
abletonlive 3y ago
Dumb framework for dealing with incompetence. "I'm so incompetent that more data is going to lead to worse outcomes! So let me stick my head in the sand and not measure!" Imagine if any other profession operated under this framework: "Ehhh, if we inspect too hard we might make a repair on this airplane that will cause further damage, lets just not do the inspection"
- queuebert 3y ago
  Do you think tearing apart a working airplane and putting it back together in order to inspect it between every flight is a safe practice? Did you see the 737 door plug accident? You are missing part of the picture here. And that part is not that everyone else is dumb but you.
  - abletonlive 3y ago
    > Do you think tearing apart a working airplane and putting it back together in order to inspect it between every flight is a safe practice? Do you think this is....the same thing as a continuous glucose monitor?
    - queuebert 3y ago
      Mathematically, yes. The probabilities involved are different, however.

deleted 3y ago

[deleted]

rockooooo 3y ago

There are downsides to over-medicating, even if your personal budget for health is ~unlimited. Nobody wants to be a false positive.

Aurornis 3y ago

> Where is the harm in getting data on how your own body deals with glucose? We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population. CGMs will often give an "estimated HbA1c" value based on statistics from the collected data. The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.

crimsontech 3y ago
At the age of 45 I had never had an HbA1c test. I found out I had T2 diabetes from getting a CGM as part of a health study I applied for, and seeing my blood glucose was at 22mmol (it should be under 10). I ordered a finger prick test kit from Amazon assuming the GCM was faulty but it wasn’t. After this I went to the doctors who confirmed with an HbA1c and put me on Metformin. It certainly should be part of routine checkups in my opinion, but I had never had more than blood pressure check and a weigh in from my doctor.
- bialpio 3y ago
  Where are you based? I have it tested annually, but only after moving to USA (from Poland). I don't remember if I had such a test done earlier - I think I might have had it done as a part of screening for whether I'd be allowed to go scuba-diving or something else sports-related.
  - crimsontech 3y ago
    Sorry I should have mentioned that in the post. I’m in the UK, so National Health Service.
- Aurornis 3y ago
  HbA1C has been checked by all of my primary care providers across several locations in the US. I also had an insurance provider who gave us a cash bonus if we had it tested (they paid) every year for a while. It’s surprising that some doctors aren’t checking it still.

akira2501 3y ago

> Where is the harm in getting data on how your own body deals with glucose? That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels. You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.