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Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

nytimes.com

21–30 of 61 posts

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#21

It wasn't for me. Individual anecdotal stories aren't evidence but without consistent feedback it's easy to get back into poor habits. When I eat a Twizzler and see my blood glucose spike at 180-200 FOR 1 TWIZZLER then it's the feedback I need. It's no different to me than frequent weighings. I'm sure some people don't need or want the feedback but for me it's essential. And using a CGM (I use 14 day Lifestyle) I can…

Data drives me to do better.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#22
post #14

Off-topic: but as someone who's not officially type 2 diabetic but would like to be proactive about measuring their sugar level (I've had my A1c at pre-diabetes levels in the past), what options do I have to secure a CGM? I've asked my physician but he said he won't be able to prescribe one that's covered by insurance. The DEXCOM website doesn't have a clear MSRP for folks like me.

14 day freestyle libre is $130ish but you can find coupons online that push it down to around $80. Dexcom is in the hundreds per month.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#23
post #14

Off-topic: but as someone who's not officially type 2 diabetic but would like to be proactive about measuring their sugar level (I've had my A1c at pre-diabetes levels in the past), what options do I have to secure a CGM? I've asked my physician but he said he won't be able to prescribe one that's covered by insurance. The DEXCOM website doesn't have a clear MSRP for folks like me.

What country is this? I just order freestyle libre online you don't need any doctors receipt for this.

US requires a prescription because it's classified as medical device "class 3"

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#24

It wasn't for me. Individual anecdotal stories aren't evidence but without consistent feedback it's easy to get back into poor habits. When I eat a Twizzler and see my blood glucose spike at 180-200 FOR 1 TWIZZLER then it's the feedback I need. It's no different to me than frequent weighings. I'm sure some people don't need or want the feedback but for me it's essential. And using a CGM (I use 14 day Lifestyle) I can…

Data drives me to do better.

Unless it misleads you. One can "lose" 2 lbs...by weighing before drinking water after a run. Did you really lose 2 lbs?

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#25
post #8

Earlier quoted context omitted.

Alas, the Dexcom is more accurate and has better calibration, but the Libre if far better covered by insurance options. Self-hackers have to pony up.

Where's the evidence of this statement? It's well known that blood glucose monitors get a wide latitude for accuracy from the FDA anyways so real accuracy would be very difficult to determine.

Why would real accuracy be difficult to determine? Clinicians get to test these on their patient populations and validate against other high accuracy methods (point-in-time serum draws). For instance, Dr. Peter Attia says he gets a useful fraction of his clinic to use CGMs (as well as personal use), and over years sees a strong signal.

There are many other Drs that have gone on record.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#26
post #14

Off-topic: but as someone who's not officially type 2 diabetic but would like to be proactive about measuring their sugar level (I've had my A1c at pre-diabetes levels in the past), what options do I have to secure a CGM? I've asked my physician but he said he won't be able to prescribe one that's covered by insurance. The DEXCOM website doesn't have a clear MSRP for folks like me.

Ha I've been trying to find one for forever. Can't even find cheap non-fda approved clones from alibaba/aliexpress. Would love to hear if anyone has made some headwind on this. It seems odd that only diabetics are allowed access to the tools that enable CGM. Blood glucose is an important marker of health, diabetic or not.

The FreeStyle Libre is a way cheaper option (and also way easier to gain access to for those of us in the UK under the NHS). Strictly speaking is not a CGM, as you have to manually scan the sensor to retrieve the last eight hours of data. However, there are devices sold by smaller manufacturers such as the MiaoMiao [1] or Blucon [2]. You mount these devices on top of the sensor (I have heard that wig glue is a good choice to attach it), which then reads the data via NFC and sends it out via Bluetooth to whatever “smart“ device that you may own. Effectively turning your FreeStyle Libre into a “CGM lite”, albeit with lover accuracy than a Dexcom.

[1]: https://miaomiao.cool

[2]: https://www.ambrosiasys.com/our-products/blucon

A word on accuracy, as a type 1 diabetic I have not pricked my fingers once since I got onto the FreeStyle Libre almost six months ago and I am achieving excellent control of my day-to-day levels. Take from this single data point what you may, but I want to offer it as a counter weight to the “need for calibration” I heard before I received the device.

