June 20, 2021

Nutritional biochemistry

Are continuous glucose monitors a waste of time for people without diabetes?

Some experts suggest CGMs are useless for nondiabetics. I disagree.

Read Time 8 minutes

As some of you may already know, I’m a proponent of continuous glucose monitors, or CGMs, in my patients, even if they don’t have diabetes. Recently, a perspective in JAMA was published on this topic, highlighting the increasing number of start-up companies promoting the use of CGM in nondiabetics, and included some arguments suggesting that CGMs are “a waste of time and money” for this population. The author states that “… aside from anecdotal stories, there’s little evidence that people with normal glucose responses benefit from tracking their blood glucose,” according to the perspective. They also argue that because glucose fluctuations are so small in nondiabetics, a CGM doesn’t provide any meaningful information for them. I want to tell you why I not only disagree with these assertions, but also why this type of thinking may be dangerous to the health of hundreds of millions of Americans.

First, arguing that there’s little evidence that people with normal glucose responses benefit from tracking their blood glucose is putting the cart before the horse. How do you know if someone has normal glucose responses without tracking their glucose first? Using CGM on someone with “normal” glucose as defined by standard measures such as fasting glucose or HbA1c can determine whether they truly do have tight glucose control and how they respond to different challenges, dietary or otherwise. Just because someone’s fasting glucose or HbA1c levels are considered normal doesn’t rule out the possibility that they have high glucose variability, which are large oscillations in blood glucose throughout the day, including episodes of hyperglycemia and hypoglycemia. Fasting glucose and HbA1c levels don’t necessarily tell us if people are experiencing normal glucose responses. The only way to know if they are is to track their blood glucose. Is it safe to assume normal fasting glucose (i.e., less than 100 mg/dL) and normal HbA1c (i.e., less than 5.7%) tightly map to low variability and spikes in glucose? 

In our practice the answer is, how shall I say it, not even close. Over the past three years we have been tracking these metrics closely and found that at least one-third of the time HbA1c is an inaccurate predictor of average blood glucose relative to true average measured by CGM (and this discordance occurs in both directions, meaning sometimes HbA1c overestimates and sometimes it underestimates). Furthermore, we’ve seen how irrelevant morning fasting glucose can be as a predictor of in-depth glucose kinetics, outside of the extremes seen in patients with type 2 diabetes. In other words, in non-diabetics, a fasting morning blood glucose level of 90 vs 95 vs 100 vs 105 mg/dL can have much more to do with the previous night’s dinner, the quality of sleep that evening, or even the speed and suddenness with which they woke up that morning (and the concomitant cortisol surge) than their true health. 

In 2018, a study in nearly 60 participants found many individuals considered nondiabetic by standard measures showed high glucose variability determined by CGM. Severe glucose variability was present in one-quarter of normoglycemic individuals, with glucose levels reaching prediabetic ranges — defined as values greater than 140 mg/dL — up to 15% of the duration of CGM recordings, suggesting glucose dysregulation is more prevalent than we might think.

But the recent JAMA perspective pointed to a 2019 study that was attempting to create reference ranges for glycemic profiles in more than 150 healthy nondiabetics that found they spent 96% of the time between 70 and 140 mg/dL based on about one week of CGM data, on average. This study was used to support the argument that there is in fact tight glucose control in these individuals, confirming that “normal is normal is normal,” as one of the study’s coauthors put it. 

A closer look at the findings, however, suggests otherwise. Median time spent with glucose levels above 140 mg/dL was 30 minutes a day and median time spent with glucose levels below 70 mg/dL was 15 minutes a day. Almost one-third of the participants had at least one hypoglycemic event, defined as a glucose level below 54 mg/dL, and almost half had at least one hyperglycemic event, defined as a glucose level above 180 mg/dL.

Spending 30 minutes a day with glucose levels above 140 mg/dL may be the benchmark in this population, but that does not mean it’s optimal. The target I want my patients to hit in terms of the number of total glucose excursions above 140 mg/dL per week is zero. We never want to see glucose above 140 mg/dL. While the study didn’t report the number of weekly excursions, it’s probably safe to assume, given the averages, that I believe there’s plenty of room for improvement in the vast majority of the participants. One of the important lessons I’ve learned from consuming a lot of the scientific literature is that being skeptical of the interpretation of the results is the default position. (In that vein, my hope is that you are now skeptical of my interpretation at this point.)

