FDA clears first over-the-counter continuous glucose monitor

https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor

by bookofjoe • 2 years ago

783 426 2 years ago

So the ones already all over amazon aren't supposed to be there?

Amazon as a gateway to illegal or fraudulent products? Please, a trillion dollar corporation must surely have professionals watching this over.

thfuran2• 2 years ago

I just searched for one and found

Important information Legal Disclaimer : Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.

At the very bottom of the description. That seems like complete BS that shouldn't hold up, but I don't know.

mattl3• 2 years ago

That's on virtually every supplement website it seems.

Johnny555• 2 years ago

I don't see any non-prescription CGM's on Amazon, are you using Amazon USA? I searched for "CGM" and "Continuous Glucose Monitor", and only found test-strip devices and CGM devices on Amazon Pharmacy available with prescription.

What search string are you using? Can you post one?

RobotToaster2• 2 years ago

I was using the UK site, that probably explains it.

Usually we lag behind the USA on approvals so just assumed if it wasn't OTC there it won't be OTC here.

baby_souffle• 2 years ago

So the ones already all over amazon aren't supposed to be there?

In the US, I only see the finger prick type. I do see the FreeStyle Libre3 but it requires a prescription

coldpie7• 2 years ago

I'm T1D (insulin-dependent). I used a Dexcom for a couple years a while ago, back around the G3 through G5 era or so. I ended up stopping using it because my diabetes is very well managed, and I found it didn't make a huge difference to my management. With my insurance, each new sensor every week cost about $50, and would fail in various annoying ways: sometimes it would just stop working in the middle of the week, or not work at all from the start, or disconnect randomly for a few hours. Each sensor also used a ludicrous amount of plastic for its applicator, like a tennis-ball-sized hunk of hard plastic, that you just chucked in the trash, every week. Maybe things have improved, but it was a bad combo of unreliable and expensive so I just quit using it and went back to finger pokes.

If it were like $5 per week, I might put up with it. Maybe this over-the-counter model will be affordable. We'll see, I guess.

mlsu8• 2 years ago

Dexcom and Freestyle both have options (G7, FSL2) that have a much narrower form factor than the old sensors. They end up being far more reliable, because the sensor doesn't dislodge. The new Dexcom sensors are more accurate. Less drift and no calibration.

Out of pocket cost is obviously your own situation but I think anyone with T1 should look at them. For me they are life changing, even moreso if you have a pump that can deliver based on CGM readings.

Plastic waste situation is still bad.

coldpie7• 2 years ago

Glad to hear they're improving, though the waste situation is bizarre. I will probably go back on one at some point, I didn't hate it, just didn't feel it was worth the cost/benefit ratio. It didn't impact my A1c, I've always been in the low 6s, and I've only had two lows that I would consider significant in my 25 years with the disease. Benefit just wasn't there for the hassle and price.

user_78327• 2 years ago

The new Dexcom sensors are more accurate. Less drift and no calibration.

As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!

umvi• 2 years ago

The new Dexcom sensors are more accurate. Less drift and no calibration.

I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.

mjaniczek• 2 years ago

life changing

Yeah, seeing ~300 datapoints a day instead of 4 while pricking your fingers is amazing QoL improvement. Dead serious.

1123581321• 2 years ago

I think your experience was unusual in that you had so many failures (hopefully you at least got your broken sensors replaced for free; both Dexcom and Libre do this) and that you are good at managing your diabetes without many measurements.

The out-of-pocket expense can certainly be rough; I use Libre right now because my Dexcom out-of-pocket would be similar to yours and Libre is a third.

I lend my CGM to people to who are possibly prediabetic. I'm very glad I can point them to an OTC solution now.

Etheryte• 2 years ago

The plastic waste issue is one of the first things that usually comes up around this topic regardless of who you ask. It's such a shame because it's not like you have many options unless you're comfortable going without sensors.

berkes• 2 years ago

All my diabetes stuff is free, in my country. But it must be shipped to my house in Quarterly deliveries.

Shipped in several boxes, each filled and wrapped. then the GCMs, strips, refills, pump connectors come in their own boxes. Some per ten, some single. Each sub-box has several booklets with instructions and safety guidelines. Each unit is individually wrapped in plastic, paper. All of them are single use. Even connectors and rods.

Our combined household has less waste than my insulin therapy produces. One single insulin therapy produces more plastic, paper and wrapping weight than what my wife and I produce together on everything else.

