The year 2020 was a difficult one for so many people, but for me personally, it was one of the hardest years I've ever faced. First, the pandemic hit, forcing me to stay in place in my one-bedroom NYC apartment. Three months later, my father passed away, and I moved back to the U.K. to look after my mum, who was left all alone. Four months after that, I moved back to the States — via 3 weeks in Dubai as I couldn't fly direct — and three days after that, disaster hit.
I'll always remember Friday, November 27, 2020. At 3 am, I woke up with my heart beating out of control, and I knew I was having a heart attack. My initial thought was to go take a shower, and two years later, I'm very glad I didn't, as I now know wouldn't have survived. When I got to the hospital about 20 minutes later, my heart rate was over 180, and a hot shower would have pushed it to over 210.
Living with the risk of hereditary diabetes and heart disease
Diabetes runs in my family. All of my father's male siblings are diabetic, and while I'm the first of my generation to be diagnosed with diabetes, I have known there was a very strong chance I would be a diabetic. For some people, this would mean taking care of yourself and doing your best to prevent it from happening, but my younger self failed to do that.
In 2019, my average glucose was 7.19 percent, which classified me as a diabetic, but had I caught it then — and the cholesterol problems, which ultimately led to a blockage in my left anterior descending artery (a.k.a., the widowmaker) — I would have prevented the heart attack. At the time of my heart attack, just 18 months later, my average glucose had grown exponentially to over 10 percent and so began a lifetime of medication and care, as well as the knowledge that diabetes is now something I have to live with.
The power of a CGM
Most diabetics have to use a fingerstick to check their blood sugar three times a day. This is the recognized method for checking blood sugar at home, and it works, albeit it with faults. The principal fault is that it only provides a snapshot at that given moment in time and it doesn't provide any information about the trends of your blood sugar.
For example, I checked my blood sugar in the morning and it would seem normal, but once I switched to a continuous glucose monitor (CGM), I realized that it was actually rising, having been low in the early hours before waking up. Similarly, post breakfast, I would check my blood sugar but sometimes be too early to check it — versus exactly two hours after eating — and it was only after starting to use a CGM that I realized how long it takes my body to normalize after a meal; for most people, it's two hours, but my blood sugar will take up to four hours to completely normalize after a meal. It took a while for me to learn this.
A CGM like FreeStyle Libre lets you discretely check your blood sugar in public.
Then we come to the social stigma of diabetes. Although it's a very common disease — according to the CDC, more than 37 million people have diabetes, or about 10 percent of the American population — there's a stigma associated with going out for dinner but needing to draw blood from your finger to check your sugar. In any public environment, I found that I was less inclined to want to check my blood sugar, mostly for the fear of what someone would think.
A CGM works differently than a fingerstick checker, and it's not as accurate, but even a regular fingerstick checker isn't as accurate as a medical device. The acceptable degree of error is about 10% percent above or below a blood reading and the difference is mostly due to how they work. The National Institute of Health summarizes it best:
A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.
Now that the science part is over, here's how the FreeStyle Libre continuous glucose monitor quite literally saved my life.
How I nearly halved my average glucose
As I covered in our Apple Watch Ultra review, I'm a huge fan of using technology to manage my health. Specifically, I'm willing to try new pieces of tech if it means that my daily tasks — such as taking meds, and checking blood pressure or blood sugar — are more integrated into my tech habits. Figuring out how to check my blood sugar in a more digital way led me to a CGM.
Every individual is different, and using the FreeStyle Libre allowed me to see how to apply diabetic best practices to my individual needs.
I am a big fan of the FreeStyle Libre over the other alternative (namely, DexCom) because it is smaller, only requires a single sensor on your arm (versus transmitter and sensor with the Dexcom) and can be checked via the LibreLink app on my phone. Dexcom offers many of the same things, and the upcoming Dexcom G7 will be the size of the FreeStyle Libre, but it is harder to get approved through insurance — well, my insurer in the US at least — unless you're taking insulin, which I do not.
Initially, my usage of the CGM was mostly to replicate the fingersticks, which meant scanning my phone on the reader three times per day. However, very quickly the true power of the CGM became apparent; it gives you eight hours of historical data, making it very easy for me to actually track how specific foods and activities affect my blood sugar. And this helped me cut my average glucose almost in half in a little over six months.
