Every day life is totally different whenever you’re monitoring glucose. Somewhat over a 12 months in the past, I used to be on my approach to a convention. My luggage had been packed, the Uber was on its approach, however there was one final thing to do earlier than I may head to the airport. Tearing open a small isopropyl alcohol wipe, I cleaned the pores and skin on the again of my arm. After that, I utilized a small applicator to the clear pores and skin, doing my finest to disregard the seen needle inside. I squeezed my eyes shut and pressed a button. It made a ka-thunk. I repeated the method on the opposite arm.
In my proper arm, I now had a Dexcom Stelo. Within the left, an Abbott Lingo. Each had been over-the-counter steady glucose displays (CGM) that may monitor the rise and fall of my glucose ranges. Opening my cellphone, I checked each the Dexcom and Abbott apps to verify the CGMs had been transmitting knowledge. I made a psychological be aware to examine how excessive altitudes may affect readings. It crossed my thoughts that, to my shock, I’d felt zero ache.
There was no pressing medical cause why I wanted to trace my glucose. I’m not a diabetic. My A1C ranges — the metric that measures long-term blood sugar — have all the time been good. However glucose monitoring isn’t only for diabetics anymore. On social media, you possibly can see medical doctors, wellness influencers, biohackers, and athletes speaking about CGM use. I simply occur to check well being tech, so I believed I’d give it a whirl for just a few weeks and see if there was any profit for a non-diabetic like myself utilizing this tech.
As a substitute, I ended up spending over a 12 months testing the units, studying up on research, talking with researchers, and falling down rabbit holes. I bounced from physician to physician attempting to determine if there was really one thing fallacious with me — or the units I used to be utilizing.
The primary “skilled use” CGM was cleared by the Meals and Drug Administration in 1999. Most individuals assume these units are used to trace blood sugar, however that’s not completely right. Technically, they supply real-time glucose measurements from the interstitial fluid between your cells, simply beneath your pores and skin. In comparison with conventional finger-stick checks, which straight measure blood sugar, CGMs can monitor glucose tendencies over an prolonged time period.
Till 2024, CGMs required a prescription and had been units primarily utilized by Sort 1 diabetics — individuals who produce little to no insulin. Now, each Dexcom and Abbott promote CGMs focused at non-diabetics, prediabetics, and Sort 2 diabetics who don’t depend on insulin. To distinguish, generally you’ll see firms market over-the-counter units as “glucose biosensors.”
The advantages of utilizing CGMs for prediabetics and Sort 2 diabetics are clear. Not like Sort 1 diabetes, prediabetes and Sort 2 are likely to develop over time because the physique turns into extra immune to insulin. If caught early sufficient, it may be “reversed” with way of life interventions like modifications to weight-reduction plan and train. Folks with pre- and Sort 2 diabetes additionally make up the overwhelming majority of instances within the US. In line with the American Diabetes Affiliation, as of 2021, Sort 2 diabetics make up about 95 % — or roughly 36 million — of the estimated 38.4 million People with diabetes. In the meantime, about 98 million had been estimated to have prediabetes. Put all that collectively, and a big variety of folks may doubtlessly study lots from utilizing CGMs about how their dietary habits affect a reputable metabolic situation.
Much less clear is whether or not this expertise is beneficial for non-diabetics. However that hasn’t stopped the push for this tech, from each the CGM makers and the federal government. If Well being Secretary RFK Jr. has his approach, in 4 years, everybody could be sporting considered one of these. Underscoring this, President Donald Trump’s controversial surgeon basic nominee Casey Means can also be the cofounder of Ranges, a CGM startup aimed toward non-diabetics. In her ebook Good Vitality, she calls out the expertise as a great tool in fixing metabolic dysfunction — one thing she claims is on the root of each attainable continual ailment immediately. Nonetheless, a number of medical consultants have publicly questioned this logic, stating the proof for non-diabetics merely isn’t there.
