At the top of the evidence hierarchy is N-of-1 trials (and below that are high quality meta-analyses of trials). Nothing is more informative about treatment response in a person than testing it in that person. This is the heart of personalized medicine, and exactly for the reason you stated: Different interventions work differently for different people.

And any practitioner worth their salt is unsurprised by this headline. A great example is that illness and inflammation increase insulin resistance via counter-regulatory hormones.

You got one thing right, intuition often turns out to be wrong. That is why the vast majority experimental therapeutics built on great ideas never get passed initial testing.

Such tools also enable studies that can be done at a scale and cost level that is reasonable and can push forward the communal knowledge base.

There's a lot of reductionist commentary that happens under these links primarily because people aren't reading past the headline or a brief skim of the article.

The topic might be common sense, but measuring and quantifying it with hard data is valuable.

The PR-massaged headlines usually omit the interesting parts and focus on something basic because they want to appeal to a wide audience, not because the study itself was so simplistic that it could be summarized by a headline.

This has not been my experience with doctors throughout the years. In fact, I'd say the opposite has been true.

In my experience, particularly when diagnoses are trickier, doctors are more likely check the efficacy of the current treatment and change things up if it's not working out.

You have this about everything, everywhere. It's a pet peeve how much stuff people will attribute to "common sense" so they can do the internet "I'm superior" thing.

"Wear sunscreen, it's just common sense". No it isn't. We evolved on Earth under the sun, we feel good when going out in the sun, it's bright and beautiful. Rubbing petrochemical distillate or industrially processed plant extract on your skin so the invisible light discovered in 1801 doesn't denature the invisible DNA discovered in 1869 is not common sense it's learned behaviour. Nothing much about Science is common sense, it took thousands of years from the dawn of Civilization until the Enlightenment era and still people can go through years of education and then choose to believe what we want to believe instead of what the evidence shows.

'Common Sense' is that the world is simple, designed for a purpose by a human-like mind one or two levels up from us on the power scale, and inhabited by life-like energies and spirits, some of them malevolent. Common Sense is that things which didn't happen today or yesterday will probably never happen. Common Sense is that things which happen together cause each other; if the relative comes to town and the crop fails then they are bad luck, if the relative comes to town and the baby is born healthy then they are good luck.

Why would it be any kind of 'common sense' - 'sound judgement not based on any specialised knowledge' - that glucose (1747) response differs for the same meal if you need a continuous glucose monitor (FDA approved in 1999) to find that out?!

The problem with studying humans is, roughly, the central limit theorem doesnt work: properties of biological and social systems do not have well-behaved statistics. So all this t-test pseudoscience can be a great misdirection, and common sense more reliable.

In the case where effect sizes are small and the data generating process "chaotic", assumptions of the opposite can be more dangerous than giving up on science and adopting "circumstantial humility". (Consider eg., that common sense is very weakly correlated across its practicioners, but "science" forces often pathological correlations on how people are treated -- which can signficantly mangify the harm).

A carb-heavy snack before a meal is going to result in a radically different response than eating the same meal on an empty stomach. I'm glad they acknowledged it, but it feels absurd to publish with this headline if they didn't record snacks.

This was my plan sometime in the next few months.

I think it's still a valid plan, just with some caveats. Anyway due to cost and annoyance I'm unlikely to wear a CGM for more than a couple of months. But that should be enough time to get usable data - like all body tracking data, I'll end up using it as guidance rather than rule.

The caveats are that I'll also need to track my sleep and workouts during that time and carefully look for patterns in the data related to all three.

I already know sleep and workouts are strongly correlated and not always in the way you'd expect. I did a strong HIIT class at 6pm last night, and due to a bit of crunch on personal projects it was my first proper workout in a week. My sleep tracker (Galaxy Watch 6) gave me a very poor sleep and energy score. 61/100 for sleep, 69/100 for energy. I normally score high eighties to low 90s in both.

These scores usually but not always match with my actual feeling. But today I also feel tired (it's 8am here now).

If I had a CGM, I'd also be keeping a strong eye out for unusual glucose response today.

This is more complex than I'd like it to be - I wish my body was as simple to read as just getting a single number like glucose response and making adjustments from that! But as a lifelong migraine sufferer who now has my migraines almost entirely under control by making lifestyle changes, I'm well aware that how my body responds is always a combination of many things. Stormy weather + ate cheese + slightly too strong coffee + stress from work = boom, migraine. Take away any one of those and maybe I wouldn't have got one. I fully expect my body's glucose response to be just as complex.

Asking for a friend.

For convenience and my experiment, I eat practically the same meals at lunch every day, precisely weighed, always starting from very similar morning glucose levels, and strictly respecting timing and consistency.