Understanding how specific foods impacted my blood sugar then gave me the ability to truly understand how diabetes affected my body and how my diet was impacting my life. Most people believe something as innocuous as cereal would probably be considered a good diet. Except, for me, cereal first thing in the morning caused my average glucose to be higher throughout the day, regardless of which cereal I chose or even if I added a protein source. Switching to an egg-based breakfast and having brunch instead of breakfast and lunch, allowed me to drop the average glucose, keep my glucose stable throughout the day, and drop considerable weight.
Some endocrinologists — the professional term for someone who studies hormones, and the person who'll ultimately be your healthcare professional when managing diabetes — will tell you to eat around 5 or 6 pm. However, when I do so, my blood sugar runs super low in the early hours of the morning, which I wouldn't be aware of without the CGM. Moving this to between 6:30 and 8 pm allows my blood sugar to remain stable throughout the night.
Why I recommend the FreeStyle Libre to every diabetic
In my opinion, every single diabetic should use a continuous glucose monitor, for a few key reasons. The first is that it provides considerable amounts of data that are just not possible to get otherwise. In the app, I can see the average glucose over the past seven, 14, 30, and 90 days, as well as graphs of how this appears during the day and my glucose averages over specific times of the day. FreeStyle Libre taught me this.
A CGM helps you save money, get better data, and ultimately helps you more than just pricking your finger three times per day.
The second is that it really helps you understand how specific foods will impact your diabetes. Coming from an Indian background, traditional vegetarian curries formed a large part of my diet yet these caused the biggest spike in my blood sugar as they weren't balanced, even when adding dal. Replacing these with grilled chicken salads — even when using Indian spices — completely transformed my average glucose during the later part of the day. FreeStyle Libre taught me this.
When you're a diabetic, more care has to be taken around things like exercising. You can't just go for a run or a brisk walk; instead, it's recommended that you check your blood sugar to ensure that it isn't too low before you start as exercise is the best way to reduce your blood sugar, but doing so when it's already low can result in it dropping to dangerous levels. If you're out and about, it's near-impossible to check your blood sugar when you've just had to do some unplanned exercise — such as running for a bus — and it's also impossible to do so if you forgot to carry your fingersticks with you. With a CGM, all you need is your phone and it's that simple.
That's not to say that CGMs are perfect. Sometimes, they fail. Other times, the readings are inaccurate and it recommends you check your sugar via your fingerstick. The FreeStyle Libre also can't be calibrated meaning some mental maths may be involved if you want it to be as accurate as possible. Despite these shortcomings, there's one final reason it's completely worth getting a CGM: price.
Diabetes care in the US is frankly, ridiculously priced. A box of 100 sticks can cost over $100, and I was spending about $150 per month just on diabetic supplies such as fingersticks and alcohol wipes. In comparison, with insurance, my CGM costs me $68 for 28 days and averages out to about $81.50 per month throughout the year. You save money, you get better data and it will ultimately help you more than just pricking your finger three times per day.
The FreeStyle Libre is not just for diabetics
All the above really only applies if you're a diabetic, yet there's a hugely growing trend of non-diabetics using CGMs as part of a growing trend of biohacking. These products are basically used by health/fitness folks in partnership with apps like levelshealth to fine tune diet, find out allergies you have and generally improve your overall health and wellbeing.
I've previously used Nutrisense.io which I found provided a lot of data but didn't provide the data I was looking for in terms of managing my diabetes. Kevin was also a beta tester for Levels Health and he said:
With the Levelshealth app i'd put in a photo of my meal, some notes on it, then get scores of how it spikes my blood sugar or not. You find out whether you're healthy and it's a great experiement to do for a couple months to help you figure out what your regular diet is working or not, and the hacks you can do to improve it.
Like if you're eating a meal with fruit or you want to actually some orange juice, have your proteins/fats (eggs/bacon) first, then orange juice toward the end of the meal, and your blood sugar will stay way flatter than if you start with orange juice and then eat food (immediately goes through roof).
In many ways, a CGM is a great way to stave off diabetes when you have questionnable diet habits. Using apps like Levels and Nutrisense, or just biohacking yourself like I have done, you ultimately find out the ways that your body processes the food you consume and how it impact your blood sugar. At the end of it, you learn how to keep your average glucose low, which, if you're not a diabetic, will help prevent you becoming a diabetic.