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:

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.

Recipe: Beef Meatballs – Grass Fed, Grass Finished

2019.09.18 Grass Fed Beef Meatballs, Washington, DC USA261 23208
2019.09.18 Grass Fed Beef Meatballs, Washington, DC USA261 23208 (View on Flickr.com)

Recipe time…

This is the last nose-to-tail sourced meal of group I experimented with in the last month or so. I’m learning a lot about regenerative grazing, ruminant agriculture, and respect for the spectrum of humanity working to achieve metabolic health.

When it comes to diet, one size does not fit all – we should not add “as long as it’s our size.” It’s healthy people healthy planet, not one or the other.

The Recipe

It turns out there are a plethora of meatball recipes online. I wanted something very simple, with real food, so I simply took a pound of 78% ground beef, added a real egg, and baked for 20 minutes at 400 degrees.

The blood glucose levels

As predicted, this meal, and every one like it, did not raise blood glucose levels.

Isn’t the human body amazing?

We’re in the era of diabetes reversal, why don’t more doctors know?

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)

Thanks for Publishing my Photo, PoPville , in “Mayor Bowser Calls On Congress to Grant DC Residents Their Full Democratic Rights by Making Washington, DC the 51st State”

2019.09.14 DC People and Places, Washington, DC USA 257 27038
2019.09.14 DC People and Places, Washington, DC USA 257 27038 (View on Flickr.com)

Thanks (again) for publishing my photo, @Popville, in this piece on the potential of DC Statehood.

This is another view from one of DC’s newest rooftops, in the NoMA neighborhood. Enjoy the photo.

Photo by PoPville flickr user Ted EytanFrom the Mayor’s Office:”Today, Mayor Muriel Bowser testified before the House Oversight and Reform Committee at a hearing on the Washington, DC Admission Act (H.R. 51), the first House hearing on DC statehood in over 25 years. H.R. 51 has been cosponso

Source: PoPville » “Mayor Bowser Calls On Congress to Grant DC Residents Their Full Democratic Rights by Making Washington, DC the 51st State”

Thanks for Publishing my Photo, in The Past, Present, And (Potential) Future Of D.C. Statehood, Explained | DCist

2017.11.23 DC People and Places 0676
2017.11.23 DC People and Places 0676 (View on Flickr.com)

Thank you for publishing my photograph, @DCist, in this timely and informative piece on DC Statehood – it’s an informative read.

The photograph was taken in the Shaw neighborhood in Washington, DC, home and former home to many civil rights leaders/revolutionaries.

Enjoy.

We’ve got answers to all the questions you were afraid to ask about the District’s bid to become the 51st state.

Source: The Past, Present, And (Potential) Future Of D.C. Statehood, Explained | DCist

Thanks for Publishing my Photo, PoPville 

2019.09.14 DC People and Places, Washington, DC USA 257 27015
2019.09.14 DC People and Places, Washington, DC USA 257 27015 (View on Flickr.com)

Thanks for publishing my photograph, @Popville.

The mural in the photo is called “28 Blocks” and you can read about it here: See: Northeast D.C. Gets A New Mural Honoring The Workers Who Built The Lincoln Memorial Statue | WAMU

My photograph was taken from one of Washington, DC’s newest rooftops, of the NoMA neighborhood, which is rapidly transforming (again). It’s why I call it “NoMAgical”

Photo by PoPville flickr user Ted EytanYou can talk about whatever is on your mind – quality of life issues, a beautiful tree you spotted, scuttlebutt, or any random questions/thoughts you may have. But please no personal attacks and no need to correct people’s grammar. This is a place to vent a

Source: PoPville » Random Reader Rant and/or Revel

Just Read: Understanding Global Methane Emissions as a Family Physician without Diabetes (and hoping to keep it that way)

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001 776
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001 776 (View on Flickr.com)

“Methane” is said to me as a statement a lot. When I probe if there’s more information behind the statement, I don’t hear very much.

The overwhelming majority of physicians do not have a good understanding of climate science. It’s okay, we’re all on a learning journey 🙂 .