However we’ve now entered a brand new period the place wearable expertise presents a tantalizing promise. It’s not nearly flagging potential sicknesses. It’s about optimizing your physique’s biometric knowledge to reside the longest, healthiest life attainable. Within the context of the US’s terribly flawed healthcare system, this tech has usually been positioned as giving again a level of management to the typical individual. Put on this machine, monitor your well being, study extra about your self, and subsequently make higher selections.
Optimization of metabolic well being has been a rising development for years. Mostly, this has come within the type of meals logging. Nonetheless, CGM-related metabolism monitoring has gained traction because of the further layer of information it gives. January AI was initially a CGM startup that then pivoted to offering glucose spike prediction inside a meal logging app based mostly on the info it collected. In the meantime, Oura has since partnered with Dexcom to offer glucose readings, meal logging, and AI interpretations inside its personal sensible ring app. Abbott additionally just lately partnered with Withings, one other wearables maker, for the same integration. If you consider that GLP-1 use is growing, alongside the return of 2000s-era, ultra-skinny weight-reduction plan tradition, it looks like CGM use is being positioned as the following evolution of health monitoring.
Why not strive biohacking my diet to handle my diabetes danger, acquire perception into PCOS, and be a greater athlete?
“It’s predicted one in two People can have weight problems by the 12 months 2030,” says Dr. Thomas Grace, a diabetes clinician with Sort 1 diabetes who consulted with Dexcom on the Stelo CGM. “I believe essentially the most thrilling factor for myself, for my sufferers, and for folks utilizing Stelo is the moment reward they get from understanding how meals, exercise, stress, and sleep have an effect on their total glucose well being.”
I’m the precise type of non-diabetic that Dexcom, Abbott, and different CGM startups are focusing on. I’ve received a household historical past of Sort 2 diabetes and excessive ldl cholesterol. I’ve been recognized with polycystic ovary syndrome (PCOS) — a continual situation that quite a few medical doctors have advised me means I doubtless both have insulin resistance or continual irritation that makes me predisposed to diabetes. As a runner, I’ve struggled with power ranges whereas coaching for long-distance races regardless of following customary fueling practices and carb loading. Why not strive biohacking my diet to handle my diabetes danger, acquire perception into PCOS, and be a greater athlete?
Carrying a CGM 24/7 is invisible till it isn’t. I went days with out remembering they had been in my arms. Then, they’d inevitably snag on my shirt sleeve, or I’d brush right into a doorframe, the contact popping the CGM out of my arm. Now, even once I don’t put on CGMs, I’m conscious of the again of my arms and the lower of all my shirts. That hypervigilance comes with being always monitored — even in case you’re the one doing the monitoring.
At first, I’d assessment my knowledge each morning, after every exercise, and some hours after every meal. Most of what I noticed was fairly regular. A bowl of pasta? Glucose spike. Roasted salmon and a facet salad? Minimal improve. Carb loading earlier than a long term? Mondo spike, adopted by a pointy lower. (I discovered CGM use too cumbersome for mid-run fueling, as there’s a five-minute delay between readings.)
Nonetheless, reviewing my knowledge a number of instances a day started spiking my nervousness. Each Dexcom and Abbott’s apps have academic articles about what the perfect glucose vary is for wholesome nondiabetics — 70 to 140mg/dL. Fasting glucose ranges — like whenever you’re sleeping — ought to sit down within the vary of 70 to 99mg/dL. These first few months, I awakened nicely past 100mg/dL daily, even with out late-night snacks. Generally, I’d get up to see the Dexcom app had alerted me to glucose spikes whereas I slept. (Abbott doesn’t ship spike notifications for Lingo.)
A 12 months prior, I had examined Nutrisense — which additionally makes use of CGMs — for 2 weeks and by no means had elevated morning glucose ranges. Clearly, diabetes had lastly come for me.
