I attempt to keep wholesome. I eat a (principally) vegetarian food regimen, prioritize every day motion and attempt to find time for sunshine. I additionally get annual blood work finished 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 power illnesses, together with Kind 2 diabetes and prediabetes, which have an effect on tens of millions of adults and will be prevented.
I notice 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 out there with out prescription within the US. Beforehand, CGMs have solely been out there as medical gadgets 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 prime greenback to get a CGM prescription off-label to allow them to higher see how their physique makes use of power (meals).
Given glucose, or blood sugar, will be the final fundamental well being metric we cannot monitor 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 reassurance from previous bloodwork and the truth that I examine well being stuff all day to protect me from the chance 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 obtained cocky.
Not solely was I incorrect about anticipating glucose fluctuations to be simple — there’s frustratingly little data on what steady glucose ranges ought to appear like in individuals with out diabetes, and mine appeared considerably totally 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 every 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 these items can have an effect on my well being, they have been by no means actually 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 is best to count on when monitoring your personal 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 repeatedly just like the Stelo however require a prescription. (The opposite large 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 individuals with Kind 2 diabetes, however any grownup who does not use insulin and desires extra perception into their blood sugar ranges can use it. The pondering goes that spending extra time in decrease blood sugar zones will scale back the danger of well being results from excessive blood sugar — that is very true for individuals with Kind 2 diabetes, who’ve the next baseline. As that is supposed for informational functions and is not the identical as prescription gadgets, you should not make any treatment choices primarily based on readings with out consulting your physician first.
Like different CGMs, the Stelo monitor does not monitor your blood’s glucose by means of precise blood. As a substitute, blood sugar is learn by means of a tiny thread-like needle that pulls 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 blissful to study the Stelo directions have been simple to observe. Step one that you must take is obtain the Stelo app, which is suitable with iPhone or Android. Then, create an account.
One essential factor to notice is that you’re going to want to pick out a “goal vary” in your glucose measurements to remain inside, primarily based on whether or not or not you’ve got 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 docs use for glucose throughout all populations. Folks with outKind 2 diabetes or prediabetes can be given a decrease goal vary to remain beneath throughout a lot of the day at 140 mg/dL.
After getting the app and an account, you’ll be able to 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 nearly painless, undoubtedly 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 bought 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 normally, however you should use your FSA/HSA {dollars}.
Whereas it is undoubtedly 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 accomplish that by getting their very own docs 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 price for the app. Nutrisense prices $225 to $299 a month.
Abbott’s basic 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 individuals 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 snug with the depressing activity of meals monitoring
I began utilizing the Stelo monitor in the midst of a piece day and was rapidly 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’ll be able to 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 can even have an effect on blood sugar and lift your ranges.
Vulnerable to sounding dramatic, I discover the thought 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 a substitute logged my meals with the primary elements. For instance, one “meal” within the Stelo app is logged as a “black bean, cheese and vegetable empanada with a facet 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 notice right here that I finally stop logging meals altogether as a result of as I obtained extra used to checking the app periodically all through the day, narrowing down a “perpetrator” meals or stressor inflicting somewhat bump or spike in my glucose graph grew to become 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 greater or decrease glucose ranges so I might finally go “off e-book.” Ensuring you notice your meal is particularly useful in case you get a “spike detected” immediate as a result of the app will solely notify you of great blood sugar jumps. There does appear to be a slight delay in these notifications, although.
A salad assessments my endurance
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 product of 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 principally 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 undoubtedly above 140 and searching down on the graph doubled my stress. It grew to become a chicken-or-the-egg state of affairs — was my glucose spiking as a result of I used to be burdened and drained after which ate a carb-y salad? Or was I feeling further drained and burdened 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 approach, life went on, I had plans with a pal to see a film later that night time and was then hit with a special curveball: The 2 glasses of pink 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 approach.
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 stuffed with vitamins and in any other case good for me may additionally trigger greater 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
This was essentially the most dramatic (and, I assumed, regarding) spike in my blood sugar since sporting the Stelo. Shortly earlier than this, I had a Pilates exercise after which ate a veggie omelet on a bagel with a beet, ginger and carrot juice. I’ve eaten a few different bagels since this incident in late August however the impact hasn’t even come near this.
