Glucose monitors

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I am prediabetic; over the last two years my A1C went from the 2s to upper fives. I started making some dietary changes last year with some minor exercise, but really hit my stride a couple weeks before my summery doc visit where I had an A1C of 6.4 I am now down to 5.5.
So, I want to have information/data on where to focus next, discussed this idea with my doc and she said it fits me. :D
Therefore, I want to find a continuous glucose monitor, that can send an alert via my phone if my glucose goes outside of a range. e.g. when it creeps up, I want to know so I can go for a walk immediately and also look at what I ate/drank and when to better manage it.

So, any suggested devices?
 
Are you going OTC or prescription? Practically speaking in the US, Abbott that makes Freestyle and its nonprescription version, Lingo. And Dexcom, which makes the Clarity G7 and it's OTC version, the Stelio. Both have phone apps. Both can send notifications, but there are some subtle differences on those notifications so you'd have to look at the websites and even query some of the forums if you're looking for a specific notification feature. Insurance doesn't cover these typically for prediabetes, although you can use FSA money, IIRC.

Having said that, in general, I would not recommend a person with pre diabetes freak out about any one single reading. Unless that reading is markedly out of range. (which is not likely in prediabetes...) It's all about the long term trends. There are very classic trends that occur over and over. A gradual morning rise in the early morning hours (before eating), when the liver is inappropriately putting glucose into the bloodstream and post meal excessive rises. Although it's very reasonable to talk a brisk walk, run, bicycle etc in response to a high, looking at the long term pattern and preventing the high is key. The problem is, you will see random rises for unclear reasons.

Being sedentary and overweight lead to a general resistance to insulin. And so your body pumps out more insulin in response, working in the short term, but actually making the long term problem worse. Regular exercise, weight management, and reduction of high sugar/high glycemic index foods over the long term is the goal.

Note that, A1c's below 5.6-5.7 are normal. prediabetes is 5.7 to 6.4%. DM is consistently over 6.4%. A young healthy athlete would typically have an A1c in the 4's. I've never seen an A1c of 2 in my practice. Of course, you wouldn't really draw an A1c on a healthy marathon runner. Not my patient population. There is some genetic variation in a1c levels for a particular sugar level. Still as a very rough rule of thumb, you can multiple your A1c by 20 to get an average sugar. So an A1c of 2-3 would mean an average sugar of 40-60. We're approaching hypoglycemic coma levels of sugar here. (I mean, probably not, as the rule of thumb likely breaks down at the extremes of A1c.)

Remember, your body needs sugar. Your brain and muscles essentially just use glucose for energy. So lower A1c's are better to a point. Then they are not...
 
>1 year ago, was unable to dl all lingo data in a single file.
All you could do was a day at a time.
So…awkward to useless for reviewing your history.
Complained.
Unsure if they fixed that.
 
Curious, what would you be downloading the data to? I'm just asking because when we review these, we never really look at downloaded raw data. I mean, in a 2 week period,if you looked at raw data, you'd have to look at 5000 to 20000 data points. We typically look at the 2 week summary report, then the daily curves to look for patterns. I'm familiar with the prescription versions, the Libre and Clarity G7, but not the OTC versions. They may be a little different since they are not targeted at diabetics per se. Patterns are key. Individual values, not so much. I guess if you had some sophisticated program you developed on your own, you might want to do this, but this is, well, off the beaten path.

If you want an article that summarizes the AGP, and how docs look at this data, this is quite readable even if you're not a healthcare provider. Again, it's more for folks with DM, not preDM, although it's a continuum...

Pub med CGM AGP article
 
@Mark K

Correct 5.4 for example, not 2s. I had to go back and read the test results again. I recalled it incorrectly.
OTC, I do not qualify for prescription, since I brought my A1C down to 5.5 on the last reading.
Already losing weight, made significant cuts to sugar and high glycemic foods. Mostly was looking to see if I can determine some trend lines to know where to focus next; more as a preventive action.

Thank you for the link; your comments and previous comments from my doc, gave me enough additional info, that I believe I will skip a glucose monitoring tool; and just start working on my sedentary habits next as planned for 2026.

