May 2024 Newsletter | Continuous Glucose Monitors Takeaways
My mission is to be the first woman in 4 generations to not develop Alzheimer’s Disease (AD). On my journey of discovering ways to mitigate my risk, I pass this information on to you in this Brain-Body-Health (BBH) Newsletter.
Hello BBH Citizen Scientists!
Last month we did a deep dive into insulin resistance its relationship to our metabolic health and how it contributes to dementia, heart disease, and cancer. What did you think? Are you altering any habits or patterns around your sugar/carbohydrate intake? Maybe like me, you are becoming a label reader extraordinaire and discovering all kinds of things you didn’t know existed in the food you eat.
Continuing our focus on blood glucose (BG), this month I am focusing on CGMS (continuous glucose monitors), the latest biotech tool that provides continuous BG feedback.
For me to be the first woman in 4 generations not to get AD monitoring my blood sugar regularly is paramount in reducing my risk for dementia. Checking my blood sugar has been something I have been doing for the past 7 years via finger sticks, but recently I decided to give continuous glucose monitoring a try.
Hats off to biotechnology! Over the last few years CGMS have come to the market and now are available to consumers. Combining science and technology into biomonitoring devices has been of interest to me ever since I was exposed to biofeedback devices for helping cancer patients reduce pain in nursing school. CGMS are a new way to measure your BG. The value of CGMS are their continuous report back from your body directly to your phone. It’s a calling that informs and educates you about the question I keep asking, “How healthy are we?”
What you will need to obtain a CGM:
A prescription from an MD is needed most of the time. Especially if you have been diagnosed with pre-diabetes or diabetes for your insurance to be billed. However, as of March 2024, the U.S. Food and Drug Administration cleared for marketing the first over-the-counter (OTC) continuous glucose monitor (CGM). The Dexcom Stelo Glucose Biosensor System is an integrated CGM (iCGM). intended for anyone 18 years and older who does not use insulin, such as individuals with diabetes treating their condition with oral medications, or those without diabetes who want to better understand how diet and exercise may impact blood sugar levels. Importantly, this system is not for individuals with problematic hypoglycemia (low blood sugar) as the system is not designed to alert the user to this potentially dangerous condition. This expands access to these devices by allowing individuals to purchase a CGM without the involvement of a healthcare provider. (No prescription necessary).
What is a CGM?
A CGM is a button-shaped disc with a small needle that inserts under the skin into the upper back side of your arm. The sensor will last for 2 weeks and then you will replace it with another.
This sensor pairs with your smartphone giving a continuous readout in numbers and graphs. The value is allowing you to see in real-time what is happening to your BG. This is important because what spikes one person’s glucose may not spike another.
This device provides immediate feedback reinforcing our citizen scientific inquiry into our metabolic health. You see the direct effect on your phone making this tool an effective personalized and behavioral strategy in controlling our BG.
Impaired blood glucose control is the most deleterious contributor to poor metabolic health and to diseases like cancer, heart disease, and dementia.
What you should know: Blood sugar should increase up to 140 mg/dL within one hour after eating and reduce down to 90/100 after 2-3 hours. Your goal using the CGM is to reduce BG variability. In other words, you don’t want big spikes or big drops or bumps up and rapid downs. You may be able to adjust your alarm to 140 but you will need to turn your alarms off at night or you may get awakened with a loud obnoxious sound in the middle of the night, which happened to me!
Several companies are making CGM’s. To determine which one to use I checked with friends, and our doctors, but what made the biggest difference was a random woman standing with her CGM visible in line at our local Thai restaurant. She had tried several CGM’s and her choice was a Libre 3, which had just come out with a painless sensor and a very small needle. That sounded good to me since believe it or not I’m not a fan of pain. Looking back, the hardest part was my fear of the insertion. I asked my friend Karen to join me in this scientific experiment. After reading the instructions and staring at the mirror in our bras, we did a countdown and injected the sensor by pushing the applicator into our arms. It sounds a little scary, after all who wants to stick themselves with a needle but this did not hurt, Girl Scout’s honor. And I highly recommend doing scientific experiments with a friend, especially one with a sense of humor, like Karen. We sat down after 2 weeks enjoying a meal of Thai curry soup and fresh salad greens from my garden.
Here are our takeaways of using the CGM for 2 weeks.
Karen’s thoughts - I noticed my highest spike of glucose was after corn and potato soup with pita bread. The morning after my glucose was still high. When possible if I went for 4 hours between meals my BG would come closer back to baseline <100.
Through the CGM, Karen learned about her BG and the relationship to her food choices. According to Karen, this was an empowering journey and well worth it.
