FDA clears first over-the-counter continuous glucose monitor
fda.gov
fda.gov
It's sort of like tracking your steps when you first get a smart watch. It may not have been the reason you got the device, but seeing the data, people are encouraged to act on it, even if you don't have an acute issue. since I didn't have a prescription, I couldn't get one here (didn't want to go through some sketch online site). I tried to get one from my family in India, but the prices were really high and they couldn't get the fancier one that tracks straight to your phone, so I didn't get one.
I think this could be a god send for preventing pre-diabetic people who would take preventative steps if it weren't such a pain in the ass to measure consistently.
The parent comment mentioned feeling tired after consuming something with a lot of sugar, was that really a mystery prior to using CGM? I doubt it.
Sure it's interesting to correlate to your perceived wellness (or lack thereof) with a wearable spitting out data but after the novelty of this discovery wears off my guess is that people will simply stop caring to check what they already know to be the case.
They may not have known just how sugary that item was since most people don't bother to calculate the sugar content of everything they consume, but the CGM puts a number on it. That experience could be enough to change the OPs behavior. I agree that most people may not care to make behavioral changes in response to more data, but there are definitely other people who will.
It seems like this thinking leads to desires, habits and behaviors remaining a mystery to us.
I could carefully track a half dozen signals to correlate consumption to effect, but if the effect is “I’m tired and don’t have much willpower”, that’s hard to remember to track. I just haven’t built up that habit; heck I’m having a hard time keeping up the habit of light exercise.
I have a cousin who was diagnosed with some stage of diabetes; got a continuous blood sugar monitor; ended up losing a ton of weight. I’m definitely in the market for this—something to make it easier for me. It’s undoubtedly healthier for me than mainlining wygovey, which is another option on the table.
I might have to get over my dislike of needles :|
My understanding was hypoglycemia only occurs in diabetes in the presence of medications used to lower blood glucose (insulin formulations, sulfonylureas, etc.) and not because of diabetes itself, which when untreated invariably leads to hyperglycemia.
You will find that diabetics often do have low blood sugar, but that's because they overestimate how much insulin they need to inect, causing their blood sugar to go too low. The hypoglycemia in this scenario is not caused by diabetes, but rather a dangerous side effect of the treatment.
OP doesn't have diabetes, and (unless he's abusing insulin for body building purposes) isn't taking insulin. His postprandial hypoglycemia is likely a benign case of "reactive hypoglycemia" (https://www.mayoclinic.org/diseases-conditions/diabetes/expe...).
https://en.wikipedia.org/wiki/Reactive_hypoglycemia
It can occur for various reasons. Personally, I was developing adult onset type 1 (LADA) for a couple of years before I was diagnosed and I had all sorts of effects. While it was of course mainly effects of chronic hyperglycemia and shortage of insulin, I also had some episodes of hypoglycemia. Now that I’m on insulin, I’m very familiar with hypoglycemia resulting from an imbalance of exogenous insulin and carbohydrates. However, I looked back and realized this happened to me a few times before I was on insulin. I recall waking up a few times at night, sweating and shaking, and having a strong urge to consume food. I’d drink some juice or eat chips, feel better in 20-30 minutes and go back to sleep. This occurred after drinking alcohol, which makes sense as alcohol intensifies the effect of insulin and also prevents your body from releasing chemicals which raise your blood glucose level. I didn’t think much about it at the time but now I can see it was related to T1 onset.
My understanding is that essentially the body’s systems which regulate blood glucose are disrupted. This happens a with type 1 in general - not only problems with the system that produces and releases insulin to lower blood glucose by allowing it into cells, but also the part that does the opposite and release glucose to raise blood glucose levels. Sometimes the glucose-raising system doesn’t work at all while other times it’s inappropriately in overdrive. The same is true for the insulin releasing/glucose lowering system as it fails.
Basically, our bodies go through much "turmoil" over the course of any day, and watching over one too many parameters is like getting hooked to TV or a video game.
Generally, medical science can mostly tell you what averages or most common patterns are, so if you do not line up with them and don't understand this, you can get overstressed.
So unless you are really someone who can objectively consider your readings combined with effects you might be seeing, I'd say don't do it.
Plus, you can see just how much different types of foods directly impact your blood sugar. For example, white rice and pizza are crazy for raising glucose levels. I knew about pizza, but I had no idea that white rice what quite _that_ bad.
Anyways, yeah rice is basically the insulin dietary equivalent of sugar.
To believe measuring something doesn't change behavior is just wrong. We know this.
I think they are amazing. It's been SO HELPFUL. However I don't think it makes sense for normal people. I am on a reddit group for prediabetes and it's not unusual that people who are underweight (anorexic?) and have completely normal metrics come in and post in an utterly freaked out state. These are people who are somewhat compulsive and anxious. I think that if you are normal for blood glucose having access to all this data can make you compulsive and anxious.
However, for me as a prediabetic, it is really useful. It tells you what’s going on with your blood sugar in real time with no ideology. In the beginning I was spiking from things that a nutritionist would say was OK. I found whole grains didn’t work for me. I was shocked at how much I spiked from oatmeal. What causes blood glucose spikes does not map directly to number of carbs and also every body is different.
After 6 mo of lowered carbs, weight training, and getting down to normal BMI, I can now eat SMALL portions of things like brown rice. My health has improved. It's great. IMHO all prediabetics and diabetics should have one, covered by insurance. It would really improve health and reduce complications.
Was it oatmeal, or what you ate oatmeal with (milk, sweetener, etc), or do you know?
You really need to spike your oatmeal with fats, protein, and fiber.
I regularly eat steel-cut oats for breakfast. My go-to is steel-cut oats, two tablespoons of Chia seeds mixed in (tons of fat and fiber), and a serving of mixed nuts and berries on top. On the side, I eat four scoops of powdered peanut butter mixed with water. This version of peanut butter is much higher in protein and much lower in fat and calories than normal peanut butter.
Doing all of this can keep the spikes to a reasonable amount (I also eat the powdered peanut butter first). Any kind of oatmeal by itself is bad. Instant oatmeal is worse. Instant oatmeal with all that sugar and stuff thrown in is terrible.
I suspect if you made your oatmeal with milk instead of water, it would help a lot, but I can't do this from being lactose intolerant.
I dunno about that: milk contains a lot of sugar. Water doesn't. You could add 3 tbsp of cream for an extra 150 calories (no protein, no sugar) vs 1 cup of milk at 150 cals, 8g protein, 12g carbs.
I add almond flour to oatmeal and protein shakes for an extra 100 cals of fat.
As for milk... I have issues with milk! I found out my morning latte by itself was raising my overall blood glucose. Milk seems to have a lot of sugar. Now (I feel guilty about this) I use heavy cream to which I get no spike at all.
You really need a CGM to figure this stuff out.
FWIW, I've mostly switched to coconut cream. My local restaurant supply has a few different brands. So I mix it up. I go thru a box of 12 cans every 2 months are so.
But I'm surprised at its longevity.
> But I'm surprised at its longevity.
Me too.
I prefer Costco's Darigold Heavy Cream 40% half-gallon. Starts to turn before I can finish it (by myself).
https://www.costcobusinessdelivery.com/darigold-heavy-whippi...
For a while, I'd make large batches of biscuits to use it up faster.
What I meant to say about the coconut cream (milk) is the 13oz cans are more practical for me.
--
FYI, I prefer these coconut milk and oatmeal products.
https://www.chefstore.com/p/chaokoh-coconut-milk_6228233/
https://www.chefstore.com/p/bobs-red-mill-steel-cut-oats_151...
Restaurant supply stores are like amazon's selection with costco's prices.
--
Lastly, elsethread, someone mentioned peanut butter powder. Would love a recommendation. Ideally something without any added sugar.
I appreciate sharing this food / meal prep tips. Every little bit helps, as I'm learning how to "hack" my body.
Coconut oil, coconut cream, ginger (w/ dash of pepper), cinnamon, hemp seeds. Something different every day, to avoid boredom.
Sometimes I go savory, swapping meat for fruit.
Which peanut powder do you use?
I boil it in water, but usually eat it with milk. I might try heavy cream though since I have that, and the chia is a good idea.
