Part 3: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: What’s Normal?

2018.05 Low Carb and Low Carbon - Ted Eytan MD.001-546
2018.05 Low Carb and Low Carbon – Ted Eytan MD.001-546 (View on Flickr.com)

I have been analyzing data from the Continuous Glucose Monitor (CGM) experience I’ve been having (see these posts for more: Why I decided to wear a continuous glucose monitor as a non-diabetic physician , and Part 2: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: The Experience) and I had run into a problem – I couldn’t find any data on what’s physiologically “normal”.

Since that time, I’ve consulted with two endocrinologists (thank you!) who have generally confirmed this problem, and also that what I’m seeing for myself is expected physiology, so I’ll begin sharing some of my findings, including the experience pictured above.

Glucose/Fat/Industrial Oil Challenge for a Fat Adapted Individual

As is pictured above, I had several bites of the dessert above, about 30 minutes after my standard diet, low carbohydrate/healthy fat, with the results pictured in the lower right corner. Essentially not much of a glucose rise at all. This was expected and also not-expected because I’ve been told that a person who’s fat adapted and has a lower basal insulin secretion could have a disproportional rise to a glucose challenge. On the other hand, there was probably enough fat in the meal above to impact things.

Finally a study of what CGM shows in a group of normal individuals

This is what gives me the confidence to share what I am beginning to share. Incredible that only until 2018 have we been able to really explain how the human body manages glucose throughout the day.

See: Virtual Meeting | EASD

Disclaimer and this is not a promotion of CGM-for-all

I’ve been asked directly or indirectly recently if I am advocating CGM-for-all. I am not, and definitely not with the current profile of devices available. This could change dramatically if CGM is more universally available (see blog posts above).

Reminder of my statement of independence and no conflict-of-interest:

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

If this is not a promotion of CGM-for-all, what is it?

It is:

  • Promotion of CGM for people charged with serving other humans to understand their own physiology so that they can be better servant leaders
  • Promotion of understanding of the role of non-pharmacologic, nutritional approaches to preventing, reversing, and potentially pre-empting diabetes. I don’t think there’s any argument that eliminating this condition with real food rather than pharmaceuticals is ideal. If there is, I’d love to hear it 🙂 .
  • Promotion of CGM to reduce and eliminate bias in the health care system – a fascinating other use that I did not discover until I started sharing my experience. I’ll post separately on that.

Any questions/comments, feel free to leave them in the comments, as usual.

7 Replies to “Part 3: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: What’s Normal?”

  1. Looking at the pictures you use a Flash device and one presentation was about difference between Flash (aka libre ) and Dexcom (CGM) https://www.easd.org/virtualmeeting/home.html#!resources/the-i-hart-cgm-study-hypoglycaemic-episodes-reduced-with-continuous-glucose-monitoring-compared-to-flash-in-adults-with-type-1-diabetes.

    One of points was hypoglycemia awareness leading to better(stable) bloodglucose control. This was for type 1. I would suggest that it’s a physiological problem for non diabetic as well, specially if you need to be physical active and problem get worse with age.

    1. Thanks for reading. What’s missing for me in these studies is impact of diet in reducing insulin to begin with. Also this study appears to be industry funded which is challenging for interpretation. I don’t believe hypo episodes are an issue for insulin-sensitive people without hyperinsulinemia. Thank you for posting! Ted

  2. Thank you Ted for this great information.

    As a healthcare worker with 21 years hospital experience who is the grandmother and caretaker of a T1D child diagnosed at 2 yrs (she just turned 5), it is IMO, incomprehensible for the average medical pro to be able to understand the daily and often, nightly grind the patient endures. Not to mention what the caregiver endures in the case of children or disabled patients.

    I seldom sleep more than 2 hour stretches when I babysit overnight just because of the responsible paranoia (for lack of a better term) that I’m burdened with to constantly check the blood glucose levels. Finger sticks used to be my norm until the CGM was approved.

    This paranoia is the legacy of fear after witnessing an urgent low that I almost missed in the early days after diagnosis before the CGM was approved by the insurance company. She could easily have passed away under my watch and I could not live with that and I won’t risk it happening again.

    For that reason alone, I would have bought the CGM outright and out of pocket (OOP) if I’d known what a lifesaver it is. I recommend it to anyone with a diabetic child who is made to wait for prior auths and insurance approval processes. They can be reimbursed later by insurance, but even without insurance, it’s more important to any parent than any other expense. Just my opinion after too many sleepless nights of 2 hour finger pricks.

    Another reason I have to thank you Ted, is that I recently checked my own glucose just out of curiosity in the middle of the night and discovered it was higher than it should be in a non diabetic. I’ve rechecked several times and it’s consistently elevated and it got my attention. Despite a healthy diet and 5 days a week of lifelong exercise and being metabolically fit according to my annual labwork, I’m apparently on a collision course with diabetes.

    I’m not waiting or guessing before requesting a prescription for my own CGM and sensors that I’ll pay for OOP. The cost is no small matter considering that the sensors for my GD’s device is $400 (covered by her insurance) for a 1 month supply. The reader cost $700.

    I’ve concluded that the general population and healthcare industry would benefit from a future less expensive CGM program because it would help turn the tide in the growing epidemic and fight against diabetes that’s just not realistic at the current price for the technology.

    It’s what preventive health care is all about if it can be made available and affordable.

    1. Dawn,

      Thanks for taking the time to relate your experience. I agree with you that I was never taught about the incomprehensible requirements placed on people living with diabetes. They are still incomprehsensible to me. Granted, when I went to medical school, people living with diabetes wasn’t 12% of the US adult population (it was closer to 2%); now more than ever it’s important for us to experience more than we do.

      I was just referred a study about the fact that people diabetes can develop over up to 20 years before it’s noticed in the medical system; I’ll post on that shortly.

      Re:CGM, myself and others believe it will eventually be integrated into the regular consumer electronics we use daily (eg Apple iPhone/Watch). Until then, there are several manufacturers who sell models that are far cheaper than the one you’re using, in the $40-50 per sensor, $60 per reader – take a look at what’s available, and best of health to you & your family,

      Ted

      1. Thank you so much for your reply. I’m relieved to read about the disparity in other CGM brands and lower costs and will research all.
        I’m also very encouraged by the advances in just 2 years that will help parents and newly diagnosed children cope thanks to ncreasingly compatible smart phone apps now applicable to both Android phones as well as Apple because it eliminates the need for the expensive receiver.

        The best improvement just happened last month with a redesigned sensor applicator that reduces the pain of the sensor wire injector to almost imperceptible. No more screams is just plain heaven sent compared the last 3 years.

        1. Dawn,

          Agreed. The sensor that I use is quite easy and painless to apply, the technology is impressive. Please keep me posted if you would and thanks for sharing your story, it’s meaningful,

          Ted

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