44: Why You Should Wear a Continuous Glucose Monitor (CGM)

[00:00:00] Michael Kummer: Can you get type two diabetes, even if you follow a low carb diet? The problem is that if your blood sugar levels are chronically elevated, and there is even certain mental conditions like Alzheimer's that are now even called Type three diabetes, the question is what influences blood sugar levels, especially chronically in elevated blood sugar levels?

[00:00:20] One of the best ways is to monitor. or to use a continuous glucose monitor. And so all of those things, um, you can figure out by just wearing a sensor for a couple of weeks. Um, actually over the last couple of years, I've been wearing blood continuous glucose monitors on and off. And I've learned a number of things that I didn't necessarily expect.

[00:00:40] And the first, the very first thing that was like an aha moment for me is.... You're listening to the Primal Shift Podcast. I'm your host Michael Kummer and my goal is to help you achieve optimal health by bridging the gap between ancestral living and the demands of modern society. Get ready to unlock the transformative power of nature as the [00:01:00] ultimate biohack, revolutionizing your health and reconnecting you with your primal self.

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Can you get type 2 diabetes even if you follow a low carb diet? And until recently I would have said of course not, that's ridiculous. But the truth is that there are other factors besides diet [00:02:00] that can cause elevated blood sugar levels, even chronically elevated blood sugar levels.

[00:02:05] So in this episode of the Primer Shift podcast, we'll talk about continuous glucose monitoring, one way of measuring your blood sugar levels on a continuous basis, as the name implies, so you get a better idea of what's going on inside of your body and how your body responds to to various lifestyle factors and choices.

[00:02:24] Now, here's the thing, you know, most of us get their blood sugar levels measured at least once a year when you go to your annual physical and you get your blood sugar, your fasting blood sugar. The problem is that metric is largely irrelevant because if your fasting blood sugar during that one time of the year is already elevated, then you're already in trouble and you don't want to even get there.

[00:02:44] And so the better way of, of figuring out what's going on, how your blood sugar levels behave on average. is to measure your hemoglobin A1c, which some blood panels include. And that gives you an idea of how your blood sugar was behaving over the last 90 or so days. [00:03:00] And that's significantly better than a snapshot measurement, but it's still not ideal because it doesn't really tell you what exactly happened.

[00:03:07] during those 90 days and what might have caused elevated blood sugar levels. So the best way of figuring out how your body responds to dietary factors, to other factors in terms of increasing or raising blood sugar is to wear a continuous glucose monitor or CGM. And before we get into all of that, let's talk briefly about what happens when your blood sugar levels rise.

[00:03:29] Some of you may already know, but when your blood sugar levels go up, your pancreas responds by releasing insulin. And insulin is a hormone that shuttles the blood sugar, or the glucose, back into cells where the glucose can be used for energy. Now, if your cells don't need any extra energy, if they're already saturated with glucose, then the excess gets sent back to the liver where it's either stored as glycogen or if those glycogen stores are full as well, it gets converted [00:04:00] into fat and then stored as body fat.

[00:04:03] So, you know, if you're have trouble losing weight or losing fat in particular, that might be an indication that you have chronically elevated blood sugar levels. So, your body always make sure you, it stores enough fat so it can be used for energy later on, which, you know, you might never need if you constantly eat carbs.

[00:04:22] Now, that's it. Generally speaking, you know, your body's blood sugar response by releasing insulin, by shuttling into cells, or back to the liver, or even storing it as fat, is a perfectly natural mechanism that we have evolved on for millions of years. So there's nothing generally wrong with that. The problem is that if your blood sugar levels are chronically elevated for whatever reason.

[00:04:45] Because if that happens, over time, your cells will become less sensitive to the signals of the hormone insulin. Meaning that, if there is always enough or more than enough glucose in your bloodstream, and your [00:05:00] cells always have enough glucose, then Insulin has a very hard job of getting that glucose into your cells, because they're already saturated.

[00:05:09] And so, your pancreas responds to that by releasing more and more insulin. That can not only fatigue your pancreas over time, but it decreases the sensitivity to insulin. And that's a bad thing because that means you're going to increase your body fat over time. It leads to inflammation and it leads to the development of chronic disease.