I am currently holding off on getting a MiaoMiao2 until mid-November just to avoid the first few batches of the device that may or may not have manufacturing issues (simply being cautious, I have no evidence). Having easy access to continuous historical data changed my life as a type 1 diabetic, imagine having pain-free and instant access to your levels when you are on the go, stressed out, sick, or just as you wake up in the middle of the night. Then add to this being able to look back eight hours in time to adjust your mental model when things go wrong. It is a matter of night and day. Now I am hoping that turning it all live will make things even better.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#27
post #26

Earlier quoted context omitted.

Ha I've been trying to find one for forever. Can't even find cheap non-fda approved clones from alibaba/aliexpress. Would love to hear if anyone has made some headwind on this. It seems odd that only diabetics are allowed access to the tools that enable CGM. Blood glucose is an important marker of health, diabetic or not.

The FreeStyle Libre is a way cheaper option (and also way easier to gain access to for those of us in the UK under the NHS). Strictly speaking is not a CGM, as you have to manually scan the sensor to retrieve the last eight hours of data. However, there are devices sold by smaller manufacturers such as the MiaoMiao [1] or Blucon [2]. You mount these devices on top of the sensor (I have heard that wig glue is a good c…

Fellow T1D in the UK Here. I'm coming towards the end of my 'trial period' with my FreeStyle Libra and I am shocked at how much I have been able to take control of my glucose levels. I have never had particularly bad control - but finger pricking 4 times a day is like using your phone light in a pitch-black forest. There are so few data points that it is nearly impossible to identify patterns. The sheer amount of data that you have access to with the sensor is amazing. You've gone from 4 data points a day to a minimum of 96 (if you are scanning once every 8 hours). Within a few weeks I had adjusted my basal insulin dose resulting in much more stable blood sugar during sleep which has gone a long way to improve my general health and wellbeing.

One other aspect of the FreeStyle Libre that I was not expecting was a feeling of accountability. When I was just finger-pricking I could essentially hide high blood sugars. Say I had eaten some sweets or something, and forgotten to take my insulin, I could sort of hide from the responsibility of that high reading by just taking my insulin when I remembered and testing in a few hours - my Consultant would never know. However, now I am aware that my sensor is going to read that high sugar, and that makes me feel accountable for it - so I have seen my insulin taking get more consistent, and this has resulted in less hyperglycemia and hypoglycemia (as a result of mistiming the insulin and whatever I have eaten).

On your point about accuracy - I have found it to be a little out in the extreme highs or lows - for example there have been a number of times when my sensor has given me a reading of, say, 2.4. However when finger-pricking I might be 3.9 or 4. Now this could be because the reading is about 15 minutes behind, and since that moment my liver has pumped out some glycogen. But I have had similar accuracy issues when high - say above 18. Having said that, to me this is not a problem, and the accuracy between 4 and 18 is pretty spot on (apart from one sensor that went bananas and was reading at least 15 above what I was for about a week).

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#28
post #16

The article says: > Of course, there are exceptions. When patients are acutely ill, or changing regimens, or finding that their blood sugar is not well controlled, testing may be appropriate. So about the regimens: unless the patient eats the same every week (same ingredients, same quantities) without any significant variation, it’s still the way to go IMHO. General guidelines can be followed by the patient but usual…

> finding that their blood sugar is not well controlled

Isn't this everyone with diabetes? Hell of an exception.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#29

Earlier quoted context omitted.

Data drives me to do better.

Unless it misleads you. One can "lose" 2 lbs...by weighing before drinking water after a run. Did you really lose 2 lbs?

Weight loss isn't really a good analogy. It's much more about trends over time than any individual data point.

When we're talking about diabetics and blood sugar, one data point could be the difference between life and death.

Re: Routine glucose monitoring may be unnecessary for people with Type 2 diabetes

#30

Earlier quoted context omitted.

Data drives me to do better.

Unless it misleads you. One can "lose" 2 lbs...by weighing before drinking water after a run. Did you really lose 2 lbs?

If you're allowing a single data point to have that much power over what or how you think, you've already lost. Especially if you decide to ignore context like "I just lost water by running and I haven't had anything to drink yet", or even important variables like time of day. The number by itself is meaningless. Data (as in a ton of data points) with context can be incredibly useful. Don't blame the tool if you don't learn how to use it properly.
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