[pak]

The history of blood glucose testing is informative here.

You're conflating a diagnostic test with a test that patients need to control dosing (of insulin). To make a diagnosis of diabetes, such frequent testing is not any more informative. Better tests, such as HbA1C, have been developed to indirectly measure blood glucose levels over a 3-month timescale, which is more appropriate for diagnosis.

I don't think there's any evidence yet that people being able to monitor their lipid levels while eating provides any useful medical information, unless you have some kind of (incredibly rare) inherited lipid metabolism deficiency.

comparing blood tests between a bipolar person's manic and depressive phases would be fascinating, but no one does it.

There in fact has been plenty of work on this, but in a research setting, where it belongs. See section 6 of http://www.ncbi.nlm.nih.gov/pubmed/27017833

it's the twenty-first century and the rate of iodine deficiency is 9%.

Micronutrient deficiencies are usually a result of dietary choices. This problem is more easily solved by encouraging everyone to take a daily multivitamin, which would be completely prophylactic, than by encouraging the same population to subscribe to series of blood tests that may or may not reveal the problem, and would require follow-up action. Again, think about it from a population health perspective.

[shanusmagnus]

The fact that you immediately jumped to the assumption that the only useful thing one could do with glucose testing is to diagnose diabetes or plan insulin doses is indicative of the failure of imagination endemic to the system.

Glucose testing is useful for all kinds of things; the fact that you yourself (and most doctors) don't know that, or think that other people can't be trusted with their own data without some Credentialed Professional to interpret it for them, is both insulting and limiting.

I don't want to go back to a world where AT&T had to anticipate the ways I'd want to use telecom. Although sadly in some respects we've never left it.

[pak]

Whoa, let's not put words in my mouth here. First of all, I said nothing about denying people access to their medical data. Once the tests are done, yes, it's the patient's data (and in the US, HIPAA concurs). We're not in disagreement there.

Secondly, there may be all kinds of other uses for glucose tests that one could research, but consumers running tests on themselves in an uncontrolled manner is not research. I would never say that no other uses will ever be discovered, but let's do that scientifically, please. My specific issue was with how diabetic glucose self-testing was used as rhetorical evidence that more blood tests help people, while failing to note that those tests are done to dose (potentially dangerous, fast-acting) medications, not to "keep tabs" on anybody's diabetes in a diagnostic sense, as was implied by the omission.

You say below that "people are coming around on glucose in the same way that we now understand that the cardio signal [...] are predictive of an enormous number of physiological and psychological phenomena." That's a lovely hypothesis, but please tell me who these people are, and please show me the evidence of the predictive value.

Until then, the Credentialed Professionals are perfectly justified in shrugging their shoulders at post-prandial glucose data from healthy patients (who, contrarily, will demand that needless and dangerous follow-up procedures are ordered for them), and the companies selling consumers these tests will not be helping anybody become healthier. I could go on, but this comment sums up the societal effects better than I could, even referencing your "ideal" of the ECG for screening. https://news.ycombinator.com/item?id=11694341

[shanusmagnus]

Really? Okay.

Dunstan, D. W., Daly, R. M., Owen, N., Jolley, D., De Courten, M., Shaw, J., & Zimmet, P. (2002). High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes care, 25(10), 1729-1736.

Mäntyselkä, P., Miettola, J., Niskanen, L., & Kumpusalo, E. (2008). Glucose regulation and chronic pain at multiple sites. Rheumatology, 47(8), 1235-1238.

Newcomer, J. W., Haupt, D. W., Fucetola, R., Melson, A. K., Schweiger, J. A., Cooper, B. P., & Selke, G. (2002). Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Archives of General Psychiatry, 59(4), 337-345.

Nybo, L. (2003). CNS fatigue and prolonged exercise: effect of glucose supplementation. Medicine and science in sports and exercise, 35(4), 589-594.

You have a lot more faith in Credentialed Professionals than I do, apparently. Or a lot less faith in anybody else.

[CJKinni]

Just curious, what are the other uses for glucose testing?

[shanusmagnus]

Getting a snapshot of your body's ability to metabolize carbohydrates is a much more granular view into metabolic health than are 'summary statistics' like A1C. Continuous glucose monitors, like those by Dexcom, are especially valuable -- you can get a detailed characterization of insulin response to food, of energy mobilization during exercise of different intensities, of general systemic stress, etc.

People are coming around on glucose in the same way that we now understand that the cardio signal (preferably using a sensitive measure like ECG, but even with crappy PPG sensors) are predictive of an enormous number of physiological and psychological phenomena.