[00:05:32] Pretty much all metabolic or chronic diseases have a component that has to do with insulin. Insulin sensitivity or reduced insulin sensitivity. And there is even certain mental conditions like Alzheimer's that are now even called type three diabetes. So it's clearly, or scientists have discovered that Alzheimer's and some other mental conditions are in fact a disease.

[00:05:56] glucose metabolism issue in the brain caused by [00:06:00] insulin insensitivity or insulin resistance. So that's not a good thing. Now, the question is what influences blood sugar levels, especially chronically elevated blood sugar levels? Well, obviously, you know, dietary carbohydrates are one of the main causes.

[00:06:13] And you probably already know this. If you consume carbohydrates, the body converts those carbs into glucose. eating rises, it causes a rise in blood sugar levels, your pancreas responds, etc, etc. We talked about this. So if you frequently consume carbohydrates, let's say you have carbs for breakfast, you know, a good bowl of cereal, then you have a carbohydrate laden snack, you know, before lunch.

[00:06:35] You have more carbs during lunch, a snack in the afternoon, and then carbs for dinner. Your blood sugar levels are all the time elevated, you know. They might go up, then they might come down, they go up, they come down, they go up, they come down. Or they stay elevated for extended periods, depending on the types of carbs you consume.

[00:06:52] And that's, again, not a good thing, because that means your pancreas is consistently pumping out insulin, your cells get oversaturated [00:07:00] with glucose, They don't need as much as you consume, and that leads to a vicious cycle of insulin resistance, to the increase of body fat, etc. So, obviously, consuming carbohydrates all the time, not a good thing.

[00:07:12] The easiest way, obviously, to reduce them, to cut them out, to only eat carbs during certain times of the day. Like, in my case, I only eat carbs in the afternoon or in the evening. I don't have carbs in the morning or throughout the day. That means I have relatively stable blood sugar levels throughout the day.

[00:07:27] But dietary considerations aside, because those are relatively easy to figure out and fix, just don't eat carbs, and your pancreas doesn't have to respond by releasing insulin. But one thing that most people don't, are not aware of, is that stress can also cause an, a rise in blood sugar levels. And if you think about it, if you're under stress, let's use acute stress as an example, you know, you, you get into a car accident, or someone threatens you, you know, your body responds by, getting into sympathetic mode by [00:08:00] getting into a fight or flight response, you know, and in order to fight or to run away, you need energy.

[00:08:06] And so your body's natural stress responses to release glycogen, to make glucose available for energy. If you need a quick burst of energy to again, fight or to flight, or, you know, to respond to the stressful situation. So acute stress causes a release of glycogen, and that turns into glucose. a elevated blood sugar levels, at least temporarily.

[00:08:26] And I've seen this response very dramatically during exercise, high intensity exercise like CrossFit. And even during sauna bathing, I've been wearing glucose monitors for a while on and off. And I've seen dramatic spikes in blood sugar during my CrossFit workouts and during intense sauna sessions, meaning that where the heat stress was so high, that my body started dumping glycogen as a response to that.

[00:08:52] Those are usually not terrible because those are short lived spikes. They go up and you recover relatively [00:09:00] quickly if you're metabolically healthy. You know, so I'm not saying that don't workout, don't sauna bathe because it causes a dumping glycogen and an increase in blood sugar levels. No, not at all.

[00:09:09] But it's something that I've noticed nonetheless, and that you should be aware of, because that can add on if you also deal with a lot of chronic stress. And that's really much more of an issue, because chronic stress might not cause those dramatic spikes in blood sugar, like a crossfit worker does, but it causes elevated blood sugar levels nonetheless.

[00:09:30] And if they stay chronically elevated, because you're under chronic stress, that can lead to at least prediabetes. in the long run. In fact, when I talked to Erin, uh, one of the primal health coaches during an episode 29 of the podcast, she told me that she was actually diagnosed with pre diabetes despite eating right.

[00:09:52] Exercising and doing everything else right, but she was under so much chronic stress that her blood sugar levels were chronically [00:10:00] elevated and that led to the diagnosis with prediabetes. And the problem with chronic stress is it can lead to poor sleep, you know, if your head is racing or if your thoughts, if you're racing thoughts at night and you can't fall asleep and you wake up a lot and you just don't get the quality sleep that you need.

