I attempt to keep wholesome. I eat a (principally) vegetarian weight loss program, 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 typically conscious of the US downside with power ailments, together with Sort 2 diabetes and prediabetes, which have an effect on hundreds of thousands of adults and could be prevented.
I word all of this to set the stage for a way boastful 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 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, often is the final primary well being metric we cannot 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 reassurance 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 bought cocky.
Not solely was I incorrect about anticipating glucose fluctuations to be simple — there may be frustratingly little info on what steady glucose ranges ought to appear 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 could’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 have been by no means actually seen to me till I allowed a CGM to get below my pores and skin.
This is my expertise carrying the Stelo and what you need 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 firms and maker of the Dexcom G6 and G7, which measure blood sugar repeatedly 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 Sort 2 diabetes, however any grownup who does 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 scale back the chance of well being results from excessive blood sugar — that is very true for folks with Sort 2 diabetes, who’ve the next baseline. As that is meant for informational functions and is not the identical as prescription gadgets, you should not make any remedy choices based mostly on readings with out consulting your physician first.
Like different CGMs, the Stelo monitor does not observe 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 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 blissful to be taught the Stelo directions have been simple to comply with. Step one it’s essential 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” on your glucose measurements to remain inside, based mostly on whether or not or not you’ve got been identified with diabetes or prediabetes. The goal vary for Sort 2 diabetes goes as much as 180 milligrams per deciliter and seems to be the usual vary docs use for taking a look at glucose throughout all populations. Individuals with outSort 2 diabetes or prediabetes will likely be given a decrease goal vary to remain beneath throughout many 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 30 days. Insurance coverage firms will not cowl CGMs for individuals who do not want insulin generally, however you need to 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 inexpensive than different client CGM firms that use a workaround for the prescription requirement. These firms accomplish that by getting their very own docs to write 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 basic wellness glucose monitor, Lingo, prices $89 for a month’s provide.
Hopefully, extra availability of glucose monitoring within the wellness area will drive down costs and even affect insurance coverage protection so folks with higher-than-normal blood sugar ranges, or these with Sort 2 diabetes who do not want insulin, can afford to maintain carrying a CGM just like the Stelo.
Day 1: Getting comfy with the depressing process of meals monitoring
I began utilizing the Stelo monitor in the course 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 may log meal descriptions (with carb counts in grams, if you wish to), train or different actions and notes.
Stress, sickness, exhausting train and even lack of sleep may also have an effect on blood sugar and lift your ranges.
Susceptible 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 substances. 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 bought extra used to checking the app periodically all through the day, narrowing down a “wrongdoer” meals or stressor inflicting just a little 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 greater or decrease glucose ranges so I may finally go “off ebook.” Ensuring you word your meal is particularly useful should 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 checks my endurance
It was the tip 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 verify 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 pressured and drained after which ate a carb-y salad? Or was I feeling additional drained and pressured 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 good friend 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 elevate my blood sugar in a noticeable approach.
I later discovered that alcohol truly 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 are filled with vitamins and in any other case good for me may 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 probably the most dramatic (and, I believed, regarding) spike in my blood sugar since carrying 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 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 bought, despite the fact that it fell again down quick.
This one wasn’t stunning — I do know bagels have a number of carbs, and whereas the juice was freshly blended and filled with nutritional vitamins, it was processed juice and a number of pure sugar. Nevertheless it 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 info 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 feel a couple of components contributed to this. One is that I have been attempting so as to add extra protein to extra snacks and meals, particularly as the primary meals alternative of the day once I are likely to not be very hungry. Protein doesn’t have the identical glucose-spiking impact as carbs. I’ve additionally been attempting to sit down round much less after consuming, as strolling or transferring following a meal is a quick solution to decrease glucose.
However I have not been attempting that exhausting to decrease my glucose ranges as I wished to get a extra correct snapshot based mostly on what my norm is. This leads me to different potential influences which are extra speculative. One is that I feel I used to be getting over some sort of virus once I first began carrying 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 combating 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 which will have lowered my fasting glucose degree is that I used to be a bit much less pressured and should’ve been getting extra restful sleep. For an enormous chunk of my Stelo assessment, I used to be spending time with household in Wisconsin. Throughout this time, I truly 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 demanding 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?
Extra days over the past two weeks carrying the Stelo have been extra aligned with its “goal” vary for somebody with out diabetes. This is without doubt one of the days I wasn’t essentially “consuming more healthy” than regular — I used to be visiting household and really 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 complete course of involves how typically my glucose ranges ought to exceed 140 mg/dL, which is the goal restrict for folks with out Sort 2 diabetes. Whereas the previous couple of weeks I have been extra aligned with the urged aim of spending 96% of time within the “inexperienced,” I positively cannot say it has been that approach from the soar.
Principally, I have been looking for out whether or not I ought to be fearful about insulin resistance, which is when the physique does not reply as properly to the blood sugar regulating hormone. If left unchecked, insulin resistance results in Sort 2 diabetes, which is related to different well being issues.
Dexcom says that they chose their below 140 mg/dL based mostly on analysis exhibiting that most individuals with out diabetes ought to keep beneath 140 mg/dL the overwhelming majority of the day. The US Facilities for Illness Management and Prevention says folks with out Sort 2 diabetes ought to be below 140 mg/dL 2 hours after the glucose tolerance check.