As I recently discussed in an AMA on the topic, higher glucose variability and higher (and more) peak glucose levels are each independently associated with accelerated onset of disease and death, even in nondiabetics. Prospective studies show that higher glucose variability in nondiabetics is associated with an increased risk of cardiovascular diseaseAlzheimer’s diseasefrailtycardiovascular deathcancer death, and death from any cause compared to lower glucose variability. Other prospective studies show similar trends for higher compared to lower peak glucose levels and several human experiments demonstrate that high glucose peaks induce endothelial dysfunction in healthy nondiabetic individuals, and higher postprandial glucose levels are also associated with higher carotid intima-media thickness, suggesting higher glucose peaks may accelerate the development of atherosclerosis, even in those with normal glucose tolerance. There is also remarkably robust data from the Interventions Testing Program, the gold standard of testing compounds for life extension in mice, demonstrating that two different drugs with completely different mechanisms of action (acarbose and canagliflozin) which suppress postprandial glucose peaks and both extended median and 90th percentile lifespan independent of body weight and average glucose levels. Granted, what’s true in mice might not translate to humans and the aforementioned prospective studies are of the observational epidemiological nature where skepticism of the results and the interpretation are required. In my partial defense, there’s a good deal of skepticism and scrutiny on my part, and those of the analysts that work with me, that factor into determining whether the data is worth considering or not. But I wouldn’t be surprised if there’s a quote out there attributed to Einstein that says confirmation bias is one of the most powerful forces in the universe. When it comes to observational epidemiology, there’s always a selective interpretation of the evidence.

Glucose control lives on a spectrum, but it conventionally gets lumped into three distinct categories: normal glucose tolerance, prediabetes, and diabetes. For example, whether your HbA1c is 4.6% or 5.6%, both are considered “normal” because they both fall under the diagnostic threshold of 5.7%. Once it hits 5.7%, so long as it does not exceed 6.4%, now you’ve got impaired glucose tolerance, also referred to as prediabetes. Once you’ve eclipsed the latter, whether your HbA1c is 6.5% or 12.5% (or even higher), you’re categorized as having type 2 diabetes. In most cases of type 2 diabetes, an individual traverses from one bucket to the next as their HbA1c slowly climbs from normal to impaired to outright diabetic. This doesn’t happen overnight, but too often it’s only confronted when the diabetes or prediabetes threshold is reached at a snapshot in time. Progressing from an HbA1c of 4.6% to 5.6% represents estimated average glucose levels climbing from 85 to 114 mg/dL. This should be setting off alarm bells along the way, but I worry that those bells aren’t ringing because it’s not deemed necessary to keep a close eye on blood glucose in someone with normal glucose tolerance. I have a friend who flies helicopters. The other day she was telling me that there is a warning system in place for when minuscule fragments of metal are in the hydraulic fluid. Though they pose no immediate danger, if left in place long enough, they will erode gears and potentially lead to a catastrophic outcome. So you overhaul the hydraulics as soon as you get the warning, not when the gears start grinding. Viewing glucose regulation as abrupt categories like this rather than a spectrum is probably one of the biggest reasons why more than 120 million Americans have diabetes or prediabetes

In the vast majority of cases, today’s normal individual is tomorrow’s diabetic patient if something isn’t done to detect and prevent this slide. Not only that, but prospective studies also demonstrate a continuous increase in the associated risk for cardiovascular diseasecardiovascular death, and deaths from all causes throughout a broad range of HbA1c values beginning at 5.0%. Similar trends are observed for elevated HbA1c values and higher rates of frailtycognitive decline and dementiaCOVID-19 hospitalizations and death, and cancer mortality, suggesting that lowering your average glucose levels even when they might be deemed normal by traditional cutoff points can make a difference.

To recap my position and interpretation of the data available (more of which you can find in the AMA 24 show notes), lower is better than higher when it comes to average glucose, glucose variability, and glucose peaks, even in nondiabetics. In other words, there’s a lot of evidence suggesting that people with glucose in the normal range can benefit from lowering their numbers.