Thanks,
 
- Ask ChatGPT after providing it with all info about your condition and practices
- Fix your gums if there is any sign of gum disease (also, stop mouth washes if you are using them)
- Only eat unprocessed (whole) grains
- You can consider: eating your salad 10-15 min before the meal, drinking 2 tbsp of vinegar daily, taking mulberry leaf extract prior to high carb meals
 
There are several CGM subscription plans that cost you out of pocket. They are expensive and in my opinion the monitors show general trends and patterns. But aren’t accurate enough to warrant the price. After using them I decided they’re great if you need motivational coaching. But you can do just as well with a finger stick a couple of times a week and a good talking to yourself about choices.
 
I'm a data nerd and wanted in on these -- my HMO (Kaiser) is less than useless and will only supply these if you are on insulin, something I strive to NEVER be on. However, I discovered that they will write the scrip and tell you to F off for free. You can get the sensors at Costco (Abbott Freestyle 3 Plus) for about $30/mo. It's fascinating seeing the effects and trends from habits and specific foods and what they do to your sugars. I wish I did it 20 or 30 years ago honestly.

Also I am now convinced that Fritos corn chips are some sort of ultra concentrated sucrose lattice creation. Watching those spike sugars lost me my taste for corn chips (and tortilla chips, and other delights) instantly. Also fascinating is finding foods that are stealth and seem to have no effects. For me that's the Trader Joes almond butter/banana smoothies, and any sort of prepared Nigiri -- I thought for certain sushi rice would be spike town. But, newp.

Then you go nuts and learn that quantity also plays a role, even with stealth foods. :D

It's interesting, can recommend.
 
Mark K said:
it's OTC version, the Stelio.
Click to expand...
Stelo, it's an easy typo to make- just fat-finger the "o" key. I only saw it on TV at the gym this morning. The have a deal, it's about $100/month for 3 months. It is probably the cost of the sensors. That's the limit of my knowledge of this device.
 
I started using Signos some time ago to help manage blood sugar post bariatric surgery. They use the Stelo platform as part of their subscription service and the sensor life is getting better with every version. I have successfully used it to keep my reading below 110 for a continuous week. Logging food in the app is fairly straightforward and has helped identify foods that give me a spike that you wouldn't normally think were issues. Cottage cheese spikes me pretty hard for example. My last A1c was 4.6 but I've never been above a 5.3.
 
schmookeeg said:
I'm a data nerd and wanted in on these -- my HMO (Kaiser) is less than useless and will only supply these if you are on insulin, something I strive to NEVER be on. However, I discovered that they will write the scrip and tell you to F off for free. You can get the sensors at Costco (Abbott Freestyle 3 Plus) for about $30/mo. It's fascinating seeing the effects and trends from habits and specific foods and what they do to your sugars. I wish I did it 20 or 30 years ago honestly.

Also I am now convinced that Fritos corn chips are some sort of ultra concentrated sucrose lattice creation. Watching those spike sugars lost me my taste for corn chips (and tortilla chips, and other delights) instantly. Also fascinating is finding foods that are stealth and seem to have no effects. For me that's the Trader Joes almond butter/banana smoothies, and any sort of prepared Nigiri -- I thought for certain sushi rice would be spike town. But, newp.

Then you go nuts and learn that quantity also plays a role, even with stealth foods. :D

It's interesting, can recommend.
Click to expand...
In Kaiser's defense, they are basically following the current medicare rule. Basically, you have DM1 or DM2 on insulin, or DM2 with a few additional criteria. Prediabetics and folks just curious don't get it covered. Why not? Kaisers operation margin is low. Which means if everyone who wanted a CGM or Zepbound, or testosterone could get it by just asking, with no specific criteria, well, then you'd be complaining about why your premium just went up another 25%. I mean, they can cover everything for everyone, but you are not going to like your premium. You have to draw the line somewhere. Up until fairly recently, the ADA did not medially recommend a CGM for type 2 DM folks specifically. And that's because, in general, health care entities pay for a service or device once there is science to prove it actually makes a difference. And until recently the data wasn't there.

Will CGM's become standard of care for all DM2. Undoubtedly. but it will take a bit more time. Will it become standard of care/paid for for pre diabetics and "curious folks?" Well, the proof, ie, the scientific literature isn't there yet, and may never be.

But the devices are not that expensive and coming down. If you can afford to fly, you can certainly afford the sensors out of pocket even if you are non diabetic or pre diabetic.