I have also made an oat "patty" by mixing oats with 1-2 eggs, salt/pepper to taste, shredded cheese if you're into that (I am), and microwaving.
(Special mention: Germany has an impressive variety of lactose-free options. Even lactose-free Nutella equivalent, lactose-free cream cheese, and lactose-free mascarpone! Many lactose-free products in Germany have competition between the store brand, a major brand or two, and/or a brand or two focused on lactose-free.)
I agree , but if it's anything like gluten free foods, having more people buying that don't need to, might push prices down for you.
Like I just learned for example about resistant starches, of which one is cooled potatoes: I ate the exact same dish but the first time, right after cooking, my levels shot up (not abnormally but you should ideally never have spikes, so your body doesn't have to keep pumping insulin), and then the second time, reheated, it was like I didn't eat anything. I was surprised so I researched and found https://www.webmd.com/diet/what-to-know-resistant-starches
Everyone is different so I definitely suggest to try them out for a month and see what gives you spikes in your diet. Then try to get rid of those spikes.
I know there are waxy and starchy potatoes that have higher rations of amylopectin vs amylose starch respectively.
One interesting thing is that if you continuously mix an amylopectin potato, it turns into a gooey, ropey substance that we don't use much in western cooking but is how some Chinese mashed potatoes are supposed to be prepared. I wonder if that transformation affects the resistance of the starch.
I also wonder what exactly is making the cooled potato tougher to digest.
Isn't hypoglycemia a side effect of insulin and other glucose lowing agent rather than of the diabetes itself?
(It actually was fun, and I’ll do it again when the data ecosystem improves.)
It sounds like an experiment I’d like to do for the purpose of optimizing my daily habits and establishing a better mental model for how my eating habits impact me throughout the day. But I really dislike needles.
I did this experiment as well, and the main thing it did was completely stop me from snacking. My habits got better because I could see how my BG could never return to baseline if I allowed myself to snack between meals.
Other than that, it was also interesting to see certain things would badly spike my BG and other things wouldn't, and they weren't always what you'd expect. A lot of "keto" and "diabetic-friendly" products are terrible for most people's BG and were for mine. I found that some things, like black tea, actually made my BG drop as well.
Overall it's worth doing at least once.
The needle is only used in the application of the sensor. It’s spring-loaded and retracts after the sensor is attached. I hate needles, but I found that the tape on the sensor provided enough stimuli to overwhelm my brain and not really feel the needle when it went in.
Having said that, it's no bug deal for 90% of people.
Think of it as a 5mm thick patch and ignore the tiny tube sucking your blood.
Again, not a doctor and not sure if this is accurate, but this is my very limited understanding
Archaic humans had access to plenty of wild fruit that were high in sugar and tubers that were high in complex carbs. They even had access to concentrated forms of sugar like sugarcane and honey.
They obviously didn't have refined sugars in everything they eat like we do but that they had access to limited sugar in the form of berries is a persistent myth. They would have been exposed to large glucose spikes regularly whenever they came upon a new tree that was in season while migrating.
However, this study seems to compare freshly baked bread to a frozen/toasted one.
I'd guess that the difference will be smaller when regular store-bought bread is used instead.
A diagnosis today that is imminently manageable like asthma was far more readily in a world without antibiotics, steroids, or even medical oxygen.
Even something like a CPAP that many of us take for granted has only been readily available for 30 years or so.
Plus, diabetes is much like AIDS in that it’s more of a systemic thing than acute. It doesn’t really have symptoms that kill you. It just slowly weakens your body until your heart gives in, or you have a serious infection, or something like that. No one dies “of” diabetes, they die with it.
But this does sounds like an interesting thing to try, if only to get a better idea of how my body works.
I've been tracking walking vs. resting heart rate, HRV, blood oxygen levels, and sleep for a few years using the Apple Watch, and while I know these measurements are imperfect, they've helped me better understand the impact of certain choices.
There's something that seems really beneficial about feeding my brain data about myself as a way to do the healthier things I've always wanted to want to do. The more data I have, the easier it feels to implement positive habit changes in a way that doesn't involve sheer willpower. There's something very satisfying about seeing the very tangible changes on a graph over time that indicate better health, even when it doesn't feel like the changes have done anything noticeable yet.
Absolutely, there are a lot of companies trying to cash in on this new-ish market, and they'll do anything to their products to get the net carbs down to 0-2g "per serving" -- scare quotes around that because this is a particular annoyance of food labeling in the States: food labels declare the amount of various nutrients per "serving", but 1) they get to choose the serving size [0] and 2) they get to round numbers, so if they just pick the serving size such that it's 1.499g of carbs per serving, they get to put that it's "1g", and so on.
It makes it impossible to compare food labels between different items even among the same manufacturer (and even the same SKU but different/later packaging, because they don't have to issue a new SKU when they change the food label). If instead they were required to show amounts in g per kg (or ml per l for liquids, or whatever), they could be compared more easily.
[0] The FDA provides "Reference Amounts Customarily Consumed" and asks manufacturers to refer to them when deciding their serving sizes, but (from [1]):
> FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe our current thinking on a topic and should be viewed only as recommendations [...]
so really they can pick almost anything they like
> [...] unless specific regulatory or statutory requirements are cited.
unless the food is medicinal in some way, I guess?
It is a CGM more or less what you would expect, insulin is the only hormone that lowers blood sugar, then you have all the stress hormones that raise it like adrenalin, growth hormone and cortisol plus glucagon for long time storage of sugars in the body. So measuring blood sugar with a CGM gives you a value between 2.9-13.5 mmol/liter that is supposed to give you picture of a rather complex system. A CGM also needs perfect access to your free flowing blood which in it self is a difficult task.
e.g. I know that the things I eat impact my blood sugar, but don't have the same kind of intimate awareness a diabetic person would have, nor would the changes in my levels have the same meaning/impact.
Put another way, and setting aside the issue of oversimplifying a complex system (so is measuring RHR, HRV, blood oxygen, etc.), the benefit of CGM for a diabetic person is obvious. The benefit of CGM for a curious person less so.
Optimizing sugar in take for exercise might be an interesting thing todo as non diabetic. There is no tool to continuously measure ketons though which is the fun part. CGMs are so slow. I really see no use at the moment.
I thought CGMs measure the interstitial fluid?
I was shocked but obviously glad I found out. I use them from time to time just to see how I’m doing and how different foods (and amounts of them) impact me.
I found I can control it through diet alone and exercising when there is a spike by using a GCM for the constant feedback.
They are very expensive here though (UK) and my doctor won’t prescribe me one because metformin is cheaper, so it’s not something I can use all the time.
I hate needles, this really isn’t like a needle though, it’s a small filament which sits just under your skin, you can’t feel it, I thought it hadn’t gone in until I saw the reading appear on my phone.
Some things I found out besides what foods and amounts give me big spikes are that I have a blood glucose spike in the morning just before I wake up, and that if I eat a small enough portion of white rice, ice cream, bread, whatever I can reduce the spike quickly by going for a walk. If I had a lot though, a walk isn’t going to help.
I let the needle (actually: annulus? see sibling comment) get into my head because I was curious and looked at it. It looks a lot scarier than it is, kind of like using contact lenses for the first time: before you've used them, you get into your own head about it, but once you've done it a couple times it's just rote and easy.
I had started the first one a day before I started a few weeks of (6-days-on, 1-day-off) keto. Keto guides will say that you should have <= 25g net carbs per day, but I specifically wanted to see how front-loading (having almost all the day's planned carbs in one meal) affected blood glucose, and also whether the number (25g) is accurate for my physiology. I found that my number was closer to 30g and that when I stayed under it, my blood glucose spikes had very short duration but when I went significantly over it, blood glucose stayed higher for longer.
edit: One more thing, I used this time to play around with various sugar substitutes and see how they affected my blood glucose. Allulose came out as the winner (if money is no object) based on not having any noticeable off-taste or aftertaste and on measuring gram-for-gram the same as sugar (well sort of, it's only like 80% as sweet as sugar, so you get the same mechanical effects of sugar if you weigh it gram-for-gram and your baked goods or whatever come out not quite as sweet, which is perfect for me. Creaming butter with liquid stevia extract or something just plain doesn't work.