Let me give you an anecdote, among several I could share, to demonstrate why I find CGM useful in nondiabetics. I have a patient who came to me with normal glucose tolerance by standard metrics. He began CGM and after about two weeks it revealed an average glucose of 104 mg/dL over that time. The standard deviation in his glucose readings, which is a metric of glucose variability, was 17 mg/dL. He averaged more than five events per week in which his glucose levels exceeded 140 mg/dL. All three of these metrics are considered normal by conventional standards, but does that mean there’s no room for improvement? I like to see my patients with a mean glucose below 100 mg/dL, a glucose variability below 15 mg/dL, and, as noted above, no excursions of glucose above 140 mg/dL. After about a four-week intervention that included exercise changes and nutritional modifications his average glucose fell to 84 mg/dL, his glucose variability to 13 mg/dL, and he had zero events exceeding 140 mg/dL. If he can maintain this way of living in the long-run, it’s likely to translate into an improvement in healthspan and reduce his risk of glucose impairment. 

Going back to the first argument from the perspective, it may be true that aside from anecdotal accounts, there’s little evidence that people with normal glucose responses benefit from tracking their blood glucose, but don’t confuse an absence of evidence with evidence of absence. I can’t point you to a long-term randomized-controlled clinical trial rejecting the hypothesis that people with normal glucose responses don’t benefit from tracking their blood glucose because those trials don’t exist (yet, hopefully), but don’t confuse an absence of evidence with evidence of absence. There are examples where the randomized-controlled clinical trial data isn’t there, but we still have a strong reason to believe it’s true. While it’s not the same level of confidence I have in parachutes improving survival when jumping out of an airplane at 10,000 feet or smoking two packs of Marlboros a day increasing the risk of lung cancer, I do believe that relatively healthy people who track their glucose responses will fare better in the long run than those who don’t. 

An important question related to these kinds of trials, and one that I can’t explore without at least doubling the length of this article is: what kinds of behavioral changes move the needle and keep it there in the long run? In other words, the reason why I have confidence that tracking glucose responses if beneficial is because I have confidence that we can optimize them (and even more confidence that we can at least stave off their decline). If we don’t have any effective interventions, saying we don’t get any benefit from CGMs is like a group of carpenters saying they don’t get any benefit from tape measures. If that’s the case, maybe it’s time to reconsider our approach to the problem. Overall, there are some interesting points from the perspective, some of which I haven’t addressed here, but I disagree with the notion that the use of CGM is “a waste of time and money that diverts consumers’ attention from useful interventions,” or that it “it’s just like a supplement—we don’t know whether it works or not,” as some experts think. 

For many people (certainly for me and most of our patients), when you start wearing CGM, it’s 90% “insight” and 10% behavioral. After a few months, the situation flips. You now have a good idea of what triggers the spikes (i.e., less insight), but it becomes a remarkable—in fact, it’s hands-down the best I’ve seen yet—accountability tool (i.e., more behavioral). It’s simultaneously a behavioral and analytical tool that can track and uncover strategies and tactics which can actually save an enormous amount of time and money by preventing bad outcomes in the future. Instead of (or in addition to) questioning groundbreaking technology like CGM, we should do more questioning of ourselves and how we use it.

 

DISCLOSURE: Due to the nature of this content, I want to remind our audience that I am a paid advisor to Dexcom; a company that develops, manufactures, and distributes CGMs. For a full list of my disclosures, please visit www.PeterAttiaMD.com/about.

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

33 Comments

  1. Thank you for writing this response Peter. I hate that you even had to do it to be honest (twitter can be cray cray at times). As a former prediabetic/prehypertensive, I have worn a CGM and after 4 years low carb, I have found it to be extremely helpful. Adding back in more carbs and seeing the rise and time taken to get back to baseline has been invaluable. Seeing the normal glucose rise in the am has also been helpful. My break fast meal is usually a protein/fat centric meal leaving the carbs until later in the day. Keep being you! Happy Sunday.

  2. A few years ago, I was listening to an LVLLC podcast (sorry–don’t recall the guest’s name other than he was a doctor), and the guest said one of the most simple yet profound things I’d ever heard at the time–“The root cause of about 90% of all chronic disease comes back to either BG levels or inflammation levels; sometimes both.”

    Ever since I heard that, I busted butt to get a prescription for the Freestyle Libre, and use that in conjunction with high-dose curcumin extract + an anti-inflammatory diet. Just monitoring and controlling those two things has increased my metabolic health substantially.

    I’m not diabetic (by clinical standards), but because of my constant monitoring and control efforts, I’m not likely to ever become one. My Freestyle Libre is the only prescription I’m on (at 58).