We should understand:

  • Climate change is a threat to human health
  • Diabetes, now a global epidemic, is also a threat to human health
  • Physicians / health professionals have a role in the mitigation of both, with the right information
2018.05 Low Carb and Low Carbon - Ted Eytan MD 2-1002 770
2018.05 Low Carb and Low Carbon – Ted Eytan MD 2-1002 770 (View on Flickr.com)

Above are calculated global sources of methane as well as modeling of the sources of the increase since 2008.

Methane is a greenhouse gas that is not the same as carbon dioxide. It has 28 times the global warming potential (GWP) of carbon dioxide. At the same time, it also has a much shorter half-life in the atmosphere, typically broken down in 12 years, unlike carbon dioxide with a half life of 1,000 years. Therefore, methane is important as a contributor to climate change, and also an important lever to mitigate it, because a reduction brings benefits much faster. For a deeper look at how this is calculated, see: Photo Friday: Beef Brisket, Brussels Sprouts and GWP*: in search of my/the Sustainable Diet

This paper (reference below) is a discussion piece on the causes of a “massive” increase in methane in the atmosphere in this century, by Robert Howarth, PhD, at Cornell (Twitter:Howarth_Cornell). He does a great job in this video explaining the methodology and the idea that previous descriptions of methane increases being driven by biogenic sources (agriculture) are probably incorrect.

Increases in Methane
Figure 1(a) Global increase in atmospheric methane between 1980 and 2015. (b) Change in δ13C value of atmospheric methane globally between 1980 and 2015. Both adapted from Schaefer et al. (2016). Used under Creative Commons license,Howarth RW. Is Shale Gas a Major Driver of Recent Increase in Global Atmospheric Methane? Biogeosciences Discuss [Internet]. 2019 Apr 23;1–23.

The image on the right, above, shows a steady increase in methane, a plateau, and then a steep rise. Below it is an image of the isotopic composition of the methane. It shows, as Howarth explains, that the rise before the plateau probably has a different cause than the rise after the plateau.

Not shown here are satellite images of global methane emissions….well okay, let’s show the satellite image…

Satellite image of methane emissions
Figure 2: The 2010–2014 trend in U.S. methane enhancements as seen from GOSAT. The methane enhancement (Δ methane) is defined as the difference in the tropospheric column mixing ratio relative to the oceanic background measured in the glint mode over the North Pacific (176–128°W, 25–43°N) and normalized with the 2010 Δ methane. Trends are computed on a 4° × 4° grid. Statistically significant trends (p < 0.01) are indicated by a dot. Source:Turner AJ, Jacob DJ, Benmergui J, Wofsy SC, Maasakkers JD, Butz A, et al. A large increase in U.S. methane emissions over the past decade inferred from satellite data and surface observations. Geophys Res Lett [Internet]. 2016 Mar 16 [cited 2019 Sep 19];43(5):2218–24. Used under Creative Commons license.

They show a signifcant rise coming from the United States, which has not increased its cattle herd, but has significantly increased production of fossil fuel energy.

Given our finding that natural gas (both shale gas and conventional gas) is responsible for much of the recent increases in methane emissions, we suggest that the best strategy is to move as quickly as possible away from natural gas, reducing both carbon dioxide and methane emissions. Natural gas is not a bridge fuel (Howarth, 2014).Howarth RW. Is Shale Gas a Major Driver of Recent Increase in Global Atmospheric Methane? Biogeosciences Discuss [Internet]. 2019 Apr 23;1–23.

Healthy People and Healthy Planet, not one or the other

Climate scientists are urging us to consider a bigger picture than we currently are, in the interest of our survival.

We don’t need to ban cars; we need to electrify them (and we need that electricity to come from clean energy). We don’t need to ban burgers; we need climate-friendly beef…The bigger issue is that focusing on individual choices around air travel and beef consumption heightens the risk of losing sight of the gorilla in the room: civilization’s reliance on fossil fuels for energy and transport overall, which accounts for roughly two-thirds of global carbon emissions.See: Individual Choices Won't Be Enough to Save the Planet | Time@MichaelEMann

Consistent with the views above, I have been witnessing cognitive dissonance in the health professions and society in general: Just Read: Carbon footprint of the global pharmaceutical industry – “Significantly worse than the automotive industry”.

