I recently had an unusual health event that resulted in me passing out. My wife, who is a physician, thought it might be hypoglycemia, since i'm at high risk for diabetes. She found a super friendly endocrinologist who put me on a CGM for two weeks. I never hit the hypoglycemia range during those two weeks, so it didn't really explain what my issue... but honestly the data was SUPER interesting. Just observing the various spikes made me make healthier choices, or noticing when I was feeling extra tired and seeing if that correlated to not having eaten for little while, or eating something sugary before.
It's sort of like tracking your steps when you first get a smart watch. It may not have been the reason you got the device, but seeing the data, people are encouraged to act on it, even if you don't have an acute issue. since I didn't have a prescription, I couldn't get one here (didn't want to go through some sketch online site). I tried to get one from my family in India, but the prices were really high and they couldn't get the fancier one that tracks straight to your phone, so I didn't get one.
I think this could be a god send for preventing pre-diabetic people who would take preventative steps if it weren't such a pain in the ass to measure consistently.
I actually just got one of these CGMs after listening to Peter Attia's (audio)book Outlive and started monitoring my glucose and experimenting with meals and exercise to see what effects they have. Apart from the weirdness of having something attached to your skin, it's like having another watch and you won't notice after a while. It's pretty cool and a lot more people than just diabetics would benefit from this knowledge.
Like I just learned for example about resistant starches, of which one is cooled potatoes: I ate the exact same dish but the first time, right after cooking, my levels shot up (not abnormally but you should ideally never have spikes, so your body doesn't have to keep pumping insulin), and then the second time, reheated, it was like I didn't eat anything. I was surprised so I researched and found https://www.webmd.com/diet/what-to-know-resistant-starches
Everyone is different so I definitely suggest to try them out for a month and see what gives you spikes in your diet. Then try to get rid of those spikes.
I know there are waxy and starchy potatoes that have higher rations of amylopectin vs amylose starch respectively.
One interesting thing is that if you continuously mix an amylopectin potato, it turns into a gooey, ropey substance that we don't use much in western cooking but is how some Chinese mashed potatoes are supposed to be prepared. I wonder if that transformation affects the resistance of the starch.
I also wonder what exactly is making the cooled potato tougher to digest.
I am prediabetic and I have one. It's partly covered by insurance. By the metrics my estimated average glucose has gone down from 129 to 98 or so (normal). I haven't had my HbA1c in awhile.
I think they are amazing. It's been SO HELPFUL. However I don't think it makes sense for normal people. I am on a reddit group for prediabetes and it's not unusual that people who are underweight (anorexic?) and have completely normal metrics come in and post in an utterly freaked out state. These are people who are somewhat compulsive and anxious. I think that if you are normal for blood glucose having access to all this data can make you compulsive and anxious.
However, for me as a prediabetic, it is really useful. It tells you what’s going on with your blood sugar in real time with no ideology. In the beginning I was spiking from things that a nutritionist would say was OK. I found whole grains didn’t work for me. I was shocked at how much I spiked from oatmeal. What causes blood glucose spikes does not map directly to number of carbs and also every body is different.
After 6 mo of lowered carbs, weight training, and getting down to normal BMI, I can now eat SMALL portions of things like brown rice. My health has improved. It's great. IMHO all prediabetics and diabetics should have one, covered by insurance. It would really improve health and reduce complications.
It can occur for various reasons. Personally, I was developing adult onset type 1 (LADA) for a couple of years before I was diagnosed and I had all sorts of effects. While it was of course mainly effects of chronic hyperglycemia and shortage of insulin, I also had some episodes of hypoglycemia. Now that I’m on insulin, I’m very familiar with hypoglycemia resulting from an imbalance of exogenous insulin and carbohydrates. However, I looked back and realized this happened to me a few times before I was on insulin. I recall waking up a few times at night, sweating and shaking, and having a strong urge to consume food. I’d drink some juice or eat chips, feel better in 20-30 minutes and go back to sleep. This occurred after drinking alcohol, which makes sense as alcohol intensifies the effect of insulin and also prevents your body from releasing chemicals which raise your blood glucose level. I didn’t think much about it at the time but now I can see it was related to T1 onset.
My understanding is that essentially the body’s systems which regulate blood glucose are disrupted. This happens a with type 1 in general - not only problems with the system that produces and releases insulin to lower blood glucose by allowing it into cells, but also the part that does the opposite and release glucose to raise blood glucose levels. Sometimes the glucose-raising system doesn’t work at all while other times it’s inappropriately in overdrive. The same is true for the insulin releasing/glucose lowering system as it fails.
Wondered this too. Diabetics are at risk for hypoglycemia because of the insulin they take, not the diabetes itself. Maybe metformin for a prediabetic could have this effect?
No, diabetes is fundamentally a lack of ability to control your blood sugar. This means you get lots of highs but also lots of lows. It's a common misconception that diabetes just means your blood sugar is always high; rather, your sugar is high because your body no longer controls it actively.
Long-term they will likely make no changes because human desire, habits and behaviors are rarely unknown to us.
The parent comment mentioned feeling tired after consuming something with a lot of sugar, was that really a mystery prior to using CGM? I doubt it.
Sure it's interesting to correlate to your perceived wellness (or lack thereof) with a wearable spitting out data but after the novelty of this discovery wears off my guess is that people will simply stop caring to check what they already know to be the case.
The ones on diabetic warehouse don't work well enough (https://www.diabeticwarehouse.org/collections/continuous-glu...? Or is that site sketch for you? I think you can just get one if you are willing to burn $500 (not cheap, but only in the price range of a higher-end smartwatch)
Keep in mind that a single sensor will work for only a week or two, depending on the type. So it's not exactly right to compare the price to a smartwatch.
I personally wouldn't mind having the data if a need comes up, but this is simply overtracking for no particular purpose.
Basically, our bodies go through much "turmoil" over the course of any day, and watching over one too many parameters is like getting hooked to TV or a video game.
Generally, medical science can mostly tell you what averages or most common patterns are, so if you do not line up with them and don't understand this, you can get overstressed.
So unless you are really someone who can objectively consider your readings combined with effects you might be seeing, I'd say don't do it.
More importantly for life style monitoring A1C is the more important number anyway, and doesn’t require wearing anything, just a simple blood test. It’s basically a 3 month moving average.
It could be related but I also want to weigh in here and say this. Hypoglycemia can occur with no relation to the other side of diabetic symptoms, i.e, hyperglycemia. In other words there are people who suffer from hypoglycemia without ever getting high blood sugar, and so they are not "diabetic" which would mean you can have issues from both directions.
At some point a person's body may become resistant to insulin and start to need more insulin to have normal functioning (pre-diabetes), sometimes this causes large variation in glucose levels, though not as drastic as taking a medication. Eventually your body would adapt to it when you reach the diabetes phase.
