Metformin and Supplements

 A recent study suggested that the supplement goldenseal interferes with the ability of metformin to control blood glucose levels.

I doubt that a lot of people are using goldenseal, but this study illustrates a general problem: Everything can interact with something else. That means not just drugs and supplements or drugs and other drugs, but drugs and foods or drugs and exercise and probably even drugs and your mental state.

For this reason, whenever you try something new, you should add only one new thing at a time, so if there is an effect, you know it's due to that new thing. If there's no apparent change in anything you can then try something else.

Vermont participates in the HomeMeds program for older adults, and although I hate to admit I'm an older adult, I took part. A nurse came to my house (this was before covid-19) and took a list of all my drugs and supplements. She then took the list to a pharmacist, who made sure there were no bad interactions. The pharmacist didn't see any.

I'm sure you can do the same yourself by making a list and taking it to a pharmacist, or running it through an online site like this. Of course if you're taking a bunch of obscure herbs, the online site might not include them. A pharmacist might be able to research them if willing to take the time.

The important thing is to be alert for any changes in your health when you try something new, even a new vegetable you just found at the grocery store.

Everything can interact with everything else. Sometimes the result is good and sometimes it's not so good. Most interactions are trivial. We just need to notice the major ones.

CGMs for Nondiabetics

 The New York Times today had an article describing the experience of a nondiabetic who tried a continuous glucose monitor. (CGM).

 It's interesting, but it bothers me that affluent nondiabetics can get CGMs when many people who have diabetes cannot because their insurance won't cover them and they can't afford to pay out of pocket. Many people with diabetes probably don't even realize that CGMs exist, not to mention their benefit.

I once met a woman on an elevator in a medical building, and she said she had type 1 diabetes. I asked if she used a CGM and she didn't know what that was.

Today, many people with type 1 get insulin pumps along with CGMs. Type 2s less so. But I've always felt that people with type 2 should use a CGM shortly after diagnosis so they can learn what foods make their blood glucose go up. Different people have different reactions to carbohydrates. Some can eat rice with no problem but potatoes make their blood glucose levels soar. Others the exact opposite.

I'm sure that in the future CGMs will become common for type 2s, and insurers will learn that controlling blood glucose levels means fewer expensive complications, so they'll be willing to pay for CGMs, maybe not all the time but periodically to check and recheck.

I hope that future isn't too far off.

Scientists to study YMMV

As diabetes patients, most of us understand the concept of YMMV, or "your mileage may vary." A diet that works great for someone else may not work well for you.

 An Israeli study a few years ago showed this to be true. A food that raised blood glucose in one person might have no effect on another.

Now NIH researchers have planned a study to test this concept in 10,000 Americans. The study will start recruiting participants by January 2023, so don't expect results in the near future.

In the meantime, keep testing before and after meals as much as you can to find out which foods are best for you. If you can afford it, a continuous glucose monitor is a good way to document this. Most insurance won't pay for the CGMs for type 2 patients, but I think the information you can get is worth the cost. I occasionally wear one, and it costs me $63 for two weeks (Freestyle Libre).

 After you learn what diet works best for you, you can cut back on the testing somewhat, although it's good to do spot checks to make sure your blood glucose isn't trending up.