The Climate is Changing

  • Plot your home city temperature and see for yourself. I did, this is Washington, DC:
2018.08.03 Low Carb and Low Carbon, Washington, DC USA 504
2018.08.03 Low Carb and Low Carbon, Washington, DC USA 504 (View on Flickr.com)

Climate models

My generation of physicians trained in an era where we had no choice but to develop insatiable curiosity; as I shared in my TedX talk way back when, the lack of it in the generation before us was devastating.

Besides the work of Robert Howarth, I’d like to acknowledge Peter Ballerstedt, PhD (@GrassBased), our metabolically healthy forage agronomist on call…

As usual, I welcome the checking of my work, feel free to post in the comments.

References

  1. Howarth RW. Is Shale Gas a Major Driver of Recent Increase in Global Atmospheric Methane? Biogeosciences Discuss [Internet]. 2019 Apr 23;1–23.
  2. Turner AJ, Jacob DJ, Benmergui J, Wofsy SC, Maasakkers JD, Butz A, et al. A large increase in U.S. methane emissions over the past decade inferred from satellite data and surface observations. Geophys Res Lett [Internet]. 2016 Mar 16 [cited 2019 Sep 19];43(5):2218–24.
  3. Lifestyle Changes Aren’t Enough to Save the Planet. Here’s What Could
  4. Scientific Consensus | Facts – Climate Change: Vital Signs of the Planet

Thanks for Publishing my Photo, in Morning Roundup | DCist

2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33044
2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33044 (View on Flickr.com)
2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33040
2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33040 (View on Flickr.com)

Thanks for publishing my photo, @DCist.

It is an image of Washington, DC’s newest mural, featuring Ruth Bader Ginsburg, Supreme Court Justice, one of many iconic pieces on U Street, NW.

Artist Credit: Rose Jaffe, more photos below, enjoy.

Source: Morning Roundup: A Boy Falsely Yelled About An Active Shooter In A Ballston Movie Theater, Setting Off A Panic | DCist

Photo Friday: “Just Focus on Being Excellent” (The 20th Century was a long time ago and it’s not coming back)

2019.09.12 Happy Birthday Ashley, Washington, DC USA 254 24032
2019.09.12 DC People and Places, Washington, DC USA 254 24032 (View on Flickr.com)

This week’s photos were taken in Washington, DC USA (Of course) at a special event featuring CNN’s Don Lemon (@DonLemon), quoted in the title, at the @Newseum, and attended by the leadership and volunteers of @CapitalPrideDC @DCTransPride365.

The occasion was a great one to celebrate and have gratitude for the fact that (a) we’re here (b) we were helped by the courage of the people who came before us, who didn’t look like us or have the same backgrounds as we did, and for me, that the 20th Century was a long time ago, and it’s not coming back.

The 🌎 is an amazing place with people in control of their health and life destinies 🏳️‍🌈. PS, Isn’t Washington, DC beautiful?

Enjoy the photos.

2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA  255 72043
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72043 (View on Flickr.com)

The Newseum continues its series of programs celebrating the “Rise Up: Stonewall and the LGBTQ Rights Movement” exhibit with an evening featuring CNN anchor Don Lemon.

The program is the latest in a series of events marking the 50th anniversary of the June 1969 police raid of New York’s Stonewall Inn and the protests that inspired the modern gay liberation movement. The “Rise Up” exhibit explores what happened at Stonewall and how it gave rise to a 50-year fight for civil rights for LGBTQ Americans.

Lemon will discuss media coverage of the gay rights movement from its early days to the present and how media coverage has helped change public views about the LGBTQ community. He will also talk about his own life and career.

2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA  255 72075
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72075 (View on Flickr.com)
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA  255 72068
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72068 (View on Flickr.com)

Thanks for Publishing my Photo, in “Is Weight Loss on Ketosis Sustainable?” | NutritionFacts.org (This one has facts in it)

2018.07.22 Ketofest, New London, CT, USA 05159
2018.07.22 Ketofest, New London, CT, USA 05159 (View on Flickr.com)

Thank you for using yet another photograph as the thumbnail/opener for this video, Nutrition Facts (TW:Nutrition_Facts).

