Continuous Glucose Monitoring (i.e. life of a cyborg 🤖)

Trends are more important than individual glucose readings. 📈

Remember how my doctors thought I might be pre-diabetic?

Well, per their recommendation, I wore a continuous glucose monitor (CGM) for a month to get a deeper look at what was going on in my body.

Do I have a career in medical device modeling?😂

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What is Continuous Glucose Monitoring (CGM)?

Continuous glucose monitoring (CGM) is an innovative technology that revolutionizes how individuals with diabetes can monitor and manage their blood sugar levels. But how does continuous glucose monitoring work? A CGM device consists of a tiny sensor inserted beneath the skin, typically on the abdomen or arm. This sensor continuously measures glucose levels in the interstitial fluid surrounding the cells and transmits the data wirelessly to a receiver or compatible smart device.

The real-time glucose readings and trend arrows in CGM systems provide invaluable insights into your glucose patterns and fluctuations. This empowers you to make timely adjustments to your insulin dosages, dietary choices, and physical activity levels, optimizing your diabetes management.

While CGM is not an absolute necessity for everyone with diabetes, it is an invaluable tool that can significantly improve your overall glycemic control and quality of life. Your healthcare provider may recommend CGM if you have type 1 diabetes, struggle with frequent hypoglycemia or hyperglycemia episodes, or face challenges in achieving stable blood sugar levels with traditional monitoring methods.

CGM technology is suitable for adults and children aged two years and older (specific age restrictions may vary). However, you'll need a prescription from your trusted healthcare provider, who will assess your needs and guide you on using the device effectively.

Embracing CGM can be a game-changer in your diabetes journey, offering enhanced convenience, improved glucose control, and a deeper understanding of your body's unique responses. Discuss with your healthcare provider if incorporating a CGM into your diabetes management plan could benefit you.

Here’s what my CGM (Abbott’s FreeStyle Libre) looks like out of the box:

if you’re not already — follow Rupa Health on instagram for the behind the scenes!

TLDR: I was a cyborg for a month. It was awesome.

Here are some interesting things I learned:

1. It’s prescription only in the U.S. 📝

Yup. Currently, it’s a regulated medical device. If you want one, you need a doctor’s approval. And that’s pretty hard to get. (The doctor or practice needs to be contracted with the lab that makes the CGM, yada yada)

The kicker? If you live in other countries like the U.K., you can just one-click order online as if you were buying toilet paper.

2. It doesn’t hurt at all.💪

I was slightly nervous about having a needle in me 24/7, but the marketing is true — you don’t feel ANYTHING at all. Not even when it goes in. The needle is about a half inch and extremely thin — like acupuncture needles!

3. The device doesn’t actually measure blood glucose. 💉

The CGM is actually measuring glucose from the interstitial fluid (fluid surrounding your cells) just under your skin. Glucose moves from the blood to the interstitial fluid so there’s a slight delay between the action and the reading. i.e. Taking the reading as you’re chewing that bite of pizza is not going to tell you as much as doing it maybe 15 mins after.

4. Trends are more important than individual glucose readings. 📈

When I first put my monitor on — I didn’t know how to interpret my glucose numbers. To date, all I’d been told about glucose was fasting glucose of 100mg/dl — 125mg/dl was pre-diabetes and 125mg/dl and above was diabetes. But what about the times I wasn’t fasting? Those numbers didn’t make sense for interpreting the CGM.

It’s obvious in retrospect, but continuous monitoring is very different than getting a blood test. It’s an entirely different way of thinking about your levels. Instead of being a point in time, it’s a continuous curve. So any one reading on the CGM isn’t going to tell you much. Instead, focusing on the direction and speed of your glucose changes is key.

Which is very interesting. We’ve been taught to focus on individual numbers.Temperature — do you have a fever or not? Blood pressure — is it high or low?

But in the future it’s going to be — how has your temperature changed throughout the day? What were you doing right before it started to spike? How fast did it come down? What does your blood pressure look like throughout the day? Was it going up rapidly during that meeting at work? When does it start to fall?

We’re going to be able to match actions (external) with our body’s response (internal) to find personalized patterns and optimize our health. That’s pretty cool.👏

5. Coming back to baseline glucose levels is more important than how high it spikes.🎢

A horribly simplified explanation of blood sugar regulation: When you eat, your body digests the food and the glucose enters your bloodstream. Ideally, insulin comes in the picture when it’s time to take the glucose out of the blood and into the cells for energy. The important piece is that insulin enters in the right amounts to bring down the sugar in the bloodstream. So actually, it’s not how HIGH we spike when we eat, but our ability to regulate and come back to a healthy blood sugar level. (oversimplified, as there are negative consequences to continually having high spikes.)

But interesting. Because almost everyone asked how high my glucose was spiking. (Even nutritionist friends, doctor friends, etc) What we should be asking is “Are you able to come back to healthy levels 1–2 hours after eating?”.

6. However, sugary beverages spiked my glucosethe most.🍜

While spikes are not the only metric — they’re still important. Sugary fluids spiked my glucose MUCH more than pizza, cake, or ice cream (and yes, I tried them all😂- in the name of science and sacrificing my body for research.) Especially on an empty stomach. And not just sugary fluids like Coke. It was Matcha with honey. Chai Lattes. Even Ramen (the broth + noodles)! Makes sense — since there’s no fiber to digest, really, and the sugar just hits my bloodstream like a slap in the face.

7. Glucose isn’t everything.🍪

There were many moments I felt hungry, tired, out of it, dizzy etc — and my glucose seemed to be stable. Was it the monitor? Was it something else in my body? Jury’s still out & it was a great reminder not to overly obsess on a single metric.

8. The future will be wild. 🤩

Here’s the thing — we rarely get an inside scoop at what’s going on inside our body (much less in real time). Instead we are forced to look at lagging indicators like weight or A1c that are difficult to influence.

We only notice our body when it gets so obviously bad we can’t ignore it. We can’t clearly draw the line between our daily actions — what we eat, how we move, etc — and how they impact our internal state.

Not being able to monitor our internal state also makes is hard for us to confidently take action and self-regulate.

That headache we’re experiencing? Is it because our blood sugar is low? Or are we thirsty, stressed, or just tired? Did we eat something bad or take a medication that didn’t agree with us?

We don’t know what got us here, and it’s a game of guess and check to solve the problem.

That critical feedback loop is missing: I do X to my body and my body’s response is Y.

Without understanding our body’s response (that Y) — it’s extremely hard to make good personalized health decisions. Period.

I’ve always dreamed of a world in which we as individuals are able to look inside. No more guessing.

How cool would that be — to know what is going on inside our bodies in real time & be able to respond to that.

I’ve fantasized about that world quite a bit. And with my CGM, I got a tiny glimpse of that reality.

🤩 The future’s not that far away. And it’s pretty cool.

Love,

Tara

P.S. Turns out I’m not pre-diabetic, but we’re back to the drawing board with figuring out what’s going on with some mysterious symptoms.

💩P.P.S. Struggling with digestive issues?

Or know someone who is? (IBS, IBD, Leaky Gut, SIBO, undiagnosed symptoms, etc.) We’re about to launch a functional medicine pilot program for patients with these conditions, and we’re covering 70% of the cost for our initial batch. You’ll get to work 1:1 with a functional medicine doctor, get 24/7 access to a care team, and more. Just email me at tara@rupahealth.com if this sounds like something that could help you — it’ll come straight to me (Tara)!