Were you able to find out what may have caused you to pass out ? I had a similar incident with no root cause. But that did set me on the path to become more healthy.
Thanks for confirming. Normal feedback on health habits is delayed by months/years and hard to trace back to specific actions so your story makes a lot of sense.
I dove into CGMs a little bit about a year ago, mostly just for fun. Yes, I paid money to some online prescription mill for CGMs (Abbott Freestyle Libre 3, IIRC), and then put one in my arm (the applicator is a short syringe section that has the monitor tube threaded into it, so the tube stays in your arm and your skin under the monitor remains broken) for a couple weeks. Just to see how various foods would affect my blood glucose, to see whether the “facts” I’m telling my kids about the glycemic index of various foods actually has the expected impact on a measurable result. You know, as you do. For fun.
(It actually was fun, and I’ll do it again when the data ecosystem improves.)
Before I got cancer, I had one through Levels, and it was informative. Dessert is much worse than I'd thought. Rice, too, including brown rice. I remember eating some biryani and a small bit of naan at an Indian restaurant and thinking that I'd been pretty healthy, only to see a spike of like 80.
I saw an interview a while back between Tim Ferriss and someone who had tried CGM for fun/research. One thing he noticed was the huge impact a short walk after a meal brought down his blood sugar levels. Tim then mentioned he experienced the same thing and that there is a saying in China, something to the effect of, "take 100 steps after a meal, live 99 years." This also linked up with something I had looked up a few years ago when I noticed that I always saw families of Indian decent walking around neighborhoods, but never anyone else. I looked it up, and founds there is a word in Marathi of taking 100 steps after a meal. (https://en.wikipedia.org/wiki/Shatapawali)
It seems there has been this age old knowledge that taking a short walk after a meal is really good for you, which somehow got lost in some/many cultures. My parents would always say they had to sit after a meal to let their food digest... it never really made sense to me. My grandma, on the other hand, is 103 and gets pretty upset if people try to stop her from walking after a meal (or whenever she wants). We always just thought she liked walking, but maybe there is something else driving her, it seems to have worked out for her. It was very interesting to hear the CGM back up some of these practices that have likely been going on for hundreds or thousands of years.
I have been wanting to try one. This approval opens up the door. I think seeing something like this with my own eyes, with my own body, with actual numbers, would have a bunch bigger impact than some anecdotal stories from others and nice sayings which align.
It looks like there is some research being done in the area as well.
Desserts can definitely send your levels quite high but I don't think I'd qualify some biryani and naan with a reading of 80 as unhealthy. You probably ate a healthy portion and left it at that. Is 80 not well within the normal range?
> so the tube stays in your arm and your skin under the monitor remains broken
That's not how it works, at least for the Freestyle Libre 3. The cross section of the needle has C shape rather than a O (technically I believe it's called a cannula). When you remove the applicator that C shape allows the needle to be removed through the hole at the top of the sensor, and only the flexible filament stays I your arm.
I belive he called the flexible filament "tube" and that you are both saying the same thing. Ie skin stays open (albeit in very tiny spot where the filament is sticked in)
Aside from the fun, how did it go? Find anything surprising or insightful in the process?
It sounds like an experiment I’d like to do for the purpose of optimizing my daily habits and establishing a better mental model for how my eating habits impact me throughout the day. But I really dislike needles.
If the needle in the CGM bothers you, don't let it. It's a quick, painless jab with a tiny needle at the beginning and then the needle comes out. The part that stays in your body is just a flexible filament made of plastic.
I did this experiment as well, and the main thing it did was completely stop me from snacking. My habits got better because I could see how my BG could never return to baseline if I allowed myself to snack between meals.
Other than that, it was also interesting to see certain things would badly spike my BG and other things wouldn't, and they weren't always what you'd expect. A lot of "keto" and "diabetic-friendly" products are terrible for most people's BG and were for mine. I found that some things, like black tea, actually made my BG drop as well.
I did it for fun about a year ago and found out I had T2 diabetes.
I was shocked but obviously glad I found out. I use them from time to time just to see how I’m doing and how different foods (and amounts of them) impact me.
I found I can control it through diet alone and exercising when there is a spike by using a GCM for the constant feedback.
They are very expensive here though (UK) and my doctor won’t prescribe me one because metformin is cheaper, so it’s not something I can use all the time.
I hate needles, this really isn’t like a needle though, it’s a small filament which sits just under your skin, you can’t feel it, I thought it hadn’t gone in until I saw the reading appear on my phone.
Some things I found out besides what foods and amounts give me big spikes are that I have a blood glucose spike in the morning just before I wake up, and that if I eat a small enough portion of white rice, ice cream, bread, whatever I can reduce the spike quickly by going for a walk. If I had a lot though, a walk isn’t going to help.
Freestyle Libre 3 only has a plastic filament and the plastic applicator pushes it in without pain. Very different than metal lancets (stick test). I can't feel it at all when its in the back of my arm. If I were worried about sweating too much and it not sticking I would get one of the third party over-patches that create a lager adhesive area. I might do that in the Summer.
I almost completely forgot about the monitor itself, and only paid attention to the numbers on my phone. It's that unobtrusive (at least the Libre 3 one that I used).
I let the needle (actually: annulus? see sibling comment) get into my head because I was curious and looked at it. It looks a lot scarier than it is, kind of like using contact lenses for the first time: before you've used them, you get into your own head about it, but once you've done it a couple times it's just rote and easy.
I had started the first one a day before I started a few weeks of (6-days-on, 1-day-off) keto. Keto guides will say that you should have <= 25g net carbs per day, but I specifically wanted to see how front-loading (having almost all the day's planned carbs in one meal) affected blood glucose, and also whether the number (25g) is accurate for my physiology. I found that my number was closer to 30g and that when I stayed under it, my blood glucose spikes had very short duration but when I went significantly over it, blood glucose stayed higher for longer.
edit: One more thing, I used this time to play around with various sugar substitutes and see how they affected my blood glucose. Allulose came out as the winner (if money is no object) based on not having any noticeable off-taste or aftertaste and on measuring gram-for-gram the same as sugar (well sort of, it's only like 80% as sweet as sugar, so you get the same mechanical effects of sugar if you weigh it gram-for-gram and your baked goods or whatever come out not quite as sweet, which is perfect for me. Creaming butter with liquid stevia extract or something just plain doesn't work.
If you want to know more about it you can just read about how diabetics treat different foods. Short version; high GI is fast high blood sugar, lots fat and sugar can results long period of with high blood sugars.
It is a CGM more or less what you would expect, insulin is the only hormone that lowers blood sugar, then you have all the stress hormones that raise it like adrenalin, growth hormone and cortisol plus glucagon for long time storage of sugars in the body. So measuring blood sugar with a CGM gives you a value between 2.9-13.5 mmol/liter that is supposed to give you picture of a rather complex system. A CGM also needs perfect access to your free flowing blood which in it self is a difficult task.
