Continuous Monitoring of Health

So the opportunity to dive deep into glucose metabolism in my body with detail previously confined to laboratories was an exciting proposition. This especially true as I contemplated CES this coming week which has seen each year an ever-expanding Digital Health Pavilion with more companies and new solutions springing up. The common thread with many of the companies offering new insights either by capturing more data or delivering insights based on that data and sometimes both. I have often been heard to quote Lord Kelvin

You cannot improve what you do not measure

This is the story of my 14-day journey with a continuous glucose monitoring device that recorded my blood glucose levels every 30 minutes and sometimes more often when I manually accessed the monitor

Key Learning Points from the experience

I came away with plenty of insights and a renewed focus on what I eat, how I exercise and even thoughts on the timing of food. Among the general insights were some of them that stood out for me

• You are highly dependent on your Mobile Phone for any of these solutions to work continuously
• Glucose swings in some counter-intuitive ways in response to external factors (rises during exercise for example)
• When Fasting – coffee is definitely a factor that needs to be considered
• The Positive Influence of Meditation
• The Huge Value of Data in Helping Understand your Health

Thanks to Qalytude

My thanks to Sajad Zalzala, MD, and Qalytude for helping get me connected to a Continuous Glucose Monitor. These devices are not available for purchase and require a prescription to be able to access them. Dr. Z and his team at Qalytude have already expanded past their original concept of offering more people access to the “The Fantastic Voyage to Wellness and Longer Life” and the access to CGM as well as NAD+ patches are recent additions

Continuous Glucose Monitoring Sensor

The first thing to note about the continuous glucose monitoring device is it has a needle. The needle is not a traditional needle seen when blood is taken and is finer but it is a needle and it looks bigger and more painful than it actually turns out to be.

EDIT Jan 6 - thanks to some clarification the original picture was the insertion needle that does not remain and what is left in the body is a much finer needle pictured here:

The needle is an “interstitial” so much finer than a needle for take-in blood but the pictures make it appear bigger than it really is. As for size, it is as one Diabetes community member posted:

“filament” is 5mm long x 0.4mm thick”

Pictures below are the needle used to Insert the device and do not stay in the body

 

My First Lesson

As I have said in other posts (Has Kindness Gone), walking a day in other people’s shoes is an important part of understanding perspectives and I have already developed a newfound respect for all diabetes patients that are living with this day in day out. For me, it was a once-off but wow. This device is progress over the needle sticks for measuring blood glucose with glucometers but that is only part of the story as they must inject themselves with insulin on a regular basis, adjusting based on variations in intake, activities and their bodies’ response to surroundings. Aside from the pain the day to day challenge and energy required to focus on this is a big additional workload.

Now to be clear the actual application was pain-free (at least for me). The applicator did a great job with a spring-loaded device that slammed down the sensor into my skin and I am guessing because of the bang, noise and associated area hitting the skin I quite frankly felt nothing aside from a tap on the skin. But over the course of the day, I did develop a steady ache probably as a result of the insertion and perhaps some slight bruising (none was visible but there is likely some)

The First Reading

Another surprise – it was far higher than I expected first thing in the morning running at 98 and that was with no food in the morning just a little coffee. But one data point does not a series make, and it certainly was only marginally useful as this single data point. But this was the good news. I was about to be awash with data points and could start to test the effect of different activities, behaviors, and foods.

In this case, I decided to start an Intermittent or time-restricted Fast thinking I would watch the level fall quickly. My second surprise was the relatively slow nature of the fall of my level over the course of the morning, but I am drinking coffee which in my personal version of intermittent fasting I consider to be negligible in the contribution of calories and drink freely – more on this later.

First Food

That afternoon I find myself out of the house and ready to eat with Panera being the best of the option around selecting “You Pick Two” with some Tomato Soup and a Sandwich. What happens to my blood glucose do you suppose…..?

The first reaction is an immediate fall in blood glucose. It is followed by the expected rise, the well known post-prandial bump in blood glucose. But falling in the first instance, that was not expected. This might be considered “Reactive Hypoglycemia” but once again a single data point and more interesting than real insights. Watching the chart as the glucose rose and then fell again over the following couple of hours was helpful but more interesting was how this rise and fall compared with different foodstuffs

Uisce Beatha

Uisce Beatha (or the water of life) is the term sometimes used to describe a wee dram of Whisky. What would the reaction be with my wee tipple of Scottish Malt Whisky be

Drinking a wee dram in the evening had the effect of lowering my glucose and this effect appeared to be somewhat dose-dependent. The more Whisky being drunk the further the glucose fell. To be clear I did not extend this aspect of the trial much beyond a second serving.