About this photograph, I have to say, wow, it was part of a great moment for me, because it was

  • Real food, not CRAP – Calorie Rich and Processed Foods – we both agree this is bad!
  • My dinner for the evening, and it’s true, I wasn’t hungry after
  • Cooked by people who have achieved metabolic health
  • Shared with inpiring humans, who can (and do) teach doctors a lot about being better for the people they serve
  • Shared with incredible doctors, too

Excuse the hard light and shallow depth of field – I was using a fancy camera in a low light / hard light situation.

That’s pulled pork, which is also NOVA Classification Group 1: Unprocessed or minimally processed food(s). The sausage is NOVA Classification group 3: Processed foods. Group 4 is ultra-processed foods – see this post for photos of Group 4 foods (which are plant based…)

I was with Brenda Zorn (@ZornFast), Kim Howerton (@TheKetonist), and Eric Westman, MD (@DrEricWestman), among others:

2018.07.22 Ketofest, New London, CT, USA 05164
2018.07.22 Ketofest, New London, CT, USA 05164 (View on Flickr.com)

They are pioneers, patient teachers (and teachers who are patients 🙂 ), and their stories remind me of the reason I came to medicine:

2018.07.22 Ketofest, New London, CT, USA 05170
2018.07.22 Ketofest, New London, CT, USA 05170 (View on Flickr.com)

As far as I can tell, we’re all maintaining our weight on our real-food low-carbohydrate diets. I’m a formerly fat person so I have that experience as well.

Facts, they are present in this video

I reviewed the video and the transcript and my impressions are

Standard American DietStandard American Diet (SAD) – yes, it’s CRAP – Calorie Rich and Processed Foods – Source: USDA ERS – A Look at Calorie Sources in the American Diet
  • I recognize some facts
    • Despite the cherry picked references which are endemic in these formats, the points made about using isocaloric diets in research corroborate the data I’ve seen
    • Agreed that studies that move people from highly processed to unprocessed, real foods tend to show improvement, plant based or plant free. This is a huge problem in nutrition research.
    • Anything is better than the standard American diet (SAD)

More cognitive dissonance – telling people what not to eat, forgetting that they will eat something in its place

I see a link to a video cautioning against eating too much soy, as well as an animation showing virtually all food choices removed from the standard American diet. This gets us back to a big problem – people ultimately will eat something. That’s sort of required….

I actually use the photo above in a montage to elucidate how much better a meal like this is than the meals that health professionals and climate change experts serve themselves at their own meetings. Take a look:

2018.07.25 Low Carbon and Low Carbohydrate 485
2018.07.25 Low Carbon and Low Carbohydrate 485 (View on Flickr.com)

Yes, CRAP. Note: these “replacements” are all plant-based.

Plant-based does not have to be unhealthy (and neither does animal-sourced). These versions of it are, and sadly, they are the ones I see the most of in these settings.

2019.06.27 Low Carb and Low Carbon, Washington DC USA 1780005
2019.06.27 Low Carb and Low Carbon, Washington DC USA 1780005 (View on Flickr.com)

Your Readers – Now they’re confused

  • The tone and tenor of this one isn’t as negative as the other ones
  • The comments also belie the false dichotomy of this series, that a very-low-carbohydrate diet is the opposite of plant-based one (it’s not).
    • The question that keeps getting asked is not responded to – “Can a plant based diet be low carbohydrate?” – it’s asked again, and again, and again (answer is yes)
  • Your readers are now confused

I thought Dr Greger said in a previous video that keto diets are bad, the example he used was about the man who went on one and then he had a heart attack.

Why is there contradictory information I don’t know what’s healthy or not.

Thank you for the platform

I’m still working on food photography – I could not have predicted that a/the platform for sharing my work would be NutritionFacts.org. If they help humanize the drive to achieve and maintain metabolic health for all people, I’m in support, and I celebrate all people who are finding their way to a long health span and life span.

Enjoy the photo. There are more coming, and I still ask the question, “We’re in the era of diabetes reversal, why don’t more doctors know?”

Might the appetite-suppressing effects of ketosis improve dietary compliance?

Source: Is Weight Loss on Ketosis Sustainable? | NutritionFacts.org