My CGM and Glucose Metabolism

I’m not sure I even know where to begin with this post. There are so many things to be angry about. And so many areas of frustration. And so many opportunities to be fearful. But I’m not going to start there. I’m going to start with my blessings and some #LoudFinancialPlanning:

• When Fred and I realized that our healthcare coverage (which is nearly free to us due to his military service) is terrible, we determined we would self-pay for executive physicals.

• When we decided on a course of action to address his desire to eliminate hypertension medications and his pre-diabetes, and my lifelong insulin resistance and high LDL-C, we determined we would self-pay for Virta.

• When I wanted more data and begged my physician to provide a prescription for a Continuous Glucose Monitor (CGM) and insurance wouldn’t cover it because I do not have a diagnosis of diabetes, I paid for it out of my Health Savings Account. (It makes my head explode that they will not pay for prevention; only disease management.)

I acknowledge that we have the blessing of being able to afford our preventive measures. And I recognize that many people can’t afford anything beyond what their insurance will pay for, if that. After reading this post, I’d like to recommend that for my Women of a Certain Age(ncy) who can afford to pay for preventive healthcare, make it a priority to do so. Do NOT let your insurance coverage drive your health plan.

With that acknowledgment, I learned something about myself that’s critical for my own longevity plan: I have nocturnal hypoglycemia, and it causes night sweats.

Dr. Peter Attia, he of the bestseller, Outlive, thinks that everyone, diabetic or not, should wear a CGM to understand the effect of food on our bodies. Soon, CGMs will be available over the counter and his wish may come true. For people trying to understand what to eat and when to eat it, it’s a critical tool that delivers near real-time data about foods that cause a glucose spike. The alternative metric is the A1C blood test, which requires a lab and reflects the most recent three-month results.

The CGM data, in addition to providing insulin-dependent Type 1 diabetics with critical dosing information, can teach the rest of us how to eat in a glycemically neutral fashion and prevent glucose spikes/crashes that make us feel terrible.

I know this from experience. For at least 40 years, a carbohydrate meal would cause me to have a sugar crash. It didn’t matter if it was healthy food or not. After a non-glycemically neutral meal, I needed a nap, sometimes in mid-sentence. (There are witnesses.) I have crazy insulin resistance, and I didn’t know until recently that fixing this was even possible.

Why does it need to get fixed? Because more and more, science is proving the link between unhealthy glucose metabolism and dementia, specifically Alzheimer’s Disease. My aunt and dad both had late-stage Alzheimer’s, and I’m going to do everything in my power NOT to go that route. If I’m going to be 96 ½ one day (that’s Hurricane Jackie’s current age, and she’s still sharp as a tack,) I certainly want to be in good condition and operating under my own cognitive steam.

Let’s talk about this scientific link and why we care. Please note that I am not a medical professional. I just read everything so you don’t have to. I’ll keep this simple. The brain requires two things to be healthy: oxygen and glucose.

• If you have an unhealthy cardiovascular profile, you risk depriving the brain of oxygen.

• If you have an unhealthy glucose metabolism, you risk depriving the brain of glucose.

That’s as far as I’ll go. But let’s agree that oxygen and the ability to metabolize glucose are not inconsequential to your brain’s health.

The way to test your cardiovascular profile is usually with a lipid panel, the well-known cholesterol and triglycerides screening. Oddly, that’s not determinative. But there is another test, a Coronary Artery Calcium (CAC) scan, that tells you whether you’re an arterial plaque producer and provides you with your relative risk for coronary disease. Guess what? It’s not covered by insurance, and doctors don’t usually mention it for that reason.

W … T … F?

Recently, a friend underwent the test for $125 … out of pocket. Wouldn’t you want to know if you’re likely to have arterial plaque in 10 or 20 years? Should the first symptom of a problem be your first heart attack? No thank you. We should all be requesting this test.

The way to test your glucose metabolism is via A1C, the hemoglobin glucose test. When your A1C is elevated, indicating you are pre-diabetic or diabetic, doctors tell you to lose weight, or they start you on Metformin. That’s it. That’s all the insight you get. From the “experts.”

Here’s a little secret. Doctors get almost no nutritional training in medical school. And the American Diabetes Association is completely in the pocket of Big Agra and Big Pharma. They only want you to “manage” your symptoms. They don’t want you to reverse them or reduce your medications.

The standards for “eating healthy” as a diabetic, are ludicrous. The plate method is 75% carbohydrates, practically guaranteeing that the problem gets worse, not better. (Diabetes is regarded as a “progressive” disease with no cure. But it can be reversed and sent into remission before it causes too much damage. They don’t tell you that.) We don’t know why some people (like me) can’t tolerate carbohydrates. But many of us simply can’t. And it’s like giving an alcoholic a drink. In the end, it’s going to kill us, slowly.