I do this with a lot of consumer measurement devices. Both for thermometers and scales (food, human, and cheap 0.1mg scales). As well as thermostats, like the kitchen oven. I also do it for my multimeters. I validate my volumetric measuring cups/spoons by weighing water in them but I don’t correct them, just return if they’re way off.
It’s okay if the reading is off as long as I can correct it the same way every time and get a pretty accurate result.
Some classically trained engineers may tell you the "true" value should always be plotted on the x-axis as it is often considered to be the more "independent" variable...but this is highly debatable, and you can skip some simple algebra later if you put the measured value on the x-axis. Then look at the shape of the scatter plot. Ideally it will be linear, so you ask Excel to do a linear curve fit (y=m*x+b). Write this on the scale, and now whenever you take a measurement on the scale, whip out your phone and do "measured_value * m + b". And that's your true value. If it's not a linear fit (quadratic, log, etc) ... that's interesting, and often it's likely "wrong", but also "it is what it is". Classically trained engineers will say you have to do a linear fit if that's what the theory says is appropriate, but for one-off home device calibration...do whatever works for you. Just as long as you don't overfit with some stupid 4, 5, 6, etc-term equation. Any reasonably simple equation with 2-3 terms is fine IMHO.
I use a set of heavy objects whose mass I know fairly precisely. They're not perfectly 10.000lbs, 20.000lbs, etc ... they're just "around 10lbs, around 20lbs" and I've used a good actually-calibrated scale (at work, some commercial business with calibrated scales that you can access, whatever) to weigh them and wrote their weights in sharpie on a piece of tape stuck to the objects. Ideally you'd go for around 10% increments. If the scale can weigh 400lbs, that would be every 40 lbs or so. But it really doesn't matter as long as you have enough good points around the range you truly intend to measure, and then a few outside of that target range at semi-regular intervals.
For my 0.1mg-resolution mass balance I have some actual calibration weights, but they're a relatively affordable OIML "M1" class, and did not come with expensive calibration certificates. The OIML tolerance ratings go E1, E2, F1, F2, M1, M2, M3 (from best to worst). For a 100g test weight, M1 precision gets you +/- 0.005g, guaranteed, for $50 ($135 if you want a calibration certificate). E1 gets you +/- 0.00005g at 100g test weight, for $500 ($1200 with cal cert). For smaller calibration weights like 10mg you'll generally want to go a step up from M1 (+/- 0.25mg) to F2 (+/- 0.08mg) for about $27.
For temperature, it's a bit trickier because the only "true" temperatures you can create are -6°F/-21°C and 228°F/109°C. If these temperatures are helpful to you, you can create them by pouring shitloads of salt in water and stirring+heating it until no more salt will dissolve and you just have a pile of salt in the bottom of the container. You can try to go for "0°C/100°C" using distilled water and it would probably be close enough but you can't know it exactly unless you use super pure de-ionized water and use extremely absurd lab technique (usually involving washing your glassware and tools with de-ionized water over and over for several days straight to get rid of trace contaminants).
So instead, to get "true" temperature in the range I care about, I use some thermocouples attached to a high-quality multimeter or oscilloscope. Then I calibrate these thermocouples using the method above, and average their reading for the oven temperature. This works and extrapolates well enough outside the range of calibration because the error of a thermocouple is basically guaranteed to be a very linear error.
In this link[0] topics 1-6 ("weeks") get into the fine details of all this and provide some worksheets/excel sheets already made up for this type of thing. If you're really getting into the weeds with this, understanding propagation of error[1] really helps but is super unnecessary for 99% of people unless they're doing actual engineering.
0: https://pages.mtu.edu/~fmorriso/cm3215/laboratory_exercise_s...
1: https://pages.mtu.edu/~fmorriso/Pintar_Error_Analysis_or_UO_...
Each time the CGM is applied, the situation is different because of the exact position and various other factors. And the CGM is not 100% consistent.
You do/can calibrate the CGM as needed. For example, when the CGM first activates, standard practice is to check with a fingerprick to see how accurate the CGM is this time and (sometimes) calibrate. (As noted in other comments, the CGM and fingerprick are not detecting exactly the same thing.)
And the next time you apply the CGM (we use a Dexcom G6, which is changed every 10 days), any previous calibration is irrelevant. There's a lot of variability and many factors that can affect results (exact location, scar tissue from previous CGM application, recent exercise, a recent hot shower, etc.)
(I didn't explain that well, but hopefully you get the idea.)
Try doing a few fingerpricks in a row. The variability will surprise you!
That means a lancet poke can be quite different from a meter like the freestyle, and both can be quite different from the level in your veins that a lab would get. So if your level is 200 one device can read 240 and the other 160 and both can be considered “correct”.
I found that the freestyle libre 2 and libre light are characteristically low while the FS 3 is characteristically high. So I use them for the shape of the curve, and that is useful.
Trying to get it filled and picked up was slightly annoying as the pharmacy initially did not want to fill it without some prodding, and I waited a while for them to figure out how to get the promotion billed.
It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.
So on a second by second basis numbers that would be concerning across an hour are fine. Similarly your average over an hour post meal can be much higher than a healthy average across a day.
Like most things, it’s mostly about area under the curve, as long as the extremes aren’t too much so.
It seems there has been this age old knowledge that taking a short walk after a meal is really good for you, which somehow got lost in some/many cultures. My parents would always say they had to sit after a meal to let their food digest... it never really made sense to me. My grandma, on the other hand, is 103 and gets pretty upset if people try to stop her from walking after a meal (or whenever she wants). We always just thought she liked walking, but maybe there is something else driving her, it seems to have worked out for her. It was very interesting to hear the CGM back up some of these practices that have likely been going on for hundreds or thousands of years.
I have been wanting to try one. This approval opens up the door. I think seeing something like this with my own eyes, with my own body, with actual numbers, would have a bunch bigger impact than some anecdotal stories from others and nice sayings which align.
It looks like there is some research being done in the area as well.
https://link.springer.com/article/10.1007/s40279-022-01649-4
I get the same feeling (of my body directing me to take some action) but it's not after meals, for me it's after having more than one beer. After 2-3 beers I want to go walk around the neighborhood for half an hour (and it's a bummer when the neighborhood is not pedestrian-friendly).
Literally "if you walk a hundred steps after eating and sleep on you left, there won't be any doctor's shenanigans"
That's not how it works, at least for the Freestyle Libre 3. The cross section of the needle has C shape rather than a O (technically I believe it's called a cannula). When you remove the applicator that C shape allows the needle to be removed through the hole at the top of the sensor, and only the flexible filament stays I your arm.
If it were like $5 per week, I might put up with it. Maybe this over-the-counter model will be affordable. We'll see, I guess.
Out of pocket cost is obviously your own situation but I think anyone with T1 should look at them. For me they are life changing, even moreso if you have a pump that can deliver based on CGM readings.
Plastic waste situation is still bad.
As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!
I am going to be biased: I both work on and use the t:slim X2. It is well worth it, especially if covered by your insurance. CIQ took me from ~70 to 85%, sometimes 90% time in range; my understanding is that it's the best closed loop algorithm out there currently.
Regardless of which pump you end up on, having a closed loop system will significantly improve your control and helps you get that extra little push from the 7's into the 6's a1c range, which I'm sure you know is tricky to do manually without lows.
It's good to hear that calibration isn't really required.
My "concern" (or rather, apprehension) with the TSlim/G6 setup (which fortunately should be fully covered by Dutch insurance) is that I'm aware I can do a DIY loop using the omnipod dash and with a libre/g6 (using a 3rd party app like diabox & nightscout if necessary). From what I've heard TSlim does seem to be the best "official"/FDA approved loop; however AndroidAPS looks very powerful and probably has much finer tunings possible.
However my diabetic nurse is strongly against the Dash/DIY setup, which is understandable (she isn't familiar with it and can't guide me, I'm also close to the 150u/3day limit, and it's my first time with a pump.)
For what it's worth an A1C of even 8 would unfortunately be an improvement where I am :') so I'd rather be sure of reaching say 7 rather than try aggressively for something like 6.3 (which I had achieved in a distant era...). I think I'll try the 1 year trial option if I can, the thought of locking in a 4 year period feels quite long.