Medicare coverage for CGM
 
Mark K said:
In Kaiser's defense, they are basically following the current medicare rule. Basically, you have DM1 or DM2 on insulin, or DM2 with a few additional criteria. Prediabetics and folks just curious don't get it covered. Why not? Kaisers operation margin is low. Which means if everyone who wanted a CGM or Zepbound, or testosterone could get it by just asking, with no specific criteria, well, then you'd be complaining about why your premium just went up another 25%. I mean, they can cover everything for everyone, but you are not going to like your premium. You have to draw the line somewhere. Up until fairly recently, the ADA did not medially recommend a CGM for type 2 DM folks specifically. And that's because, in general, health care entities pay for a service or device once there is science to prove it actually makes a difference. And until recently the data wasn't there.

Will CGM's become standard of care for all DM2. Undoubtedly. but it will take a bit more time. Will it become standard of care/paid for for pre diabetics and "curious folks?" Well, the proof, ie, the scientific literature isn't there yet, and may never be.

But the devices are not that expensive and coming down. If you can afford to fly, you can certainly afford the sensors out of pocket even if you are non diabetic or pre diabetic.

Medicare coverage for CGM
Click to expand...

This defense would hold if I was on Medicare and paying "free government cheddar" handout rates instead of the nearly 2K/mo we actually pay.

Are their margins low? I keep reading about KP acquiring new networks and expanding. Meanwhile I've been unable to switch my primary care preventer for lack of anyone taking new patients. All "care" is entirely reactive, no prevention to be seen anywhere. It's an expensive shiz show and probably still less of one than the alternatives.

Sigh.
 
schmookeeg said:
This defense would hold if I was on Medicare and paying "free government cheddar" handout rates instead of the nearly 2K/mo we actually pay.

Are their margins low? I keep reading about KP acquiring new networks and expanding. Meanwhile I've been unable to switch my primary care preventer for lack of anyone taking new patients. All "care" is entirely reactive, no prevention to be seen anywhere. It's an expensive shiz show and probably still less of one than the alternatives.

Sigh.
Click to expand...
All "prevention" is on us. As it should be. I neglected it for a while, paid the price, now I'm back on track.
 
schmookeeg said:
All [insurance] is entirely reactive . . . .
Click to expand...
Well, it should be at least. And is in almost every field except health insurance. You want lower premiums? Buy insurance with less coverage--if you can. I used to have a catastrophic only policy that was dirt cheap.

I mean, you wouldn't expect your car insurance to repaint your car because you don't like the color.
 
I don't see a need for long term continuous glucose monitoring other than for many Type 1 diabetics. However, intermittent 2 week use of continuous glucose monitoring can be helpful for those with Type 2 diabetes or pre diabetics or even those at risk of diabetes. It allows a person to have a better understanding of the glycemic consequences of our dietary choices. I paid about $100 for two Stelo sensors and my wife and I each wore one for about 2 weeks. I was very surprised to see how high and fast glucose levels increased with various dietary choices. My A1c is well below pre diabetic levels but I saw signs of impaired glucose tolerance. It also showed how bad ultra processed food affects glucose levels. So I will probably wear a 2 week monitor for 2-3 times a year to help me understand the glycemic consequences of what I consume and hopefully induce me to make better choices.

Many diseases have specific numerical criteria such as A1c over 5.7 for pre diabetes but in reality that a misleading oversimplification. The road to Type 2 diabetes (which is also rather arbitrarily defined by certain numbers) typically begins at least 10 years before a person meets the official criteria. Endogenous insulin levels begin to rise to compensate for the body's impaired ability to deal with glucose intake above what is required. After many years the pancreas can no longer keep up with the demand, and glucose levels rise. Blood vessels and other tissues in the body are gradually adversely affected by the increased glucose and possibly by elevated insulin type substances.

Metformin is used by some physicians when the A1c is elevated (5.9ish) in an attempt to slow the progression to type 2 diabetes. Metformin can improve insulin sensitivity and decrease the release of glucose by the liver.

I think the wisest approach is to consume a more healthful diet. Most of the stuff they sell in grocery stores is garbage. Ultraprocessed food is widely believed to have adverse effects on the body. I've attended many lectures given by Mayo Clinic preventive cardiologists who advocate the Mediterranean diet. Google "Mayo Clinic Mediterranean diet for heart health" as it won't let me post a link here. Mayo Clinic offers a good online diet plan subscription.

Regular exercise by walking briskly at least 30 minutes a day 5 days a week has been shown to be helpful for cardiac patients and presumably everybody else.
 
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