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6 Feb, 8 tweets, 4 min read
1/8 Continuous Glucose Monitors (CGM) and *type 2* diabetes - can they help?🤔

A short thread...

Over the last 2 years I've found a 2-4 week opportunity for my patients to learn how their body reacts to different foods can be invaluable

But @NICEComms don't recommend in T2DM☹️
2/8 CGMs have revolutionised monitoring of type 1 diabetes. Currently recommended by @NICEComms only for some *not all* with type 1 eg:

Frequent asymptomatic hypos >2x/week
Severe hypos >1x/yr
Loss of awareness of hypos
Very poor control

See 👇nice.org.uk/guidance/ng17/…
3/8 My practice has now helped 92 people reverse their type 2 diabetes using dietary change; cutting out sugar + starchy carbs

It's not rocket🚀science, see my previous thread on how it can be done👇

Here's our published research👇
nutrition.bmj.com/content/early/…
4/8 The key to reversing type 2 diabetes is understanding which foods to avoid: which foods⬆️your sugar + those that don't

This is almost impossible to know without real time feedback on the impact of different foods on sugar levels

(Technically CGMs read interstitial glucose)
5/8 The fab work of @segal_eran shows that generally sugars + starchy carbs (cereals, rice, bread, potatoes and pasta)⬆️blood sugar but individuals vary greatly in their degree of response to foods

*You need to know what works/doesn't work for you*

See👇
6/8 I've found by lending CGMs to my patients with type 2 diabetes:

2-4 weeks alone gives enough info to revolutionise their understanding of how their diet impacts blood sugar

They can then decide their goals BUT NOW they have the knowledge, tools + motivation to achieve them
7/8 The cost of 1 or 2 CGM sensors (say £30-60) pales into insignificance when compared to the cost of medication for diabetes

My practice saves >£50k/year on diabetes drugs by supporting dietary/lifestyle change rather than jumping in with medication

nutrition.bmj.com/content/bmjnph…
8/8 So I'm interested in the thoughts of others about whether short term loan (2-4 weeks) of a CGM could help people with type 2 diabetes reverse or improve their condition

@Diabetescouk

ps No conflicts of interest to declare
I've never received £ from a pharmaceutical company

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More from @DocRunner1

Simon Tobin Profile picture
18 Jan
1/4 A baffling type 2 diabetes mystery

Can anyone help?

A brief thread..

This patient of mine is 55 and has mysteriously reversed her type 2 diabetes with a huge drop of HbA1c from 77➡️32mmol/mol (9.2-5.1%) in only 3 months

She is not on any new medications for her diabetes..
2/4 She swears she has NOT made any dietary changes EXCEPT cutting out all sources of sugar like sweets🍬, biscuits🍪, chocolate, cake🧁, fruit juice🧃 + avoiding starchy carbs such as bread🍞, cereals🥣, potatoes🥔, rice🍚+ pasta🍝

I really believe she is telling me the truth🤔
3/4 It's particularly spooky👻because she's the 88th person at my practice to whom this has happened

@lowcarbGP is baffled too🤔

Neither of us can explain it apart form the curious coincidence they've all⬇️their sugar + carb intake

Guess it may just have to remain a mystery 🤷‍♂️
Read 4 tweets
Simon Tobin Profile picture
14 Nov 20
1/10 Pre-Diabetes 🤔

On #WorldDiabetesDay perhaps we should spend some time thinking about *preventing* type 2 diabetes

Here's a short thread on what I think folk should know about pre-diabetes

References at end

#MedTwitter #tweetorial #LCHF
2/10 Pre-diabetes has many names, often with subtle differences in definition

It's often called:

Impaired glucose tolerence, IGT
Impaired fasting glycaemia
Intermediate hyperglycaemia (preferred by @WHO )
High Risk State of Developing Diabetes (preferred by @AmDiabetesAssn )
3/10 Pre-diabetes is *NOT A DISEASE*