At least for me the readings that it shows are not accurate (when verified with old style finger pricking glucose monitoring machine). These CGMs are good for knowing the general variability of glucose level in your blood based on your diet exercise etc; I don’t trust the absolute numbers from CGM like Freestyle Libre - haven’t used any other one though yet.
Apart from the latency of diffusion from bloodstream to interstitial fluid (and the lower levels in the interstitial fluid) the FDA requires that consumer devices be with 20% of the venipuncture level.
That means a lancet poke can be quite different from a meter like the freestyle, and both can be quite different from the level in your veins that a lab would get. So if your level is 200 one device can read 240 and the other 160 and both can be considered “correct”.
I found that the freestyle libre 2 and libre light are characteristically low while the FS 3 is characteristically high. So I use them for the shape of the curve, and that is useful.
It would be interesting to see whether a group of 20-100 people could manually calibrate their readings by fitting their CGM readings to their fingerprick glucose readers. I wonder what the accuracy would be after a very basic personal curve fit.
I do this with a lot of consumer measurement devices. Both for thermometers and scales (food, human, and cheap 0.1mg scales). As well as thermostats, like the kitchen oven. I also do it for my multimeters. I validate my volumetric measuring cups/spoons by weighing water in them but I don’t correct them, just return if they’re way off.
It’s okay if the reading is off as long as I can correct it the same way every time and get a pretty accurate result.
This is highly personal thing it is apparently very inaccurate for some people, I've never been below or over dangerous levels without it giving a warning. What has happend once or twice over the decade I've used it is that it will get stuck in a bad reading, so you do not see the variations. It has always got unstuck when I've gone below 3.5 mmol/liter or so.
There is generally a latency of a few minutes between blood and interstitial fluid (the CGM) readings- up to 15 minutes. You may find if you account for latency your consistency between the two increases
Same, but my doctor pointed me to a promotion for a free sensor. It did require a prescription, but since I don't have diabetes, it's not covered by insurance.
Trying to get it filled and picked up was slightly annoying as the pharmacy initially did not want to fill it without some prodding, and I waited a while for them to figure out how to get the promotion billed.
No, it's mostly water proof. You wear it through showers and even swimming for 2 straight weeks. The adhesive is pretty good; rarely does it come off on its own prior to say, a week and a half in.
It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.
What symptoms would one have to present for an "online prescription mill"/"virtual care provider" to prescribe a CGM? I'm fascinated by this and would love to try it out but I don't want to bother my family doctor with this.
The only symptoms needed are a pulse, the ability to type out a credit card number, and availability for a sham phone call. It's virtually impossible to not get prescribed one from a mill.
I'm T1D (insulin-dependent). I used a Dexcom for a couple years a while ago, back around the G3 through G5 era or so. I ended up stopping using it because my diabetes is very well managed, and I found it didn't make a huge difference to my management. With my insurance, each new sensor every week cost about $50, and would fail in various annoying ways: sometimes it would just stop working in the middle of the week, or not work at all from the start, or disconnect randomly for a few hours. Each sensor also used a ludicrous amount of plastic for its applicator, like a tennis-ball-sized hunk of hard plastic, that you just chucked in the trash, every week. Maybe things have improved, but it was a bad combo of unreliable and expensive so I just quit using it and went back to finger pokes.
If it were like $5 per week, I might put up with it. Maybe this over-the-counter model will be affordable. We'll see, I guess.
Dexcom and Freestyle both have options (G7, FSL2) that have a much narrower form factor than the old sensors. They end up being far more reliable, because the sensor doesn't dislodge. The new Dexcom sensors are more accurate. Less drift and no calibration.
Out of pocket cost is obviously your own situation but I think anyone with T1 should look at them. For me they are life changing, even moreso if you have a pump that can deliver based on CGM readings.
Glad to hear they're improving, though the waste situation is bizarre. I will probably go back on one at some point, I didn't hate it, just didn't feel it was worth the cost/benefit ratio. It didn't impact my A1c, I've always been in the low 6s, and I've only had two lows that I would consider significant in my 25 years with the disease. Benefit just wasn't there for the hassle and price.
> The new Dexcom sensors are more accurate. Less drift and no calibration.
I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.
> The new Dexcom sensors are more accurate. Less drift and no calibration.
As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!
> Each sensor also used a ludicrous amount of plastic for its applicator, like a tennis-ball-sized hunk of hard plastic, that you just chucked in the trash, every week.
Erm, let's be a little defensible here.
These sensors have to be stored in sterile packaging--that means thick enough to be a barrier. That means it also has to hold the sensor in such a way that a palette can be gamma irradiated. It also needs to be resistant to drops, crushes, and other accidents.
The sensor has to not be harmful with organisms irrespective of the understanding of the person using it. Any change to that packaging has to be re-evaluated for effects on that sterilization.
And while I understand people having concerns, if the only reason we needed to use plastic was to treat folks with diabetes--I think the world would somehow manage.
I work in the medical device space (mostly software as a medical device). I attended the AAMI Nexus conference two weeks ago and attended a talk about making devices more eco friendly. The tension between safety and sterilization and packaging was definitely brought up. It’s a hard balance to make. One example I thought was interesting was that the NIH did a study to see if it was necessary to swab people’s skin and use gloves before a shot. It turned out it wasn’t and it didn’t make a difference, so they stopped requiring the providers to swab people’s skin or wear gloves, thus saving an immense amount of waste when taken over all vaccine shots.
Eh, maybe, but the bulk of the applicator is just empty plastic molded to fit an adult's hand. I have to believe they could figure something less wasteful out (reusable applicator?) if they wanted or needed to. Regardless, it was just another downside for me weighed against the relatively few upsides that made me quit using it. It felt terrible to chuck all that in the trash, especially when I'd have to do it two days in a row because a sensor failed.
The g7 is definitely a bit better on all counts except maybe bluetooth reliability. I use them with [open source closed loop](https://loopkit.github.io/loopdocs/) insulin pump software and it is pretty great.
Still a lot of plastic but the sensor comes in a smaller jar/applicator in a cardboard box and it pretty reliably lasts 10 days cutting down waste.
It sounds like this new sensor is just a g7 but with less stringent accuracy standards for non insulin users allowing it to last 15 days.
I just started with the G6 (still using it), and when I started I'd have that sometimes. Whatever they changed in the past year or so, it has gotten waaaaay better. (They would always replace them if they failed early, but was still a huge pain.) I'm exited to move to the G7 (mainly because of the shorter warmup time).
