How can I best use my CGM

[Subtle_badger]

I have acquired a continuous glucose monitor, a CGM. It will tell me my blood glucose every minute or so for 14 days, if I don't knock it off my arm 2 days after I start using it. I am very clumsy, so I may do that.

Anyway, I thought I might crowd source the best way to use this device to learn how my body responds to inputs.

I have a fairly consistent day, so I would want to spend a few days seeing how my body responds to my typical day. If the first two or three days are almost identical, then I will be happy with my everyday and move on, but if they are not? Should I stay with those inputs, or shut them down?

Once I have my everydays, I would like to see what stressors change it. In 14 days, I can't duplicate every situation - especially as I need a few days to establish normal.

So my thoughts are that after a few days to see my glucose is stable (🤞) to do a 36-60 hour fast, and to have a pizza. These are both things I love to do, and am interested in how they change my body.

It doesn't seem like much for 14 days on a CGM that costs nearly £50, but better to do a small thing right, than a big thing badly

Do we agree that's a good use of the second week of a CGM? I would be excited to put together a more thoughtful plan if one was suggested. Or even intimated.

[MikePollard]

I don't understand why if you are not diabetic, and even if you are, the solution we know about.

We all know here exactly what will happen eating a slice of pizza after a keto fest will do to blood sugar, and it certainly won't change your body.

Follow a diet based on fat, not carbohydrate and things will work out naturally without high tech.

[Subtle_badger in reply to MikePollard]

Do we know these things? Do we know how my body responds to different foods? I don't, and I would like to learn. Monitoring ketones is expensive and bothersome, monitoring insulin is impossible, so glucose is my only option.

I have heard a few people on low carb/keto say their bodies let them know they have eaten carbs. The feel bloated, inflamed, gain weight, headaches etc etc.

I do still like pizza. I don't have them often, the last one was in October. I felt fine. No cravings, no bloat, no weight gain. I fasted the next day as easily as the previous one. So it's either because I am metabolically flexible, and my body digests it slowly, and my hormones process it so my blood sugar remains stable. Or it's because I do have a dangerous blood sugar spike, so even if I feel fine, I am damaging my body. I would like to find out which. This seems a way.

[happytulip in reply to Subtle_badger]

Monitoring ketones is expensive....yes it is! The NHS ketone monitor strips cost a fortune as they're made with gold.

Can you not measure your ketones in your urine or is that not specific enough?

[Subtle_badger in reply to happytulip]

I don't believe urine ketones are much practical value. They are a useful indicator when you first start that you are generating ketones, but as your body learns to use ketones, they can disappear from urine.

I am not that keen on sticking my finger either, so I probably won't be measuring ketones ever, unless I buy a breath monitor.

[Shield-Maiden]

Hi SB,

Silly question here....but shouldn't your blood glucose be, continually, very low, as your diet is Low Carb ?

Do you have to keep the monitor on 24/7?

If so, wishing you luck.

Shield

[Subtle_badger in reply to Shield-Maiden]

I don't know what my blood sugar will be. I am not in a coma even while fasting, so I am definitely using gluconeogenesis to create some glucose. I am curious how much.

The monitor has a probe that goes into your skin. You can't take it off and replace it again, too big a risk of infection. So it stays until it stops working.

People on ebay are selling sticky patches to go over the monitor to keep it from being knocked off, so I assume that is a thing.

[Shield-Maiden in reply to Subtle_badger]

You're brave...do take care Subtle_badger.

[Professor-Yaffle]

A new gadget. Sounds an interesting experiment Subtle_badger.

Rumour has it that most smart watches will soon include non-invasive glucose monitoring technology...... I think it's amazing how far the tech has come along recently. It's going to make such a difference for people with diabetes. It will also be very interesting for non-diabetics to have info on their glucose levels in their smartphone.

[Subtle_badger in reply to Professor-Yaffle]

I just googled that. Glucose, hydration, blood pressure and blood alcohol. I would read the privacy agreements very carefully before wearing one.

The nerd thing runs strong. You can get an integrated training plan that uses a similar (maybe the same) monitor as it's basis. supersapiens.com/en-GB and they are popular amongst the biohacking community in Silicon Valley.

(must be annoying to people in the USA; apparently you have to get a prescription to get one even if you are paying for it yourself, but anyone can buy one in Europe)

[Professor-Yaffle in reply to Subtle_badger]

I think I'd keep the blood alcohol function switched off at the weekends. I'm pretty keen to monitor the rest of that stuff though. Eager to upgrade my watch if the next version has glucose monitoring.

[Professor-Yaffle in reply to Professor-Yaffle]

Will be good to hear about how your experiment is going. Keep us updated please.

[Subtle_badger in reply to Professor-Yaffle]

I haven't opened the package yet, let alone applied it.

But I will share.

[Shield-Maiden in reply to Professor-Yaffle]

Yes, I agree👍

[Cosmo501]

Fascinating. I’ll be very interested to hear how you get on. I’ve been thinking along these lines for a few weeks- keen to see if I can figure out why I start to feel bad when fasting longer than about 21 hours. Wondering if it’s blood sugar related. . I’m pretty sure it was queenie-duke who was giving me some advice on using these gadgets… She may be able to add something useful to the discussion. Your post flagged up an old ‘similar post’ from S-f-good. Makes an interesting read. — hope she is doing well these days.

healthunlocked.com/lchf-die...

I’d be really keen to hear how you get on with this.

[Subtle_badger in reply to Cosmo501]

Thanks for the link. Good times. S-f-g and I have become friends. Well, Facebook friends anyway. We chat every few days in messenger. She's doing OK, tweaking things.

