I attempt to keep wholesome. I eat a (largely) vegetarian weight loss plan, prioritize day by day motion and attempt to find time for sunshine. I additionally get annual blood work executed that measures issues like ldl cholesterol, vitamin ranges, thyroid well being and glucose. That is as a result of I am usually conscious of the US drawback with continual ailments, together with Kind 2 diabetes and prediabetes, which have an effect on thousands and thousands of adults and might be prevented.
I word all of this to set the stage for a way smug I used to be earlier than I began testing a Stelo steady glucose monitor, the primary accessible with out prescription within the US. Beforehand, CGMs have solely been accessible as medical units for individuals who use insulin and are required to trace their blood sugar for medical functions, together with a small variety of wellness biohackers who’ve paid high greenback to get a CGM prescription off-label to allow them to higher see how their physique makes use of vitality (meals).
Given glucose, or blood sugar, stands out as the final fundamental well being metric we will not observe with a traditional smartwatch, I did not suppose twice earlier than stamping the quarter-sized biosensor to my higher arm and wading into deeper wellness waters, anticipating the peace of mind from previous bloodwork and the truth that I examine well being stuff all day to protect me from the probability of something scary popping up on this new wellness terrain. Plus, my Oura ring says my cardiovascular age is a number of years youthful than my actual age.
In different phrases, I received cocky.
Not solely was I mistaken about anticipating glucose fluctuations to be easy — there may be frustratingly little data on what steady glucose ranges ought to seem like in folks with out diabetes, and mine appeared considerably completely different from the primary week of my trial run to the final couple of weeks — I additionally realized I’ll’ve been underestimating the significance of different day by day habits which have impacts on my well being, like chronically skimping on sleep, sitting down for too lengthy and never taking time to handle my stress. Whereas I understood this stuff can have an effect on my well being, they had been by no means really seen to me till I allowed a CGM to get beneath my pores and skin.
This is my expertise sporting the Stelo and what it’s best to count on when monitoring your individual glucose 24/7.
Sticking on a Stelo and Dexcom CGM fundamentals
The Stelo glucose monitor is made by Dexcom, one of many two main diabetes care corporations and maker of the Dexcom G6 and G7, which measure blood sugar constantly just like the Stelo however require a prescription. (The opposite massive diabetes firm is Abbott, which introduced the US availability of its personal prescription-free CGM shortly after Dexcom had cleared its personal.)
The Stelo was designed for folks with Kind 2 diabetes, however any grownup who would not use insulin and needs extra perception into their blood sugar ranges can use it. The considering goes that spending extra time in decrease blood sugar zones will cut back the chance of well being results from excessive blood sugar — that is very true for folks with Kind 2 diabetes, who’ve a better baseline. As that is supposed for informational functions and is not the identical as prescription units, you should not make any treatment selections primarily based on readings with out consulting your physician first.
Like different CGMs, the Stelo monitor would not observe your blood’s glucose by precise blood. As an alternative, blood sugar is learn by a tiny thread-like needle that attracts interstitial fluid, which surrounds the cells. This tiny needle is caught to the again of a small sensor that sticks to the arm with adhesive tape.
I might by no means used a CGM earlier than, however I used to be joyful to study the Stelo directions had been simple to comply with. Step one it’s good to take is obtain the Stelo app, which is appropriate with iPhone or Android. Then, create an account.
One necessary factor to notice is that you will want to pick a “goal vary” in your glucose measurements to remain inside, primarily based on whether or not or not you have been recognized with diabetes or prediabetes. The goal vary for Kind 2 diabetes goes as much as 180 milligrams per deciliter and seems to be the usual vary medical doctors use for taking a look at glucose throughout all populations. Folks with outKind 2 diabetes or prediabetes will likely be given a decrease goal vary to remain beneath throughout a lot of the day at 140 mg/dL.
After you have the app and an account, you may connect your sensor by following the app’s directions.
The biosensor attaches to the again of the arm, ideally to an space with much less muscle. After selecting the fleshiest a part of my higher arm and disinfecting it with an alcohol wipe, per the directions, I unscrewed the applicator’s cap and pushed the button to eject the sensor into my arm. It was just about painless, positively a “lower than one” on a 1 to 10 ache scale, however the sound it makes upon ejection is surprisingly loud.