Also, pairing it with the Omnipod 5 is just next level. Closed loop. Never having to inject in public. No tubes.
fwiw, my wife uses Freestyle Libre 3 and the with-insurance cost every two weeks is about $40. Whenever she's had one fail (which seems to be about 1:10), Abbott has replaced it free of charge and sent a pre-paid label so she can return the failed device for QA review.
Yeah, I feel like prices are on a downward trend the last couple years, which is great. For me personally, I try to spend absolutely as little time and effort as possible thinking about my diabetes. So having to call the manufacturer or fill out forms and receive a package (more waste) and ship a thing back (even more waste) is just too much time and effort for me to want to bother. I hope they keep improving, it's cool tech and I'd like to like it. Just not there yet.
The FreeStyle Libre 3 has a lower ongoing out of pocket cost for people who just need diagnotic monitoring but no integration with a pump. Dexcom , however, offered rebates that made it cheaper in initial outlay by the PBM to get people using, then left them paying the higher upkeep costs for functionality they may never need.
Something to keep in mind. Your insurer doesn't optimize for you. They optimize for them.
The plastic waste issue is one of the first things that usually comes up around this topic regardless of who you ask. It's such a shame because it's not like you have many options unless you're comfortable going without sensors.
All my diabetes stuff is free, in my country. But it must be shipped to my house in Quarterly deliveries.
Shipped in several boxes, each filled and wrapped. then the GCMs, strips, refills, pump connectors come in their own boxes. Some per ten, some single. Each sub-box has several booklets with instructions and safety guidelines. Each unit is individually wrapped in plastic, paper. All of them are single use. Even connectors and rods.
Our combined household has less waste than my insulin therapy produces. One single insulin therapy produces more plastic, paper and wrapping weight than what my wife and I produce together on everything else.
I'm really intrigued by your statement that your diabetes is well managed, if I wake up in the wrong side of the bed, my insulin resistance change!
Wondering how you can maintain that, do you have a very rigid routine and meal plan?
I'm using Libre2 as part of my prescription and it has been working wonders by alerting early on before it is too low or too high to have enough time for a correction dose, or a small bite. The fact that you can see the trajectory of Glucose going up or down is by itself a reason to get.
Hm, I'm not sure. I don't talk with other diabetics much so I guess I don't know what other's experiences are like. I go to sleep and wake up on the same schedule every day including weekends. My eating is not rigid, but does tend to be consistent just because my daily routine is consistent. I'm not "low carb" or anything, but I do follow a healthy-ish diet and avoid hyper sugary foods (soda, coffee milkshakes, sugary cereals) like the plague. Diabetes or not, no one should be eating that stuff :)
I do miss having the moment-to-moment trajectory information. Knowing whether I'm still going up 90 minutes after a meal was valuable. But I find I'm able to feel when I'm above 200 mg/dL, so can just correct by feel most of the time.
I think your experience was unusual in that you had so many failures (hopefully you at least got your broken sensors replaced for free; both Dexcom and Libre do this) and that you are good at managing your diabetes without many measurements.
The out-of-pocket expense can certainly be rough; I use Libre right now because my Dexcom out-of-pocket would be similar to yours and Libre is a third.
I lend my CGM to people to who are possibly prediabetic. I'm very glad I can point them to an OTC solution now.
Definitely not low carb, no. I have a bowl of oatmeal for breakfast 4-6 times a week :) My diet is pretty consistent though. I know how that oatmeal will respond to insulin 90% of the time, and the remaining 10% random quirks I can just deal with by feel & a finger prick to confirm. The thing I'm most strict about is I only allow myself to have about one "bad diabetes meal" per week. So that's like any restaurant food, or doughnuts, or pizza, or whatever. I mostly only eat home made meals, my wife & I both love to cook. But those aren't low carb, just whatever we feel like cooking that week.
I walk about a mile a day, to the bus & back for work and a bit for leisure and to get up from my desk. Otherwise I don't exercise.
For having participated in a study, they installed an Abott FreeStyle Libre 2 sensor on me for 14 days. I could get minute readings, which is not possible with either the hardware reader nor the official app, using the almost entirely FOSS android app Juggluco.
Another FOSS web tool is Nightscout -- it generates reports and live graphs from data gathered from your CGM via for example Juggluco. My instance is at http://sladkor.4a.si. My sensor expired, so there's no more live data.
glucometerutils is an interesting repo for downloading stored data from hardware readers etc. Abott encrypted the Libre 2 USB communication to force users to use their proprietary software, but hackers managed to extract keys.
I use Abbott Freestyle Libre 3 and it has been deeply insightful about my progress with T2D. An increase in fasting glucose over 2-3 days tells me I need course correction (more movement, choice of food).
I also noticed consistent correlation between bad sleep days and raised glucose levels over the day. Made me internalize how important sleep is.
I believe, next major uptick will come from CGM in wearables like Apple/Samsung watches [1][2].
I hope, even non diabetic folks use it to improve their health.
These are so interesting and not just for diabetics who benefit from them the most.
Top athletes have been using them for exercise to make sure their blood sugar remains in the correct ranges.
But Diabetics are using them to help identify how particular foods impact their blood sugar levels (obviously). The reason being is that whilst some foods might be considered high/low in sugar, each of us reacts differently in how we absorb those foods or drinks. So a bagel you eat might not spike your blood sugar like someone else, or conversely it does. You can then correlate that spike or reduction in blood glucose with how you're feeling throughout the day, how your blood sugar levels impact exercise.
Also it allows you to see how combinations of foods and the order that you eat them in impacts blood sugar. If you eat a chunk of white rice without any fibre you might find it spikes, if you each a bunch of vegetables in the bowl before hand you might find it doesn't rise as high or give you a steadier release of blood sugar.
I'd use one for a few months just to see how foods impact my blood sugar and how I can make different choices. It's one thing to interpret a label, but it's another to see it's impact on your body in real time.
I put something like this on my cat, because the vet thought she may be pre-diabetic, but stress response can also cause blood sugar to spike, so we needed to see what her blood sugar was like multiple times per day.
The device worked for 5 days until she had managed to dislodge it enough so it wouldn't get a reading. The skin glue lasted another 5 days before the device fell off. Since then, she has had a "crop circle" behind her shoulder where her fur was shaved away, and which is ever so slowly filling in.
Her readings were fine, so we are feeding her low carbohydrate food, because the vet thinks she may become diabetic in the future.
Unfortunately, I had to place the reader device almost directly on the sensor, which was a pain, because my cat likes to hide under the bed. So, I had to squirt her with water to get her out, which was undesirable, but didn't seem to affect the readings.
I would recommend anyone to experiment with this. I did, and found out I was more glucose sensitive than I expected. This led me to get more broad labs done, with which I was able to find additional treatable issues that are likely the cause. If I hadn't done this, I would have found out via symptoms years later, after irreversible damage had already been done.
You are your only medical advocate, no one else is going to do it for you. The standard of care is shit, don't rely on it.
