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October 25, 2016
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Variable Glucose Distribution?

Don't go swimming right after eating lest you drown. -- Advice to schoolchildren, circa 1970.


When our gradeschool teachers started teaching us the basics of physiology, they taught us that blood brought oxygen and nutrients to our brains, our digestive systems (simplified to "stomachs"), and our limbs, and that these three systems were constantly battling for better allocation of resources.


According to our teachers, our brains always won out because they had to control the rest of our bodies.


Our legs came second, for survival reasons. The concepts of "adrenaline rush" and "fight or flight" were simplified to our grade level.


Lastly, came our stomachs -- and because they had the least priority, any strenuous physical activity engaged right after eating was presumed to cause stomach cramps. On dry land, it was presumed you'd just keel over or vomit or something -- but in open water, you'd not be able to fight the current or actively maintain buoyancy, so you'd drown.


While our knowledge of human physiology has changed considerably in the past forty years or so, the old film loops and safety posters have me asking some questions.


We are taught to use only our fingertips to test within 20 minutes of eating, under the assumption that nutrients extracted from our digestive system would be directed to our keyboard-hopping fingers before anywhere else. While my understanding of human physiology is generally limited to a 35-year-old AP Biology curriculum, I would think that nutrients would have to first perfuse through the tissues in which they are removed from the {mouth, stomach, intestine, colon} before entering the bloodstream, and then what? Does our circulatory system have some sort of direct flight that shunts sugar directly from our buccal linings to our fingertips, rather than routing it through the same aortic highway system that red blood cells normally take? (If not, wouldn't a blood glucose measurement taken from, say, a cracked lip be higher than one from a fingertip?)


But if the concepts behind my gradeschool science lessons were correct, then shouldn't we have higher blood glucose levels in our legs than our arms when we are running, and always higher along our digestive tracts than our fingertips (or not, if we've not eaten just before or during our activity)? If so, could this differential circulation be behind some of the wild differences between some folks' CGM sensor readings and their calibration/verification fingersticks? (Could this also be why, when doing calorie-intense anaerobic-zone cardio, I can get a headache that requires glucose to resolve even though my fingerstick reading is normal-to-high?) And if this is true, should our current theory of blood glucose measurement and management be replaced by information gained from something with multiple leads -- more like an EKG -- with sensors placed in several key spots along the body (including one or more implanted, ingested, or injectable sensors to measure glucose levels in our internal organs), mapping the base, prandial, and athletic distributions and based on that knowledge, require more tailored drugs and insulin-injection-site choices to manage those distributions?


While today's medical technology would make such a system of glucose measurement too unwieldy for daily use, could it, should it, be something worth studying?

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