The Stelo monitor is offered in a two-pack field with two sensors in separate applicators. Every sensor lasts as much as 15 days and a month’s provide prices $99. If you need a renewing subscription, it prices $89 per thirty days. Insurance coverage corporations will not cowl CGMs for individuals who do not want insulin typically, however you should use your FSA/HSA {dollars}.
Whereas it is positively not low-cost at $99 for a month’s provide of sensors, the Stelo is extra reasonably priced than different shopper CGM corporations that use a workaround for the prescription requirement. These corporations achieve this by getting their very own medical doctors to jot down the prescriptions and utilizing Dexcom and Abbott’s sensors for diabetics. Ranges, for instance, prices $199 for a month’s provide of sensors plus a separate $199 yearly charge for the app. Nutrisense prices $225 to $299 a month.
Abbott’s common wellness glucose monitor, Lingo, prices $89 for a month’s provide.
Hopefully, extra availability of glucose monitoring within the wellness house will drive down costs and even affect insurance coverage protection so folks with higher-than-normal blood sugar ranges, or these with Kind 2 diabetes who do not want insulin, can afford to maintain sporting a CGM just like the Stelo.
Day 1: Getting comfy with the depressing job of meals monitoring
I began utilizing the Stelo monitor in the course of a piece day and was shortly met with my first head-scratcher blood sugar occasion: consuming a vegan bowl of brown rice, grilled greens and vegan dressing shot my blood sugar up fairly excessive. I used to be made to know precisely what I ate as a result of the Stelo app has an “occasions” tab the place you may log meal descriptions (with carb counts in grams, if you wish to), train or different actions and notes.
Stress, sickness, laborious train and even lack of sleep also can have an effect on blood sugar and lift your ranges.
Vulnerable to sounding dramatic, I discover the concept of logging the carbs in a salad dressing preposterous. I knew I could not final a month doing it, so I did not. I as an alternative logged my meals with the principle components. For instance, one “meal” within the Stelo app is logged as a “black bean, cheese and vegetable empanada with a aspect salad of arugula and ranch.” Different “meals” are literally extra like snacks (“popcorn with butter, parmesan and dietary yeast,” “banana,” “carrots and hummus”) or drinks (“espresso with half and half and agave).”
I’ll word right here that I ultimately stop logging meals altogether as a result of as I received extra used to checking the app periodically all through the day, narrowing down a “wrongdoer” meals or stressor inflicting somewhat bump or spike in my glucose graph turned simpler.
This is not to say you should not log any of your meals within the Stelo app — doing so within the early days actually helped me get within the behavior of associating sure meals with larger or decrease glucose ranges so I may finally go “off e-book.” Ensuring you word your meal is very useful in case you get a “spike detected” immediate as a result of the app will solely notify you of serious blood sugar jumps. There does appear to be a slight delay in these notifications, although.
A salad checks my persistence
It was the top of a piece week and I used to be hurrying to complete an article that had a deadline whereas additionally consuming a late lunch I thought was fairly wholesome: a salad made from a mattress of arugula, sauteed peppers and onions, seasoned black beans, cheddar cheese and croutons. I additionally had a small black bean empanada and put salad dressing on the salad. And I do know croutons are largely carbs and little substance however I like including crunch to salads and nonetheless think about the meal total to be pretty nutrient-dense and colourful.
I used to be shocked, then, to test the Stelo app and see a excessive spike in glucose. It was positively above 140 and looking out down on the graph doubled my stress. It turned a chicken-or-the-egg scenario — was my glucose spiking as a result of I used to be confused and drained after which ate a carb-y salad? Or was I feeling additional drained and confused as a result of I went a very long time with out consuming after which ate a carb-y salad and my blood sugar is now crashing down?
Both manner, life went on, I had plans with a buddy to see a film later that night time and was then hit with a unique curveball: The 2 glasses of crimson wine and buttered popcorn that I consumed virtually in spite, assuming my biosensor was going to scream at me, did not increase my blood sugar in a noticeable manner.
