Do I Need a Continuous Glucose Monitor?

If you’re into biohacking or personalized nutrition — or even if you’re not — you’ve probably heard about continuous glucose monitors (CGMs). These wafer-thin disks stick to the back of your arm, with a tiny wire inserted just below the skin to measure blood-sugar levels. They send minute-by-minute measurements to an app on your phone, which then sounds an alarm if your blood sugar spikes or dips.

CGMs can be useful for anyone who struggles with blood-sugar management — or who wonders whether they do. “We can use CGMs to get a bunch of data about how the body responds not just to how we eat but also to the intervals at which we feed ourselves, and the impact that physical activity and stress have on blood glucose,” says functional nutritionist Jesse Haas, MS, CNS, LN.

When you see and feel how a plate of pasta or a good morning workout affect your blood sugar, she adds, you can start to connect this information to other signals from your body. “That can be really empowering.”

As it happens, Haas is my nutritionist. I sought her out after discovering I had high blood sugar. That was a surprise — but also, it wasn’t.

I grew up in a family that loved food, especially carbs, and toast in particular. At family breakfasts, my grandfather kept a four-slot toaster and a loaf of country white on a bar cart at his elbow. Upon request, he’d send slices of piping hot toast flying down the table. (You want that butter to melt!)

As an adult, my professional life has revolved around writing about food. At home I’ve long maintained a solid Mediterranean diet, and I was a runner for years; for a time these healthy habits were enough to keep the effects of my dining life in check.

Then the day arrived when I got a note from my physician about my recent A1C blood test: It showed my average blood-sugar level in the prediabetic range. I needed to make some lifestyle changes, so I started using a CGM to help me identify which shifts made a helpful impact and which didn’t.

This worked well for me, but metabolic health is complex, and different bodies need different interventions. So, when considering whether to invest time, energy, and money into a CGM, it’s worth pausing to make sure you really need one. These are a few things I learned from using mine.

( 1 )

You may not know you have dysregulated blood sugar.

The Centers for Disease Control and Prevention (CDC) estimates that more than one in three adults have prediabetes — and that more than eight out of 10 don’t know it. According to Rita Rastogi Kalyani, MD, MHS, president-elect of medicine and science for the American Diabetes Association (ADA), there may be many reasons for this, including that most people probably aren’t getting a fasting glucose or A1C test on a regular basis as recommended. Even if they are, physicians don’t always flag a prediabetic number.

The blood-sugar range for prediabetes is 5.7 to 6.4 percent; diabetes is 6.5 percent or above. I had been hovering at 5.9 percent, but my own physician hadn’t mentioned it, possibly because my other health markers were good.

More than one in three adults have prediabetes — and that more than eight out of 10 don’t know it.

Yet prediabetes can be serious. Not only does it increase the likelihood of developing type 2 diabetes but the condition also raises the risk of heart disease, stroke, and nerve damage. Diabetes itself can lead to additional major complications, including kidney failure and blindness.

Among the risk factors for developing type 2 diabetes, according to Kalyani, are being higher weight, having a family history of the disease, and being in a high-risk group — African American, Latino, Native American, Asian American, or Pacific Islander. Hypertension and dyslipidemia (a metabolic disorder involving abnormally high or low levels of lipids in the blood) are other potential risk factors.

Women who have had gestational diabetes or have polycystic ovary syndrome are also at higher risk. The ADA recommends regular diabetes screenings if you’re over 35 whether you have any of these characteristics or not.

Because of my Asian American and Pacific Islander heritage, I’m not only genetically predisposed to develop type 2 diabetes but also at risk of developing it even with a lower body-mass index (BMI). The general rule is that diabetes risk increases at a BMI of 25 — but both the ADA and the CDC acknowledge that Asian Americans should screen at a BMI of 23. (It’s important to note that BMI itself is an unreliable measurement of body composition and health, which may be another reason to simply get screened no matter what.)

The signs of dysregulated blood sugar (also called dysglycemia) can be subtle. I often felt cranky or physically shaky between meals and tired after meals, but I assumed everyone did.

“The symptoms of dysglycemia are sneaky,” says Haas. “We don’t think about difficulty concentrating or making decisions as symptoms of low blood sugar. And we tend to associate the more cognitive, emotional, and mental symptoms — like anxiety, irritability, or depression — with something other than biochemistry, but that’s a part of it too.”