There is a good bagel store down the road from the place I stay 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 Huge Daddy Blood Sugar was going to have one thing to say about it. And oh, did it. This stays my largest glucose spike since I started monitoring my blood sugar, and it was fairly stunning to see how excessive it obtained, regardless that it fell again down quick.
This one wasn’t stunning — I do know bagels have a variety of carbs, and whereas the juice was freshly blended and stuffed 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 comprehend 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 stage 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 individuals can use to share their glucose data with a well being care supplier. My glucose ranges have additionally been decrease within the mornings after I get up, suggesting a barely decrease fasting glucose stage (or morning glucose stage).
I feel 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 after 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 strategy to decrease glucose.
However I have never been making an attempt that laborious to decrease my glucose ranges as I wished 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 feel I used to be getting over some kind of virus after I first began sporting the monitor. I felt fatigued sufficient to check for COVID a few instances (adverse), 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 urged that extra extreme sicknesses raised blood sugar, not minor bouts of fatigue.
The opposite issue that will have lowered my fasting glucose stage is that I used to be a bit much less burdened and will’ve been getting extra restful sleep. For a giant chunk of my Stelo evaluate, 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 in addition exercising a bit much less. However popping out of a irritating couple of weeks in New York Metropolis stuffed with journey and poor sleep, might working within the peace and quiet and spending time with household improved my stress ranges in ways in which could have inadvertently lowered my blood sugar?
Extra days over the past two weeks sporting the Stelo have been extra aligned with its “goal” vary for somebody with out diabetes. This is among the days I wasn’t essentially “consuming more healthy” than regular — I used to be visiting household and truly consuming extra desserts than regular — suggesting that blood sugar is affected by greater than particular meals decisions.
What the docs 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 individuals with out Kind 2 diabetes. Whereas the previous couple of weeks I have been extra aligned with the urged objective of spending 96% of time within the “inexperienced,” I undoubtedly cannot say it has been that approach from the bounce.
Principally, I have been looking for out whether or not I must be frightened about insulin resistance, which is when the physique does 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 exhibiting 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 individuals with out Kind 2 diabetes must be beneath 140 mg/dL 2 hours after the glucose tolerance check.
There’s additionally newer analysis stepping into the nitty-gritty of what glucose spikes and dips ought to appear like in non-diabetic individuals as a strategy to optimize well being. One small examine from 2018, for instance, discovered there are variations in the best way individuals with out diagnosable diabetes course of blood sugar, suggesting there could also be totally different “glucotypes” with greater danger of well being issues, even when they do not meet the medical standards for prediabetes or diabetes.
However in response to Dr. Scott Isaacs, a board-certified endocrinologist and president-elect of the American Affiliation of Medical Endocrinology (endocrinologists are specialists in hormone-related bodily capabilities equivalent to diabetes and blood sugar management), the proof for a particular “goal vary” in these with out diabetes is probably not stable but. Listening to my stress about going above 140 mg/dL, he pushed again on the concept it isn’t wholesome for individuals with out diabetes or prediabetes to rise above 140, and even as much as 200.
“When it spikes up like that, that may be fully regular.” He informed a narrative about being at a convention with different endocrinologists a few years in the past when CGMs have been nonetheless new and lots of docs have been testing one out.
“All people was sporting one, and all people was freaking out,” he mentioned, notably when blood sugar spiked after lunch.
“It occurs,” Isaacs mentioned. “For those who eat a sure meal, it is gonna go as much as 200.” Whereas these spikes ought to come down rapidly, it is one metric that could be “deceptive” about sporting a CGM, Isaacs mentioned.
“You’ll be able to 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 might 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 have a look at my Stelo graphs by means of 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 finished 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 at the moment being finished to outline that.”
Grace additionally referred to as my consideration again to Stelo’s actual objective: It is aiming to assist individuals 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 trying to do, is type of give individuals light nudges to assist them with what we all know is among the most impactful issues on their diabetes, which is their meals decisions,” Grace mentioned.
“Despite the fact that individuals have been informed to do these issues for years, it is actually eye opening to see which you can see the direct causation of issues occurring,” Grace mentioned. “And I feel that there is such an enormous profit there for individuals to have the ability to see these items.”