This, of course, explains the late nite munchies you may have experienced after a Friday evening in the pub or out drinking with friends. It was certainly how our Friday evenings would go to Medical school. Out at a party or drinking and then heading home on the underground we frequently are found exiting at Kings Cross Station and overcome with a huge desire for food and heading over the road the Donner Kebab shop (I think it is still there!). No doubt the alcohol consumed had pushed our glucose levels low and the body was reacting with signals seeking sources of energy. The fact those Donner Kebabs were especially tasty and satisfying was just a bonus

Night Time

The first night was filled with several discoveries. The first and most important was that the buffer in the CGM device could only hold about 8 hours of data so if you did not download data to your phone before you went to sleep you were at risk of losing data.

There was a steady decline in the glucose levels over the course of the night but then at some point in the early hours of the morning, the body starts to increase the levels again. The timing of this was varied and I could not link it to any specific behavior, foods the night before or anything else but it happened consistently each morning. In fact, if I remembered to measure as soon as I woke up and then again when I got up I could see this increase in level taking place and appeared to be more pronounced as I woke up and my body and muscles became more active.

It made me wonder about the “Fasting Blood Glucose” study that is fairly routine for annual physicals and what the impact was on the fasting level of getting up, driving and then having your blood sugar tank vs the level that would have been the case if taken immediately you woke up and got out of bed?

Exercise

I exercise most days and was looking forward to taking measurements through a range of fitness classes I take that vary from Yoga through to High-Intensity Interval Training. The first and clear learning point for me was no matter my nutritional state (if I had eaten food that day or was fasting) my glucose would always rise during exercise. There was no drop as a result of exercise and my body appeared tor act to the increased demand of my muscles by producing more glucose in the bloodstream. This effect was dependent on the level of exercise and seemed more pronounced with more intense exercise.

It certainly put to rest the notion of a need to have food or energy to exercise. To be clear for differentiations exercise, take a marathon, for example, there are different demands so this insights is individual and also exercise dependent

But there was something else that was helpful in the data on one day when I ate rather too close to the start of the exercise. The exercise effect was the opposite where I arrived having just eaten (for the first time that day) and was watching the typical postprandial rise in glucose. Exercise induces a faster dip in the glucose and then when the exercise stopped it started to bump up again but not as much or for as long.

This lends weight to the notion of my father and mother in law who were often found heading out for a walk after a big meal since I am guessing this helped the body digest and remove the excess glucose spike (especially true at the holidays when we have an increased tendency to overeat)

Time-Restricted Fasting

The results of a solid 36 hours or so of fasting were as expected, but only if there was no coffee in the diet

Meditation Effects

It was surprising to note that 10 minutes of meditation appeared to drop my glucose level by 8-10 points. As someone pointed out that could just be the effect of sitting quietly, so I tested that, sitting quietly for 10 mins and discovered a 5 point drop and followed this with 10 minutes of meditation to see an additional 5 point drop. So both sitting quietly and meditating can compound and help decrease glucose in the bloodstream (in me at least).

Coffee

To this point I had considered coffee a zero-calorie drink (I drink it black with nothing in it) and an option during time-restricted fasting but testing my bodies response with an IF with coffee and without showing a clear and significant difference. It would appear that coffee has an effect on glucose causing a significant rise every morning

When I tried an IF day with no coffee my glucose level stayed normal the whole day.

Without eating anything and just drinking coffee I watched my glucose level rise again

Candy

There were no real surprises here!

Eat (or drink) sugar and you will see a rapid spike in Blood glucose but one that does not last as long as a post-prandial (food) related rise and looks much more like a roller coaster. There did seem to be an upper limit to the level even if I continued eating, all I seemed to do was add a second peak but the levels never really continued to rise but again, I did not stress this response much beyond the second helping of candy.

Technology Dependence

In a related incident, my iPhone suffered a battery “swelling”

This was significant because it required an urgent visit to have the device “repaired”. In this case, repair is not an option and it is a swap for a refurbished device. Backup was made and data restored (which took several hours). But unfortunately, the LibreLink application does not sync data to the cloud all the time so I lost a day’s worth of data to this debacle and it made me realize that if your health depends on this device you need backup solutions to be able to use the device and get readings. In my case, my backup iPhone 6 was no use as it was not new enough to load the Libre App which requires NFC not available in older models of phones

I see more of these sensors in our future tracking many more variables continuously. I am most excited by the opportunity to link this factor to blood pressure as you can hear in this podcast: Tackling the Epidemic of Chronic Illness.

---

Tagged as Blood Sugar, Diabetes, DigitalHealth, education, Healthcare Technology, Incremental, Incremental Healthcare, Intermittent Fasting, Medical Devices, mHealth, Obesity, Personal Health Records