She adds that the restrictive eating patterns lauded by diet culture have also helped normalize the symptoms of low blood sugar. “This sets us up to have a really distorted expectation of what it feels like to be a human doing human life.”

( 2 )

A CGM can help you stay motivated.

A study from the CDC’s National Diabetes Prevention Program shows that lifestyle changes are about twice as successful as medications at lowering the risk of diabetes. Losing a little weight, changing your diet, and exercising regularly can all help the body regulate blood glucose. In fact, the study found that these changes can cut your diabetes risk in half.

My physician advised I get a minimum of 150 minutes of cardio activity a week; lose 5 to 7 percent of my body weight; consume fewer simple carbohydrates; and eat a diet rich in vegetables and fruits, fiber, and healthy fats, like avocado, nuts and seeds, olive oil, and fish.

I was already doing most of that, though I did need to cut back on the cake and toast. When I did, my A1C improved, but soon the desire for sugar crept back. I reverted to old eating habits, and after three months my A1C was back to 5.9 percent.

Lifestyle changes are about twice as successful as medications at lowering the risk of diabetes.

“A1C lab tests can be run at 90-day intervals to monitor blood-glucose averages, but a check-in every 90 days offers little accountability,” says Haas. “For people who are really interested in making a behavioral change, a CGM gives us real-time data.”

This internal feedback can also be a great source of “inspiration, motivation, and accountability,” she adds. The CGM reveals precise information about how specific choices affect your body, which can help you fine-tune the more general advice you might get from your physician or nutritionist.

Fitness and nutrition educator Mike T. Nelson, PhD, MSME, CSCS, CISSN, has given a lot of thought to CGMs and motivation. He says it can be hard to convince the athletes he works with that they have dysregulated blood sugar. They may not be feeling optimal, but when their lifestyle, sleep, and nutrition habits are all pretty good, they’re often convinced there’s no need for change.

“There’s something about looking at actual data, seeing their blood-glucose numbers — then they’re like, ‘Oh, there is something going on,’” he says.

That was true for me. I could not change my habits until I went to see an endocrinologist and got a prescription for a CGM, which provided me with real-time feedback on how my choices were affecting my body.

 

( 3 )

Getting a CGM is becoming easier.

CGMs are still used primarily by people with diabetes, and you need a prescription if you hope to get one covered by insurance (though not all insurance plans cover them). I was able to get two CGM sensors, a month’s worth, for a $75 copay. (If I hadn’t had insurance, the cost would have been double.)

Until recently it was tough to get a CGM without a prescription, but that’s changing. A growing number of digital health companies, like Nutrisense, Levels, and Zoe, are pairing CGMs with phone apps to monitor blood-glucose levels, track nutrients, and offer personalized nutritional feedback. In addition, Dexcom and Abbott, two of the primary CGM manufacturers in the United States, recently gained FDA approval to launch over-the-counter versions of their glucose monitors.

 

( 4 )

For best results, partner with a professional and set goals.

Nelson suggests setting parameters for your CGM use. The first is to be sure to work with a health professional. This can help you put the feedback you get into a larger context. “You need someone to help you figure it out,” he says. “Even when people are trying to do their best, they can just get hung up on a number — a number that’s not always good or always bad.”

The second parameter: Know your goals. “Figure out what you want to learn from this data ahead of time,” advises Nelson. “You need a hypothesis and some experiments so that you can learn from it.”

Know your goals. “Figure out what you want to learn from this data ahead of time.”

The initial revelations from my own CGM allowed me — with help from my endocrinologist — to understand how to begin lowering my A1C: Cut down on simple carbohydrates; increase the fiber, fat, and protein in my meals; and get more regular exercise.

Then I started working with Haas for nutritional fine-tuning. She helped me address the subtler questions, like, Why am I having low blood sugar in the morning? Can I have some grains in my diet? What should I do if I’m experiencing high blood sugar over a longer term? I would have been pretty lost without this guidance.

The third parameter Nelson suggests: Be ready to change. Once you establish how you need to adjust your diet and lifestyle, be ready to do it. Your partnership with a health professional can provide accountability.