If you're familiar with them, what are your opinions on diy loop setups? Do you have any other suggestions for someone in my situation? Thanks a lot!
It ended up being fairly inconvenient. My setup was a pi zero with a radio bonnet running on my desk; it would connect to the internet to pull CGM data, and deliver boluses accordingly.
I think the main issue was that I wasn't babysitting it enough to know if it was working or not. It was hard to see/understand bolus decisions it was making unless I checked iob, and it absolutely destroyed the battery life of my pump; I used a AAA once every couple days when I was near my desk, nevermind the battery on the rig (I had it plugged into the wall).
Overall, the system that you actually use the most, that is the most reliable, is the most effective system, even if it's a little bit suboptimal. In my case, CIQ is probably a bit less aggressive than the openAPS system; but importantly, it is truly "set and forget." I never have to worry if it's enabled or when, or how, it's just always working, 24/7. With a condition like ours, consistency is the best predictor of performance. That makes it the clear winner imho, unless you really like to tinker with things and you want to be very active with your loop.
The other thing is that the software (openAPS) was Javascript and Bash on a Linux system. Those architecture choices just make me nervous. Too many bad things that could happen. I'm not saying it's impossible for open source software to be reliable, certainly not, but the complexity of their system was just too large of a surface area to fully test. There are extremely significant cybersecurity risks using those older pumps also. It's basically root access to the bolus button.
I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.
Yeah, seeing ~300 datapoints a day instead of 4 while pricking your fingers is amazing QoL improvement. Dead serious.
The out-of-pocket expense can certainly be rough; I use Libre right now because my Dexcom out-of-pocket would be similar to yours and Libre is a third.
I lend my CGM to people to who are possibly prediabetic. I'm very glad I can point them to an OTC solution now.
Shipped in several boxes, each filled and wrapped. then the GCMs, strips, refills, pump connectors come in their own boxes. Some per ten, some single. Each sub-box has several booklets with instructions and safety guidelines. Each unit is individually wrapped in plastic, paper. All of them are single use. Even connectors and rods.
Our combined household has less waste than my insulin therapy produces. One single insulin therapy produces more plastic, paper and wrapping weight than what my wife and I produce together on everything else.
It's utterly insane.
Erm, let's be a little defensible here.
These sensors have to be stored in sterile packaging--that means thick enough to be a barrier. That means it also has to hold the sensor in such a way that a palette can be gamma irradiated. It also needs to be resistant to drops, crushes, and other accidents.
The sensor has to not be harmful with organisms irrespective of the understanding of the person using it. Any change to that packaging has to be re-evaluated for effects on that sterilization.
And while I understand people having concerns, if the only reason we needed to use plastic was to treat folks with diabetes--I think the world would somehow manage.
[1] https://fm.cnbc.com/applications/cnbc.com/resources/img/edit...
The worst is every 90 days when I get a new G6 transmitter. It comes in a box the size of Two video tapes stacked on top of each other. I've tried reaching out to my mail-order pharmacy about it since I know there are smaller versions of it (or used to be), but nothing yet.
From what I've seen, the packaging for Dexcom G7 and it's applicator seems much smaller than G6's.
Side note: That applicator for G4 instilled fear every time I had to use it and I was already 20 years into T1D by then. The spring loaded applicators in G6/G7 are a big improvement as far as end user experience IMO :-)
Yeah the Dexcom stuff always felt like they were going for super-premium Packaging Experience. But after the first couple weeks that wears thin, and now you've got all this crap to throw away. Like, guys, my pen needles come in a dense little cardboard box and it's totally fine. Chill out with the packaging.
Agreed that it's gotten old, especially if I'm traveling somewhere. Needing to cart what you needed (plus backups of course) ends up taking up a surprising amount of space.
I will say that making the switch from a tubed pump (t:slim) to a tubeless (omnipod), it's drastically cut down on the waste for pump stuff at least.
The FreeStyle Libre 3 has a lower ongoing out of pocket cost for people who just need diagnotic monitoring but no integration with a pump. Dexcom , however, offered rebates that made it cheaper in initial outlay by the PBM to get people using, then left them paying the higher upkeep costs for functionality they may never need.
Something to keep in mind. Your insurer doesn't optimize for you. They optimize for them.
Also, pairing it with the Omnipod 5 is just next level. Closed loop. Never having to inject in public. No tubes.
Still a lot of plastic but the sensor comes in a smaller jar/applicator in a cardboard box and it pretty reliably lasts 10 days cutting down waste.
It sounds like this new sensor is just a g7 but with less stringent accuracy standards for non insulin users allowing it to last 15 days.
I walk about a mile a day, to the bus & back for work and a bit for leisure and to get up from my desk. Otherwise I don't exercise.
Wondering how you can maintain that, do you have a very rigid routine and meal plan?
I'm using Libre2 as part of my prescription and it has been working wonders by alerting early on before it is too low or too high to have enough time for a correction dose, or a small bite. The fact that you can see the trajectory of Glucose going up or down is by itself a reason to get.
I do miss having the moment-to-moment trajectory information. Knowing whether I'm still going up 90 minutes after a meal was valuable. But I find I'm able to feel when I'm above 200 mg/dL, so can just correct by feel most of the time.
Another FOSS web tool is Nightscout -- it generates reports and live graphs from data gathered from your CGM via for example Juggluco. My instance is at http://sladkor.4a.si. My sensor expired, so there's no more live data.
glucometerutils is an interesting repo for downloading stored data from hardware readers etc. Abott encrypted the Libre 2 USB communication to force users to use their proprietary software, but hackers managed to extract keys.
http://juggluco.nl http://nightscout.github.io https://github.com/glucometers-tech/glucometerutils http://ni.4a.si./anonymous/freestyle-keys/tree/freestyle_key...
I believe, next major uptick will come from CGM in wearables like Apple/Samsung watches [1][2]. I hope, even non diabetic folks use it to improve their health.
[1] https://www.macrumors.com/2023/09/14/apple-watch-blood-gluco... [2] https://www.macrumors.com/2024/01/23/samsung-racing-to-beat-...
Top athletes have been using them for exercise to make sure their blood sugar remains in the correct ranges.
But Diabetics are using them to help identify how particular foods impact their blood sugar levels (obviously). The reason being is that whilst some foods might be considered high/low in sugar, each of us reacts differently in how we absorb those foods or drinks. So a bagel you eat might not spike your blood sugar like someone else, or conversely it does. You can then correlate that spike or reduction in blood glucose with how you're feeling throughout the day, how your blood sugar levels impact exercise.
Also it allows you to see how combinations of foods and the order that you eat them in impacts blood sugar. If you eat a chunk of white rice without any fibre you might find it spikes, if you each a bunch of vegetables in the bowl before hand you might find it doesn't rise as high or give you a steadier release of blood sugar.
I'd use one for a few months just to see how foods impact my blood sugar and how I can make different choices. It's one thing to interpret a label, but it's another to see it's impact on your body in real time.
The device worked for 5 days until she had managed to dislodge it enough so it wouldn't get a reading. The skin glue lasted another 5 days before the device fell off. Since then, she has had a "crop circle" behind her shoulder where her fur was shaved away, and which is ever so slowly filling in.
Her readings were fine, so we are feeding her low carbohydrate food, because the vet thinks she may become diabetic in the future.
Unfortunately, I had to place the reader device almost directly on the sensor, which was a pain, because my cat likes to hide under the bed. So, I had to squirt her with water to get her out, which was undesirable, but didn't seem to affect the readings.
The device was the Freestyle Libre 2.
https://www.freestyle.abbott/us-en/products/freestyle-libre-...
You are your only medical advocate, no one else is going to do it for you. The standard of care is shit, don't rely on it.
It was very very surprising which foods, and quantities of foods, caused huge spikes.
However, this stuff is difficult to interpret. What should be the goal number for managing glucose spikes? What's good, what's bad? Ultimately there's a lot of judgement calls, just as there is with any health or fitness goal.
I learned a lot from Peter Attia's podcasts, but that required hours of listening.