[00:10:17] That as well can lead to elevated blood glucose levels because your body responds by releasing stress hormones. The same goes with alcohol consumption. So imagine now, you know, you're someone who eats well, maybe even, you know, if you're on a low carb diet or even a ketogenic diet, and you exercise a lot, you cold plunge, you, you know, you sauna bathe, you do all of those things.

[00:10:40] that are conducive to good health, but you're super stressed because of maybe your day job, you know, that's why you don't sleep very well. You know, you need a drink or two at night to, to settle down. You know, all of those things combined, then, can lead to chronically elevated blood sugar levels that have, then, you know, those [00:11:00] exercise, sauna, whole plunge induced spikes, and all of that combined can significantly Decrease your insulin sensitivity because your blood sugar levels are always chronically elevated, and then you have those spikes on top of that.

[00:11:15] And then maybe on the weekend, you know, say, you know what, I've been eating low carb all week, you know, let's do pizza night, you know, and you have, you know, a whole pizza or even two, like in my case, if I'm really hungry and we have that once every two months pizza night, I might eat two pies, you know.

[00:11:28] And if you monitor your, if you look at your blood sugar levels after consuming a regular. You know, wheat crust pizza, it's a dumpster fire, all throughout the night. So you have, you know, your exercise induced spikes, your sauna bathing induced spikes, your chronically elevated blood sugar levels from your stress and poor sleep and alcohol consumption.

[00:11:45] And then on the weekend you have those dumpster fire spikes. You know, if you continue doing this over a certain period, you might actually end up with blood sugar issues. You know, with pre diabetes maybe, or even worse, you know. And so, that's something to keep in mind, [00:12:00] and that leads us into the question, so how do you best monitor, how do you figure out if that's going on with you, if stress might have a negative impact on your blood sugar levels?

[00:12:08] And, as I've alluded to before, one of the best ways is to monitor, or to use a continuous glucose monitor. Continuous glucose monitors, as the name implies, continuously monitor. Monitor your blood sugar levels. And depending on the type of sensor you use, there is, you know, one from Abbott, there is one from Dexcom.

[00:12:25] There are little sensors that you can apply to the back of your, to your tricep area here, to the back of your upper arm. You can, you know, wear them on your abdomen. There are different locations where you can wear them. And they consist of a, of electronics, basically, it's usually a small disc or a sensor.

[00:12:41] And a tiny filament. It's like a very, very, very thin needle. You know, you're not going to notice applying them, but you, there is an applicator, you know, you punch a button and it goes in, doesn't really hurt at all, and then it, that sensor continuously monitors in maybe intervals of 15 minutes or even shorter of five minutes, depending again [00:13:00] on the type of sensor you're using.

[00:13:01] And it reports those measurements back to your phone where there is an app. And you can check, so it continuously records those blood sugar readings, so you can see exactly throughout your day and throughout your night, how your blood sugar responds to maybe exercise, to sauna bathing, to certain meals you're consuming, to stress, to all of those things, and it gives you a good idea of what's going on, so you can correlate, okay, I worked out, and that's why I had a spike in blood sugar, I consumed pizza, and that's why for the next Six hours, my blood sugar was all over the place and many other things.

[00:13:36] And then you can start experimenting and say, okay, what if I, instead of consuming regular wheat dough pizza. I make my own sourdough crust pizza. How does that make a difference? And I've noticed in our case, if I, if we make sourdough at home and we make pizza out of that sourdough, my blood sugar response is significantly better than to regular pizza.

[00:13:58] Or what if I eat blueberries [00:14:00] instead of a banana? You know, if I enjoy fruits, you know, all of those things might have a different impact. on your body's blood sugar response. And more importantly, though, how are my blood sugar levels throughout the day when I'm not eating, when I'm not exercising, just due to, you know, regular stress at work or at home with the kids or, you know, with your spouse or whatever the case might be, how does my blood sugar change if I consume carbohydrates and then go for a walk?