It's utterly insane.

bsder• 2 years ago

Each sensor also used a ludicrous amount of plastic for its applicator, like a tennis-ball-sized hunk of hard plastic, that you just chucked in the trash, every week.

Erm, let's be a little defensible here.

These sensors have to be stored in sterile packaging--that means thick enough to be a barrier. That means it also has to hold the sensor in such a way that a palette can be gamma irradiated. It also needs to be resistant to drops, crushes, and other accidents.

The sensor has to not be harmful with organisms irrespective of the understanding of the person using it. Any change to that packaging has to be re-evaluated for effects on that sterilization.

And while I understand people having concerns, if the only reason we needed to use plastic was to treat folks with diabetes--I think the world would somehow manage.

coldpie7• 2 years ago

Eh, maybe, but the bulk of the applicator is just empty plastic molded to fit an adult's hand. I have to believe they could figure something less wasteful out (reusable applicator?) if they wanted or needed to. Regardless, it was just another downside for me weighed against the relatively few upsides that made me quit using it. It felt terrible to chuck all that in the trash, especially when I'd have to do it two days in a row because a sensor failed.

[1] https://fm.cnbc.com/applications/cnbc.com/resources/img/edit...

innolitics• 2 years ago

I work in the medical device space (mostly software as a medical device). I attended the AAMI Nexus conference two weeks ago and attended a talk about making devices more eco friendly. The tension between safety and sterilization and packaging was definitely brought up. It’s a hard balance to make. One example I thought was interesting was that the NIH did a study to see if it was necessary to swab people’s skin and use gloves before a shot. It turned out it wasn’t and it didn’t make a difference, so they stopped requiring the providers to swab people’s skin or wear gloves, thus saving an immense amount of waste when taken over all vaccine shots.

eitally2• 2 years ago

fwiw, my wife uses Freestyle Libre 3 and the with-insurance cost every two weeks is about $40. Whenever she's had one fail (which seems to be about 1:10), Abbott has replaced it free of charge and sent a pre-paid label so she can return the failed device for QA review.

coldpie7• 2 years ago

Yeah, I feel like prices are on a downward trend the last couple years, which is great. For me personally, I try to spend absolutely as little time and effort as possible thinking about my diabetes. So having to call the manufacturer or fill out forms and receive a package (more waste) and ship a thing back (even more waste) is just too much time and effort for me to want to bother. I hope they keep improving, it's cool tech and I'd like to like it. Just not there yet.

salawat• 2 years ago

Worked at a PBM. Interesting factoid.

The FreeStyle Libre 3 has a lower ongoing out of pocket cost for people who just need diagnotic monitoring but no integration with a pump. Dexcom , however, offered rebates that made it cheaper in initial outlay by the PBM to get people using, then left them paying the higher upkeep costs for functionality they may never need.

Something to keep in mind. Your insurer doesn't optimize for you. They optimize for them.

cadr4• 2 years ago

I just started with the G6 (still using it), and when I started I'd have that sometimes. Whatever they changed in the past year or so, it has gotten waaaaay better. (They would always replace them if they failed early, but was still a huge pain.) I'm exited to move to the G7 (mainly because of the shorter warmup time).

Also, pairing it with the Omnipod 5 is just next level. Closed loop. Never having to inject in public. No tubes.

lewismenelaws• 2 years ago

I have the G7 and it's incredible. On a medtronic pump... wanting to switch asap

micro_cam• 2 years ago

The g7 is definitely a bit better on all counts except maybe bluetooth reliability. I use them with [open source closed loop](https://loopkit.github.io/loopdocs/) insulin pump software and it is pretty great.

Still a lot of plastic but the sensor comes in a smaller jar/applicator in a cardboard box and it pretty reliably lasts 10 days cutting down waste.

It sounds like this new sensor is just a g7 but with less stringent accuracy standards for non insulin users allowing it to last 15 days.

ng12• 2 years ago

You went back to finger sticks? I am floored. Do you follow a strict low carb diet? How often are you exercising?

coldpie7• 2 years ago

Definitely not low carb, no. I have a bowl of oatmeal for breakfast 4-6 times a week :) My diet is pretty consistent though. I know how that oatmeal will respond to insulin 90% of the time, and the remaining 10% random quirks I can just deal with by feel & a finger prick to confirm. The thing I'm most strict about is I only allow myself to have about one "bad diabetes meal" per week. So that's like any restaurant food, or doughnuts, or pizza, or whatever. I mostly only eat home made meals, my wife & I both love to cook. But those aren't low carb, just whatever we feel like cooking that week.