My doctor offered to review my data with me, which was amazing. But many people's primary care docs may not have the experience or time.
As far as spikes are concerned, I convinced my wife and my dad to both try out the same CGM. Neither of them really ever had any spikes of significance (maybe up to 130's), even when eating cake, etc. Obviously it varies from person to person, but the fact I would spike easily above 140 with boring foods (steel cut oats with no sweetener as an example) said to me something was wrong. My daily averages hovering around 100 to 105 were not in the pre-diabetes level but were close to it, even when eating minimal carbs and being extremely fit with a natural healthy diet. Also most of what you read out there with CGMs is related to people who actually have diabetes.
Finally, there's no one really to talk to about this stuff. You can eclipse your doctor's knowledge on the topic with about 5-10 hours of research. You can go get a broad set of labs and be right at the edge of the reference range on something (which is, depending on the lab, just a range of the general population, not a healthy range) and your doctor will shrug it off. The system is setup so that as long as you are in a sort of average, even with that average being pretty bad (half of the country is fat and pre-diabetic), the standard of care is to ignore it until you fall off the end. The line between hypochondria and being on top of your health is pretty thin, and most doctors will consider you a hypochondriac if you research and come ready to talk about the topic with any level of knowledge.
People are often surprised when I tell them about the insane levels of pre-diabetes in the US:
> The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.
It’s honestly insane to continue a way of life that’s doing this to the majority of the population.
https://www.uspharmacist.com/article/prediabetes-trends-amon....
"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."
https://clindiabetesendo.biomedcentral.com/articles/10.1186/...
No, fasting is problematic because people don't like it.
Health conscious people don't understand how much resistance the average patient has to advice about lifestyle modifications, or how difficult it is to get patients to adhere to recommended lifestyle changes.
A good example is sleep apnea and CPAP machines: In theory, a CPAP machine should provide life-changing improvements in sleep quality and daytime energy for someone with sleep apnea, yet patient adherence rates are shockingly low (even when covered by insurance). Many patients are simply annoyed by the machines and give up on it.
That's not to mention the fact that weight loss is extremely effective in many (though not all) sleep apnea situations, but it's rare that patients will actually follow through with that.
US healthcare is crisis focused, not health focused.
Genuinely curious... have you ever been an obese person? Every fat person I've known have told me they're constantly shamed about being fat in medical settings, some to the point where they actively avoid going to a doctor anymore because they've given up on anything beyond being told they're fat.
I don't want to confuse my experience with actual data. Also, I don't think it's shaming if it's a health issue and obesity should be recognized as such.
I don't think this is true. Doctors do tell patients if they are overweight, and they do encourage them to make lifestyle changes including losing weight.
"Fewer than one of five overweight patients and slightly over half of obese patients reported being told they were overweight by their provider."
So "rare" is the wrong word.
https://www.commonwealthfund.org/publications/journal-articl...
You don’t need to completely throw in the towel if you don’t want to. Take breaks, try different masks as much as you can, get your dr to help adjust pressures. At least for some of us it does eventually click.
Good luck!
At the end of the day, we are all different, and the threshold for what physical sensations a person can tolerate is highly variable. Everyone understands that about pain (I hope!), but this goes just as much for all these other things that are not necessarily painful as such, but are still physical.
Is this just an American thing? Every GP I've ever seen has asked me about my diet and exercise despite me being in the healthy BMI range.
I've had doctors (in America) tell me to not worry about medical issues and others recommend a battery of tests to look for correlated but uncommon issues. My current GP recommends basic, palatable approaches to diet and exercise that have nothing to do with giving them money (and, presumably, reduce my medical costs with them down the road.)
I've also had doctors suggest that I get an issue reclassified so they could do surgery. That could be viewed as them wanting money, but I view it as them seeing a problem that can be fixed by surgery because, as a surgeon, that's how they approach problems.
Where is the harm in getting data on how your own body deals with glucose?
Not necessarily.
Rohin Francis (Medlife crisis) has I think a video on overtesting, but for example, if you have a new technology that tests and suspects a tumor, which results in CT scans for patients, if millions of users use this tech there's a likely non-zero number of people who may get cancer from the CT exposure.
"What about those who actually had the tumor?"
Well it's possible that 99% of these cases would've been symptomatic anyway in a few more months.
By explanation isn't the best, but over-medication is not a non-issue.
Then you can decide whether a test makes sense or doesn't make sense, given the tradeoffs of radiation and cost vs. the risks of harm.
In the real world, information absolutely can lead to harm, but it's still all in the response and how medicine and patients use information.
But as information gets cheaper and more common we can develop ways of dealing with it. If it was difficult and expensive to test for fever you'd see people in the medical profession warning against it because it could lead to overreaction.
Another thing I seem to remember in his video was that a tumor is not necessarily dangerous. Out of a hundred (say) tumors in a person's life, only maybe 5 are risky. But I'm paraphrasing this badly.
Edit: https://www.youtube.com/watch?v=7kQk9-KLPfU is one of the videos, however I think he's talked about this more (likely on instagram or another video too).
>For a lot of people, if you get a positive result from a test that a doctor brushes off that's not going to go well.
This is precisely because of the rarity of testing. Suppose the cost of testing dropped 1000x and we could get tests for things each day or each month. We'd start to have systems that put these things on context.
When you have a single isolated result there really isn't that much to go on.
E.g. CT scan shows an incidental, tiny lung nodule. You do a biopsy. Unfortunately, during the process of getting a biopsy, you develop a pneumothorax (an uncommon but well-known complication of a lung biopsy) and need a chest tube, hospitalization, etc. You get discharged and you're fine, but man, that wasn't fun. Biopsy comes back negative for cancer. Nodule goes away on its own with time.
Edit: that being said, I'm excited about OTC CGMs! But the "data" we have in medicine is not as accurate as other fields and always subject to false positives/negatives.
"I'm so incompetent that more data is going to lead to worse outcomes! So let me stick my head in the sand and not measure!"
Imagine if any other profession operated under this framework:
"Ehhh, if we inspect too hard we might make a repair on this airplane that will cause further damage, lets just not do the inspection"
Did you see the 737 door plug accident?
You are missing part of the picture here. And that part is not that everyone else is dumb but you.
Do you think this is....the same thing as a continuous glucose monitor?
We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population.
CGMs will often give an "estimated HbA1c" value based on statistics from the collected data.
The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.
It certainly should be part of routine checkups in my opinion, but I had never had more than blood pressure check and a weigh in from my doctor.
I also had an insurance provider who gave us a cash bonus if we had it tested (they paid) every year for a while.
It’s surprising that some doctors aren’t checking it still.
That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels.
You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.
However i recently saw a video of a woman that carried a glucose monitor (even if she didn't need one) as part of a study (she volunteered) and was able to correlate her mood and her weight take/loss with sugar intake.
I'm very curious about this. I've started a diet recently and after quitting many sources of sugar completely I'm very surprised how long i can go without eating and how little calories per day i can consume (well, as long as i have fat to burn at least).
If anybody wants to chime in and suggest a glucose monitor that i can get without prescription in EU (Italy) and from which i can pull off data, please do.
I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.
I tried a CGM twice. I triggered the hypoglycemia (blood sugar too low) alarm multiple times, but felt completely fine.
After some research I discovered it's actually not uncommon for healthy people to have occasional dips below the preset hypoglycemia threshold, but as long as you're not having symptoms then there's no cause for concern.
I also talked to a doctor who complained that she had multiple patients showing up with concerns about their glucose numbers for various reasons after trialing CGMs, but they had similar spurious and unimportant problems (brief excursions out of range, etc.).
So if you're going to experiment, at least familiarize yourself with what's truly problematic. It's easy to misinterpret the data if you don't know what it means.
Hiding information from people because they might misinterpret it is not a successful medical strategy, the better strategy is to educate, see if the information will be welcome, then provide the information in the context of what it means.
I wasn't technically pre-diabetic, but did have a few higher-than-expected resting glucose blood tests, and the CGM showed me that I'm actually really close to pre-diabetes.
That was the kick I needed to clean up my diet (specifically eat less), exercise 5-7 days of the week, and I'm feeling better than ever.
