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Comment by hirundo | Hacker News Reader

I highly recommend getting a continuous glucose monitor and wearing it for at least a few weeks. I was able to find a model at about $35/week, which required a prescription (US).

You can quickly get a good idea about how different foods and exercises affect your blood glucose. For me it was fun and motivating. It's helped a lot to put my diabetes into complete remission. The improvement in my daily quality of life is not subtle.

Since an improvement in your insulin levels can easily add healthy years to your life, it's worth doing even if you have no diagnosis of (pre)diabetes.

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This. If you are in the US, you want a Freestyle Libre 2, which costs what you state, with coupons: $35/week

In the European Union, the Freestyle Libre 3 is available and is far better technology than the Freestyle Libre 2, for a variety of reasons. This also does not require a prescription in Europe. Because I cannot get a Freestyle Libre 3 in Croatia, I order the Freestyle Libre 3 from Abbott Diabetes Care in Germany, without a prescription using a German mail forwarding service (I personally use myGermany). You can ship to the USA using this method. The pricing is also regulated by the German government, so the price of the sensor is reasonable.

I actually use 2 glucose sensors in tandem: a Freestyle Libre 3 and a Dexcom G6. The Freestyle Libre technology is better than the Dexcom. It is also, way, way, cheaper.

While these articles were for older iterations of the Dexcom and Freestyle Libre, they are still very applicable. [1] [2] [3]

I use the Dexcom because it connects to my Tandem t:slim x2 insulin pump and it creates an “artificial pancreas”. It automatically manages my blood glucose, with very little effort. I can get a 6.2 or 6.3 A1c with almost no effort, using only the Dexcom G6 sensor (no Freestyle Libre 2|3 sensor use), and I have an profoundly messed up digestive tract, that really should profoundly mess up my blood glucose values.

Anyways, the Freestyle Libre updates more frequently (1 minute versus 5 minutes) and responds to changes in blood glucose faster than the Dexcom, so I can take action and dose insulin much faster.

With the Freestyle Libre 3, used in tandem with my Tandem t:slim x2 insulin pump using artificial pancreas technology via the Dexcom, my A1c hovers around a 4.9 or 4.8.

[1] https://type1tennis.blogspot.com/2014/12/how-much-faster-is-...

[2] https://type1tennis.blogspot.com/2014/12/14-days-with-dexcom...

[3] https://type1tennis.blogspot.com/2015/02/another-view-of-fre...

I've heard Freestyle Libre, and most portable models, is not very accurate.

Freestyle Libre has the additional feature of continuity, which IMO, is likely to be more inaccurate (generally portable models take a blood drop and give one reading, i.e., are not continuous monitors).

Any thoughts on this?

It’s static (blood glucose testing) sampling versus dynamic (continuous glucose monitoring via interstitial fluid) sampling. The best comparison is that it is like a picture (static sampling) versus a movie (dynamic sampling). It makes a huge difference: you can actually prevent blood glucose fluctuations, blood glucose lows/highs, with a continuous glucose monitor. With a blood glucose meter, at least with type 1 diabetes, you really only can take action after the blood glucose (static sample) is taken, and you really cannot use informed insight moment to moment to prevent things.

The continuous glucose monitors tend to be pretty accurate. The Mean Absolute Relative Difference (MARD) for the ascribed devices:

Freestyle Libre 3: 9.2% (in adults)

Freestyle Libre 2: 9.2% (in adults)

Dexcom G6: 9.0% (in adults)

Also, I regularly test my blood glucose using finger sticks whenever I need to take a fairly large insulin dose and there is a large amount uncertainty of where I may possibly be (such as when my two sensors have a big discrepancy, and especially when my blood glucose is fluctuating). For that, I use Freestyle Lite blood glucose test strips.

About 1 in 25 to 1 in 30 Freestyle Lite test strips I use is about 50 mg/dL off, despite me using proper testing technique, which is quite significant, since my blood glucose values are very tightly managed. It is obvious when it happens, looking at the Freestyle Libre 3 graph, and the Freestyle Libre 3 in this case keeps me from overdosing and causing a serious low.

Really interesting. Thanks for sharing your experience!

In Australia we only have access to the Libre 1. Which is both frustrating as I’d like my girlfriend to have the ease of the Libre 2/3 (bluetooth etc) but it’s tolerable given the more open nature of the first iteration where we double the function life - essentially halving the high cost.

I’m looking at grabbing a Bubble glucose monitor (https://www.bubblan.org/) that adds bluetooth functionality to the Libre 1 amongst other monitoring etc.

Have you looked into OpenAPS / AndroidAPS to move away from the Dexcom? Still learning so this may be an overly simplistic question.

I'm very interested in the Freestyle Libre 3 and the order-from-Germany approach. They don't list the model on their website yet: https://www.freestylelibre.de/libre/produkte.html so I can't check the price.

Can you call on the phone and order? Also how does it work about shipping internationally? Do they ship to Croatia or do you need to ship to a DE address first, then FWD to Croatia. Contact info in profile. If you can send me any info or tips, I would greatly appreciate.

