Will Using a Continuous Glucose Monitor (CGM) Have a Lasting Impact on My 8-year Diabetic Risk Score and other biometric values?

 As an amateur self-scientist with the benefit of access to both the internet and many big brains from real scientists, I love having the opportunity to use data to optimize my performance and reduce my own risks for disease. I feel extremely fortunate to live in an era with more access to my personal health data and more diagnostic network tools to collect my data. I commonly use a combination of iOS apps, wearable devices, meters, calculators, and reports to check in on my progress.

I’m excited to have the opportunity to be in the early customers program with Levels Health and test drive their app with a FreeStyle Libre continuous glucose monitor (CGM). I initially connected with some of the founders when we were just forming Precision Health Reports. After a brief discussion, it was clear that our missions were similar in purpose to help people use data to deeply understand their metabolic health.

 My Experiment Using the CGM to Improve my Diabetic Risk

Using the unique combination of biomarkers and guidelines that inform our Diabetic Risk Assessment report and the real-time biofeedback that the CGM and the Levels app offer, I believe that I can further optimize my personal performance, improve my metabolic health, and reduce my risk for future cardiovascular events like heart disease, stroke, or heart attack.

For some background, I’m a recovering “dad bod.” Despite nine years as an Army Infantry officer and all of the physical rigors that come with such a fun job, I spent the next ten years working hard at a fast-growing company and really let my personal health take a backseat to most everything else. Three years ago, I was 240lbs and likely was an undiagnosed pre-diabetic. I fortunately got involved with a local gym (here’s a shout out to my D1-Little Rock gym-fam for making a difference in my life!) and learned more about a low-carb lifestyle and eventually intermittent fasting. The snowball of better exercise and better nutrition has led me to a continual search for more and better information and an increased amount of data about myself.

My Pre-assessment Values & Goals

With the assistance of our Chief Medical Officer, Dr. William Cromwell, M.D., I subjected myself to the (rather easy) Precision Health Reports Diabetic Risk Assessment Report. This report brings together my personal background information with the LabCorp NMR LipoProfile and my fasting glucose to produce an accurate 8-year diabetic risk value. I simply completed the 2-minute survey from the link emailed to me, took my provided lab order to my local LabCorp Patient Service Center for a quick blood draw, then waited about two days for my report results.Although my 8-year diabetic risk score is a fairly low 4%, some of my other biomarkers have quite a bit of room for me to improve. Here is a summary of my starting numbers:

All in all, I was fairly satisfied with the biomarker values and my 8-year diabetic risk…although anything more than “you are not at risk at all” feels like too much to chance for such a horrible, and mostly preventable, disease. I do know that would like to address the following areas:

• Blood pressure to less than 120/80 (unmedicated if possible). I think I attribute my currently higher-than-desired blood pressure to an increase in my daily carbohydrate intake. When previously using a keto diet, my blood pressure was usually a nice 112/70 despite my propensity to add salt to everything including drinks.

• Body fat percentage to less than 20%. This is an easy one for me to target. Excess body fat is a first domino to attack that will have many other positive health benefits. Working toward this goal alone will surely impact many of the other goals. The big culprit here for me is excess carbs and wearing the CGM and logging meals will make me more mindful.

• Fasting glucose to a steady 80. Achievable…and being able to monitor my glucose continually will make this a target that I can really measure my progress.

• LDL-P from 1426 to under 800. LDL-P is a little harder too monitor continually, but is still a biomarker that I can address through better nutrition and exercise. Learn more about the risks associated with LDL-P and App B.

 Most of these target goals that I want to work on are parts of addressing metabolic syndrome. Managing each of the risk factors for metabolic syndrome will give me the best chance of an increased healthspan with lowered risk for a catastrophic health event.

Beginning to Wear the CGM and Use the Levels App

Receiving and applying the FreeStyle Libre device and connecting to app was pretty simple. All in all, it took about five minutes to get my meter applied to my arm, scan the meter to get it fully activated, then about an hour for the meter and the app to begin to transmit to each other.

Week 1: CGM-wearing Lessons Learned

tl;dr: Wearing my CGM and having the data available in the Levels app was REALLY helpful in making more mindful eating choices.

Has it already been a week of wearing my continuous glucose monitor!? Even though you don’t really need to scan the meter more than roughly every 8 hours, I enjoy the random scans to see how I’m doing at the moment. Wearing the meter despite intense daily workouts, hot tub sessions, and daily showers has not be intrusive. As you’ll see below, I’ve had some insights proven that were not surprising (but interesting to see) and others that were more surprising.

My top week #1 observations:

1. Foods that I knew were not good choices cause glucose spikes that are MUCH worse than I had envisioned in my head.

2. Immediately prior to waking up, my glucose spikes briefly (weird?).

3. The Levels app interface and daily emails are solid encouragement via gamification (intentional or not) to make good nutrition and activity choices.

Feedback on food choices

I’m sure that I’m not alone in, more periodically than I realize, choosing foods that I know are less healthy than others but rationalizing my choices with, “this _________ is probably not that bad…” it turns out that bad foods hit my glucose value fairly hard as you’ll see below—THEY REALLY ARE THAT BAD! Fortunately, I have strong insulin sensitivity (LP-IR <25) to well-regulate my fasting glucose of 90 mg/dL.

Meals/Snacks that Caused Glucose Spikes

You’ll probably notice the trend that the foods that caused a spike were primarily quick-serve dining-out events and the better choices were mostly those made at home. That should shock no one—it’s typically easier (and cheaper) to make better eating choice when you are in control of the ingredients and preparation. To not cross too far into the debate of the standard American diet (SAD) vs. keto vs. primal vs. carnivore vs. vegan, I noticed that my body responds well to more primal and carnivore sources. I definitely would recommend checking out what works for you then find the foods that your body responds best to eating.

Glucose spikes when waking up

A phenomenon that I did not previously know was that my body has a very short insulin spike when I wake up in the morning. Perhaps as a residual of too many years in the Army or just being a creature of habit, I almost always wakeup +/- 15 minutes of 6 a.m. every day of the week (I’m paranoid so I do set an alarm just in case I miss my normal time). My blood glucose each morning at wake time was anywhere between 103 mg/dL and 118 mg/dL but within minutes drops back down into the low 90s.

Apparently, glucose spikes around wake time may be caused by dawn phenomenon and the Somogyi effect (“rebound hyperglycemia”) as well as high-carbs bedtime snacks. Since I know that it is not the latter for me, and the other two are primarily symptoms experienced by those with diagnosed type 2 diabetes, I found this curious. When consulting further with our Chief Medical Officer, Dr. Cromwell, he indicated that this is a natural phenomenon of the body ensuring that it has sufficient energy to get up and get going. Tracing back to primitive humans, in otherwise healthy people, this morning glucose spike is considered part of our natural “fight or flight” stress response.

Levels app and The Impact on My Personal Choices

Overall, I know that seeing the glucose spikes nicely displayed in the Levels app because of certain nutrition choices and no/low response from others has definitely caused me to make better choices when deciding on my next meal. Wearing the meter and seeing my ongoing scores in the app has definitely shown me just how bad the “this is probably not bad” choices really were.

Understanding that a healthy body releases stress hormones, like adrenaline and cortisol, with intense exercise, I was not surprised to see good-spikes during/after a hard HIIT workout. Because of good insulin sensitivity, my glucose levels quickly recovered and I was back to normal, near-fasting levels quickly.

Overall, actually seeing the data that shows the impact of good exercise, the (bad) impact of bad food choices, and the results of good nutritional choices, has been really useful. I’m eager to see what this next week brings as well as the insights that I’ll carry over after wearing the meter.