 

( 5 )

CGMs can stoke anxiety.

While some of us find the real-time feedback of a CGM motivating in a healthy way, that’s not true for everyone. “There’s a caution for folks who are inclined to get more anxious when they’re getting a lot of input,” Haas explains.

She suggests anyone with disordered eating may want to steer clear of a CGM, especially those inclined to extreme food restriction. “It’s not all good, right?” she adds. “That’s part of personalized healthcare — reflecting and self-selecting.”

Anxiety around blood-glucose numbers may also provoke people to make sweeping nutrition decisions — even when everything else is fine. Nelson has watched clients adopt a ketogenic protocol after seeing borderline high blood sugar on their CGM, which could easily end up being an overcorrection.

“I get worried when people take data out of context,” he says. “It happens with heart-rate variability, it happens with sleep data, it happens with a CGM. People are so into optimizing that they’re worrying about stuff they just should not be worried about.”

 

( 6 )

Monitoring your blood sugar can teach you a lot about what’s going on in your body.

Metabolic health influences all the body’s systems, so blood-sugar regulation has a broad impact on well-being. These are just a few examples of what blood-sugar measurements can reveal.

• Stress: When we’re worried, triggered, or in a stressful situation, the body releases cortisol, which raises blood glucose, Haas explains.

• Sleep: There are many potential causes for poor sleep, and a CGM can reveal if blood sugar is what’s keeping you awake. Our body’s natural circadian rhythms raise blood-sugar levels at night, a surge called the dawn effect. For people with dysglycemia, this surge tends to affect sleep quality.

The reverse is also true. “It’s not just that dysglycemia disrupts sleep,” says Haas. “Poor sleep can also disrupt your blood sugar.”

• Weight management: A CGM can show how different foods affect our blood sugar. This feedback can help us adjust our diet in favor of greater blood-sugar regulation. “We’re telling our pancreas, ‘Hey, we’re good. We’re going to reduce the glucose burden so that you’re not exhausted pumping out insulin.’ And that’s going to support weight balance,” Haas explains.

• Exercise and athletic performance: CGMs can show us how exercise affects our blood sugar, including how quickly we’re recovering from strenuous workouts. They can also show you the positive impact of a postmeal walk in real time.

 

( 7 )

Unless you have diabetes, a CGM is a place to visit, not to live.

Experts agree that for most people who don’t have diabetes, a CGM is best used as a short-term intervention. Nelson recommends wearing a CGM for two weeks to establish a baseline. He believes it’s paramount to avoid data overwhelm, and counsels his fitness clients not to look at their data for the first week. He does this to prevent them from making dramatic changes on their own without his input.

After reviewing the data from the first week, Nelson and his clients decide on three or four areas of focus for the next round. “By the end of two weeks, they have some actionable data and a couple things that we’ve found that are really going to move the needle.”

Haas aims for three months with a CGM to establish a baseline. “Ninety days is enough time to focus on virtually anything — and to really create a new habit.”

Beyond that, she suggests using the CGM for short periods a couple of times a year to support habit maintenance. A CGM can also be useful anytime you’re undergoing a notable transition, such as perimenopause, during which the body’s needs are likely to change.

“[It’s good for] any big life change where stress is high and relearning self-care is really critical,” she advises.

 

( 8 )

A CGM can give you a better understanding of what your body needs.

For me, the CGM was the equivalent of a front-row seat at the carb-tolerance show: I learned that rutabagas don’t work for me but lentils do. That I can eat brown rice if it’s had a night in the fridge developing resistant starches. Not so with sweet potatoes: Even a wee dollop is a problem.

There were other great lessons, too, like everything goes better if I load up on protein and fiber; I need a small snack before bed; and, wow, does public speaking give me a spike — even though I kind of dig talking to a crowd.

Most importantly, the CGM plus some excellent healthcare advice helped me figure out how to keep my blood sugar fairly balanced — and I got my A1C down to 5.4 percent. My endocrinologist tells me that if I keep it down, I’m less likely to develop type 2 diabetes. That’s life-changing medicine.

“That’s the beautiful thing about a CGM,” says Nelson. “You can make huge changes to your data with simple interventions. There aren’t a lot of other measurements in the body that you can push around that much. And you can see a pretty big change, sometimes in short order.”

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