Anecdata, of course, but there is no single intervention that has been discovered to improve people's weight and metabolic problems in the US (except perhaps the new GLP-1 inhibitors). Adding a CGM, at least for people interested in it, can be very effective, and we should use all the tools we have to improve the population's health.
And thus I doubt very much that with this device or devices like this, the diabetic population will be reduced. In fact, I believe it to be the opposite.
Even if you don't suspect underlying health issues, the data provided for health optimization and gamification is worth it.
I used the GCM for 4 weeks and mostly tested how my body responds to various types of foods and meal timing. I also used an Oura ring to track sleep.
Main lessons learned: fat loading in the morning with a bulletproof (ghee) coffee didn't spike glucose and provided sustainable energy. Carbs for dinner helped with sleep but only if the meal was several hours before bed, allowing enough time for the double glucose spikes to return to baseline.
And Japanese sweet potatoes massively spike my glucose unless they're slightly undercooked. Cooking methods significantly changed how my body responded to the food.
I wore a CGM for about a month. Also found that my glucose numbers were not nearly as good as I would have expected, especially considering that I'm quite active and not overweight. But it's the "what next" that I'm stuck on.
I was on strict keto for a year, with daily blood tests to monitor ketone levels. My fasting glucose would still be above 100 often enough. Even a moderately sized carb-heavy meal can send my BG above 200 (even after being off of keto for a few months).
Maybe if I paid the $2500 for his "Early" program that details all the labs he does I might get some insight, but that is clearly priced for someone outside my tax bracket.
https://www.ultalabtests.com/test/advanced-cardiovascular-he... https://www.ultalabtests.com/test/hormone-health-men-compreh...
Front page has 20% off coupon. This should get you a pretty wide view. You can add on extras, but this should get you most of what you want to understand. But, this level of lab work is going to require 20+ hours of research to understand, and even more if you pop funny values and want to figure out why. Have fun....
Walking was by far the most effective way to keep blood sugar down after a meal.
Most of what I ate didn't cause a problem. However tend avoid sugar and carbs. The worst offender was a PB&J sandwich. That was surprising.
Assuming this was a Libre, this is likely reader inaccuracy that does not reflect an actual blood glucose event.
A quick read of their privacy policy suggests that the mobile app is full of personalized ads and they use your data for "direct marketing" as well as "research". They offer your data to third parties for both "marketing" and "analytics" reasons. They'll send your data overseas whenever it suits them, even to places where your data will not have the same protections, and they'll keep the data they collect forever unless you submit a request for them to delete it and they are actually required to do so by law.
Since I'm only mildly curious to see what the numbers would look like, I'm fine with waiting until someone puts one on the market that saves its data to storage that can later be copied over to an offline PC.
Nobody has access unless the patient wants them to.
HIPAA only covers "protected health information" and not all of the data collected by their products.
They also state: "You can ask us not to use or share certain protected health information for treatment, payment, or our operations. We are not required to agree to your request"
Once a year you can also request that they send you a report on who they shared your data with and why without paying them for it, but it will not include anything involving "treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make)."
>You can ask us not to use or share certain protected health information for treatment, payment, or our operations. We are not required to agree to your request
What they're talking about here isn't necessarily what you expect. It's that, if you e.g. encounter a bug in the product that they need to disclose to the FDA, you cannot withhold information from them that would prevent them from doing that. Or, if they need to know what kind of diabetes you have so that they can charge your insurance for the correct prescription, you can't say "you're not allowed to share that." (doesn't really apply here, but that's kind of what's meant in that clause). You can see: treatment, payment, or operations. The scope of each of those is kept as small as possible, and they do have audits from time to time ensuring that it is.
I assure you that CGM readings, trends, averages, reports, etc. ALL of that stuff is absolutely, positively considered PHI and considered extremely privileged. The only time anyone, even in the company, can see that data is if they are a customer support agent helping a specific customer, or if they are on the data science team looking at broad trends to help e.g. calibrate the product.
>Once a year you can also request that they send you a report on who they shared your data with and why without paying them for it, but it will not include anything involving "treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make)."
It's because they have extra requirements around storage, retention, etc of that PHI data. It's very likely that they can't send you a report because all parties have much stricter access controls on that data so it can't be aggregated and put in a report without filing a mountain of paperwork.
I assure you, these companies do not fuck around with patient data. They don't even do things that give off the appearance of fucking around with patient data, because they know that if the HHS thinks that they are that's millions of dollars in audit costs.
In the following article, see: Sleep aid or surveillance device?
https://www.npr.org/sections/health-shots/2018/11/21/6697510...
Maybe glucose monitoring data is different than sleep data, but I don't see why it would be. In that article, even random customer service representatives had access to his device data despite his asking them to stop storing it. I had a similar experience with a medical device that the person in the article had with their CPAP machine: I yanked a wireless modem out of the thing and stuck a flash card in there, because fuck those creeps. They sent me a very large bill retroactively denying coverage for the device for non-compliance, but luckily I didn't end up having to pay because they accepted the local data I provided without (much of) a fight. But what if the claim wasn't for a comparatively inexpensive machine, and it was for an inpatient medical procedure with surgery, lots of imaging, and a 10k ambulance ride? You better fucking believe I'm not going to voluntarily help them weasel out of coverage.
It takes some work, but you can "liberate" your data from the app without the cloud account: https://frdmtoplay.com/freeing-glucose-data-from-the-freesty...
I learned to leave my phone someplace else, upstairs, wherever, just check it a couple times a day. Else I'd go crazy.
I took the speedometer off my bike, I was looking at it more than the road.
So I understand my limits and take steps to keep my self from compulsive behaviors. I guess(?) other people do better and can handle these things.
Even as an experiment, I'd say most people should get one just to understand their bodies, and their specific responses to certain foods, once in a while.
> The markup on OTC products is generally higher than on prescription medications.
https://www.eposnow.com/us/resources/how-do-pharmacies-make-....
Olopatadine eye drops are amazing for allergy season, and they used to be like $250-400/bottle just 5 years ago or so, even the generic version. Then they went OTC for like $10/bottle.
This pricing difference might be true for things that are already mostly cheap, like Omeprazole -- where branding on consumer products drives OTC markup, but consumers don't pick the brand when doctors prescribe it and the pharmacy just gives them whatever cheapest generic they have in the back that they negotiated excellent pricing on.
Though you can easily close the gap on these prices by shopping for the store-brand generics at Costco, Walmart, Sam's Club, etc.
And yet, the article from GP shows that the added cost of this insurance billing bureaucracy is still less than the added cost of consumer shelf-branding markups.
Says nothing about it being cheaper; and honestly, taking the requirement to see a doctor out of it may end up reducing the total cost for a patient anyways.
There are odd things like glasses or CPAP machine prescriptions - but at least I understand it's theoretically possible to cause some harm to oneself with those, if someone is really uneducated, reckless or stupid. With a CGM I just can't think of a sensible scenario. Except for the really stupid ones, but then a simple kitchen fork is a four times worse hazard.
I had T2D, well controlled now, my A1C is below the diabetic diagnostic range.
I used CGMs, and they taught me a lot about how my body reacted to food and exercise.
But I sweat a lot and they would always fall off, halving the useful life of each monitor. I would probably still use them from time to time if they didn't sweat off; and if an implantable version was available for a reasonable price (under $500, with no ongoing costs), I'd probably get it.
I feel like a lot of prediabetic people could learn a lot about their situation with this. I think this is a very good thing.
If you ever want to give it another go, try Hypafix. I tore my skin the first time and quickly learned to soak it and use soap to remove the GCM.
It seems like this is a stripped down version of the G7 (albeit with a longer wear time) as the ONE is a stripped down version of the G6.
https://blog.steady.health/the-wearable-that-changed-my-life...
I also started a company focused on CGMs which was too early and didn't work. Maybe its time to try again? :)
The interesting thing to observe is to see in real time the metabolic spectrum of the foods we consume. Liquid sugars cause glucose spikes within 6 minutes. Solid carbs 30-120 minutes depending on carb complexity etc. Proteins 3h+. Fats can be six hours or more.