Elevated morning glucose is a priority due to the Daybreak Phenomenon. To assist put together your physique to get up, you produce hormones like cortisol and development hormone. That indicators to your liver to launch glucose, providing you with power for the day. In diabetics and insulin-resistant folks, nonetheless, it results in overly excessive blood sugar ranges through the morning. One thing, maybe, like what I used to be seeing.
Cue nervousness, scheduling a flurry of medical doctors’ appointments, and hyperfixating on my weight-reduction plan and train. On the physician’s workplace, I received shrugs, quizzical forehead raises, and a reluctant acquiescence to run blood checks. (“Do they actually have non-diabetics sporting these?” a nurse requested whereas taking my blood strain.) My A1C, a gauge to your common glucose ranges over two to 3 months, was completely regular. No diabetes right here. I did, nonetheless, have elevated liver enzymes and levels of cholesterol.
Out of an abundance of warning, my physician ordered an ultrasound. I needed to wait a number of weeks for an appointment. Later, as soon as the goo was slathered over my stomach, I watched nervously out of the nook of my eye as an ultrasound technician muttered to herself. After one other few days, I received a name from the physician. I used to be recognized with a “nothing to fret about proper now” case of non-alcoholic fatty liver — a situation that generally happens alongside PCOS. Perhaps, my physician prompt, I ought to lower out all alcohol (I not often drink) and lose physique fats (I’ve been attempting for 10 years). Come again in a couple of 12 months, they stated, and we’ll see the place you’re at.
Learn a technique, this might be successful story for CGMs. The units flagged one thing had modified, and although it wasn’t diabetes, I had at the least one new official analysis. Glass half full: Management over my well being had been handed again to me.
A extra skeptical take is that elevated liver enzymes and excessive ldl cholesterol had been current in earlier blood work. A former physician had additionally suspected fatty liver illness, however stated an ultrasound wasn’t obligatory until my ranges worsened. Have been my ranges worse at this CGM-inspired blood take a look at? Not notably. The recommendation I’d been given was the identical because it had been in years previous. Glass half empty: I realized nothing new.
It wasn’t till a lot later, after consulting with Dexcom and Abbott, that I realized facet sleeping may result in inaccurate in a single day glucose readings. If you’re in your facet, the CGM can get compressed. That, in flip, may result in readings decrease or increased than your precise glucose ranges. I attempted swapping arms for the Lingo and Stelo to check for this, however it was not possible to account for the way I shifted positions every evening. Both approach, I continued getting excessive in a single day and morning glucose readings from each sensors for months.
The worst half was that I couldn’t inform whether or not the info was inaccurate or my physician had missed one thing.
I began operating into points after the primary month of steady put on. For starters, it may be dear. Dexcom and Abbott each gave me a number of take a look at items, however for the typical individual, it could actually price round $100 a month. A single sensor lasts about 15 days if every thing goes nicely. Generally, they malfunction or get ripped out after getting caught on clothes and different objects. The adhesive additionally leaves cussed residue that takes weeks of showering to totally take away. Partly to stretch out my provide, partly to offer my pores and skin a break, I began testing two weeks of each month. After six months, I pared all the way down to as soon as 1 / 4.
However no matter how usually an individual makes use of CGMs, each physique is totally different. Meals that trigger a spike for me might do nothing for you. The one approach to know for certain is thru diligent logging and experimentation. The conundrum is that this creates a mountain of information, and as I realized, decoding that knowledge with out enough context can result in pointless nervousness.
Compounding the difficulty? CGM makers have differing approaches on how you can current that knowledge. The Dexcom Stelo app, for instance, gives you spike alerts after about an hour or two. Abbott’s Lingo CGM eschews such alerts altogether. As a substitute, Abbott opts for a Lingo Rating that tries to simplify uncooked knowledge right into a digestible quantity that signifies how nicely you probably did on common at preserving your glucose inside a wholesome vary of 70 to 140mg/dL.
