The Hypoglycemia Support Foundation is blessed with an amazing group of medical advisors, including Dr. Mark Cucuzzella. One really hot topic right now is the use of Continuous Glucose Monitors (CGM), which have traditionally been used by Type I Diabetics for years. While most insurance companies do not currently cover the expense of the devices, the costs have come down and the technology is more available than ever for non-diabetics. Many doctors have been adopting the technology for themselves and their patients. Here is a fantastic in-depth article by Dr. Cucuzzella describing his experience with one of the devices: the Abbott Freestyle Libre.

The Freestyle Libre Can Liberate You

By Dr. Mark Cucuzzella

One of the most empowering and liberating self monitoring devices I have ever used for myself and for patients is the continuous glucose monitor or CGM. Just as the simple glucometer now is readily accessible and affordable to all without a prescription, the time is coming soon where this will also be true of the CGM. A CGM measures glucose continuously with immediate results beamed to your phone or small reader. A colleague of mine, Dr. Dan Cox, University of Virginia, is a psychiatrist researching CGMs and he empowers patients by placing the tool in the patient’s hand to make change. [Two good articles from Dan are here and here]. The experience can be liberating since the CGM can show you exactly what happens with foods that many believe to be safe but yet still have natural sugar and drive hyperdopaminergic responses (dopamine-driven disruptive deficits in decision making) that hijack your brain. With the CGM barking at you in a friendly way, you can finally liberate yourself from these foods and addictive metabolic states of being.

My introduction to a CGM occurred in 2012 when at age 45 I was identified with an elevated glucose and Hemoglobin A1c (3 month average glucose) on a military physical. I did not fit the profile of the usual middle-aged male or female who presents with high sugar along with other common metabolic suspects of central obesity and high blood pressure. The patients fitting this profile often have high insulin levels and Insulin Resistance and are on their way to Type 2 Diabetes. Another colleague of mine, Dr. Jason Fung, describes the issue of insulin not being able to move any more glucose into the cells with the metaphor that “they cannot stuff any more shirts in the suitcase” – causing the glucose to creep up in the blood. To understand Insulin Resistance and its relevance to almost all modern chronic disease you must dig into the work of pioneer researcher Dr. Gerald Reaven who recently passed at age 89 with nearly 1000 scientific papers, chapters, and books to his name.

Even though I presented with similar high glucose readings as folks in this category, I was lean and still running marathons and ultra races in my mid 40s. After a battery of tests I came back with a low c-peptide insulin level. This is a scenario where you are becoming insulin deficient as opposed to hyperinsulinemic (high insulin levels and Insulin Resistance). There are several non-specific names for this condition – none of which identify the root cause. It can be referred to as Latent Autoimmunity Diabetes of Adulthood (LADA), Maturity Onset Diabetes of Youth (MODY), or the even more non-descript Type 1.5 Diabetes. In most cases when a person continues exposure to the same environment and foods it will progress to a Type 1 equivalent and a reliance on insulin therapy.

As chance or luck would have it, this was occurring at the same time I was doing a deep dive into obesity in the military as it related to passing or failing the fitness test. This article by Gary Taubes changed my life and led me to read dozens more books and 1000s of scientific papers on root causes of obesity and diabetes. Probably even more fortunate was access to test an early model Dexcom CGM at the base where I was stationed. The base was using this for some research and, as a doctor, I knew of it and asked to try it. The device has a small catheter that inserts under the skin on the belly and the readings went to a pager like device. I wore the device for 3 days before turning it back in.

What was shocking at the time (not so much now after learning about glucose response to carbohydrates) was the super high and immediate glucose rise well over 200mg/dl with any cereal or bread product in small serving size quantities. These rises were usually followed by sharp declines and a feeling of uneasiness mentally and physically and a bit of what is commonly called “hangry” (hungry+angry). I had been a monster cereal eater for breakfast, meals, evening snacks, and even middle-of-the-night snacks for years and had not been feeling well for the previous year. When cereal was not the entrée it was bread or pasta. I had sworn off eggs and most meats since the government and heart specialists gave them the lethal tag and with my father needing a bypass at age 35 and a redo at 45 I heeded this flawed advice.

During the short 3 day experiment I did try some eggs and there was no rise in blood sugar and I even dipped into former forbidden foods such as bacon with similar encouraging results. Some fruits gave significant rise but I did not have time to fully test many varieties in the 3 days. The CGM trial did convince me that food really mattered and I purchased a glucometer to continue the testing old school fashion with frequent finger sticks and I have tested thousands of times in the last 7 years in order to sort it out.

People say coming off grains is hard but when one sees the effect it has on blood sugar, especially if you have any type of diabetes, the decision is an obvious one out of necessity. Thus, since 2012, I have followed podcast friend Vinnie Tortorich’s NSNG rule (No Sugar No Grain) and my A1C has come down from above 6 to near 5 with no medication. I think the CGM saved the life of my pancreas and liberated me from grains. Yes, liberated me. There is no moderation if a substance is causing harm and feeding more addiction. For me as well as for much of the population, sugars of all forms light up the addictive parts of the brain like the Fourth of July.

Fast forward to 2019 and the world of accessible and affordable CGMs is upon us. Through a small sensor catheter CGMs read glucose from the interstitial fluid which is a close reflection of capillary blood glucose (fingerstick). There are two high end and expensive versions mostly geared to people with Type 1 Diabetes – Medtronic Gaurdian and Dexcom G6 (the most current model). These are precise enough within a 3% margin of fingerstick glucose. The Medtronic requires twice a day cross calibration with a glucometer but the new Dexcom G6 does not require this.

The true disruptor in the CGM space is the Abbott Freestyle Libre. This entry level device is available for about $60 per 2 week sensor (try goodrx) and with free apps or iphone (7 or higher) or android it can make direct communication with your, negating the need for the $70 reader and another device to carry. Abbott offers “LibreView” and also Tidepool offer online tools for uploading, tracking and interpreting data and producing insightful reports. A plus is the extreme ease of insertion and use as well as the affordable cost. A con is the accuracy can be off by 10%, but unless you are precisely dosing insulin this small variance doesn’t negate any practical reason to not learn from and follow the glucose trends. It also does not have alarm functions. Many patients are diagnosed with Type 2 Diabetes with a single blood sugar (see ADA criteria). Many take meds and think they are managing their diabetes and never check blood sugar. One isolated blood sugar reading would be similar to one blood pressure reading, which most would agree is not enough information to make long term diagnosis and management decisions.

So What Does Freestyle Libre Look Like and Where Does It Go?