I later discovered that alcohol really lowers blood sugar and that not consuming sufficient protein, even when there are many vegetables and fruit concerned, causes my glucose ranges to go up. Nonetheless, the primary few days of monitoring my blood sugar served to inform me that meals which can be filled with vitamins and in any other case good for me can also trigger larger spikes in glucose than meals that I really feel assured aren’t doing me any well being favors (wine or alcohol).
Bagels and blood sugar
There is a good bagel store down the road from the place I dwell in Brooklyn. One Saturday after a Pilates exercise, I ordered a veggie omelet on a salt bagel with a beet, carrot and ginger juice.
In different phrases, it was a carb-heavy meal. And whereas it was scrumptious, I knew Massive Daddy Blood Sugar was going to have one thing to say about it. And oh, did it. This stays my greatest glucose spike since I started monitoring my blood sugar, and it was fairly stunning to see how excessive it received, despite the fact that it fell again down quick.
This one wasn’t shocking — I do know bagels have a variety of carbs, and whereas the juice was freshly blended and filled with nutritional vitamins, it was processed juice and a variety of pure sugar. But it surely was round this level that I began to get genuinely involved that I could also be one of many 1 in 3 US adults who’ve prediabetes however do not but understand it.
The Stelo begins to mellow out
A pair weeks into testing the Stelo, my glucose charts began turning into rather less spikey and my common glucose degree is trending down. I am in a position to do that within the glucose abstract within the Stelo app, in addition to a extra complete view in Dexcom Readability, an app folks can use to share their glucose data with a well being care supplier. My glucose ranges have additionally been decrease within the mornings once I get up, suggesting a barely decrease fasting glucose degree (or morning glucose degree).
I believe a couple of components contributed to this. One is that I have been making an attempt so as to add extra protein to extra snacks and meals, particularly as the primary meals selection of the day once I are inclined to not be very hungry. Protein doesn’t have the identical glucose-spiking impact as carbs. I’ve additionally been making an attempt to take a seat round much less after consuming, as strolling or transferring following a meal is a quick method to decrease glucose.
However I have not been making an attempt that laborious to decrease my glucose ranges as I needed to get a extra correct snapshot primarily based on what my norm is. This leads me to different potential influences which can be extra speculative. One is that I believe I used to be getting over some sort of virus once I first began sporting the monitor. I felt fatigued sufficient to check for COVID a few occasions (destructive), however my tiredness endured for a number of days after a fast sore throat, suggesting my physique was preventing one thing and (doubtlessly) elevating my glucose ranges. At first, I did not suppose a lot of this as a result of the knowledge I might seen steered that extra extreme sicknesses raised blood sugar, not minor bouts of fatigue.
The opposite issue that will have lowered my fasting glucose degree is that I used to be a bit much less confused and should’ve been getting extra restful sleep. For an enormous chunk of my Stelo evaluation, I used to be spending time with household in Wisconsin. Throughout this time, I really anticipated my blood sugar ranges to spike a bit greater than regular contemplating I used to be consuming desserts extra typically than I often do and likewise exercising a bit much less. However popping out of a annoying couple of weeks in New York Metropolis filled with journey and poor sleep, may working within the peace and quiet and spending time with household improved my stress ranges in ways in which might have inadvertently lowered my blood sugar?
What the medical doctors and analysis say
A lot of my concern and confusion all through this entire course of involves how typically my glucose ranges ought to exceed 140 mg/dL, which is the goal restrict for folks with out Kind 2 diabetes. Whereas the previous couple of weeks I have been extra aligned with the steered purpose of spending 96% of time within the “inexperienced,” I positively cannot say it has been that manner from the soar.
Mainly, I have been looking for out whether or not I ought to be anxious about insulin resistance, which is when the physique would not reply as effectively to the blood sugar regulating hormone. If left unchecked, insulin resistance results in Kind 2 diabetes, which is related to different well being issues.