I tried a CGM twice. I triggered the hypoglycemia (blood sugar too low) alarm multiple times, but felt completely fine.
After some research I discovered it's actually not uncommon for healthy people to have occasional dips below the preset hypoglycemia threshold, but as long as you're not having symptoms then there's no cause for concern.
I also talked to a doctor who complained that she had multiple patients showing up with concerns about their glucose numbers for various reasons after trialing CGMs, but they had similar spurious and unimportant problems (brief excursions out of range, etc.).
So if you're going to experiment, at least familiarize yourself with what's truly problematic. It's easy to misinterpret the data if you don't know what it means.
Freestyle libre has a lot of hypoclyemia events due to pressure on the sensor. If you roll over at night, or lean on the sensor it reads way too low. It’s very annoying since you can’t disable the alarm, I have to turn off the Bluetooth at night. Similarly when you go into very cold water it will read lower incorrectly.
People are often surprised when I tell them about the insane levels of pre-diabetes in the US:
> The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.
It’s honestly insane to continue a way of life that’s doing this to the majority of the population.
The other insane thing is studies have shown that type 2 diabetes can be reversed by fasting. Fasting is problematic to the medical industry because it is zero cost.
"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."
This is why it made me upset to see this Doctor on TikTok telling people unless you have Diabetes, you don't need a glucose monitor and making fun of people who had one.
Where is the harm in getting data on how your own body deals with glucose?
False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.
> Where is the harm in getting data on how your own body deals with glucose?
We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population.
CGMs will often give an "estimated HbA1c" value based on statistics from the collected data.
The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.
> Where is the harm in getting data on how your own body deals with glucose?
That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels.
You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.
Agreed, this is one of the better things I have done to take control of my own health!
It was very very surprising which foods, and quantities of foods, caused huge spikes.
However, this stuff is difficult to interpret. What should be the goal number for managing glucose spikes? What's good, what's bad? Ultimately there's a lot of judgement calls, just as there is with any health or fitness goal.
I learned a lot from Peter Attia's podcasts, but that required hours of listening.
My doctor offered to review my data with me, which was amazing. But many people's primary care docs may not have the experience or time.
+1 +1 +1 to Peter Attia, huge amounts of great content. My philosophy is that if there's any single topic where I should be spending five hours a month researching, it's personal health.
As far as spikes are concerned, I convinced my wife and my dad to both try out the same CGM. Neither of them really ever had any spikes of significance (maybe up to 130's), even when eating cake, etc. Obviously it varies from person to person, but the fact I would spike easily above 140 with boring foods (steel cut oats with no sweetener as an example) said to me something was wrong. My daily averages hovering around 100 to 105 were not in the pre-diabetes level but were close to it, even when eating minimal carbs and being extremely fit with a natural healthy diet. Also most of what you read out there with CGMs is related to people who actually have diabetes.
Finally, there's no one really to talk to about this stuff. You can eclipse your doctor's knowledge on the topic with about 5-10 hours of research. You can go get a broad set of labs and be right at the edge of the reference range on something (which is, depending on the lab, just a range of the general population, not a healthy range) and your doctor will shrug it off. The system is setup so that as long as you are in a sort of average, even with that average being pretty bad (half of the country is fat and pre-diabetic), the standard of care is to ignore it until you fall off the end. The line between hypochondria and being on top of your health is pretty thin, and most doctors will consider you a hypochondriac if you research and come ready to talk about the topic with any level of knowledge.
Experimenting with GCMs is by far the most useful and fun biohacks I've tried. I was part of the early beta for Levels Health.
Even if you don't suspect underlying health issues, the data provided for health optimization and gamification is worth it.
I used the GCM for 4 weeks and mostly tested how my body responds to various types of foods and meal timing. I also used an Oura ring to track sleep.
Main lessons learned: fat loading in the morning with a bulletproof (ghee) coffee didn't spike glucose and provided sustainable energy. Carbs for dinner helped with sleep but only if the meal was several hours before bed, allowing enough time for the double glucose spikes to return to baseline.
And Japanese sweet potatoes massively spike my glucose unless they're slightly undercooked. Cooking methods significantly changed how my body responded to the food.
I'd really love to be able to do that (experimenting) but i'm in the EU and haven't looked at the possibilities yet (i'm not diabetic).
However i recently saw a video of a woman that carried a glucose monitor (even if she didn't need one) as part of a study (she volunteered) and was able to correlate her mood and her weight take/loss with sugar intake.
I'm very curious about this. I've started a diet recently and after quitting many sources of sugar completely I'm very surprised how long i can go without eating and how little calories per day i can consume (well, as long as i have fat to burn at least).
If anybody wants to chime in and suggest a glucose monitor that i can get without prescription in EU (Italy) and from which i can pull off data, please do.
I'm in the Netherlands and just bought a Freestyle Libre 3 from https://www.dia-centrum.nl/. It didn't require a prescription and was easy to set up and you can get the data out of Freestyle's website, as a CSV download if I remember correctly.
I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.
Can you share a little about the "additional labs" you did?
I wore a CGM for about a month. Also found that my glucose numbers were not nearly as good as I would have expected, especially considering that I'm quite active and not overweight. But it's the "what next" that I'm stuck on.
Front page has 20% off coupon. This should get you a pretty wide view. You can add on extras, but this should get you most of what you want to understand. But, this level of lab work is going to require 20+ hours of research to understand, and even more if you pop funny values and want to figure out why. Have fun....
One example is an iron overload disorder. Excess iron accumulates in various organs including your pancreas, liver, and pituitary gland. Catch it early and you can avoid liver cirrhosis, busted pituitary function, poor pancreatic function, heart issues, dementia, etc. Wait too long and you are on the transplant list.
I found out I was barely in the diabetic range a couple of months ago; hopefully, with diet changes and Metformin, I will see my A1C at a better number in a month or so. Otherwise, I would like to try a CGM to see what I am missing.
Prevention of diabetes or even of pre-diabetes is well worth the experiment. At least for folks in the US, where metabolic syndrome is hanging over the head of a huuuuuge percentage of the population.
Hiding information from people because they might misinterpret it is not a successful medical strategy, the better strategy is to educate, see if the information will be welcome, then provide the information in the context of what it means.
I wasn't technically pre-diabetic, but did have a few higher-than-expected resting glucose blood tests, and the CGM showed me that I'm actually really close to pre-diabetes.
That was the kick I needed to clean up my diet (specifically eat less), exercise 5-7 days of the week, and I'm feeling better than ever.
Anecdata, of course, but there is no single intervention that has been discovered to improve people's weight and metabolic problems in the US (except perhaps the new GLP-1 inhibitors). Adding a CGM, at least for people interested in it, can be very effective, and we should use all the tools we have to improve the population's health.
