Two weeks of glucose monitoring, here's what I learned
I hit my 40’s and started to not recognize my body. Not just externally, but internally. I hear this from most women my age. The creeping decline in stamina, sleep quality and mood, an increase in body aches and weight gain. It took me by surprise and by the age of 46 it became clear this wasn’t all in my head. I started to pay attention, learning the new messages and how to best support my body.
I hate to admit that the most distressing piece of these changes was the weight gain. I am not immune to diet culture and my own history, but I do know how to act in a way that is respectful. I let myself get curious about potential causes and what is actually within my control. Obviously the hormonal shifts of peri-menopause disrupt usual signaling. These changes impact the whole system, but there is still so much to learn about how we can best move through this transition.
Outside of speaking with my doctor to confirm dipping hormones I started to consider my risk factors for insulin resistance, which can make it difficult to lose weight. My hemoglobin A1c, always within normal limits, had been trending up. Could this be part of the issue?
Risk factors:
Age (check)
Carrying extra weight (check)
Physical inactivity (not awful, but definitely room for improvement)
Family history (kind of)…let me explain
My mother has type 1 diabetes and was diagnosed during her pregnancy with me. 1978 was not a great time for screening and diabetes management. This resulted in high blood sugars for most of her pregnancy. Despite the uncontrolled diabetes, we were both lucky. She came out of that pregnancy with a great endocrinologist and I was born at a high weight, but with no health issues. In fact, metabolically, I have always been healthy. But I wondered, could this history put me at higher risk for impaired blood sugars later in life?
Around this time I was starting to hear a lot of chatter about using continuous glucose monitors (CGMs) outside of diabetes. Individuals were using this data tracking to improve weight loss and athletic performance. Now, I am very familiar with CGMs. They came on the scene in the early 2000’s and quickly became integrated into the standard care for individuals with type 1 diabetes. Although I was intrigued by what can be observed for those without blood sugar impairment, I was not happy about the dip in supplies that was happening due to this popularity. I was unwilling to participate in a trend that was impacting those who needed those supplies the most.
Thankfully the companies recognized an opportunity and in 2024 started producing over the counter CGMs. These paired down devices are suitable for individuals without diabetes or those with pre-diabetes. My curiosity was re-energized recently after working with a client who purchased one of these devices to be used in concert with our work. I was most familiar with using the application for diabetes, but to help someone without diabetes interpret their readings provided a whole new perspective.
I was ready to give it a shot. I purchased the Stelo from Dexcom and was ready to answer the following questions:
Do I have abnormalities in my glucose tolerance or insulin production?
I had already started to monitor my carb portions, keeping them to 40-45g/meal, and planning in walks after dinner to optimize insulin sensitivity. Was this the best approach?
Could the shift in reproductive hormones impact hunger and appetite signals? Do I need to fine tune my perception of these signals? Since biological hunger is associated with the stomach emptying and declining blood sugar, monitoring could help me better decern what I am sensing.
The instructions and application of the transmitter was simple. It is a small disk with a thin needle placed at the back of your arm. A protective adhesive patch is placed over the disk to keep it water tight for 14 days. I downloaded the app, entered the serial number and voila…blood sugar monitoring.
Stelo graphs blood sugar readings within a range of 70-250mg/dL with the default target range between 70-140mg/dL, which is normal for someone without diabetes. Ideally you want your fasting reading to be 70-99 and 2 hours post-meal to be 70-139 mg/dL. The Stelo updates your reading every 15 minutes compared to every 5 minutes with models made for those with diabetes.
Insight #1
After a couple of days I realized I was rarely going over 125mg/dL. So, I re-set my target range to be 70-125. I also noticed that when I was being very mindful of my timing and carb intake my plot line was nearly strait, with gentle rises and decreases as my food hit my blood stream and then was taken up to be metabolized. This is not what I expected.
For this reason, I loosened up my eating to see how it may impact. I learned that my top threshold for carbs is 60g/meal. If I stayed between 40-60 grams, I felt well nourished and my blood sugar did not go over 125mg/dL. On the night I overindulged? My blood sugar spiked to 135 and it took much longer to get my blood sugar to even out.
This is exactly how those with insulin resistance are primed for development of diabetes and those with uncontrolled type 2 diabetes and hasten complications. Frequent, dramatic spikes in blood sugar increase the demand on the pancreas to produce insulin. Eventually, the cells burn out and stop producing insulin. Although my spike was not dramatic, it is something to consider when trying to preserve functioning as I age.
Insight #2
I noticed I was getting flagged for a low blood sugar between 1-3am, but it would quickly pop back up and normalize. I had noticed I was waking more frequently around that time and now, I wondered if it was related to the low blood sugar. Unfortunately, the Stelo (unlike those designed for diabetes) does not show the exact number of a low.
In looking back I could see that there were two factors in the low.
The night I had a couple glasses of wine, I dropped low. This I understood. The liver releases glucose during the night to keep blood sugars even. Alcohol is processed in the liver and hinders the release of glucose, leading to a low.
A few nights I ate less carbs at my dinner at 5pm. I go to bed sleep around 10pm. Cortisol rises during sleep to facilitate the release of glucose and dampen insulin release when food is not available. Could it have been that by creating too much of a fast that I dropped low before my cortisol could do it’s magic? The next week I made sure to eat more carbs and have my meal closer to 6pm. That did the trick.
.Insight #3
True hunger hits for me at 4 hours after a meal. I had been reading my hunger at about 3 hours, but when comparing my perception and my blood sugar readings, I noticed what I was naming “hunger” at the first subtle signs, before blood sugar started to trend down. By pushing the timing of my meal a bit, I was re-fueling right when the tank needed to be filled.
With the insights gained, I was able to keep my blood sugars within range 98% of the time with <1% below and 1% above. I feel lucky to have access to such technology and look forward to using this tool with clients struggling with impaired glucose. For now, I continue to listen to my body, have conversations with my doctors, and over time will find what works best for me as I navigate what it means to be healthy as I age.