The medical community is now calling Alzheimer's Disease “Type 3 Diabetes.” But here’s the kicker: insulin resistance is also the single biggest risk factor for coronary artery disease, causing 42% of heart attacks. And the American Diabetes Association is doing almost nothing to educate the public on how to mitigate our risk by reducing our overall carbohydrate intake.

The reason Fred and I settled on Virta* to reverse our numbers before we have these diseases, is that it was the program he was willing to do based on his sister’s success with it. It’s largely a supervised ketogenic diet (high fat, medium protein, low carb, mostly veggies) and marketed to corporate benefits departments and insurers as an off-ramp from diabetes medications and GLP-1s. (It is. And that saves them money.)

Virta’s origin story appeals to me. In short, a doctor running an obesity and diabetes clinic wants to get funding to run a study on 1,000 diabetics to determine the effects of a low-carbohydrate diet. A tech-bro triathlete is told by his doctor that he’s pre-diabetic. So, he goes looking for the thought leaders in the industry. He has immediate success on a low-carbohydrate diet and learns of the team’s need for a study. The groups collaborate to build a telehealth app to collect the data. Ten years later, the company is valued at $2 billion, and I can’t wait for the IPO!

Thanks to Virta, Fred can satisfy his bacon “fix” and enjoy almond-flour-crusted cheesecakes made with an allulose sweetener. That makes him a happy camper. In addition, we’re doubling down on our exercise and weightlifting to ensure we maintain muscle mass into our ninth and tenth decades. Six months in, he is no longer pre-diabetic, his blood pressure is normal, and he’s cut his medicine in half. My A1C is down, my blood glucose levels are stable overall, and I no longer have sugar crashes. Big improvement.

However, I still get these pesky hot flashes in the middle of the night. So wasn’t I amazed to see that they correspond to the “critical alarm” on my CGM. Turns out I’m not having post-menopausal hormonal swings. I’m having hypoglycemic events that cause night sweats! Usually, that only happens with diabetics who take too much insulin; but it’s clearly happening to me, a non-diabetic. And I need to fix it because glucose variability (GV)–the size of the glucose “ricochet”–matters. So, now the plan is to have a tiny snack before bed consisting of equal parts protein and fat. I’ll let you know how it goes. (Update: It worked fine the first night. No alarms.) If I can improve my glucose metabolism and my sleep, I’ll be golden.

Why, you may ask, did I find out about this accidentally? Because there’s not enough research done on women. Women are menopausal. Women are insulin resistant. But is there a CGM study regarding women and nocturnal hypoglycemia? Of course not. If you suspect that this describes you, you’re on your own. But I hope I’ve provided a small path of breadcrumbs for you, and it leads you down the path to better sleep.

Here are the three summary points I want to make:

• Diabetes is surging because so many of us don’t know how to eat, and the information we receive is conflicting. I have landed on an option works for me and the Hubs, and it might work for others. Check out Dr. Sarah Hallberg’s 2015 TEDx talk link at the bottom of this post. (Full disclosure: I have done other forms of glycemically-neutral eating in the past. But they were 30-day “detox” diets and not sustainable as a lifestyle. This feels sustainable.)

• 50% to 80% of Americans have an unhealthy glucose metabolism. Dr. Attia suspects it’s worse than that, because an A1C test will only show the smoothed average over three months, not the daily swings a person experiences. Alzheimer’s Disease in the population will double by 2060 with no intervention. Yikes.

• Health insurance and our medical professionals are NOT going to solve the problem for us. As Women of a Certain Age(ncy), we are underrepresented, so we must do it ourselves. With lifetime risk of developing Alzheimer’s Disease at 21% for women aged 65, this is a big deal.

If we’re going to go the distance into our 90s, we need to take the initiative to research our own bodies. #WeRescueOurselves We are our greatest projects, no matter our starting points. It’s worth it to spend some out-of-pocket money now to avoid spending $17,000 a year (that’s the average) on diabetes management in retirement. It’s worth it to carve out time to move and lift daily. It’s worth it to recognize that you have #MoreRunwayThanYouThink to create and execute your longevity plan.

And if you have the patience to experiment, I highly recommend you wear a CGM for a few months to learn about your own glucose metabolism. I guarantee it will change how and what you eat. #NotYoungNotDone

Reading: Dr. Peter Attia, Outlive, Harmony 2023

Obesity-induced chronic low-grade inflammation in adipose tissue: A pathway to Alzheimer’s disease

Dr. Sarah Hallberg, Status Quo Thinking is Harming Your Health, Olio Media 2024

Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU

https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

*No compensation was received in exchange for these statements

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Copyright © Madrina Molly, LLC 2024. All rights reserved.

The information contained herein and shared by Madrina Molly™ constitutes financial education and not investment or financial advice

Sherry Finkel Murphy, CFP®, RICP®, ChFC®, is the Founder and CEO of Madrina Molly, LLC.

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