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It's sort of like tracking your steps when you first get a smart watch. It may not have been the reason you got the device, but seeing the data, people are encouraged to act on it, even if you don't have an acute issue. since I didn't have a prescription, I couldn't get one here (didn't want to go through some sketch online site). I tried to get one from my family in India, but the prices were really high and they couldn't get the fancier one that tracks straight to your phone, so I didn't get one.
I think this could be a god send for preventing pre-diabetic people who would take preventative steps if it weren't such a pain in the ass to measure consistently.
Like I just learned for example about resistant starches, of which one is cooled potatoes: I ate the exact same dish but the first time, right after cooking, my levels shot up (not abnormally but you should ideally never have spikes, so your body doesn't have to keep pumping insulin), and then the second time, reheated, it was like I didn't eat anything. I was surprised so I researched and found https://www.webmd.com/diet/what-to-know-resistant-starches
Everyone is different so I definitely suggest to try them out for a month and see what gives you spikes in your diet. Then try to get rid of those spikes.
I know there are waxy and starchy potatoes that have higher rations of amylopectin vs amylose starch respectively.
One interesting thing is that if you continuously mix an amylopectin potato, it turns into a gooey, ropey substance that we don't use much in western cooking but is how some Chinese mashed potatoes are supposed to be prepared. I wonder if that transformation affects the resistance of the starch.
I also wonder what exactly is making the cooled potato tougher to digest.
I think they are amazing. It's been SO HELPFUL. However I don't think it makes sense for normal people. I am on a reddit group for prediabetes and it's not unusual that people who are underweight (anorexic?) and have completely normal metrics come in and post in an utterly freaked out state. These are people who are somewhat compulsive and anxious. I think that if you are normal for blood glucose having access to all this data can make you compulsive and anxious.
However, for me as a prediabetic, it is really useful. It tells you what’s going on with your blood sugar in real time with no ideology. In the beginning I was spiking from things that a nutritionist would say was OK. I found whole grains didn’t work for me. I was shocked at how much I spiked from oatmeal. What causes blood glucose spikes does not map directly to number of carbs and also every body is different.
After 6 mo of lowered carbs, weight training, and getting down to normal BMI, I can now eat SMALL portions of things like brown rice. My health has improved. It's great. IMHO all prediabetics and diabetics should have one, covered by insurance. It would really improve health and reduce complications.
I agree , but if it's anything like gluten free foods, having more people buying that don't need to, might push prices down for you.
Was it oatmeal, or what you ate oatmeal with (milk, sweetener, etc), or do you know?
https://en.wikipedia.org/wiki/Reactive_hypoglycemia
It can occur for various reasons. Personally, I was developing adult onset type 1 (LADA) for a couple of years before I was diagnosed and I had all sorts of effects. While it was of course mainly effects of chronic hyperglycemia and shortage of insulin, I also had some episodes of hypoglycemia. Now that I’m on insulin, I’m very familiar with hypoglycemia resulting from an imbalance of exogenous insulin and carbohydrates. However, I looked back and realized this happened to me a few times before I was on insulin. I recall waking up a few times at night, sweating and shaking, and having a strong urge to consume food. I’d drink some juice or eat chips, feel better in 20-30 minutes and go back to sleep. This occurred after drinking alcohol, which makes sense as alcohol intensifies the effect of insulin and also prevents your body from releasing chemicals which raise your blood glucose level. I didn’t think much about it at the time but now I can see it was related to T1 onset.
My understanding is that essentially the body’s systems which regulate blood glucose are disrupted. This happens a with type 1 in general - not only problems with the system that produces and releases insulin to lower blood glucose by allowing it into cells, but also the part that does the opposite and release glucose to raise blood glucose levels. Sometimes the glucose-raising system doesn’t work at all while other times it’s inappropriately in overdrive. The same is true for the insulin releasing/glucose lowering system as it fails.
The parent comment mentioned feeling tired after consuming something with a lot of sugar, was that really a mystery prior to using CGM? I doubt it.
Sure it's interesting to correlate to your perceived wellness (or lack thereof) with a wearable spitting out data but after the novelty of this discovery wears off my guess is that people will simply stop caring to check what they already know to be the case.
Basically, our bodies go through much "turmoil" over the course of any day, and watching over one too many parameters is like getting hooked to TV or a video game.
Generally, medical science can mostly tell you what averages or most common patterns are, so if you do not line up with them and don't understand this, you can get overstressed.
So unless you are really someone who can objectively consider your readings combined with effects you might be seeing, I'd say don't do it.
Isn't hypoglycemia a side effect of insulin and other glucose lowing agent rather than of the diabetes itself?
I might have to get over my dislike of needles :|
(It actually was fun, and I’ll do it again when the data ecosystem improves.)
It seems there has been this age old knowledge that taking a short walk after a meal is really good for you, which somehow got lost in some/many cultures. My parents would always say they had to sit after a meal to let their food digest... it never really made sense to me. My grandma, on the other hand, is 103 and gets pretty upset if people try to stop her from walking after a meal (or whenever she wants). We always just thought she liked walking, but maybe there is something else driving her, it seems to have worked out for her. It was very interesting to hear the CGM back up some of these practices that have likely been going on for hundreds or thousands of years.
I have been wanting to try one. This approval opens up the door. I think seeing something like this with my own eyes, with my own body, with actual numbers, would have a bunch bigger impact than some anecdotal stories from others and nice sayings which align.
It looks like there is some research being done in the area as well.
https://link.springer.com/article/10.1007/s40279-022-01649-4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8912639/
That's not how it works, at least for the Freestyle Libre 3. The cross section of the needle has C shape rather than a O (technically I believe it's called a cannula). When you remove the applicator that C shape allows the needle to be removed through the hole at the top of the sensor, and only the flexible filament stays I your arm.
It sounds like an experiment I’d like to do for the purpose of optimizing my daily habits and establishing a better mental model for how my eating habits impact me throughout the day. But I really dislike needles.
I did this experiment as well, and the main thing it did was completely stop me from snacking. My habits got better because I could see how my BG could never return to baseline if I allowed myself to snack between meals.
Other than that, it was also interesting to see certain things would badly spike my BG and other things wouldn't, and they weren't always what you'd expect. A lot of "keto" and "diabetic-friendly" products are terrible for most people's BG and were for mine. I found that some things, like black tea, actually made my BG drop as well.
Overall it's worth doing at least once.
I was shocked but obviously glad I found out. I use them from time to time just to see how I’m doing and how different foods (and amounts of them) impact me.
I found I can control it through diet alone and exercising when there is a spike by using a GCM for the constant feedback.
They are very expensive here though (UK) and my doctor won’t prescribe me one because metformin is cheaper, so it’s not something I can use all the time.