  3. Could you post some information on initial and continuing costs of a CGM ? Also can you describe how this device is attached to your arm/ body?
    Thank you

    • I can’t add an image here but the freestyle libre is a round disc a little larger than a £2 coin, certainly thicker. Costs here are a little less than £50 ex. Vat. And each lasts 2 weeks. Advisable to place some sort of medical tape over it to help prevent it being knocked off.

    • You currently can’t, but you *can* ask your GP to give you a prescription. Just send them this article (or any number of others). I’ve recommended this to my non-diabetic friends, and all have said it works great.

    • Yes you can buy one without a prescription, you can buy them direct from the manufacturer or from for instance, amazon. Plenty of non diabetics use them without prescriptions, including me.

    • For $9 you can get a finger stick glucometer at Walmart without a prescription and $5 gets you 50 strips.
      If your appetite for data is then whetted, then you can ask your doc for a prescription. There are few who would deny you after seeing you are serious about monitoring and your health.
      I’m a doc (though a surgeon, not a pcp) and I would say, good for you, you did the work and learned to use the hand tool, here’s a power tool now that you understand the basics.

  4. I was wondering the same as Tracie and Maureen.

    Btw, thank you, doctor, for everything you do for us. Your podcasts are so helpful, for those who are willing to go along with science in stead of the mainstream whatever of this era.

    Sandra from Belgium

  5. Ditto what Maureen, Tracie, and Sandra asked.

    Costs are opaque when insurance isn’t involved. I’m not diabetic; insurance won’t cover it. Info on initial and recurring costs would be great.

    Could you have someone on your staff do a white paper or simple video that provides a primer on what’s needed to get started (transmitters, smartphone, insertion tool, etc.), recurring costs, and a few recommendations on deals such as Good Rx?

    We are all hoping you are working on some kind of PA membership discount deal with Dexcom!

    Thank you and your staff for all the work you’ve been doing making great info from the best sources available to those of us in the interested public!

    Hank in San Diego

  6. I’m a type 1 diabetic (T1D), and I’ve been following — and recommending — your podcasts to the T1D community for years. I have always said, “The best way to learn how to manage diabetes is to study non-diabetics.” This gives you the baseline (reference point) for how the metabolic system works, including when it goes wrong (insulin resistance, etc.). It’s a highly complex system, but the better you understand its nuances, the better prepared you are to manage your carb and insulin dosing regimen, and especially exercise.

    I say the same thing to non-diabetics: If you really want a true magnifying glass on how the metabolic system works, study type 1 diabetics. Why? Because now you have a 24/7 front row seat into that correlation between insulin and everything else. The best subjects to study are those in optimal euglycemic control (I offer myself as an example: I’m 95-99% in-range with a SD of 10-20.) This doesn’t mean I don’t have wild glucose swings–I do! And they’re not unlike what we’ve seen in non-diabetics. So, what can we learn?

    The fascinating part is the discorrelation between the variables that you think you should otherwise see. There are times when my insulin levels spike without many carbs, and vice-versa. The post-exercise latent-hypoglycemia (9-15hrs after zone 2 running) can be investigated in very detailed minutiae — exactly how low glucose levels can go, and how many carbs is necessary to bring them back — all in the service of replenishing glycogen stores that weer exhausted during and after exercise. You cannot possibly measure stuff like this in non-diabetics.

    I track just about everything you can possibly track (including sleep, heart rate, cholesterol, etc.

    In short, the best thing about T1Ds that you cannot get from non-diabetics is the ability to *control insulin* as a variable. In non-diabetics, you have no way to know with enough frequency how much insulin is being secreted without doing a blood draw. And that’s about as useful as doing finger-prick glucose testing vs. a CGM.

    You want real data and insights? T1Ds should be your test subjects.

  7. A dear friend of mine just got diagnosed with diabetes #2. She is 74 and has serious arthritis which makes taking blood testing and giving herself shots very difficult. She doesn’t qualify for a insulin pump or meter because she doesn’t take 4 shots a day. I.feel she needs both to have a much healthier life. Help!

  8. Excellent article! Well done!

    For those asking about acquiring a CGM without a prescription, in the US a prescription is required for a CGM at this time. You may want to start with your doctor, but most US doctor’s won’t prescribe a CGM to a non-diabetic patient, and insurance companies won’t cover the cost for a non-diabetic. But, there are some new companies that will provide the prescription and the CGM. Here a few to check out:

    levelshealth.com
    january.ai
    supersapiens.com

    I will say the Levels customer support has been outstanding.