[00:14:24] Like one of the experiments I've done together with Levels Health, one of the blood sugar or continuous blood sugar monitoring platforms that I've used. And so all of those things. Um, you can figure out by just wearing a sensor for a couple of weeks, you don't have to do it for the rest of your life, obviously, like a, unfortunately, you know, a diabetic might have, but just for a couple of weeks to find out how your ever, how your lifestyle choices impact your blood sugar levels.

[00:14:49] And if you wonder now, so, okay, how can I get my hands on a, on a CGM? Well, the problem is you need a prescription for that. And the way I got my first CGM, I just went to the doctor and said, Hey, [00:15:00] You know, during my annual physical and said, Hey, I would like to wear a CGM. Can you get me a prescription? And depending on, you know, your state of health.

[00:15:08] And if you already have a blood sugar problem, your insurance might pay for it. But chances are, if you, if you're not diabetic or pre diabetic, your insurance is probably not going to pay for it. But at least if you get a prescription from your doctor, you can take it to the pharmacy and get a sensor from there.

[00:15:22] And I got, the first time I did this, I got a Freestyle Libre 1. I think I paid 60 for that sensor. That sensor lasts you for two weeks. And that was it, you know, not a problem. Now, the issue is by going that route, the application that you get with those sensors or that are, you know, that are made available by, Abbott or by Dexcom, they suck.

[00:15:45] I mean, they are very poorly, poor user experience and not a whole lot of functionality to allow you to correlate meals and exercise with changes in blood sugar levels. And that's why I really like using a continuous glucose [00:16:00] monitoring platform. Um, like the one from NutriSense or Levels Health. Those are the two that I've used.

[00:16:04] And I have additional resources like reviews and side by side comparison on my blog posts and also on the YouTube channel. So check that out. I'm going to link everything down below, but basically with Nutrisensor with Levels Health, you get the prescription through them so you can direct, you can go to them, you sign up for a membership or for, you know, maybe only one month or for several months in a row.

[00:16:24] If you want to continue doing that for extended periods and you pay them, you get your prescription, they take care of everything. You don't need to, you know, go to your doctor, they send you the hardware. Um, you can download their app. And then using those apps, you can, it integrates with Apple health and with, you know, some of the other platforms out there.

[00:16:42] So you can really get a comprehensive idea of what's going on. You can take pictures of your meals, you can log workouts, or, you know, if you have an Apple watch, you know, that gets imported automatically via Apple health. So it's a, a very comprehensive platform or platforms that you can use to really make sense.

[00:16:58] Of your glucose data to [00:17:00] figure out what exactly is happening. You can run experiments. You can say, okay, today, I'm going to have a banana tomorrow. I'm going to have blueberries. How do they compare, you know, what, what fruit, what sweet fruit leads to a better blood sugar response? You know, compare regular pizza with sourdough pizza, compare, you know, a high intensity crossfit workout with.

[00:17:20] You know, maybe a bike workout, you know, what happens if I consume carbs and then go for a walk? So you can do all of the things and make sense of it and get really detailed reporting that's useful to make changes. You know, you can log your, you know, mental, you know, state of mind. You can say, Hey, you know, today I'm not feeling well, you know, and how does that, what does that mean in terms of blood sugar levels?

[00:17:41] Are my blood sugar levels maybe higher? If I feel anxious, if I feel stressed, you know, all of those things. And, and I've done this, as I said, on and off for, for several weeks, um, actually over the last couple of years, I've been wearing blood continuous glucose monitors on and off. And I've learned a number of things that I didn't [00:18:00] necessarily expect.

[00:18:00] The first, the very first thing that was like an aha moment for me is when I saw how exercise or what impact on my blood sugar exercise is causing. I see dramatic spikes up to 170. milligrams per deciliter as a response to CrossFit. That was completely unexpected. I kind of had an idea that exercise would impact my blood sugar levels, but to that extent I did not expect.

[00:18:25] So that was super interesting for me to find out. Just recently during an experiment with both infrared and traditional finish saunas, I realized that heat stress has a dramatic impact on my blood sugar levels as well. They're all short lived and not a problem in the grander scheme of things because my blood sugar recovers really quickly.