You can also play with the data directly using open source projects like nightscout. I used that to convert a days worth of glucose data into sound :) https://dddiaz.com/post/glucose-sound/

> Since an improvement in your insulin levels can easily add healthy years to your life, it's worth doing even if you have no diagnosis of (pre)diabetes.

Proof that healthy people benefit from caring about something that isn't broken?

You mean like teeth brushing?

No, there is already plenty of proof for that.

In this study it looks like the hazard ratio is at its lowest at about 80 mg/dL. So maybe if you're at that level lowering your glucose/insulin levels won't help.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557842/

I'd love to see what my insulin levels do throughout the day. I have a lot of issues which feel like they're blood sugar related(extreme fatigue after meals, "brain fog", low energy, sleepy all the time but my apnea and nighttime SpO2 is fine, bouts of feeling hypoglycemic), but every time I've checked my glucose levels they're normal. I suspect I am becoming insulin resistant but I'm not sure.

Things seemed to really go downhill after I tried intermittent fasting(16/8).

That sounds a lot like residual effects of Epstein-Barr/Mono and/or Lyme disease.

I feel like there is a weird viral component to this but I'm not sold on that theory. A lot of my problems(apnea, brain fog, worsening attention span) happened when I got divorced. I try to avoid jumping to an unsubstantiated and fringe interpretation, but I do wonder if this is all neuroinflammation from HPV or something. Up until my divorce I had 2 partners. Then again, the stress of the divorce didn't help.

After research indicated that stress can alter DNA on the fly, I became more inclined to consider physio/enviro factors together, instead of allowing one to exclude the other.

Yeah, it's possible that the extreme stress I was under activated a HERV(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1187282/#:~:tex....) and caused a lasting autoimmune issue.

How much coffee do you drink?

Usually a half a cup of fairly weak, instant espresso. Lately I've been increasing it but it doesn't do anything. I'm generally sensitive to caffeine so I drink my usual half-cup over 4-5 hours and sometimes fail to finish it. My genetics indicate I'm a fast metabolizer of caffeine.

Sounds exactly like me, got tested for Epstein Barr and sleep apnea with no results though. Let me know if you find anything.

> I was able to find a model at about $35/week, which required a prescription (US).

Can I get a prescription at Walmart? Asking because I'm in one of the several states where the cost of healthcare exceeds total earnings.

I suppose it's off to the black market to see what's available - same as everyone else around here.

If your are serious I'd suggest a community clinic and apart from that insulin strips. It's not continuous but ballpark.

I am. Our county clinics provide a small list of services - mostly new family stuff like prenatal and inoculations.

Living with diabetes is about decision making. CGMs help some people make better decisions. I’m glad it worked for you.

I’m curious as to what you mean by “remission.” Aren’t you simply making better decisions now which is reflected in your A1C and blood glucose numbers?

I just mean that my A1c is at 5.3% and fasting blood glucose around 85 mg/dL, below the prediabetic range. Yes, that's because of daily decisions. If I ate one pizza I'd get symptoms again.

That’s dope. Congrats. It’s not easy. I’m Type 1 and have been between 5.9% and 6.4% for a couple years now.

Tell us some of the insights you got about different exercises and food on your body

Exercise tends to reduce my baseline glucose, but on the next day. I do best on a very low carb diet, getting most of my energy from fat. It's obvious to me that not everyone is like this. That's why a CGM helps so much. There is no good one-size-fits-all advice, but the CGM lets you develop a bespoke profile.

Just out of curiosity, since it's the other end of the diet extremism: Have you tried an all complex carbs (so no sugar, no broken free carbs), low fat diet?

Are you concerned about other health parameters with your low carb diet? Like high IGF-1 or blood vessel and digestive health?

Yes, I was deeply into the McDougall Program, even went to the week long training. I lost a bunch of weight on it. Then it seems that my body adapted and without changing the ingredients, my appetite returned, and so did the weight.

Something similar happened to me with a low carb paleo diet years later. I've had to become more extreme to succeed. But I think that's because of the damage I've done to my own metabolism with a fork and spoon, and isn't true for most people.

Most people, I think, would benefit greatly from changing to a complex carb diet from a Standard American Diet.

You can also just get regular testing kit on Amazon for $30 that comes with a lancer, test strips, and monitoring device. I bought one recently precisely after reading a headline like this to keep an eye on myself.

Yes, but you will also quickly learn why diabetics complain about this method of testing.

do you have diabetes? suggestions on getting a perscription?

I've used Levels, but at $400/mo, not very sustainable.

I'd have access to health insurance, I'd be happy to nag my primary care doctor for a prescription.

My doctor was happy to give me a prescription for the cost of an office visit. I've heard that's generally the case. The only reason not to provide them OTC seems to me to be an outrageous and harmful paternalism.

Can you buy one without a prescription?

https://www.nutrisense.io can send you CGMs without a prescription, but isn't available yet to diabetics for that reason. There's an online evaluation. It's far more expensive than just the Freestyle Libre CGM they provide, but their app is far better, and the price comes with a decent consulting service.

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