Dexcom says that they chose their beneath 140 mg/dL primarily based on analysis displaying that most individuals with out diabetes ought to keep under 140 mg/dL the overwhelming majority of the day. The US Facilities for Illness Management and Prevention says folks with out Kind 2 diabetes ought to be beneath 140 mg/dL 2 hours after the glucose tolerance check.
There’s additionally newer analysis entering into the nitty-gritty of what glucose spikes and dips ought to seem like in non-diabetic folks as a method to optimize well being. One small research from 2018, for instance, discovered there are variations in the way in which folks with out diagnosable diabetes course of blood sugar, suggesting there could also be completely different “glucotypes” with larger danger of well being issues, even when they do not meet the medical standards for prediabetes or diabetes.
However in line with Dr. Scott Isaacs, a board-certified endocrinologist and president-elect of the American Affiliation of Scientific Endocrinology (endocrinologists are specialists in hormone-related bodily capabilities akin to diabetes and blood sugar management), the proof for a selected “goal vary” in these with out diabetes will not be strong but. Listening to my stress about going above 140 mg/dL, he pushed again on the concept that it isn’t wholesome for folks with out diabetes or prediabetes to rise above 140, and even as much as 200.
“When it spikes up like that, that may be utterly regular.” He informed a narrative about being at a convention with different endocrinologists a few years in the past when CGMs had been nonetheless new and plenty of medical doctors had been testing one out.
“All people was sporting one, and everyone was freaking out,” he mentioned, notably when blood sugar spiked after lunch.
“It occurs,” Isaacs mentioned. “In case you eat a sure meal, it is gonna go as much as 200.” Whereas these spikes ought to come down shortly, it is one metric that could be “deceptive” about sporting a CGM, Isaacs mentioned.
“You possibly can eat one thing and get a spike that goes actually excessive in your CGM, after which it comes proper again down,” he defined. On the identical time, one other individual may eat a higher-fat meals that is not essentially more healthy, “however the sugar by no means spiked.”
Dr. Thomas Grace, head of scientific advocacy and outcomes at Dexcom, took a take a look at my Stelo graphs by the Dexcom Readability app (which anybody with a Dexcom CGM can obtain and use to share their data with a physician) and informed me my swings did not elicit any fear. However he acknowledged there is a analysis hole in CGMs being worn extra usually, and that these spikes can be utilized as a studying expertise.
“There’s nonetheless some work being executed on this subject,” Grace mentioned. “Earlier than the appearance of getting steady glucose readings, we had a variety of assumptions that numbers ought to run in sure areas, and so we’re very early into this house, and there is work presently being executed to outline that.”
Grace additionally referred to as my consideration again to Stelo’s actual function: It is aiming to assist folks with Kind 2 diabetes handle and have company over their very own blood sugar ranges so that they really feel higher, or doubtlessly reverse their want for treatment or extra medical interventions.
“That is what we’re seeking to do, is sort of give folks light nudges to assist them with what we all know is without doubt one of the most impactful issues on their diabetes, which is their meals selections,” Grace mentioned.
“Though folks have been informed to do these issues for years, it is actually eye opening to see you can see the direct causation of issues taking place,” Grace mentioned. “And I believe that there is such an enormous profit there for folks to have the ability to see this stuff.”
A1C vs. CGM: Is yet another correct than the opposite?
One of many advantages to sporting a CGM, in line with Isaacs, is that it could be extra telling than an A1C check drawn in a physician’s workplace. An A1C is a mean of your blood glucose ranges over the past three months. It is used for diagnosing diabetes and prediabetes, however it could be affected by small variabilities or abnormalities in crimson blood cells.
And it may’t observe blood sugar in actual time like sporting a CGM can, so individuals who have important lows and important highs might have a deceptive A1C as a result of it is simply averaging out, in line with Isaacs.
“The CGM helps you determine form of extra exactly what is going on on in comparison with the A1C,” Isaacs defined, particularly by a metric referred to as a GMI. I may see mine as soon as I downloaded Dexcom Readability, which was simple to do and one thing I like to recommend as a result of it stuffed out a number of the long-term knowledge lacking from the Stelo app.