In the event you put on two CGMs concurrently, as I did, it’s attainable to get totally different numbers and never know which one is actually right
Utilizing a CGM to remain inside that vary sounds comparatively easy and simple. In actuality, it’s sophisticated.
“The one examine that did take a look at follow-up outcomes discovered that individuals who spent extra time above that vary had been extra prone to get diabetes, however this was in a fairly small inhabitants,” says Nicole Spartano, assistant professor at Boston College’s Chobanian and Avedisian College of Medication. “They could have already had prediabetes and are type of on their approach already. I believe we’re actually at a degree the place we don’t have a variety of data from a analysis standpoint.”
For instance, Spartano notes that there’s usually a scarcity of context for the way CGM numbers may relate to a person’s well being. On the one hand, medical doctors usually see a fasting blood glucose stage of over 100mg/dL as a trigger for concern. CGMs, nonetheless, don’t measure blood glucose. They measure interstitial glucose, which might, at instances, be increased than blood glucose. Spartano says extra analysis is required to find out what the variations between blood and interstitial glucose might be, each broadly and on a person stage.
“We assume that they’re utterly correct, however they’re not precisely correct. There’s a sure stage of accuracy that the FDA requires, however that also leaves some wiggle room,” says Dr. David Klonoff, medical director on the Diabetes Analysis Institute at Mills-Peninsula Medical Heart and editor-in-chief of the Journal of Diabetes Science and Expertise.
Principally, in case you put on two CGMs concurrently, as I did, it’s attainable to get totally different numbers and never know which one is actually right. And whereas most individuals would solely put on one after the other, there is also a distinction between one CGM you put on and the following, based mostly on whether or not they had been utilized appropriately and several other different elements.
However say every thing is assumed to be correct. What’s the easiest way to interpret CGM knowledge for non-diabetics? To attempt to discover out, Spartano ran a medical examine through which 18 endocrinologists had been requested to judge knowledge from non-diabetics.
“We gave them 20 totally different glucose monitor studies and requested them, ‘If somebody got here in with this report, would you recommend they’ve a follow-up screening for this?’” says Spartano. She says some consultants seen peaks as a standard a part of physiology. Others noticed elevated ranges as an indication somebody may want additional testing.
“Basically, there was no consensus. Even clinicians who learn CGM knowledge all day, daily don’t know what to do with this knowledge,” says Spartano.
“One of many issues is we don’t have a super approach of analyzing the data but. We all know if somebody is doing actually poorly or utterly usually, however the folks that appear to be headed for hassle? We are able to solely say, ‘It doesn’t look regular, however it’s not irregular. It’s one thing within the center,’” agrees Klonoff.
“Basically, there was no consensus. Even clinicians who learn CGM knowledge all day, daily don’t know what to do with this knowledge.”
In line with Klonoff and Spartano, there isn’t a reference set of information that’s been vetted and agreed upon by a gaggle of consultants. The information that’s coming in from totally different subgroups of individuals utilizing over-the-counter CGMs is all so new that it’ll take years earlier than that’s even attainable.
So, say you, a non-diabetic, wanted assist decoding your CGM knowledge. It’s very attainable that in case you had been to current your knowledge to 10 totally different medical doctors, you may get 10 totally different suggestions.
Throughout my analysis, a number of medical doctors and diabetes consultants advised me I used to be superb provided that my A1C remained optimum and my CGM knowledge — for essentially the most half — stayed inside a wholesome vary. Spikes, they assured me, are a standard a part of my metabolism functioning because it ought to.
Nonetheless, that’s technically not optimizing. Take Means. Whereas her credentials are questionable (she thinks you possibly can forestall most cancers with “good power” habits), in her New York Occasions bestseller Good Vitality, she advises, “We need to reduce spikes as a result of they’re related to worse outcomes.” She advocates for stricter standards. Put up-meal glucose ranges shouldn’t rise above 115mg/dL, no spike must be above 30mg/dL, and “optimum” morning fasting glucose must be between 75 and 80mg/dL. I’ve seen different influencers advocate comparable recommendation, albeit with barely totally different numbers.
