#479: Blood Glucose, CGM Use, Diabetes Remission & High-Protein for Diabetes – Nicola Guess, PhD, RD

In Podcasts by Danny Lennon4 Comments

Table of Contents

  1. Introduction
  2. Guest Information
  3. Related Resources
  4. Premium Content
    • Lecture Slides from Live Event


Blood glucose responses play a crucial role in maintaining good health, and any abnormalities in glucose regulation can lead to several chronic conditions. Diabetes is one such disease that results from a lack of insulin production or the body’s inability to use insulin effectively, leading to elevated blood glucose levels.

There has been debate about what exactly constitues a “healthy” and “unhealthy” blood glucose response. While it is suggested that unhealthy blood glucose responses are characterized by erratic and unpredictable “spikes” in blood glucose levels, sometimes vague terminology leads to people worrying about normal blood glucose responses. This may be particularly related to the increasing prevalence of continuous glucose monitoring (CGM) devices that allow individuals to track their glucose levels in real-time. While these devices can be helpful for people with diabetes to manage their glucose levels, they can also lead to unnecessary concern and anxiety about small, normal glucose elevations.

In recent years exciting advances have been made in diabetes remission research. And off the back of that, more research has looked at various dietary interventions that could either directly impact remission, or act as an adjuct to other interventions.

In this discussion with Dr. Nicola Guess, we discuss a range of topics related to glycemia, diabetes, and diet. This includes the potential for high-protein interventions, what utility CGMs actually have, what to make of diabetes remission trials, and future directions for the field.

Guest Information

Nicola Guess, PhD, MPH, RD

Dr. Nicola Guess is a dietitian and the research programme manager for type 2 diabetes remission at the University of Oxford. And she is currently a member of the National Institute for Health and Care Excellence (NICE) expert committee.

Her research interests are on the effect of diet on the prevention and management of type 2 diabetes. But she also has a strong interest in looking at sustainable diets, plant-based diets, dietary fibre, and weight-independent approaches to health.

Dr. Guess was previously an assistant professor at King’s College London, and Head of Nutrition at the Dasman Diabetes Institute in Kuwait.

She completed her clinical dietetic training at the University of Houston, and holds a Masters in Public Health from Florida International University and a PhD from Imperial College London.

You can find Dr. Guess on both Twitter and Instagram (dr__guess).

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  1. Hi All. Would it be possible to look at the lecture slides? It might just be my setup, but they are formated in the landscape view as PDF.

    1. Author

      Hi Tim,

      The slides are available in PDF format, yes. I’ve just re-uploaded them so that the full slide is in view, I didn’t realize the inital set-up was cutting off the end. So they should be fully viewable now.

  2. Do you any references I can use for the hypothesis she gave around glucose toxicity and challenging the Twin Cycle Hypothesis? Many thanks, Carl

    1. Hi Carl,

      I believe she was refering to this article: https://www.tandfonline.com/doi/full/10.2147/VHRM.S345810

      Here’s a citation from the paper on short term insulin therapy which would speak more to the glucotoxicity theory than the lipotoxicity. Or at least just acknowledging that both strategies could work in inducing remission:

      “In fact, the feasibility of reversing T2DM with pharmacotherapy has been demonstrated in numerous studies and with different medications – therapeutic strategies that have not been adopted as first-line. Studies have shown that, when implemented early in the course of T2DM (ideally less than 2 years), intensive insulin therapy for 2–3 weeks can induce a glycemic remission, wherein patients are able to maintain normoglycaemia without any anti-diabetic medication. When followed-up in a meta-analysis, short-term intensive insulin therapy was found to significantly improve islet function and induce remission in 46% of patients at 12 months, and 42% at 24 months. This effect is not weight-loss dependent, and patients were not administered with VLEDs or LCDs. Beta-cell redifferentiation was considered the important underlying mechanism for the treatment effect. Short-term intensive insulin therapy can improve the underlying pathophysiology in early T2DM, and this approach clearly provides one treatment strategy for modifying the natural history of the disease.Citation82–Citation87

      I hope this was helpful!

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