I walk about a mile a day, to the bus & back for work and a bit for leisure and to get up from my desk. Otherwise I don't exercise.

agawish• 2 years ago

I'm really intrigued by your statement that your diabetes is well managed, if I wake up in the wrong side of the bed, my insulin resistance change!

Wondering how you can maintain that, do you have a very rigid routine and meal plan?

I'm using Libre2 as part of my prescription and it has been working wonders by alerting early on before it is too low or too high to have enough time for a correction dose, or a small bite. The fact that you can see the trajectory of Glucose going up or down is by itself a reason to get.

coldpie7• 2 years ago

Hm, I'm not sure. I don't talk with other diabetics much so I guess I don't know what other's experiences are like. I go to sleep and wake up on the same schedule every day including weekends. My eating is not rigid, but does tend to be consistent just because my daily routine is consistent. I'm not "low carb" or anything, but I do follow a healthy-ish diet and avoid hyper sugary foods (soda, coffee milkshakes, sugary cereals) like the plague. Diabetes or not, no one should be eating that stuff :)

I do miss having the moment-to-moment trajectory information. Knowing whether I'm still going up 90 minutes after a meal was valuable. But I find I'm able to feel when I'm above 200 mg/dL, so can just correct by feel most of the time.

post_break• 2 years ago

Can we do CPAP machines next?

polishdude20• 2 years ago

Technically you can buy them on Facebook marketplace, craigslist etc

asow922• 2 years ago

Something about a used CPAP machine raises my yuck alarm

akulbe• 2 years ago

Not really. It's against ToS in both cases, to sell used medical equipment.

dumbfounder• 2 years ago

I had to buy one for a friend. But then he ordered a new one and all he had to do was send them a picture of his old one (after some persistence). It’s ridiculous.

electriclove• 2 years ago

And contact lenses too!

bookofjoe3• 2 years ago

Continuous Glucose Monitoring

https://www.niddk.nih.gov/health-information/diabetes/overvi...

005• 2 years ago

I don't think this is particularly special. In other countries it's possible to obtain Dexcom's current line up by purchasing it online (G6, ONE, G7) and other brands too like Abbott's Freestyle Libre.

It seems like this is a stripped down version of the G7 (albeit with a longer wear time) as the ONE is a stripped down version of the G6.

ethanbond• 2 years ago

"In other countries"... right... opening it up to a market of 340 million people with rampant metabolic problems is what's special about it.

m3kw9• 2 years ago

80$ a pop for 2 weeks and most people cannot access it long enough

gumby2• 2 years ago

Hopefully they are cheaper than the copay on the Libre 3 sensors.

rkagerer• 2 years ago

When your smartphone becomes a critical health device to support/treat a condition I wonder how that will impact case law around things like police confiscation.

uxamanda• 2 years ago

Interesting, never thought about that. Also wonder what happens in Airplane mode / poor reception?

hammock• 2 years ago

CGMs use bluetooth

shanselman• 2 years ago

it's all BLE and works great on an airplane as long as BT is on

saagarjha2• 2 years ago

What happens when an officer confiscates your glucose monitor today? I assume you die and they claim they did it for some valid reason or the other.

Terr_• 2 years ago

Or just withholding the insulin itself: https://www.thenation.com/article/society/diabetes-police/

bschne2• 2 years ago

Yes, but you can't easily use your non-smartphone glucose monitor as a communications device to manage a bunch of drug dealers which can't be confiscated because your life depends on it. That changes once it's your smartphone.

mft_• 2 years ago

Type 1 diabetics have been managing their insulin for decades with occasional blood sugar testing - i.e. certainly not testing for every dose. They’d be fine to manage things for a period without a confiscated monitor.

smileysteve• 2 years ago

They jail you, give you low quality food, and eventually the jailer may send a medical team to manage your type 2 diabetes -- most likely with a finger prick and test strip; and they'll give you dietary guidelines that the jail/prison food doesn't satisfy.