By these requirements, you may be in a wholesome vary one hundred pc of the time however nonetheless have a “suboptimal” metabolism. By no means thoughts that consultants have stated there’s not sufficient consensus to outline what warrants “good” or “dangerous” CGM knowledge in non-diabetics. Many CGM apps gives you scores and extra metrics to purpose for. In the event you’re a perfectionist like me, that may be a recipe for catastrophe.
The longer I wore CGMs, the extra obsessed I turned with the meals on my plate. A slice of pizza at a gathering would make me get away in a chilly sweat. Frequent sense says a single slice of pizza on occasion is just not the tip of the world. However the considered a spike alert or a nasty rating was sufficient to persuade me that I ought to forgo consuming meals or snacks completely, even when my abdomen was growling. Likewise, I started overexercising. I’d really feel good if my fasting glucose was beneath 85mg/dL, and burdened if it was something over 100 — even when there was a logical, non permanent, good cause for that. I started to really feel burdened about being burdened. At a sure level, I turned incapable of having fun with social occasions and began avoiding them. The worst second got here early on in testing at a household Thanksgiving dinner. I began negotiating with myself about what I may eat based mostly on the way it was displaying up in a CGM app. After six months, it turned dangerous sufficient that folks near me felt the necessity to intervene. I had been too fixated on efficiently “optimizing my metabolism” to note.
That is usually forgotten within the narrative to optimize metabolism. Research have discovered that it’s troublesome to conclude that wearables, weight-reduction plan, or health apps have a definitive hyperlink to disordered consuming or consuming problems — although the danger is there, and so they have been related to exacerbating signs in those that have already got skilled them. For some folks, CGM use received’t include this sort of darkish facet. For me, it completely did.
I now decide to make use of CGMs solely to check new options.
After a couple of 12 months, I made a decision to conduct one closing take a look at. As soon as once more, my knowledge was wonky. Morning glucose was elevated. Put up-meal spikes had been extended. And my each day common glucose was increased than it’d ever been. I used to be persistently exhausted. I saved gaining weight regardless of vigilantly monitoring my diet and train. I discovered a brand new physician and received some extra blood work carried out. Nonetheless no diabetes or prediabetes. However my dangerous ldl cholesterol had worsened, and two liver enzymes had greater than tripled from the earlier 12 months. An ultrasound confirmed my fatty liver had progressed from delicate to reasonable. For the primary time, I had my insulin resistance examined and was discovered to be on the “excessive facet of regular.”
My new physician concluded that my non-medicated efforts to rein in my chaotic metabolism, whereas admirable, weren’t chopping it. Prescriptions had been written, a plan was fashioned, and 4 months into remedy, my CGM knowledge and blood work have dramatically improved. For the primary time in a decade, my dangerous ldl cholesterol is regular. I’ve misplaced 15 of the 25 kilos I gained, and my liver enzymes have dropped by roughly 65 %. My morning glucose ranges are now not elevated.
Proponents of non-diabetic CGM use may body this as an outright win. In some ways, it’s. Even so, I’m hesitant to characterize it that approach. I used to be usually stumped by my knowledge, anxious when consulting medical doctors, and for a time, wrecked my hard-fought relationship with meals and train. General, it took 13 months from beginning CGM testing to discovering a passable remedy for my metabolic points and 17 months to lastly see enchancment. Alongside the way in which, I shed many tears of frustration, and I’m nonetheless adjusting to the unintended effects of my new medicines.
I’m grateful to see my well being enhance. My long-term testing of CGMs undeniably performed a task in that. However arguably, medicine — not CGM use and positively not “taking management of my well being” by way of way of life modifications alone — is what’s finally serving to me really feel higher. I’m all for non-diabetics getting access to these sensors, as long as they’re conscious of the constraints. What I’m not for is framing CGMs as a silver bullet for demystifying and optimizing your metabolism.
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