This is really important

It's a *RISK FACTOR* for developing type 2 diabetes

Other risk factors include:

Age >40 (>25 if S Asian)
Family History
Being overweight
People of Asian, African-Caribbean or black African origin, even if born in🇬🇧
Read 10 tweets
Simon Tobin Profile picture
3 Nov 20
1/11 I think that the most important piece of research since 2017 about putting #type2diabetes into remission was published today in @BMJNutrition

The results are simply astonishing 😲

A twitter thread.... #MedTwitter #LCHF

Here's the paper👇

nutrition.bmj.com/content/early/…
2/11 The study is by @lowcarbGP @jen_unwin + others and looks at reversing T2DM and pre-diabetes by lifestyle change, in particular by ⬇️sugar and starchy carbs
3/11 The study builds on the work of Prof Roy Taylor's DiRECT Study which found that *severe* calorie restriction could put T2DM into remission👍
More info here 👇
directclinicaltrial.org.uk

This was great news but SO many people find calorie restriction IMPOSSIBLE TO SUSTAIN 🤔🤷‍♂️
Read 11 tweets
Simon Tobin Profile picture
30 Jun 20
1/11 WHAT IS THE BEST DIET FOR HUMANS?

A Twitter thread...

I've spent the last 10 years wondering about this. A TED Talk and paper by @segal_eran (refs at end) has completely blown my mind 🤯
He provides some of the answers - but they may not be what you think

Here goes....
2/11 The incidence of diet-related disease has ⬆️⬆️ in last 30 years

In 🇺🇸 70% of population are overweight, diabetic or have NAFLD (fatty liver)

38% are obese 😲

10% have type 2 diabetes 😲

Diet and lifestyle are the major drivers
3/11 So why don't we know what is the best diet for humans?

It's because we are asking the wrong question

Much of what constitutes the best diet depends on the individual human every bit as much the food

Nutrition needs to be personally tailored to each individual
Read 11 tweets
Simon Tobin Profile picture
19 Jun 20
1/8 Use of defibrillators in the community. Is it worth it?

5 years ago I wasn't so convinced but now I've changed my mind. Here's why

A short Twitter thread....

#MedTwitter #TeamGP @rcgp @k8coleman24 @DrAbdulZubairu @Trisha_the_doc @irishayesha @Mummydoc1 @DrAmirKhanGP Image
2/8 I've been prompted to tweet about this after hearing some wonderful news today. A year ago @DrPaulaPowell1 and I assisted at a cardiac arrest on the beautiful but remote Isle of Lewis. David survived and posted a really moving video on FaceBook
Image
3/8 David's was the 3rd community cardiac arrest I have been involved with in the last 5 years

All 3 people required defibrillation (electric shock) and all 3 were conscious and talking by the time they left the scene 👍
But that's unusual....
Read 8 tweets
Simon Tobin Profile picture
25 Apr 20
1/8 In the midst of a pandemic that predominantly affects people with poor metabolic health, why is nobody talking about nutrition?

A Twitter thread..

This is the ELEPHANT IN THE ROOM discussed in the fab @EuropeScientist article by @DrAseemMalhotra 👍

europeanscientist.com/en/article-of-… elephant in the room
2/8 Evidence (refs at end) tells us some medical conditions are strongly associated with poor outcomes and death ⚠️in #Covid_19 eg:

Hypertension (high BP) 2.5x⬆️
Diabetes 10x⬆️
Overweight/obesity (accounts for 73% of 🇬🇧hospital admissions with #COVID19 )
Heart disease 10x⬆️risk
3/8 What have these conditions got in common?

ANSWER: They're all associated with poor metabolic health

Some people can be TOFI - Thin Outside Fat Inside

It's not just about your weight says @DrAseemMalhotra

"THERE’S NO SUCH THING AS A HEALTHY WEIGHT, ONLY A HEALTHY PERSON"
Read 8 tweets

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