    I expect the perspective for CGM use in non-diabetics will change as more data becomes mainstream. This is not a lot different than the CDC initially stating that masks were not necessary at the beginning of the COVID-19 pandemic, but later reversed that statement once more data became available. However, it may be a while since CGM’s are not yet easily accessible for everyone.

    More power to these companies and those pushing the CGM technology!!!

    A CGM will change your eating habits and has the potential to change the food industry when they become mainstream.

  9. As an RN, I dp see some value for those who are unconvinced of the dangers of high carbs because they have no visible signs of I’ll helath….yet!

    That being said these patients need true education not just some monitor they’re dependent on. Hell, let them get fat, fatty liver, hypertension, metabolic syndrome, possibly even cancer…. I have them all now and have learned better through natural consequences when I wouldn’t listen so well before.
    One way or another…
    They will learn. I just don’t think continuous monitoring should be needed for people who have brains and take the time to learn healthy ways of eating and fasting!

    Machines and monitors are not the ideal answer. Maybe if your working with a lot of monkeys who can’t but I digress. I’ve seen enough monkeys in videos who are smarter than a lot of people.
    Why chain them to some monitor and phone app to look at all the time when we know blue light creates I’ll health and we get plenty of that without needing to add more.
    If they open up their minds and ears a good doctor takes the time it requires to provide proper education. Don’t make the mistake of cutting corners teaching your patients, maybe you could try educating more doctors who aren’t aware of proper nutrition. Then more one on one education is possible. Individualized patient focused education starting with finding out their medical and nutritional literacy.

    I mean this is a huge reason why so many are dying from covid!

  10. I have been quite taken aback by the strong negative response to CGMs on twitter. I might be wrong but I get the impression the discussion on the potential benefits of CGMs has become collateral damage in the ‘diet wars’. In particular, there seems to be a strong negative reaction from the vegan and vegetarian end of the spectrum which seems to fear that CGMs may provide information that might discourage people from these diets.
    Personally, I think knowledge is power and I struggle with the idea that such information cannot be of value.
    While there are still many unknowns, the wide availability of such information will only encourage more research.
    Many thanks for your efforts in exploring the realm of what is possible.

    • Bingo. I was a “health oriented vegan” for 7 yrs before discovering via CGM that I had serious glucose issues. I now eat according to the Zone Diet and include eggs, Greek yogurt, and fish. Occasionally wear a CGM and now have average glucose below 90, seldom over 125. 😁

      I recently read somewhere that the population of India has the highest % of diabetics. Many there live on dal, many others vegetarian by religion…

    • I think you’re right about the diet wars, but I also I think it’s just part of the “outrage culture” that we live in now (especially on Twitter and other social media). It’s one more thing that outrage-addicts have latched onto, as if it somehow harms people with diabetes when non-diabetics use CGM’s.

      I’m pretty sure there are enough to go around! Plus, when a non diabetic uses a CGM, they’re less likely to get diabetes later on (for all the reasons Peter described).

  11. I am a non-diabetic that just starting wearing a CGM, and the insights I gleaned from its use have been invaluable. I’ve learned things I never would have learned without the feedback the CGM’s confers. At the end of the first week, my fasting, post-prandial, peaks, and variability have all significantly improved. Also, I’ve lost weight, and my hunger is more easily managed! All this, yet I had to struggle a little with my PCP to obtain a one time Rx, and that was with the proviso that I pay for it myself and not submit it for insurance reimbursement. Thanks, Peter, for writing this letter! I would like to share it with my doctor if he declines to renew my CGM order.

  12. I would be happy with any sort of facility to test blood sugar levels as a t2 diabetic. Really don’t understand why money is flushed away on more meds when NHS would do better to help me monitor and control my diabetes (possibly subsidise even one cgm sensor a month). I do so much better when I can afford to purchase a sensor but I simply can’t do so regularly so have close to no chance of reversing this damn curse. I was first diagnosed with t2 age 33 but suspected I was had it a couple of yrs before. I did a fasting test and was told it was not the case. I now belive that was wrong and a cgm could have helped back then. I’m now 40 and feel terrible most of the time.

  13. Nondiabetic here. Sudden, sometimes severe, hypoglycemic episodes run in the men on my mom’s side of the family. They happen sometimes more than once a month, sometimes none for many months. I’ve measured my blood glucose as low as 45 on a very good finger-stick meter during attacks, and usually have the severe symptoms (extreme sweating, shakiness, nausea, etc…) to go with it. I’ve let them go for as long as an hour before, before finally getting some sugar in me.