US version; (oh, and they'll charge you for the medical care)

reaperman5• 2 years ago

Sadly it will probably receive very little consideration.

contravariant• 2 years ago

There's a reason most regulations are written in blood.

huytersd2• 2 years ago

The cops will probably deliberately keep it from you as a threat.

eitally2• 2 years ago

Software as a Medical Device has been a regulated "thing" for years now, and in this case the Abbott Freestyle app is a mandatory requirement for the CGM To function. If the app can't connect to the CGM, the thing will make your phone beep incessantly. Similarly, if your blood glucose levels exceed "safe" thresholds, it will alert at full volume in a way you are not allowed to override. Frankly, this is as it should be, but it does indeed convolute things when the device interface (phone) is used for so much more, too.

lacoolj• 2 years ago

inb4 apple watch integration

asow922• 2 years ago

I'll be buying that apple watch if it ever gets here

cadr4• 2 years ago

https://www.massdevice.com/dexcom-direct-to-watch-g7-cgm/

(There is already an app to show on the watch, but you still need the phone in the loop - this is directly to the watch without the phone.)

bradleyy2• 2 years ago

Dexcom already has an integration; are you talking about hardware?

mattl3• 2 years ago

Yeah, it would be great if the watch could just do this for you, instead of needing to buy a new sensor every 14 days.

gamepsys• 2 years ago

I like this trend of the FDA making more and more things OTC.

hanniabu• 2 years ago

Don't be fooled by the reason though

The markup on OTC products is generally higher than on prescription medications.

https://www.eposnow.com/us/resources/how-do-pharmacies-make-....

nickthegreek• 2 years ago

For medical products though, it seems great. OTC hearing aids are a big win for society.

LordKeren• 2 years ago

I have an extremely hard time buying into the idea that that the reason for making glucose monitors available over the counter is simply to increase the profit margins of drug stores.

reaperman5• 2 years ago

I haven't noticed this as a consumer in the context we're talking right now. I think that article is measuring the difference between OTC and pharmacy pricing after a drug is approved OTC. But it is not looking at prices pre- vs. post- OTC approval.

Olopatadine eye drops are amazing for allergy season, and they used to be like $250-400/bottle just 5 years ago or so, even the generic version. Then they went OTC for like $10/bottle.

This pricing difference might be true for things that are already mostly cheap, like Omeprazole -- where branding on consumer products drives OTC markup, but consumers don't pick the brand when doctors prescribe it and the pharmacy just gives them whatever cheapest generic they have in the back that they negotiated excellent pricing on.

Though you can easily close the gap on these prices by shopping for the store-brand generics at Costco, Walmart, Sam's Club, etc.

bobthepanda2• 2 years ago

“CGMs can be a powerful tool to help monitor blood glucose. Today’s clearance expands access to these devices by allowing individuals to purchase a CGM without the involvement of a health care provider,” said Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Giving more individuals valuable information about their health, regardless of their access to a doctor or health insurance, is an important step forward in advancing health equity for U.S. patients.”

Says nothing about it being cheaper; and honestly, taking the requirement to see a doctor out of it may end up reducing the total cost for a patient anyways.

crakenzak• 2 years ago

Is the FDA capturing any of that markup somehow? I fail to see how it would impact their decision process on approving if it had no impact on their incentives.

drdaeman• 2 years ago

I don't get why things like CGMs require a prescription. It's just a kind of a wearable sensor. While typically only a diabetic person would need it, I fail to see any harm for any adult human if they get curious and want to stick one.

There are odd things like glasses or CPAP machine prescriptions - but at least I understand it's theoretically possible to cause some harm to oneself with those, if someone is really uneducated, reckless or stupid. With a CGM I just can't think of a sensible scenario. Except for the really stupid ones, but then a simple kitchen fork is a four times worse hazard.

csours2• 2 years ago

I wish Theranos had worked on a more reasonable goal - like an implantable CGM.

I had T2D, well controlled now, my A1C is below the diabetic diagnostic range.

I used CGMs, and they taught me a lot about how my body reacted to food and exercise.

But I sweat a lot and they would always fall off, halving the useful life of each monitor. I would probably still use them from time to time if they didn't sweat off; and if an implantable version was available for a reasonable price (under $500, with no ongoing costs), I'd probably get it.

I feel like a lot of prediabetic people could learn a lot about their situation with this. I think this is a very good thing.

guidopallemans• 2 years ago

I used to have this problem as well, so I talked it over at my endo office. They suggested that I order some specially shaped stickers to keep them on, but instead I just bought some Kinesiology Tape (hansaplast, but also exists store-brand). 10cm of that works perfectly, even for heavy contact sports combined with sweating (and many showers).

mapkkk2• 2 years ago

Just make sure you cut a small circle from the tape overlying the breather hole of the sensor - that hole serves to let moisture buildup from underneath the sensor escape.

csours2• 2 years ago

Yup, I tried this. I sweat A LOT

T1DTech3• 2 years ago

Eversense is implantable, but you have to have a healthcare provider insert it and remove it. So mini surgery every six months. I'll pass.

philsnow5• 2 years ago

I dove into CGMs a little bit about a year ago, mostly just for fun. Yes, I paid money to some online prescription mill for CGMs (Abbott Freestyle Libre 3, IIRC), and then put one in my arm (the applicator is a short syringe section that has the monitor tube threaded into it, so the tube stays in your arm and your skin under the monitor remains broken) for a couple weeks. Just to see how various foods would affect my blood glucose, to see whether the “facts” I’m telling my kids about the glycemic index of various foods actually has the expected impact on a measurable result. You know, as you do. For fun.