[00:18:43] But nonetheless, dramatic spikes by hormetic stressors, exercises on a bathing. I've also noticed that chronic stress has a lower grade but more sustained impact on blood sugar. So my levels might rise just by maybe 15 milligrams per [00:19:00] deciliter. But stay elevated for extended periods, or as long as my stress is present, you know, so that's also, and that's again, a very important factor if you do, even if you do everything else right, you know, chronic stress can negatively impact your blood sugar and can lead to chronic disease in the long run.

[00:19:16] So that's a very important takeaway. I've also noticed that by consuming a boatload of protein and fat before carbs, I barely respond with elevated blood sugar levels. Thanks. And what, what I mean by that is, for example, you know, during dinner I have a lot of protein, I have a lot of fat, and then I might have a couple of tablespoons of honey or maple syrup or you know, fruits, fried plantains, what have you.

[00:19:41] And my blood sugar level belly goes up because the protein and fat slows down my digest or the, the metabolism of, of the carp so much. that my blood sugar levels barely spike, and that's a good thing, because you don't want to have constantly spiking blood sugar levels, that's not a good thing. So, that's how you can [00:20:00] maybe, you know, get away with consuming more carbs without negatively impacting your blood sugar levels by just consuming the appropriate amount of protein and fat beforehand.

[00:20:08] I've also noticed that fermenting certain foods, be it grains to make sourdough, or even dairy to make kefir, significantly improves my blood sugar response. I can drink a 16 ounce or 20 ounce jar of kefir without any noticeable impact on my blood sugar. And that's really cool because that means I can get my carbs in.

[00:20:28] I can get, you know, all the good stuff in from the kefir without necessarily, you know, getting me out of ketosis if I'm in ketosis or spiking my blood sugar levels. So the question now is who should wear a CGM? And I would think that if you're, if you know that you're stressed, chronically stressed, if you sleep poorly, if you don't get the quality sleep you think you should be getting, I think it's a good idea to wear a CGM for a while to see if maybe your Blood sugar might be either impacted by the stress and by the poor sleep or maybe, you [00:21:00] know, Frantic blood sugar levels at night might be, you know, influencing you or causing you poor sleep.

[00:21:06] So it goes both ways and so if you fall into either of those categories, wearing a CGM for a while might be a good idea. If you have trouble losing weight, especially body fat, you know, that might be an indication that your blood sugar levels are constantly high, that you're Your body is converting sugar into fat to store it for later on in case you need the energy later, you know, that's might be a good idea to wear a CGM for a while and see if that's maybe Blood sugar plays a role here.

[00:21:32] If you're always hungry or have issues skipping a meal, that again could be a sign of wonky blood sugar levels, likely due to dietary reasons or to chronic stress, might be a good idea to wear a CGM. Or if you have blood sugar issues running in the family, you know, I don't necessarily believe that just because your, your parents had an issue, a chronic disease or a metabolic disease, that you need to have it too.

[00:21:52] And there is nothing you can do about it. I firmly believe that's not the case, but if you already are predisposed genetically maybe to blood sugar [00:22:00] issues, to metabolic issues, to certain types of, you know, cognitive dysfunction, what have you, wearing a CGM might be a good idea to figure out what you can do on the blood sugar side.

[00:22:09] To reduce your risk. Now, before we wrap it up, I wanna point out to the show notes. There are a lot of resources, um, including certain podcast episodes where I talked about continuous glucose monitoring, or you know, one with, uh, Erin and Laura where we talk about how chronic stress can lead to pre-diabetes, IFA detailed comparison between levels, health and nutrition, a comparison between the different CGM sensors, Dexcom and freestyle.

[00:22:33] And a lot of other things, a lot of other resources that go into much more detail that, um, enable you to maybe make the decision to wear a CGM. You don't have to do it for a whole year or whatever, but doing it for a couple of weeks at least will give you a very good understanding of how your body responds to certain environmental stressors, to dietary factors.

[00:22:54] So with that, we're going to wrap it up, give it a thought, maybe it makes sense for you to wear a CGM for a while to find [00:23:00] out exactly. How your blood sugar responds to environmental factors, to diet, to exercise, to stress, and what you can do about it.