I hate needles, this really isn’t like a needle though, it’s a small filament which sits just under your skin, you can’t feel it, I thought it hadn’t gone in until I saw the reading appear on my phone.
Some things I found out besides what foods and amounts give me big spikes are that I have a blood glucose spike in the morning just before I wake up, and that if I eat a small enough portion of white rice, ice cream, bread, whatever I can reduce the spike quickly by going for a walk. If I had a lot though, a walk isn’t going to help.
I let the needle (actually: annulus? see sibling comment) get into my head because I was curious and looked at it. It looks a lot scarier than it is, kind of like using contact lenses for the first time: before you've used them, you get into your own head about it, but once you've done it a couple times it's just rote and easy.
I had started the first one a day before I started a few weeks of (6-days-on, 1-day-off) keto. Keto guides will say that you should have <= 25g net carbs per day, but I specifically wanted to see how front-loading (having almost all the day's planned carbs in one meal) affected blood glucose, and also whether the number (25g) is accurate for my physiology. I found that my number was closer to 30g and that when I stayed under it, my blood glucose spikes had very short duration but when I went significantly over it, blood glucose stayed higher for longer.
edit: One more thing, I used this time to play around with various sugar substitutes and see how they affected my blood glucose. Allulose came out as the winner (if money is no object) based on not having any noticeable off-taste or aftertaste and on measuring gram-for-gram the same as sugar (well sort of, it's only like 80% as sweet as sugar, so you get the same mechanical effects of sugar if you weigh it gram-for-gram and your baked goods or whatever come out not quite as sweet, which is perfect for me. Creaming butter with liquid stevia extract or something just plain doesn't work.
It is a CGM more or less what you would expect, insulin is the only hormone that lowers blood sugar, then you have all the stress hormones that raise it like adrenalin, growth hormone and cortisol plus glucagon for long time storage of sugars in the body. So measuring blood sugar with a CGM gives you a value between 2.9-13.5 mmol/liter that is supposed to give you picture of a rather complex system. A CGM also needs perfect access to your free flowing blood which in it self is a difficult task.
That means a lancet poke can be quite different from a meter like the freestyle, and both can be quite different from the level in your veins that a lab would get. So if your level is 200 one device can read 240 and the other 160 and both can be considered “correct”.
I found that the freestyle libre 2 and libre light are characteristically low while the FS 3 is characteristically high. So I use them for the shape of the curve, and that is useful.
I do this with a lot of consumer measurement devices. Both for thermometers and scales (food, human, and cheap 0.1mg scales). As well as thermostats, like the kitchen oven. I also do it for my multimeters. I validate my volumetric measuring cups/spoons by weighing water in them but I don’t correct them, just return if they’re way off.
It’s okay if the reading is off as long as I can correct it the same way every time and get a pretty accurate result.
Try doing a few fingerpricks in a row. The variability will surprise you!
Trying to get it filled and picked up was slightly annoying as the pharmacy initially did not want to fill it without some prodding, and I waited a while for them to figure out how to get the promotion billed.
It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.
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If it were like $5 per week, I might put up with it. Maybe this over-the-counter model will be affordable. We'll see, I guess.
Out of pocket cost is obviously your own situation but I think anyone with T1 should look at them. For me they are life changing, even moreso if you have a pump that can deliver based on CGM readings.
Plastic waste situation is still bad.
Yeah, seeing ~300 datapoints a day instead of 4 while pricking your fingers is amazing QoL improvement. Dead serious.
I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.
As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!
Erm, let's be a little defensible here.
These sensors have to be stored in sterile packaging--that means thick enough to be a barrier. That means it also has to hold the sensor in such a way that a palette can be gamma irradiated. It also needs to be resistant to drops, crushes, and other accidents.
The sensor has to not be harmful with organisms irrespective of the understanding of the person using it. Any change to that packaging has to be re-evaluated for effects on that sterilization.
And while I understand people having concerns, if the only reason we needed to use plastic was to treat folks with diabetes--I think the world would somehow manage.
[1] https://fm.cnbc.com/applications/cnbc.com/resources/img/edit...
Still a lot of plastic but the sensor comes in a smaller jar/applicator in a cardboard box and it pretty reliably lasts 10 days cutting down waste.
It sounds like this new sensor is just a g7 but with less stringent accuracy standards for non insulin users allowing it to last 15 days.
Also, pairing it with the Omnipod 5 is just next level. Closed loop. Never having to inject in public. No tubes.
The FreeStyle Libre 3 has a lower ongoing out of pocket cost for people who just need diagnotic monitoring but no integration with a pump. Dexcom , however, offered rebates that made it cheaper in initial outlay by the PBM to get people using, then left them paying the higher upkeep costs for functionality they may never need.
Something to keep in mind. Your insurer doesn't optimize for you. They optimize for them.
Shipped in several boxes, each filled and wrapped. then the GCMs, strips, refills, pump connectors come in their own boxes. Some per ten, some single. Each sub-box has several booklets with instructions and safety guidelines. Each unit is individually wrapped in plastic, paper. All of them are single use. Even connectors and rods.
Our combined household has less waste than my insulin therapy produces. One single insulin therapy produces more plastic, paper and wrapping weight than what my wife and I produce together on everything else.
It's utterly insane.
Wondering how you can maintain that, do you have a very rigid routine and meal plan?
I'm using Libre2 as part of my prescription and it has been working wonders by alerting early on before it is too low or too high to have enough time for a correction dose, or a small bite. The fact that you can see the trajectory of Glucose going up or down is by itself a reason to get.
I do miss having the moment-to-moment trajectory information. Knowing whether I'm still going up 90 minutes after a meal was valuable. But I find I'm able to feel when I'm above 200 mg/dL, so can just correct by feel most of the time.
The out-of-pocket expense can certainly be rough; I use Libre right now because my Dexcom out-of-pocket would be similar to yours and Libre is a third.
I lend my CGM to people to who are possibly prediabetic. I'm very glad I can point them to an OTC solution now.
I walk about a mile a day, to the bus & back for work and a bit for leisure and to get up from my desk. Otherwise I don't exercise.
Another FOSS web tool is Nightscout -- it generates reports and live graphs from data gathered from your CGM via for example Juggluco. My instance is at http://sladkor.4a.si. My sensor expired, so there's no more live data.
glucometerutils is an interesting repo for downloading stored data from hardware readers etc. Abott encrypted the Libre 2 USB communication to force users to use their proprietary software, but hackers managed to extract keys.
http://juggluco.nlhttp://nightscout.github.iohttps://github.com/glucometers-tech/glucometerutilshttp://ni.4a.si./anonymous/freestyle-keys/tree/freestyle_key...
I believe, next major uptick will come from CGM in wearables like Apple/Samsung watches [1][2]. I hope, even non diabetic folks use it to improve their health.