(It actually was fun, and I’ll do it again when the data ecosystem improves.)

hasty_pudding• 2 years ago

I would love to see the results of that!

haswell3• 2 years ago

Aside from the fun, how did it go? Find anything surprising or insightful in the process?

It sounds like an experiment I’d like to do for the purpose of optimizing my daily habits and establishing a better mental model for how my eating habits impact me throughout the day. But I really dislike needles.

smt883• 2 years ago

If the needle in the CGM bothers you, don't let it. It's a quick, painless jab with a tiny needle at the beginning and then the needle comes out. The part that stays in your body is just a flexible filament made of plastic.

I did this experiment as well, and the main thing it did was completely stop me from snacking. My habits got better because I could see how my BG could never return to baseline if I allowed myself to snack between meals.

Other than that, it was also interesting to see certain things would badly spike my BG and other things wouldn't, and they weren't always what you'd expect. A lot of "keto" and "diabetic-friendly" products are terrible for most people's BG and were for mine. I found that some things, like black tea, actually made my BG drop as well.

Overall it's worth doing at least once.

pastage6• 2 years ago

If you want to know more about it you can just read about how diabetics treat different foods. Short version; high GI is fast high blood sugar, lots fat and sugar can results long period of with high blood sugars.

It is a CGM more or less what you would expect, insulin is the only hormone that lowers blood sugar, then you have all the stress hormones that raise it like adrenalin, growth hormone and cortisol plus glucagon for long time storage of sugars in the body. So measuring blood sugar with a CGM gives you a value between 2.9-13.5 mmol/liter that is supposed to give you picture of a rather complex system. A CGM also needs perfect access to your free flowing blood which in it self is a difficult task.

galago2• 2 years ago

Freestyle Libre 3 only has a plastic filament and the plastic applicator pushes it in without pain. Very different than metal lancets (stick test). I can't feel it at all when its in the back of my arm. If I were worried about sweating too much and it not sticking I would get one of the third party over-patches that create a lager adhesive area. I might do that in the Summer.

crimsontech4• 2 years ago

I did it for fun about a year ago and found out I had T2 diabetes.

I was shocked but obviously glad I found out. I use them from time to time just to see how I’m doing and how different foods (and amounts of them) impact me.

I found I can control it through diet alone and exercising when there is a spike by using a GCM for the constant feedback.

They are very expensive here though (UK) and my doctor won’t prescribe me one because metformin is cheaper, so it’s not something I can use all the time.

I hate needles, this really isn’t like a needle though, it’s a small filament which sits just under your skin, you can’t feel it, I thought it hadn’t gone in until I saw the reading appear on my phone.

Some things I found out besides what foods and amounts give me big spikes are that I have a blood glucose spike in the morning just before I wake up, and that if I eat a small enough portion of white rice, ice cream, bread, whatever I can reduce the spike quickly by going for a walk. If I had a lot though, a walk isn’t going to help.

philsnow5• 2 years ago

I almost completely forgot about the monitor itself, and only paid attention to the numbers on my phone. It's that unobtrusive (at least the Libre 3 one that I used).

I let the needle (actually: annulus? see sibling comment) get into my head because I was curious and looked at it. It looks a lot scarier than it is, kind of like using contact lenses for the first time: before you've used them, you get into your own head about it, but once you've done it a couple times it's just rote and easy.