The thing is there are a variety of insulins available, some of which are rapid acting and others act more slowly. So to keep my son in range with multiple daily injections you are playing this game of giving him the right mix of foods where his carb digestion matches the profile of his rapid acting insulin.
Pizza is an interesting case study. It is by far the most carb rich deal we've tried and it is almost impossible to manage. With so many carbs it's hard to get the insulin dosage right, and once he is high, once he is coming down from that the digestion of the fats kicks in and he remains high through the night.
I think it would be a great thing for people to wear even just for a couple of weeks.
I am glad to see an increase in access to live changing medical care for a disease that is mostly just bad luck.
So, having ketoacidosis feels like having your blood turn to acid. Death from ketoacidosis is an excruciating death. Fermenting from the inside out as your heart pumps your increasingly acidic blood through your entire body. You're technically starving, so you're hungry, but at the same time your body is trying to expel glucose at all costs, so everything you look at makes you sick.
Extended periods of high blood glucose and lack of insulin especially is up there as one of the most uncomfortable things I've ever experienced personally. Just unimaginable cruelty.
Basically someone with diabetes can seem to be a very unhealthy and drunk person, and people do not tend to take these people serisouly.
That could go very wrongly if they're already at the end of the safety period when they're grabbed by the cops.
But before long there will be diabetics that never really learned to do that because they never had to. Even people that have done that for decades still mess up dosing sometimes.
How likely is it that someone might die? I don’t know. But saying they will be fine might not be fair.
I can fast for days, my blood sugar does not go down.
On my last 4 day fast, my blood sugar stayed within about 20Mg/Dl.
And no, I cannot manage without my medical devices. Or are you telling me that I should fast for the entirety of police custody?
This is similar to saying "X person can survive without y medicine which has only been around for 10 years". Or "people survived fine without seatbelts for so many years".
That's a classic survivorship bias, because a ton of diabetics didn't survive, who'd possibly have a much higher chance of surviving today with current tech. Heck, I personally know the brother of a late diabetic who would've been alive today if he had a phone connected to a CGM because of it's low glucose alarm function.
I understand HN is a place for discussion, but in potentially deadly situations like this, it's worth avoiding to make statements against medical care.
US version; (oh, and they'll charge you for the medical care)
I've found it to be mostly accurate.
Placing it on the back of the arm was always a problem for me, it was constantly getting knocked/pulled, and otherwise disturbed. I had to buy adhesive patches that covered the entire unit. I later discovered that another decent place to apply them in on my chest between my collar-bone and shoulder-joint but lower (towards the nipple). I always had decent reliability/accuracy there. It also hurt less (from the adhesive) then on the back of the arm.
Having a CGM is amazing, and if you have medical coverage that will pay for it then you should get it.
With the test strips, I measured myself AT MOST, 7 times a day. Often just once or twice.
THAT is what makes them worthwhile. It keeps measuring so you don't have to.
One helpful thing that I don't worry about: Low blood sugar alarms. Hypoglycemia is a real concern, and just as serious as hyperglycemia. A CGM will alter you when your sugar gets too high OR too low.
I'm poor. I can't afford a CGM anymore. So I have been going months now without measuring. Because I keep forgetting. A CGM doesn't have that limitation.
I was really hoping that Apple was going to announce a CGM. I avoid the Apple ecosystem, but I would have invested in that.
A -> B, then B -> A => incorrect
In a fire, we see firefighters, that doesn't mean firefighters cause fire. In diabetic patients, we see high glucose level. That doesn't mean eating high GI food causes someone to have diabetes.
If we look at the Blue Zone, many people eat mostly carb. So carb/high GI food definitely doesn't cause diabetes.
Devices like this will make other people fearful of high glucose and think they're getting diabetes. People without the disease shouldn't focus on monitoring the glucose level, focus on eating healthy instead. And of course eating healthy is another complex topic.
This is correct but probably not in the way you think. It is not the glucose in and of itself that is the problem but the level of the hormone insulin circulating around your system that is at the root of Type II diabetes. Glucose and insulin are highly related. Insulin is released by the pancreas to help control the level glucose in our blood.
Virtually no insulin is required when metabolising fats, a small amount is required for protein and a larger amount of insulin is required when dealing with glucose dense carbohydrate based foods. The faster a carbohydrate is metabolised the greater the dose of insulin required to quell the resulting glucose rush in the blood.
What does the insulin do? As a hormone it has many functions. The presence of insulin in the blood signals to all cells to burn sugar (glucose) rather than fats (ketones) for their energy. It prompts the cells in the skeletal muscles to store up glucose in the form of glycogen for later use and it signals the liver to store excess glucose that is not immediately needed. Once the liver and muscles are full then the liver then converts any excess to triglycerides.
Where do the triglycerides go? They get stored as subcutaneous fat all over but largely in the belly (in men) and bum/upper legs (in women). What happens when subcutaneous stores are full? Then the triglycerides are shoved anywhere and everywhere. Fat is pushed into muscle cells as well as the cells in individual organs. The fat molecules present in cells in organs are particularly pernicious (visceral fat) but any cells that contain these triglycerides seems to disrupt the insulin signalling within the cell. This results in insulin resistance i.e., the ineffectiveness of insulin to signal to the cell to take up excess glucose.
When sufficient threshold of insulin resistance is reached, you will get higher blood sugar readings and a higher A1C at which point your doc will say you have prediabetes or full on type II diabetes.
Insulin is the master key variable that unlocks the type II diabetes puzzle. High blood sugar levels are just a symptom. The problem with modern day Type II diabetic care is they consider the high blood sugar as the root problem. So this is treated with meds such as metformin and eventually MORE insulin. Understanding type II diabetes as a disease of too much insulin sheds the disease in a very different light.
Anyway, you are correct, the high glucose level per se is not the cause, but high levels of insulin constantly circulating around your system is the big problem. Of course an effective way of doing that is to continuously eat foods dense in glucose and fructose that are metabolised very quickly e.g., cookies, ice-cream, orange juice etc.
> If we look at the Blue Zone, many people eat mostly carb. So carb/high GI food definitely doesn't cause diabetes
Blue Zone areas such as Okinawa, you do find people eating carb rich foods but they are also high in fibre e.g., root vegetables, sweet potatoes etc. look at books by Robert Lustig to learn more about the importance of fibre in relation to metabolism and diabetes risk.
Recommended further reading
- Pure, White and Deadly (John Yudkin)
- Fat Chance (Robert Lustig)
- Outlive (Peter Attia) contains an excellent and concise synopsis of the mechanisms behind metabolic disease
> Devices like this will make other people fearful of high glucose and think they're getting diabetes.
Elevated glucose is exactly what causes type 2 diabetes. Take away the glucose supply, and you don't have elevated insulin. Fear of glucose that is too high too often is entirely justified and is not something that should be going on if people can avoid it. Sugar molecules are damaging to cells and are related to other things like cardiovascular calcification.
> If we look at the Blue Zone, many people eat mostly carb.
So-called "Blue Zones" are not science. They are anecdotal, cherry-picked, uncontrolled, and can't be tested. Also, some of those zones, such as Okinawa, are mythical. Okinawans historically have eaten a lot of pork, and still eat a ton of pork. They also used to not keep much in the term of birth records, so there was really no way to know how old any of those people were back when they were studied.
> So carb/high GI food definitely doesn't cause diabetes.
Propose a model of type 2 diabetes that doesn't involve dysregulation of blood glucose and come back to us.
No, it doesn't: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602127/
You said Okinawa people eat a ton of pork, please compare with something.
You said they don't have birth record accuracy which is not totally true. In many asian culture, they use Zodiac and similar methods to keep track of age, the exact date may be off, but the year cannot be off because if it's off, that's 12 year difference. I cannot be a dragon and claim myself to be 84 when I am only 72 because all of my friends around know how old I am around.
When 1 or 2 persons say it, it may be mythical. But when most of population say it, there must be some truth. And it's also up to you how you believe it.
While obesity is known to be the greatest risk factor for T2DM, you can induce insulin resistance in weight-stable individuals just by shifting the macro composition of their diet towards saturated fat:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291812/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171936/
Sugar, amusingly, doesn't seem to have the same effect.