[1] https://www.macrumors.com/2023/09/14/apple-watch-blood-gluco... [2] https://www.macrumors.com/2024/01/23/samsung-racing-to-beat-...
Top athletes have been using them for exercise to make sure their blood sugar remains in the correct ranges.
But Diabetics are using them to help identify how particular foods impact their blood sugar levels (obviously). The reason being is that whilst some foods might be considered high/low in sugar, each of us reacts differently in how we absorb those foods or drinks. So a bagel you eat might not spike your blood sugar like someone else, or conversely it does. You can then correlate that spike or reduction in blood glucose with how you're feeling throughout the day, how your blood sugar levels impact exercise.
Also it allows you to see how combinations of foods and the order that you eat them in impacts blood sugar. If you eat a chunk of white rice without any fibre you might find it spikes, if you each a bunch of vegetables in the bowl before hand you might find it doesn't rise as high or give you a steadier release of blood sugar.
I'd use one for a few months just to see how foods impact my blood sugar and how I can make different choices. It's one thing to interpret a label, but it's another to see it's impact on your body in real time.
The device worked for 5 days until she had managed to dislodge it enough so it wouldn't get a reading. The skin glue lasted another 5 days before the device fell off. Since then, she has had a "crop circle" behind her shoulder where her fur was shaved away, and which is ever so slowly filling in.
Her readings were fine, so we are feeding her low carbohydrate food, because the vet thinks she may become diabetic in the future.
Unfortunately, I had to place the reader device almost directly on the sensor, which was a pain, because my cat likes to hide under the bed. So, I had to squirt her with water to get her out, which was undesirable, but didn't seem to affect the readings.
The device was the Freestyle Libre 2.
https://www.freestyle.abbott/us-en/products/freestyle-libre-...
You are your only medical advocate, no one else is going to do it for you. The standard of care is shit, don't rely on it.
I tried a CGM twice. I triggered the hypoglycemia (blood sugar too low) alarm multiple times, but felt completely fine.
After some research I discovered it's actually not uncommon for healthy people to have occasional dips below the preset hypoglycemia threshold, but as long as you're not having symptoms then there's no cause for concern.
I also talked to a doctor who complained that she had multiple patients showing up with concerns about their glucose numbers for various reasons after trialing CGMs, but they had similar spurious and unimportant problems (brief excursions out of range, etc.).
So if you're going to experiment, at least familiarize yourself with what's truly problematic. It's easy to misinterpret the data if you don't know what it means.
People are often surprised when I tell them about the insane levels of pre-diabetes in the US:
> The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.
It’s honestly insane to continue a way of life that’s doing this to the majority of the population.
https://www.uspharmacist.com/article/prediabetes-trends-amon....
"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."
https://clindiabetesendo.biomedcentral.com/articles/10.1186/...
Where is the harm in getting data on how your own body deals with glucose?
We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population.
CGMs will often give an "estimated HbA1c" value based on statistics from the collected data.
The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.
That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels.
You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.
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It was very very surprising which foods, and quantities of foods, caused huge spikes.
However, this stuff is difficult to interpret. What should be the goal number for managing glucose spikes? What's good, what's bad? Ultimately there's a lot of judgement calls, just as there is with any health or fitness goal.
I learned a lot from Peter Attia's podcasts, but that required hours of listening.
My doctor offered to review my data with me, which was amazing. But many people's primary care docs may not have the experience or time.
As far as spikes are concerned, I convinced my wife and my dad to both try out the same CGM. Neither of them really ever had any spikes of significance (maybe up to 130's), even when eating cake, etc. Obviously it varies from person to person, but the fact I would spike easily above 140 with boring foods (steel cut oats with no sweetener as an example) said to me something was wrong. My daily averages hovering around 100 to 105 were not in the pre-diabetes level but were close to it, even when eating minimal carbs and being extremely fit with a natural healthy diet. Also most of what you read out there with CGMs is related to people who actually have diabetes.
Finally, there's no one really to talk to about this stuff. You can eclipse your doctor's knowledge on the topic with about 5-10 hours of research. You can go get a broad set of labs and be right at the edge of the reference range on something (which is, depending on the lab, just a range of the general population, not a healthy range) and your doctor will shrug it off. The system is setup so that as long as you are in a sort of average, even with that average being pretty bad (half of the country is fat and pre-diabetic), the standard of care is to ignore it until you fall off the end. The line between hypochondria and being on top of your health is pretty thin, and most doctors will consider you a hypochondriac if you research and come ready to talk about the topic with any level of knowledge.
Even if you don't suspect underlying health issues, the data provided for health optimization and gamification is worth it.
I used the GCM for 4 weeks and mostly tested how my body responds to various types of foods and meal timing. I also used an Oura ring to track sleep.
Main lessons learned: fat loading in the morning with a bulletproof (ghee) coffee didn't spike glucose and provided sustainable energy. Carbs for dinner helped with sleep but only if the meal was several hours before bed, allowing enough time for the double glucose spikes to return to baseline.
And Japanese sweet potatoes massively spike my glucose unless they're slightly undercooked. Cooking methods significantly changed how my body responded to the food.
However i recently saw a video of a woman that carried a glucose monitor (even if she didn't need one) as part of a study (she volunteered) and was able to correlate her mood and her weight take/loss with sugar intake.
I'm very curious about this. I've started a diet recently and after quitting many sources of sugar completely I'm very surprised how long i can go without eating and how little calories per day i can consume (well, as long as i have fat to burn at least).
If anybody wants to chime in and suggest a glucose monitor that i can get without prescription in EU (Italy) and from which i can pull off data, please do.
I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.
I wore a CGM for about a month. Also found that my glucose numbers were not nearly as good as I would have expected, especially considering that I'm quite active and not overweight. But it's the "what next" that I'm stuck on.
https://www.ultalabtests.com/test/advanced-cardiovascular-he...https://www.ultalabtests.com/test/hormone-health-men-compreh...
Front page has 20% off coupon. This should get you a pretty wide view. You can add on extras, but this should get you most of what you want to understand. But, this level of lab work is going to require 20+ hours of research to understand, and even more if you pop funny values and want to figure out why. Have fun....
Hiding information from people because they might misinterpret it is not a successful medical strategy, the better strategy is to educate, see if the information will be welcome, then provide the information in the context of what it means.
I wasn't technically pre-diabetic, but did have a few higher-than-expected resting glucose blood tests, and the CGM showed me that I'm actually really close to pre-diabetes.
That was the kick I needed to clean up my diet (specifically eat less), exercise 5-7 days of the week, and I'm feeling better than ever.
Anecdata, of course, but there is no single intervention that has been discovered to improve people's weight and metabolic problems in the US (except perhaps the new GLP-1 inhibitors). Adding a CGM, at least for people interested in it, can be very effective, and we should use all the tools we have to improve the population's health.