I had started the first one a day before I started a few weeks of (6-days-on, 1-day-off) keto. Keto guides will say that you should have <= 25g net carbs per day, but I specifically wanted to see how front-loading (having almost all the day's planned carbs in one meal) affected blood glucose, and also whether the number (25g) is accurate for my physiology. I found that my number was closer to 30g and that when I stayed under it, my blood glucose spikes had very short duration but when I went significantly over it, blood glucose stayed higher for longer.

edit: One more thing, I used this time to play around with various sugar substitutes and see how they affected my blood glucose. Allulose came out as the winner (if money is no object) based on not having any noticeable off-taste or aftertaste and on measuring gram-for-gram the same as sugar (well sort of, it's only like 80% as sweet as sugar, so you get the same mechanical effects of sugar if you weigh it gram-for-gram and your baked goods or whatever come out not quite as sweet, which is perfect for me. Creaming butter with liquid stevia extract or something just plain doesn't work.

itpragmatik• 2 years ago

At least for me the readings that it shows are not accurate (when verified with old style finger pricking glucose monitoring machine). These CGMs are good for knowing the general variability of glucose level in your blood based on your diet exercise etc; I don’t trust the absolute numbers from CGM like Freestyle Libre - haven’t used any other one though yet.

reaperman5• 2 years ago

It would be interesting to see whether a group of 20-100 people could manually calibrate their readings by fitting their CGM readings to their fingerprick glucose readers. I wonder what the accuracy would be after a very basic personal curve fit.

I do this with a lot of consumer measurement devices. Both for thermometers and scales (food, human, and cheap 0.1mg scales). As well as thermostats, like the kitchen oven. I also do it for my multimeters. I validate my volumetric measuring cups/spoons by weighing water in them but I don’t correct them, just return if they’re way off.

It’s okay if the reading is off as long as I can correct it the same way every time and get a pretty accurate result.

pastage6• 2 years ago

This is highly personal thing it is apparently very inaccurate for some people, I've never been below or over dangerous levels without it giving a warning. What has happend once or twice over the decade I've used it is that it will get stuck in a bad reading, so you do not see the variations. It has always got unstuck when I've gone below 3.5 mmol/liter or so.

mlsu8• 2 years ago

It actually may actually be the other way around, at least for newer CGMs.

Try doing a few fingerpricks in a row. The variability will surprise you!

Engineering-MD• 2 years ago

There is generally a latency of a few minutes between blood and interstitial fluid (the CGM) readings- up to 15 minutes. You may find if you account for latency your consistency between the two increases

gumby2• 2 years ago

Apart from the latency of diffusion from bloodstream to interstitial fluid (and the lower levels in the interstitial fluid) the FDA requires that consumer devices be with 20% of the venipuncture level.

That means a lancet poke can be quite different from a meter like the freestyle, and both can be quite different from the level in your veins that a lab would get. So if your level is 200 one device can read 240 and the other 160 and both can be considered “correct”.

I found that the freestyle libre 2 and libre light are characteristically low while the FS 3 is characteristically high. So I use them for the shape of the curve, and that is useful.

jablongo3• 2 years ago

Another reason they are sometimes different is because there is a lag in the CGM data. It's estimated the lag is about 12 minutes.

turtlebits• 2 years ago

Same, but my doctor pointed me to a promotion for a free sensor. It did require a prescription, but since I don't have diabetes, it's not covered by insurance.

Trying to get it filled and picked up was slightly annoying as the pharmacy initially did not want to fill it without some prodding, and I waited a while for them to figure out how to get the promotion billed.

znpy3• 2 years ago

What's the lifetime of a single device? Are you supposed to remove it before a shower and reapply it later?

hlfshell• 2 years ago

No, it's mostly water proof. You wear it through showers and even swimming for 2 straight weeks. The adhesive is pretty good; rarely does it come off on its own prior to say, a week and a half in.

It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.

jseliger• 2 years ago

Before I got cancer, I had one through Levels, and it was informative. Dessert is much worse than I'd thought. Rice, too, including brown rice. I remember eating some biryani and a small bit of naan at an Indian restaurant and thinking that I'd been pretty healthy, only to see a spike of like 80.

meindnoch• 2 years ago

Momentary high blood sugar is perfectly fine after eating carbohydrate-rich meals.

colordrops• 2 years ago

Is 80 high? That seems totally fine.

illegalsmile• 2 years ago

Desserts can definitely send your levels quite high but I don't think I'd qualify some biryani and naan with a reading of 80 as unhealthy. You probably ate a healthy portion and left it at that. Is 80 not well within the normal range?

al_borland• 2 years ago

I saw an interview a while back between Tim Ferriss and someone who had tried CGM for fun/research. One thing he noticed was the huge impact a short walk after a meal brought down his blood sugar levels. Tim then mentioned he experienced the same thing and that there is a saying in China, something to the effect of, "take 100 steps after a meal, live 99 years." This also linked up with something I had looked up a few years ago when I noticed that I always saw families of Indian decent walking around neighborhoods, but never anyone else. I looked it up, and founds there is a word in Marathi of taking 100 steps after a meal. (https://en.wikipedia.org/wiki/Shatapawali)