Betty’s thoughts - The CGM is like having Jiminy Cricket on your shoulder. My goal was to not spike my BG (go above 140). This led to eating less of foods I suspected would increase BG. As a result, I had better and steadier levels, especially after the first week. After 2 weeks I interestingly had less cravings. Both Karen and I used the Libre 3 Freestyle device.
The individual cost was $75 for 2 weeks.
Friends who have been using CGMS for longer periods:
Mimine- has been using a Libre 3 for 1 year after being diagnosed with pre-diabetes, with a Hgb A1c of 5.9 which is now hovering at 5.7. (Normal Hgb A1c is 5.6 or below). Looking back at her lab work her HgbA1c was 5.8 in 2018. Her doctor did not make these results known nor did Mimine check labs on her portal. A reminder to know and follow up on your labs. Part of the ‘L’ in SLEDSSS.
Mimine is “addicted” to her CGM which keeps her accountable “like having a report card for BG”. She found starchy veggies and complex carbs such as beans, quinoa, and lentils will spike her BG so she sticks with protein, vegetables, and salad for most meals. She recalls her biggest spikes have been with corn, corn chips and rice up to 220. When she wakes up, her BG rises before she out of bed. This is sometimes called the “dawn phenomena”, which can be triggered by our natural cortisol, or the meal one had the day before. Mimine feels the CGM has kept her BG at a better level and she's seen proof of that in the lowering of her HgbA1c.
Mimine pays: $140/month
Al - was diagnosed with pre-diabetes 13 years ago. He has a strong family history of diabetes and heart attacks. He has cut back on carbohydrates and uses exercise to control his BG. His highest HgbA1C has been 6.1 while his last HgbA1C was 5.6. He used the Libre 3 CGM for 6 weeks as an experiment but found it too expensive to continue. He felt it was a useful educational tool and liked the graphic representations of his BG. He discovered his fasting blood sugar (FBG) is variable. His notable experiments included: french fries = 180 spike; small apple = 170 spike; fruits and white bread were “bad”. This was news to Al and he is altering his diet accordingly.
Al paid $75 every 2 weeks.
Summary of our experiment with CGMS:
Portions: of food made a big difference. When Karen had a small piece of cake her BG did not increase. Same for me. When I had 1-2 cups of popcorn no spike, but 3 increased it.
Exercise: all of us agreed that it made a big difference. Al uses it to control his BG. I made a point when I was approaching BG levels of 140 to go for a walk and every time my BG decreased. Make walking for 10-15 minutes after a meal a part of life. Add strength training to help glucose be synced to your muscles so less is in your blood.
Pairing foods: to reduce spikes Karen and I use nuts, (protein and fiber) sources with dessert, fruit, or chocolate. We have since changed our salads to before meals since the acid from vinegar lowers the ph of meals and slows the rate of transition through the intestines creating less BG spikes. Mimine did not find pairing helped.
Carbohydrates: are the biggest culprit for spiking glucose. Generally, the more you eat the bigger spikes. Corn, popcorn, corn chips, potatoes, white bread, and fruit were the culprits that caused the biggest spikes. Some do better with complex carbohydrates, ie. whole grains, but Mimine did not.
Give the body a rest: Continuous eating or snacking will keep your glucose continually elevated, use up more insulin, and increase your risk for diabetes. 3-4 hours between meals is preferable.
Bottomline: we all metabolize glucose differently. CGMS allow you to see how your food choices determine your BG, empowering you to create healthier choices.
LESSONS FROM COACHING:
Most people that work through the brain-body health program are excited about their weight loss, but I have to be honest, I am most happy that they are becoming metabolically healthy and reducing their chances of dementia.
My mother used to say one of the worst things you can drink is juice. Although I shrugged off her wisdom at the time, take a look at this label as proof. This popular juice many of us have had before heading out to school or work. Notice the total sugar 27 grams which is just shy of 7 teaspoons of sugar in one cup. This might be the worst thing you could have for breakfast! Mom was right again. Juices contain no fiber, no protein, no fat, and are high in carbohydrates, and will spike your BG. Juices are the equivalent of sugar plus water. Label reading is well worth your time and your health!
Mom was a wonderful Mother and a great coach! Her memory is a blessing! Hope you all had a memorable Mother’s Day!
LESSONS FROM SCIENCE:
Insulin resistance and how it increases dementia: Studies have also established, et al., 2017).
I want to thank several readers for sending me the CNN report “The Last Alzheimer’s Patient.” This ongoing study is an example of preventive neurology that is having success with the potential to prevent dementia. I will be devoting a future BBH Newsletter about this.
To our optimized health!
Subscribe to the email list for news and updates on Body-Brain Health
“If you want to go FAST, go alone. If you want to go FAR, go together."
- African proverb
To our optimized health!