Part 11: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: The Experience (Updated for 2019)

2018.11.21 CGM Sensor 5 with iPhone scanning, Washington, DC USA 08283
2018.11.21 CGM Sensor 5 with iPhone scanning, Washington, DC USA 08283 (View on Flickr.com)

In Part 1 (2018) of this series, I described why a physician without diabetes (me) would wear a continuous glucose monitor (CGM): Why I decided to wear a continuous glucose monitor as a non-diabetic physician

I followed up with a Part 2, which this post updates based on the change in technology.

Disclaimer/Caveats

2018.11.07 Low Carb and Low Carbon 583
2018.11.07 Low Carb and Low Carbon 583 (View on Flickr.com)

Acquiring the device

In the United States, a physician order is required to purchase the device, even if using personal funds (which I did – no health care premium dollars were used to subsidize this experiment). In Canada, this is not the case, as physician colleagues there have been able to purchase the device over the counter. The manufacturer will assist by providing the wording of the order that the physician needs to write to allow access at a retail pharmacy.

The device was initially sold as two devices, a reader and a sensor. The reader is still available, but no longer necessary as the sensor now communicates directly with an iPhone via NFC.

Installation and Operation

2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1285
It stays put, and it doesn’t hurt. 2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1285 (View on Flickr.com)

The system is ingeniously put together. I assume it has to be for something as sensitive as diabetes management. The sensor comes with an applicator that pushes a close to 1″ needle into your upper arm, in my case my triceps muscle. The sensor will stay there 24/7 for 14 days. It is safe to bathe, swim, or workout with the sensor in place. I did all of these things, sometimes quite intensively, and the sensor worked for the entire time.

I have now had incidents of sensor loss either due to scraping my arm against a hard object like a door or another person. I tend to walk in a protection stance when I am wearing the device.

I don’t mind being asked what it is wherever I go. It’s a good test to see how much the population knows about this technology (not very much at all) or the experience of having diabetes. Currently 88% of the US population does not have diabetes. In a future iteration, it might be nice to have a flesh colored sensor that doesn’t stand out as much. In my situation, though, I’ve loved every conversation started with the device.

This brand of meter arrives calibrated; it will be 1 hour before you get your first reading, and then readings will occur every 15 minutes if you don’t do anything. You can acquire readings more frequently if you’d like, up to 1 a minute.

The sensor will store 8 hours of readings, which means you need to scan the sensor at least that often, or you will lose data. This experience, of being tethered to a device like this, was a good experience for me to have. Why? Because all I needed to do was wand the sensor every 8 hours. This is a fraction of the work that a person living with diabetes must do to maintain their health and prevent life threatening complications.

When a reading is scanned, there’s an option to include information about food (carbohydrate counts), exercise, or other custom notes. The device keeps track of pre-meal and post-prandial readings, which is nice.

The Interface and the Software

The iPhone app has a fairly simple interface and will do some basic trending.

There are two official software options to analyze the data: A desktop software program, and web-based one. The desktop software only works with the older reader-version of the kit. I now exclusively use the web-based version of the software. The phone automatically uploads all readings to the manufacturer’s cloud for analysis.

The iOS software is more elegant in terms of setup and manages a few issues that I noticed with the desktop software’s assumptions about target glucose level and carbs per meal.

The interesting thing is, there’s really no reference on what a glucose level should be for a non-diabetic person on a 24/7 basis. There’s this guidance from Richard Bernstein, MD:

“Keep Your Glucose Levels Tightly Controlled Between 70 and 100 mg/dl all day long, everyday… or else you will pay the consequences.”Source

I am managing to do that quite well, and where I used to do sophisticated analysis with the raw data, I find I can tell stories from the data that’s presented day by day, like this one:

Isn’t it amazing how the liver can shovel glucose into the tissues at high speed, on demand, even though none (glucose) has been eaten (it is):

2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012
2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012 (View on Flickr.com) See post: Recipe: Beef Meatballs – Grass Fed, Grass Finished
2018.05 Low Carb and Low Carbon - Ted Eytan MD 2-1002 756
2018.05 Low Carb and Low Carbon – Ted Eytan MD 2-1002 756 (View on Flickr.com) See post: Part 10: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: Impact of a (mostly) meat diet; Learning about the lives of people with diabetes

New Insights, Much Wonderment

2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1198
2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1198 (View on Flickr.com)

To be able to see how your body regulates glucose is really a thing of wonder that we haven’t been able to do until now. I am in awe of what the body can do, and do it well. At the same time, I am also in awe of the impact of the body failing to do what it needs to do well, and how serious a situation that can be, especially if worsened by the nutrition/advice given by the health profession(s).

The photo to the right is one of my first measurements, from the old (reader) kit

88% of people with prediabetes don’t know it

I understand that things like ECGs are being integrated into the wearable world, but really, they don’t hold a candle to the impact of understanding one of the most important risk factors for health and life. This is especially true in a country where the majority (88%) of people with pre-diabetes don’t know they have it, and are therefore very likely to progress to fulminant diabetes.

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  454
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 454 (View on Flickr.com)

This paper shows a graphic of the incubation period – up to 10 years before glucose intolerance shows in normal screening

2018.10.24 Low Carb and Low Carbon 572
2018.10.24 Low Carb and Low Carbon 572 (View on Flickr.com)

The future

The old reader has now been integrated into our mobile phone. I’m sure the engineers in Cupertino will be able to tell us what will happen to the sensor… 🙂

Should every human wear a continuous glucose monitor? I’m not sure. Should they wear it episodically to see how they’re doing? Maybe. I previously posted on a paper describing today’s use of CGM in medical practice, and its gaps in not recognizing this device as a part of a diabetes pre-emption strategy.

Will these be integrated into wearable devices eventually anyway? Probably.

I’ve since purchased many more sensors and there are now many parts to this story, which you can access here

My Why (am I doing this)?

I get asked this a lot. Read:

Feel free to ask questions or add comments in the comments.

My disclosures

I have none. You may see a full accounting on this page.

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