It seems there has been this age old knowledge that taking a short walk after a meal is really good for you, which somehow got lost in some/many cultures. My parents would always say they had to sit after a meal to let their food digest... it never really made sense to me. My grandma, on the other hand, is 103 and gets pretty upset if people try to stop her from walking after a meal (or whenever she wants). We always just thought she liked walking, but maybe there is something else driving her, it seems to have worked out for her. It was very interesting to hear the CGM back up some of these practices that have likely been going on for hundreds or thousands of years.

I have been wanting to try one. This approval opens up the door. I think seeing something like this with my own eyes, with my own body, with actual numbers, would have a bunch bigger impact than some anecdotal stories from others and nice sayings which align.

It looks like there is some research being done in the area as well.

https://link.springer.com/article/10.1007/s40279-022-01649-4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8912639/

o_____________o2• 2 years ago

Eat fiber first. Add more protein. Eat reheated rice (resistant starches). Isn't it interesting how much these little details matter?

gregschlom• 2 years ago

so the tube stays in your arm and your skin under the monitor remains broken

That's not how it works, at least for the Freestyle Libre 3. The cross section of the needle has C shape rather than a O (technically I believe it's called a cannula). When you remove the applicator that C shape allows the needle to be removed through the hole at the top of the sensor, and only the flexible filament stays I your arm.

rnewme• 2 years ago

I belive he called the flexible filament "tube" and that you are both saying the same thing. Ie skin stays open (albeit in very tiny spot where the filament is sticked in)

barbazoo• 2 years ago

What symptoms would one have to present for an "online prescription mill"/"virtual care provider" to prescribe a CGM? I'm fascinated by this and would love to try it out but I don't want to bother my family doctor with this.

CaptainNegative• 2 years ago

The only symptoms needed are a pulse, the ability to type out a credit card number, and availability for a sham phone call. It's virtually impossible to not get prescribed one from a mill.

terhechte• 2 years ago

I bought a Sibionics GS1 recently and am about to use it (SIBIONICS GS1 Sensor Continuous... https://www.amazon.de/dp/B0CPDHKGYK?ref=ppx_pop_mob_ap_share). Reading this thread I’m wondering if it is a safe / good product to use. Does anybody happen to have knowledge?

dddiaz1• 2 years ago

Great to see it be OTC. But it's weird that it is advertised to last for 15 days, while the prescription version for T1ds/T2ds only lasts for 10 days. The hardware looks the same.

thecosas10• 2 years ago

Had the same thought! https://news.ycombinator.com/item?id=39621575

Also... does this mean they are direct-to-consumer as well as retail channels? https://news.ycombinator.com/item?id=39622192

anonfornoreason4• 2 years ago

I would recommend anyone to experiment with this. I did, and found out I was more glucose sensitive than I expected. This led me to get more broad labs done, with which I was able to find additional treatable issues that are likely the cause. If I hadn't done this, I would have found out via symptoms years later, after irreversible damage had already been done.

You are your only medical advocate, no one else is going to do it for you. The standard of care is shit, don't rely on it.

epistasis3• 2 years ago

Agreed, this is one of the better things I have done to take control of my own health!

It was very very surprising which foods, and quantities of foods, caused huge spikes.

However, this stuff is difficult to interpret. What should be the goal number for managing glucose spikes? What's good, what's bad? Ultimately there's a lot of judgement calls, just as there is with any health or fitness goal.

I learned a lot from Peter Attia's podcasts, but that required hours of listening.

My doctor offered to review my data with me, which was amazing. But many people's primary care docs may not have the experience or time.

anonfornoreason4• 2 years ago

+1 +1 +1 to Peter Attia, huge amounts of great content. My philosophy is that if there's any single topic where I should be spending five hours a month researching, it's personal health.

As far as spikes are concerned, I convinced my wife and my dad to both try out the same CGM. Neither of them really ever had any spikes of significance (maybe up to 130's), even when eating cake, etc. Obviously it varies from person to person, but the fact I would spike easily above 140 with boring foods (steel cut oats with no sweetener as an example) said to me something was wrong. My daily averages hovering around 100 to 105 were not in the pre-diabetes level but were close to it, even when eating minimal carbs and being extremely fit with a natural healthy diet. Also most of what you read out there with CGMs is related to people who actually have diabetes.

