[One day in September, I stood in front of my open refrigerator, ravenous but unable to figure out what to eat. I was worried that whatever I chose to eat would cause the new app on my phone to record a spike in my glucose levels that would count against the number I was allowed that day – and I was determined to conquer this algorithm.
I’d just put on a continuous glucose monitor, a device that sticks to your arm and uses a tiny needle to provide near-real-time information about how much sugar is circulating in your blood – not because I have diabetes, the main use for what are called CGMs, but because these devices are starting to be marketed as wellness tools for everybody, and I wanted to see how they work.
Apple? Too sugary. Granola bar? Hello, glucose spike. Cheese – that’s the ticket. A few days of wearing this monitor had taught me that cheese would not cause my glucose to go up.
“Is this thing just inadvertently putting you on the keto diet?” my husband – who’d witnessed a few episodes of hanger while I was trying to figure out how to please my CGM – finally asked.
Pretty much. Avoiding carbohydrates and prioritizing protein and fat, often together, didn’t lead to spikes in glucose that my CGM and app, Lingo from the health company Abbott, would count against me.
But because I wasn’t aiming to switch to a very low-carb, ketogenic diet, I initially struggled to figure out what to eat; in the first week or so of wearing the CGM, my scale read my weight at 3 pounds lower than usual – a blip, I presume, because I was too nervous to eat normally.
This is not, unsurprisingly, how experts say CGMs should be used, whether you have diabetes or not. Continuous glucose monitors have been revolutionary for people with type 1 diabetes, for whom glucose levels are life and death, providing information about how much insulin they need to inject to keep their blood sugar stable. The alternative is finger-stick testing, pricking fingertips to draw drops of blood to check glucose levels, often multiple times a day.
I was excited to try it. Putting the device on was surprisingly painless, and an hour after the little disc was secured to my arm, I started seeing my glucose levels on the accompanying app on my phone.
Dr. Jody Dushay, a physician at Beth Israel Deaconess Medical Center who works with people with obesity and diabetes, reviewed my CGM findings with me. She warned me that blood sugar could range from the high 50s when fasting to the 150s after eating in a generally healthy young woman. She also emphasized that continuous glucose monitoring shouldn’t be used to diagnose prediabetes or diabetes.
Her caution about how I might react to seeing my data turned out to be warranted.
In the first week I wore the monitor, I was glued to the app, watching my glucose rise shortly after eating. The app accumulates metrics that it calls Lingo Counts to try to help users make sense of the data, with a higher number associated with a bigger or longer elevation of glucose.
Although the app gave me an initial target of 60 or under for my daily Lingo Count, I found myself trying to keep it as low as possible, a tendency reinforced by the app’s suggestions to do 20 squats after lunch to “find some balance” as my count was going up. I ended up keeping my count so low initially that the app reset my daily target to 22, which I exceeded frequently once some of my anxiety wore off.
And although the finding that cheese didn’t lead to a glucose spike wasn’t a huge surprise, there were a few other readings that were interesting.
A salad with chopped vegetables and quinoa that I thought was a healthy choice for a quick lunch registered one of my largest Lingo Counts of the week, probably because of the sugar in the peanut dressing. A glass of wine and a slice of pizza, on the other hand, didn’t cause a glucose surge – a happy revelation but not one that I can pretend will lead to better health.
Dr. Dushay told me when I sent her screengrabs of my glucose levels that “your values are all completely normal. What look like ‘spikes’ are perfectly fine excursions within the normal range.”
But could those increases, even within a normal range, give me feedback on ways I could feel healthier? Stay full longer? Have more energy? Lower my risk of metabolic disease? Or would I learn only that, as Marston put it, my “pancreas functions as it should”?
The scientific community appears to be divided on the value of continuous glucose monitoring for people who don’t have diabetes, a gulf that researchers say is exacerbated by a lack of data. Dr. Nicole Spartano, an assistant professor at Boston University’s Chobanian and Avedisian School of Medicine, says she conducted a study in which she surveyed clinicians who had expertise on CGMs and asked them to interpret about 20 reports on glucose levels in people without diabetes.
“There’s no consensus about how they view the data,” she said. “Some people think high spikes are bad; some people think they’re meaningless in people without diabetes; some people think, ‘if it’s a prolonged period of a glucose excursion,'” over 180 or so, those people should be screened for diabetes; “other experts will see that and say that person is fine.”
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