    Of course, because I’m a NON diabetic, insurance will never ever pay for a Dexcom G6. For a while, I as able to afford a G6 out of pocket by buying directly from Dexcom, and it was able to provide very good insights. Once they shut that program down, I could only buy through distributors, and the price went up *another* one hundred dollars, so that was the end of that experiment.

    I still don’t know what causes the episodes. A geneticist suggested some as-of-yet x-linked recessive disorder. It’s not too bad, it’s never landed any of us in the hospital (I don’t think?) and I can carry glucose tablets. I hear the G7 may be half the price when it comes out, so I have some hope.

  14. Hi Peter, thank you for this article! Do you recommend a specific device and tracking method for self blood glucose rate monitoring? If you write an article on how to “do it yourself” and interpret the results that would be very useful for a lot of people, starting by myself 🙂

  15. Your blog regarding if cgm can be beneficial to non diabetic patients or not is excellent, perfect.The world will be a healthier place if we had more doctors like you.CGM as you mentioned offers information on our blood sugar status which will otherwise be not known to humans.A user can also know if their insulin is working properly by observing blood sugar behaviour.Most important,it tells your endothelium health.Your blog is excellent and we should not rely on rct placebo trails or peer reviewed documents to make sensible decisions.

  16. Thank you for the commentary Dr. Attia, I think one more VERY important thing missing from the overall discussion is the accountability effect that wearing a CGM can have on someone with already known health challenges, such as obesity. I’m in the process of getting one and I just know in my heart that before I put anything in my mouth that can cause a spike I will think twice and probably drop it and walk away slowly, just from the fact that there is a “Big Glucose Brother” on my arm watching me.

    This might seem aggressive to some people, but food addition issues are a real problem and a CGM can be a technological solution in my opinion.

  17. Well articulated commentary on the JAMA opinion/viewpoint on CGMs. Clearly key proponents of the JAMA view have something to lose from the unveilings that continuous monitoring brings. It is such an incredible tool; dietary analysis being a smaller part of it. I understand the resistance because it one’s working theoretical framework does not match the CGM reality that causes a significant amount of emotional pain. There will hard changes for many. At some point not collecting 24 – 72 hours of metabolic data will be akin to leech therapy

  18. Hi,
    Could you please explain this in a bit more detail…

    “The target I want my patients to hit in terms of the number of total glucose excursions above 140 mg/dL per week is zero”

    As in, what is the reasoning behind such a strict limit, and, if available, what is the evidence that it is bad to have glucose over 140 mg/dL after meals if it lowers down in the course of 2 hours?

    thank you!

  19. Thank you for this article. My husband had severe low blood sugar episodes for years. I begged his doctor for a monitor to no avail because I know low blood sugar can be a precursor to diabetes. My husband went fullblown diabetic but thanks to the same supplements I’ve been using for so decades his glucose levels are back to normal. My 74yo Grandma was checked once a year & told she was NOT diabetic according to her A1C & fasting blood glucose results back in the late ’90s. I was diagnosed diabetic in 1994. I used Alpha-lipoic acid, evening primrose oil, chromium picolinate & CoQ10 with each meal to reverse my diabetes to normal fasting blood glucose levels & an A1C of 5.4 for 5yrs along with higher protein lower carb plus more fruits/veggies servings than recommended way of eating. I KNEW my Grandma had diabetes from her lack of appetite, her apple shaped belly, constant carb cravings and painful tingling feet. Her doctor refused to listen to me. She refused to try my supplements that saved my life because her doctor said she didn’t need them. She had a massive heart attack in 99 & was discovered to have had a prior heart attack as well. She had 5 heart blockages. Sadly I helped convince her to let them operate on her. She died less then a month later after the leg they removed the vein needed for the heart surgery became infected due to her high glucose levels. If she had been able to wear the glucose monitor or even use a portable monitor for a few months in the years before it possibly could’ve saved her life. Since then I’ve known so many family members & friends who’ve gone the same route as she. I myself wasn’t diagnosed as diabetic until I had the glucose tolerance test. By then I was passing out after eating but strangely my A1C was barely elevated. They gave me the glucose sugary liquid & I passed out in my car for 3 hours until someone realized I hadn’t come back in to be rechecked. If insurance won’t pay for it the patient should be informed about the potential life saving use of the continuous glucose monitor to enable them to buy it for themselves with their doctor’s prescription.

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