I NEVER get the same response. Never. It’s an experiment I’ve been running on myself for a year. It’s useful for me, but for the diabetes team following me, “that’s not possible, there must be other factors, it doesn’t show, it’s the ‘CGM algorithm’” (a mystical object no one knows anything about, except that it’s supposedly intelligent).

This study is interesting. I hope this kind of information, this doubt, trickles down into the medical community. Even though I don’t have much hope. Maybe in years and years.

(Purchased sorta 'just for fun', to evaluate my own metabolic responsiveness. I wrote about it once: [0])

if I moved around much after eating, my muscles would "soak" lots of glucose from my blood and the insulin change would be relatively low. If it was something sugary and I then went to sleep, it would be a big slow rise for a few hours of blood sugar, then insulin would seem to be released, and it would decline a bit, then flatten, then decline, until it went back to a regular level. When waking up, it would often by around 70 mg/DL, and even if I eat zero carbs (or am full-on fasting!) it would bounce up/around during the day. I appreciated that my body seemed quite capable of doing whatever it needed to do to raise my blood glucose levels. (They always go up when exercising, for instance, even if no food is consumed)

I think everyone would likely find the data interesting, it's so freaky customized to yourself, it cannot help but be interesting. They're expensive, so I think buying even one sensor and wearing it for 2 weeks or however long is worth it.

[0]: https://josh.works/cgm

Type 2 "resistance" is about the quality of the response to high glucose levels, not the complete lack of a response to them. There shouldn't be a long buildup overnight in that scenario for a person without insulin resistance/deficiency and still having a measurable insulin response is normal/expected of all but the worst Type 2 diabetics. Yes, you're still digesting, but in individuals without diabetes the blood sugar peak occurs (and ends) well before digestion is finished because influxes of carbs can still be effectively managed by the insulin alone rather than by the lack of additional carbs to digest. If it were just that one's digestion were a lot slower than a normal persons then it should still result in a lower, but still quickly managed to baseline, peak.

You may well actually be prediabetic though, it just depends on the specific numbers for A1C/average & peaks combined over time and not the presence of a response itself. The recommendations between higher side prediabetic and lower side type II diabetic shouldn't be all that different in the end anyways though.

I'm a type 1 and my blood glucose can response can vary wildly. Sometimes it can spike quickly (15-30 minutes), other times it can take 2, 3, or even 4 hours. The reverse is also true, in that insulin can sometimes effect me quickly, and sometimes it can take effect 3+ hours later. In general, when having a big meal, I'll take a "fairly large" amount of insulin, but not enough for the entire meal; then I'll take more[1] when my blood starts increasing into 200+ range. Otherwise, I risk it dropping because the insulin was having a "fast" day but the food was "slow".

My endo finds it weird, but we've gone over specific cases of it, including exactly what I ate, when, and what the CGM history for the day looked like. I'm just defective :)

[1] Note I'm not talking about reactively taking more insulin after the "right" amount turned out not to be enough (which is generally a bad idea). Rather, I'm talking about splitting what I know to be about the right amount... into 2 different doses.

Typically the glucose level in the interstitial fluid takes longer to respond to your food intake, and the GCMs measure that instead of the blood glucose level.

I think you could have a point at around 100-105 baseline but 120 seems too high.

I also found that sweets not only spiked my values but did so over a 6-12 hour period! That was shocking. I have not had dessert for 107 days because of it. I plan to do a fasting test (and A1C) in August to see how many values are. I hope they are much lower, but we'll see.

EDIT: also, popcorn with nothing on it but salt gave me a huge spike.

I don't think anybody was expecting to be surprised by this study. In practice, most science is pretty boring and rarely breaks expectations. But being unsurprising does not mean it's not worth doing. A lot of studies are simply validating expected outcomes and providing foundational data points for future studies to refer back to. For example, a future study might use this study to justify funding ("as shown in Study 2025.abcd, glucose is highly variable... we propose to further study this by controlling for ... which will help us understand the influence of ..." etc etc).

Well of course. Studies like this help collect data and quantify the variations.

There's more to the study than the headline or even the simple summary. Knowing the range of variations is important, as well as starting to build a foundation to understand some of the factors that lead to the variations.

I think it will/would take a lot of data to uncover the most important factor(s).

For example, AAPS has since version 3.2 dynamic IFS. ( https://androidaps.readthedocs.io/en/latest/DailyLifeWithAap... )

For me this works quite well

- You able to learn better about how your body responds to different foods

- You are more secure about your blood sugar dropping when you don't expect/realize it (sleeping, driving, etc)

- You better able to detect when your body isn't behaving the way you would normally expect it to (the point we're discussing here)

I do keto diet long term but for other reasons, often the epilepsy version where it's more strict and higher fat.