There’s additionally newer, doubtlessly extra speculative analysis stepping into the nitty-gritty of what glucose spikes and dips ought to appear like in non-diabetic folks as a solution to optimize well being. One small examine 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 greater threat of well being issues.
However in response to Dr. Scott Isaacs, a board-certified endocrinologist and president-elect of the American Affiliation of Scientific Endocrinology (endocrinologists are specialists in hormone-related bodily features resembling 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 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 fully regular.” He instructed a narrative about being at a convention with different endocrinologists a few years in the past when CGMs have been nonetheless new and plenty of docs have been testing one out.
“All people was carrying one, and all people was freaking out,” he stated, notably when blood sugar spiked after lunch.
“It occurs,” Isaacs stated. “In case you eat a sure meal, it is gonna go as much as 200.” Whereas these spikes ought to come down rapidly, it is one metric which may be “deceptive” about carrying a CGM, Isaacs stated.
“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 similar 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 medical advocacy and outcomes at Dexcom, took a take 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 info with a health care provider) and instructed me my swings did not elicit any fear. However he acknowledged there is a analysis hole in CGMs being worn extra typically, and that these spikes can be utilized as a studying expertise.
“There’s nonetheless some work being executed on this area,” Grace stated. “Earlier than the arrival of getting steady glucose readings, we had a number of assumptions that numbers ought to run in sure areas, and so we’re very early into this area, and there is work at present being executed to outline that.”
Grace additionally referred to as my consideration again to Stelo’s actual goal: It is aiming to assist folks with Sort 2 diabetes handle and have company over their very own blood sugar ranges in order that they really feel higher, or doubtlessly reverse their want for remedy or extra medical interventions.
“That is what we’re seeking to do, is form 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 decisions,” Grace stated.
“Though folks have been instructed to do these issues for years, it is actually eye opening to see that you would be able to see the direct causation of issues taking place,” Grace stated. “And I feel that there is such an enormous profit there for folks to have the ability to see this stuff.”
In line with 2024 info from The Commonwealth Fund, the US ranks final in comparison with different rich international locations resembling Australia, the UK and Canada, in terms of weighing well being care efficiency with the amount of cash spent. This leaves the door extensive open for extra innovation in preventive care, which might cease ailments from progressing and assist reduce prices.
A1C vs. CGM: Is another correct than the opposite?
One of many advantages to carrying a CGM, in response to Isaacs, is that it could be extra telling than an A1C check drawn in a health care provider’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 could be affected by small variabilities or abnormalities in crimson blood cells.
And it might probably’t observe blood sugar in actual time like carrying a CGM can, so individuals who have vital lows and vital highs might have a deceptive A1C as a result of it is simply averaging out, in response to Isaacs.
“The CGM helps you determine kind 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 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 crammed 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 beneath a cut-off that may 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 info now aside from speculatively sift by means of 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 thought. However I completely plan to carry it up at my subsequent physician appointment.
If I have been to put on a Stelo once more, I might spend money on some sort of patch like Pores and skin Grip or GrifGrips, which I discovered from Reddit and Taking Management of Your Diabetes might assist maintain your CGM connected, or tape to maintain it from peeling up. This photograph was taken when there have been 4 days left of the sensor. Glucose readings have been nonetheless going robust and remained unaffected, although.
What are the advantages and dangers of monitoring your blood sugar?
Steady glucose monitoring offers folks direct perception into their blood sugar ranges, which might point out diabetes, a preventable illness that may result in nerve injury, 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 truly develop signs. These can embrace elevated thirst and tingling within the palms and ft.
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 weight loss program and different way of life components have an effect on blood glucose. As long as they perceive the restrictions of carrying a CGM, which incorporates not overreacting to what might be “presumably regular.” (Responsible.)
“Alternatively, I am positive there are those who have diabetes that do not understand it, they usually put out a sensor and it exhibits their diabetes,” Isaacs stated. “It might probably go each methods,” he stated, however CGMs do are likely to encourage folks to take well being into their very own palms.
From a public well being standpoint, extra folks carrying glucose screens will encourage extra analysis and assist inform what it means to be “metabolically wholesome” — a aim publish I nonetheless do not feel assured is sturdy sufficient on the finish of scripting this assessment.
What monitoring my blood sugar with the Stelo taught me
I discovered there are nonetheless a number of questions we do not have solutions for when monitoring glucose within the basic inhabitants. For instance, how significant are the variations by way of long-term well being or total wellness between folks with various glucose ranges or spikes? Well being steerage round blood sugar appears to revolve round “illness” vs. “no illness.”
Alternatively, will glucoses monitoring monitoring give folks a false sense of well being safety? What if their blood sugar stays low, however their weight loss program is usually missing in vitamins that are likely 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 be taught loads from a month spent monitoring my glucose. (I did miss a couple of days when switching sensors.) Largely, 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 — resembling calorie counting, making use of ethical values to meals as “dangerous” with a purpose to prohibit them or over-exercising.
It additionally highlighted unhealthy habits of mine I have been sweeping below the rug. For instance, I’m a chronically poor sleeper who will keep up very late or rise 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 am going to have a more healthy sleep sample, proper? That is even with the data that analysis has straight pointed to brief sleeping as a possible reason behind insulin resistance in girls.
On a follow-up query about stress, Isaacs instructed 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 folks with diabetes. Whether or not or not my poor sleep and perceived excessive stress in my Stelo testing was an actual cause for the refined constructive 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 larger sense of well-being when you’ve gotten company and selection over them.