Given that the typical recreational CGM wearer (in my experience) is a low-carb/keto type (who ruined their insulin sensitivity), you should probably take the comments in this thread touting CGM use with a grain of salt.
[1] Meet the inventor: Professor Adrian Porch from Cardiff University:
https://www.med-technews.com/medtech-insights/latest-medtech...
[2] Microwave Noninvasive Blood Glucose Monitoring Sensor: Human Clinical Trial Results:
https://www.fda.gov/news-events/press-announcements/fda-clea...
First off, he had discomfort with the study methodology. Didn't go into details, but was surprised that the FDA was less conservative than himself in this case.
Secondly, it has been common in his practice for someone to have an unusual event. Someone does something out of the ordinary, they have an unusual circumstances, they don't adjust their treatment, and something goes wrong.
His question was -- does the device have a reset button? Is there a way to restart the management and learning? The answer is no -- the device will learn! But there's no way for the patient or the physician to adjust the treatment. So his answer is -- he would never recommend this device, not the way it's currently setup. It's opaque and there's no means for a person to influence the device's learning.
https://www.fda.gov/news-events/press-announcements/fda-clea...
This does not parse. This device is for patients that are managed with oral meds and not insulin. Yes, sulfonylureas carry some risk of hypoglycemia, but not as much as insulin proper and its fast- and slow-acting friends.
If someone is on a pump, they sure as heck will be using prescribed equipment.
Yeah, eating stuff that's bad for me caused a blood sugar spike and made me feel crummy. Eating healthier foods did not cause the same spike and I felt better.
I didn't need to spend money to tell me that.
The app is missing some obvious features, and people are right to complain, but its way better it seems than devices that came before.
Stelo will be available for purchase **online** without a prescription starting summer 2024.
[1] https://investors.dexcom.com/news/news-details/2024/Stelo-by...
This OTC model limits the measurements to every 15 mins instead of every 5 for the prescription version; this will limit its ability to be integrated into open source automated insulin delivery systems. Not sure why they made this choice as the hardware looks the same as the Dexcom G7. In theory they could be doing it to increase battery life or allow for cheaper batteries to be used in the consumer version.
Also... does this mean they are direct-to-consumer as well as retail channels? https://news.ycombinator.com/item?id=39622192
So far it’s shown me that the sluggishness after a carb-heavy meal its heavily correlated with the glucose spike and how good my organism copes with it.
Can’t wait for the day we have our own Fallout style Pip-Boys!
https://www.dutchnews.nl/2024/03/artificial-pancreas-offers-...
I used sticky tape as an experiment because there are no arm bands for Fitbit products. That was a year and a half ago and have worn it like that every day since.
I can't wait until trackers can be implanted under the skin, track blood glucose, and improved accuracy.
Let's gooooo
It also has informed family diet change, in the direction of keto practices, that has compressed the baseline to high delta for our son.
It's a relief to know that an OTC product exists as a backstop to our prescription CGMs.
https://www.garmin.com/en-US/blog/health/how-garmin-and-dexc...
Anyone knows if there's a reason for this? I don't want to think is just a money grab. Perhaps the patch wears off?
There's one company that's experimenting with an implantable CGM that will supposedly have a 6 month lifespan, with a bluetooth powered patch that you apply on the skin overlying the implant.
>Important information Legal Disclaimer : Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.
At the very bottom of the description. That seems like complete BS that shouldn't hold up, but I don't know.
Look at all the legalese at the bottom of https://www.freestyle.abbott/us-en/home.html
What search string are you using? Can you post one?
Usually we lag behind the USA on approvals so just assumed if it wasn't OTC there it won't be OTC here.
In the US, I only see the finger prick type. I do see the FreeStyle Libre3 but it requires a prescription
Very interested in that
Curious if anything is driving the increase in wear time other than battery life savings from reporting back fewer readings.
CGM: G7 / Stelo
Wear time: 10 / 15 days
Time between readings: 5 / 15 minutesA 50% increase in wear time is HUGE in my opinion.
...guess that concern is no longer an issue!
The FDA approval is only a revelation to the extent that the hidden truth of the extant prescription CGM market is poor data veracity combined with high catastrophic failure of the devices under manufacturer warranty in some patients.
It's difficult to know for sure the size of the patient cohort impacted here since these numbers are not made public. If the market functioned transparently, this knowledge would be of great benefit to consumers.
Given the proprietary nature of these organizations, and the fact that they spend lots of money on lobbyists and lawyers to maintain the status quo, I'm not expecting this to get better, at least in the United States. This leaves the hope that the EU or elsewhere may be more aggressive in regulation, as they have demonstrated recently around Apple and Google.
LSS: there's a ton of room for competition, cooperation, and innovation in CGM's and their slowly evolving ecosystem of software, smart phones, and smart watches, particularly in open source where hacks frequently work around the proprietary limitations in software, i.e. information devices that have little to do with telling time save for putting a date/time stamp on their event stream which is nowhere near the 5 V's of big data in volume, velocity, or veracity.
The two leaders in the space, Dexcom and Abbott both fail at a high rate with some individuals, such as me. Turns out that at the edges, adipose tissue and its interstitial fluid are a poor proxy to plasma blood glucose in some individuals. This is likely due to fluctuations in the composition of that tissue during times of fasting: exercise and sleep.
Sadly, the price of admission for my family has been high given that no one has slept normally for five years with the screeching alarms nightly at 3 AM, which are not adequately configurable. The design failure here is clearly driven by liability.
It's worth considering that the brain's default mode network (DMN) is impacted by glycemia. This has been demonstrated via an fMRI lab at Harvard via Nicolas Bolo, et al using a small cohort of diabetics.
The leap from there to what families of diabetics have known intuitively for decades may be phenomenological, but it isn't difficult.
Put simply: diabetic mood swings may not give rise to psychosis, but the mood dynamics of glycemia have been clear for almost as long: a spectrum from hypomania or nightmares induced by hypoglycemia to hyper compulsivity or depression induced by hyperglycemia.
I'm not certain that a researcher or clinician like Bolo exists to put data behind these glycemic mood associations, but speculatively, the relationship is clear to me from a subjective metacognition perspective, as someone who's been T1D for ~50 years and also has an HbA1c below the diagnostic threshold for T1D and routinely stays functional with accurate plasma BG < 50 and shows no signs of cognitive impairment accruing to these brain states after various neurology studies.
It's worth noting that hypoglycemia itself is a dynamic range, not a constant, and is frequently lower for people who have eaten or trained on the ketogenic spectrum, i.e. ultra marathon runners like Zach Bitter.
My experience has been that the feelings associated with hypoglycemia can be paradoxically awful at BG=80 and no problem at BG=40. If you've never eaten a half gallon of ice cream yourself with no signs of obesity, then you may not understand the zen state it takes to overcome this "beyond hunger" that's immediately familiar to any experienced diabetic on earth, while recognizing that that problem does not occur naturally with the disease. It's the result of insulin overdose, carbohydrate under-supply, or both.
FWIW, Microdosing carbohydrate may be key.
I believe the first use of the term in science was actually in glucagon, IIRC, i.e. the need for yet another syringe of glucagon in emergent insulin pumps that would go beyond the current crop of devices that are near autonomy, but may inadvertently overdose or underdose the patient due to the poor veracity of CGM sensors across the board and the hybrid closed loop devices which dose based on CGM which may be demonstrably inaccurate on occasion to the tune of several hundred points off high and low.
I have n-of-1 empirical evidence of this given the fact that I wore several insulin pumps for twenty five years and used multiple CGMs over that time, some concurrently. All were what we call, "shipping the prototype". Fortunately, beyond Therac 25, that was not an option in other medical device markets; certainly not those under FDA oversight.
(There is already an app to show on the watch, but you still need the phone in the loop - this is directly to the watch without the phone.)
Don't get me wrong; I have had T1D for 30+ years and would love to have reliable, non-invasive, glucose monitoring on my wrist.
We've come so far already from a finger stick that would take 2 minutes to get a result. Have hope :-)
[1] https://www.fda.gov/medical-devices/safety-communications/do...
[2] https://www.theverge.com/2024/2/21/24079495/smartwatch-smart...
https://www.niddk.nih.gov/health-information/diabetes/overvi...