Yeah,thanks for the mention of fasting. My last fast I really pushed myself, nearly too far. In a poorly planned attempt to cycle to Stonehenge for the solstice, I ended up bonking - I think. I haven't had that feeling since January last year, just when in was learning to fast. Sitting on a narrow grass verge on the edge of a now busy A-road, feeling nauseous and faint. I assumed it was low sugar, but then it was cured by rest and carb-free snacks. Would a bonk be cured by meat? I don't know. Maybe the rest gave my body time to replace the glycogen with gluconeogenesis, while the food reassured me and settled my tummy.

I am very curious to see what is going on in my body, but is fasting for 2 days and then cycling 60+km an experiment I should repeat. Something to think about.

Also 14 days isn't long to establish a baseline, eat carbs, fast etc etc.

[Subtle_badger]

😯

At the end of a 40 minute cycle. Should I be worried?

[Professor-Yaffle in reply to Subtle_badger]

I have no idea whether this is worrying or not. Are you prone to hypoglycaemia? Do you have symptoms? I imagine medical advise would be to eat something if you have symptoms.

Also, How does the monitor feel on your arm? Does it feel like it might fall off? I'll be interested to see the variations after you have eaten various foods.

[Subtle_badger in reply to Professor-Yaffle]

I feel great. Just cycled back and enjoying a second flat white, and it's dropped further.

Except for the two coffees, I am fasted since last night.

The thing looked terrifying before I installed it, but I can't tell it's there.

Will play with foods. Tonight is steak with red wine. I installed it today because I want to see what alcohol does before I cut right down in August.

2.9 mmol/l

[Subtle_badger in reply to Subtle_badger]

Diet doctor to the rescue

dietdoctor.com/blood-sugar#...

Conversely, if you are on a ketogenic diet and have elevated ketones, your blood sugar may naturally be 70 mg/dL (3.9 mmol/L)or slightly below. In this case, because ketones are fueling your body, you likely won’t have typical symptoms of hypoglycemia, such as shakiness or lightheadedness.

Now I am wondering if my hba1c might be single digits 🤔 😁

I just got offered a free chocolate cookie. I said no. Maybe it would have taught me something useful.

[Subtle_badger]

This is crazy. I've been home for about 90 minutes. I've eaten a scotch egg, an avocado, half kg tomatoes, a bunch of asparagus and a bavette steak cooked in butter - and a couple of glasses of wine. It's insane. Glucose has already dropped again into hypoglycaemic range after rising briefly.

It may peak again in the next hour or two. Watch this space.

3.7mmol/l

[Cosmo501]

How're you getting on SB? xx

[Subtle_badger in reply to Cosmo501]

F'ing thing has failed after less than 36 hours.

😡

I will contact support tomorrow and see what they say.

[Cosmo501 in reply to Subtle_badger]

Oh god, that’s not good. At least your life is not dependent on the gadget’s reliability thankfully. It could be pretty catastrophic for a child wearing one and being monitored remotely whilst at school, for example?

[Subtle_badger in reply to Cosmo501]

Fortunately it can't be used like that. It needs to be monitored by bringing a reader or phone within a few centimetres (warnings work via Bluetooth, but still a short range), so there needs to be someone close by if a young kid is usually using it. There is also the assumption that you still have your finger prick tester as a back up. So annoying, but not catastrophic for a diabetic.

As long as they replace the ones that fail (they say they do), this sort of failure would be manageable. Just have a new one on hand, at all times, which as they only last 14 days, isn't too onerous. You are going to be needing it soon

[Subtle_badger in reply to Cosmo501]

Ah! You might be pleased to know they treat this failure as seriously as you might hope. I just get an email response to my fault report

"As this is a medical device, we are required to document all reported issues onto our Complaint Handling System. In order to document a full report, may we please ask you to provide the following information."

And one of the questions was

"14) Did this issue result in third party medical intervention, loss of consciousness or seizure? (E. g. Were paramedics called?) Kindly note that as this is a medical device, this information is required to be documented onto our Complaint Handling system"

So yes, they are treating it with the same seriousness they would treat a failed pacemaker, or other surgical device.

[Cosmo501 in reply to Subtle_badger]

That is reassuring -- and I'm still really curious to know the outcome of how you get on with it, once they replace it for you!

[Subtle_badger in reply to Cosmo501]

Me too. Googling I found that some people think it's not reliable at first. One person said they apply it 48 hours before they start using it. so maybe the first day's apparently hypoglycemia was just the device warming up.

I won't be that extreme, but if I get another one, I will put it in my arm 24 hours before activating it.

---

To explain, I think this is how it works:

It comes with an applicator, that has a spring to push it into your arm - which makes it easy and painless. The CGM must have a battery, and to keep the battery fresh on the shelf, the device must be switched on when it's installed; presumably the applicator does that. So when you stick it on your body, it is turned on. But to start it working, you need to tap it with your phone. I am pretty sure if you tap your phone against it in the package, it will do nothing, because it's not on so won't register the tap.

[Subtle_badger]

Because I have only ended up with 36 hours of data, I thought I would see if any patterns emerged. Glucose rises with meals, even low carb ones, but settles quickly afterwards. Ditto with exercise.

But it's not really enough data to make a judgement, it might be random. Nothing explains why I seemed to be in the hypoglycaemic range on Saturday, then on Sunday morning it went up into the normal range, and even into values that might indicate diabetes in a fasted test. I thought that might be the dawn effect, but it stayed there all day.

Maybe the device was broken all along 🤔

36 hours interstitial glucose monitoring

[Subtle_badger]

Looks like a CGM is not for me. They sent me a replacement sensor; I applied it but it never worked. Just a series of error messages then a message to replace it.

😤

[Cosmo501 in reply to Subtle_badger]

How frustrating!!! Grrr.....