In response to 2024 data from The Commonwealth Fund, the US ranks final in comparison with different rich nations equivalent to Australia, the UK and Canada, relating to weighing well being care efficiency with the amount of cash spent. This leaves the door huge open for extra innovation in preventive care, which may cease illnesses from progressing and assist minimize prices.
A1C vs. CGM: Is another correct than the opposite?
One of many advantages to sporting a CGM, in response to Isaacs, is that it might be extra telling than an A1C check drawn in a physician’s workplace. An A1C is a median of your blood glucose ranges over the past three months. It is used for diagnosing diabetes and prediabetes, however it might be affected by small variabilities or abnormalities in pink blood cells.
And it could possibly’t monitor blood sugar in actual time like sporting a CGM can, so individuals who have vital lows and vital highs could have a deceptive A1C as a result of it is simply averaging out, in response to Isaacs.
“The CGM helps you determine form of extra exactly what is going on on in comparison with the A1C,” Isaacs defined, particularly by means of a metric referred to as a GMI. I might 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 crammed out among the long-term information 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 will counsel diabetes, prediabetes or insulin resistance. However my GMI estimate from Dexcom is certainly greater 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 means of different blood work findings. I did discover out I had a vitamin B12 deficiency in 2023 — might this have an effect on my blood outcomes or be an element? I’ve zero concept. However I completely plan to convey it up at my subsequent physician appointment.
If I have been to put on a Stelo once more, I might spend money on some kind of additional patch like Pores and skin Grip or GrifGrips, which I discovered from Reddit and Taking Management of Your Diabetes could assist maintain your CGM connected. This picture was taken when there have been 4 days left of the sensor. Glucose readings have been nonetheless going sturdy and remained unaffected, although.
What are the advantages and dangers of monitoring your blood sugar?
Steady glucose monitoring provides individuals direct perception into their blood sugar ranges, which may 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 individuals getting common blood work or having diabetes progress sufficient to the place individuals really develop signs. These can embrace elevated thirst and tingling within the palms and toes.
Along with being a real-time different to conventional bloodwork, Isaacs says glucose monitoring is useful for individuals who need extra details about how their food regimen and different way of life components have an effect on blood glucose. As long as they perceive the restrictions of sporting a CGM, which incorporates not overreacting to what could possibly be “presumably regular.” (Responsible.)
“Alternatively, I am certain there are those that have diabetes that do not comprehend it, they usually put out a sensor and it reveals their diabetes,” Isaacs mentioned. “It may well go each methods,” he mentioned, however CGMs do are inclined to inspire individuals to take well being into their very own palms.
From a public well being standpoint, extra individuals sporting glucose screens will encourage extra analysis and assist inform what it means to be “metabolically wholesome” — a objective publish I nonetheless do not feel assured is sturdy sufficient on the finish of penning this evaluate.
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 basic inhabitants. For instance, how significant are the variations when it comes to long-term well being or total wellness between individuals with various glucose ranges or spikes? Official well being steerage round blood sugar appears to revolve round “illness” vs. “no illness.”
Alternatively, will glucoses monitoring monitoring give individuals a false sense of well being safety? What if their blood sugar stays low, however their food regimen is mostly missing in vitamins that are inclined to result in optimistic long-term well being outcomes?
On a private stage, and regardless of my early frustrations with the ups and downs, I did study lots from a month spent monitoring my glucose. (I did miss a couple of days when switching sensors.) Principally, I discovered that making very small modifications 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 modifications required me to tackle habits I discover unsustainable and even dangerous in the long term — equivalent to calorie counting, making use of ethical values to meals as “unhealthy” as a way 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 rise up very early within the title of getting issues finished, 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 am going to have a more healthy sleep sample, proper? That is even with the information that analysis has straight pointed to quick sleeping as a possible reason behind insulin resistance in ladies.
On a follow-up query about stress, Isaacs informed me that stress could make blood sugar greater, however there are components that have an effect on how a lot. He added that the influence is extra pronounced in individuals 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 optimistic glucose shift from begin to end, I’ve determined it does 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 better sense of well-being when you have got company and selection over them.