However studying this was regarding to me, as I used to be leaning on my final couple of years’ price of A1C numbers to really feel assured I used to be firmly under a cut-off that might counsel diabetes, prediabetes or insulin resistance. However my GMI estimate from Dexcom is certainly larger than my previous two A1Cs. (My GMI has decreased a bit over time since I began utilizing the sensor, as my common glucose ranges have been decrease, however nonetheless.)
I’ve nothing to do with this data now aside from speculatively sift by different blood work findings. I did discover out I had a vitamin B12 deficiency in 2023 — may this have an effect on my blood outcomes or be an element? I’ve zero concept. However I completely plan to carry it up at my subsequent physician appointment.
What are the advantages and dangers of monitoring your blood sugar?
Steady glucose monitoring provides folks direct perception into their blood sugar ranges, which might point out diabetes, a preventable illness that may result in nerve harm, imaginative and prescient issues, coronary heart issues and extra.
With out glucose monitoring, detection of diabetes depends on folks getting common blood work or having diabetes progress sufficient to the place folks really develop signs. These can embody elevated thirst and tingling within the palms and toes.
Along with being a real-time different to conventional bloodwork, Isaacs says glucose monitoring is helpful for individuals who need extra details about how their weight loss plan and different life-style components have an effect on blood glucose. As long as they perceive the constraints of sporting a CGM, which incorporates not overreacting to what may very well be “presumably regular.” (Responsible.)
“However, I am certain there are those that have diabetes that do not understand it, they usually put out a sensor and it reveals their diabetes,” Isaacs mentioned. “It may possibly go each methods,” he mentioned, however CGMs do are inclined to inspire folks to take well being into their very own palms.
From a public well being standpoint, extra folks sporting glucose displays will encourage extra analysis and assist inform what it means to be “metabolically wholesome” — a purpose put up I nonetheless do not feel assured is sturdy sufficient on the finish of penning this evaluation.
What monitoring my blood sugar with the Stelo taught me
I discovered there are nonetheless a variety of questions we do not have solutions for when monitoring glucose within the common inhabitants. For instance, how significant are the variations when it comes to long-term well being or total wellness between folks with various glucose ranges or spikes? Official well being steering round blood sugar appears to revolve round “illness” vs. “no illness.”
However, will glucoses monitoring monitoring give folks a false sense of well being safety? What if their blood sugar stays low, however their weight loss plan is usually missing in vitamins that are inclined to result in constructive long-term well being outcomes?
On a private degree, and regardless of my early frustrations with the ups and downs, I did study rather a lot from a month spent monitoring my glucose. (I did miss a couple of days when switching sensors.) Principally, I discovered that making very small adjustments like prioritizing consuming just a bit bit extra protein every day, and taking a brief little stroll after a meal does appear to maintain my glucose from rising excessive.
Importantly, none of those adjustments required me to tackle habits I discover unsustainable and even dangerous in the long term — akin to calorie counting, making use of ethical values to meals as “unhealthy” with a view to prohibit them or over-exercising.
It additionally highlighted unhealthy habits of mine I have been sweeping beneath the rug. For instance, I’m a chronically poor sleeper who will keep up very late or stand up very early within the identify of getting issues executed, often extra inventive or enjoyable issues I haven’t got time for within the common weekday. However as a result of my poor sleep hygiene hasn’t been affecting my well being in apparent methods, and I really feel rested sufficient most days, I have been treating it extra because the ghost of Christmas future that may solely hang-out a future model of myself. And by then, I will have a more healthy sleep sample, proper? That is even with the data that analysis has immediately pointed to quick sleeping as a possible explanation for insulin resistance in girls.
On a follow-up query about stress, Isaacs informed me that stress could make blood sugar larger, however there are components that have an effect on how a lot. He added that the affect is extra pronounced in folks with diabetes. Whether or not or not my poor sleep and perceived excessive stress in my Stelo testing was an actual motive for the delicate constructive glucose shift from begin to end, I’ve determined it would not matter a lot. As a result of if there are two patterns that do appear to solidify time and time once more within the wellness world, it is that wholesome habits encourage different ones, and that you just really feel a larger sense of well-being when you may have company and selection over them.