Finally, there's no one really to talk to about this stuff. You can eclipse your doctor's knowledge on the topic with about 5-10 hours of research. You can go get a broad set of labs and be right at the edge of the reference range on something (which is, depending on the lab, just a range of the general population, not a healthy range) and your doctor will shrug it off. The system is setup so that as long as you are in a sort of average, even with that average being pretty bad (half of the country is fat and pre-diabetic), the standard of care is to ignore it until you fall off the end. The line between hypochondria and being on top of your health is pretty thin, and most doctors will consider you a hypochondriac if you research and come ready to talk about the topic with any level of knowledge.

happytiger• 2 years ago

That’s some sage advice.

People are often surprised when I tell them about the insane levels of pre-diabetes in the US:

The National Center for Chronic Disease Prevention and Health Promotion notes that approximately 96 million U.S. adults aged 18 years and older (38% of the adult population) have prediabetes, and nearly 80% of them are unaware that they have it.

It’s honestly insane to continue a way of life that’s doing this to the majority of the population.

https://www.uspharmacist.com/article/prediabetes-trends-amon....

narrator• 2 years ago

The other insane thing is studies have shown that type 2 diabetes can be reversed by fasting. Fasting is problematic to the medical industry because it is zero cost.

"Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician."

https://clindiabetesendo.biomedcentral.com/articles/10.1186/...

Aaronstotle• 2 years ago

This is why it made me upset to see this Doctor on TikTok telling people unless you have Diabetes, you don't need a glucose monitor and making fun of people who had one.

Where is the harm in getting data on how your own body deals with glucose?

queuebert5• 2 years ago

False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.

rockooooo• 2 years ago

There are downsides to over-medicating, even if your personal budget for health is ~unlimited. Nobody wants to be a false positive.

Aurornis4• 2 years ago

Where is the harm in getting data on how your own body deals with glucose?

We have a relatively good indicator of long-term glucose levels: HbA1c blood testing. It's included in a lot of physicals now because it's relatively cheap. It's not 100% sensitive to every possible condition, but it's quite good as a screening mechanism for the general population.

CGMs will often give an "estimated HbA1c" value based on statistics from the collected data.

The challenge with CGMs is that it can he harder to know what's "normal" or not than you might think. There are a lot of stories of people becoming unnecessarily worried about occasional spikes or dips that are virtually inconsequential in the grand scheme of things.

akira25013• 2 years ago

Where is the harm in getting data on how your own body deals with glucose?

That's not what you're actually measuring though. You're just measuring instantaneous blood sugar levels.

You're hoping that your process for correlating this data with other events and trends in your life is accurate and useful. Unless you're planning on bringing a lot of documentation and other data recording to pair with this, it's not likely this single data point is going to beneficially change outcomes for you.

pastor_bob2• 2 years ago

What are 'treatable' causes other than food intake?

anonfornoreason4• 2 years ago

One example is an iron overload disorder. Excess iron accumulates in various organs including your pancreas, liver, and pituitary gland. Catch it early and you can avoid liver cirrhosis, busted pituitary function, poor pancreatic function, heart issues, dementia, etc. Wait too long and you are on the transplant list.

NotGMan• 2 years ago

I second, I wore it multiple times as a non-diabetic and it was very enlightening.

znpy3• 2 years ago

I'd really love to be able to do that (experimenting) but i'm in the EU and haven't looked at the possibilities yet (i'm not diabetic).

However i recently saw a video of a woman that carried a glucose monitor (even if she didn't need one) as part of a study (she volunteered) and was able to correlate her mood and her weight take/loss with sugar intake.

I'm very curious about this. I've started a diet recently and after quitting many sources of sugar completely I'm very surprised how long i can go without eating and how little calories per day i can consume (well, as long as i have fat to burn at least).

If anybody wants to chime in and suggest a glucose monitor that i can get without prescription in EU (Italy) and from which i can pull off data, please do.

dhoe2• 2 years ago

I'm in the Netherlands and just bought a Freestyle Libre 3 from https://www.dia-centrum.nl/. It didn't require a prescription and was easy to set up and you can get the data out of Freestyle's website, as a CSV download if I remember correctly.

I had a doctor comment that he'd never seen anybody wearing one just out of interest, and he was slightly condescending about it.

Aurornis4• 2 years ago

Read up on what's normal, though.

I tried a CGM twice. I triggered the hypoglycemia (blood sugar too low) alarm multiple times, but felt completely fine.

After some research I discovered it's actually not uncommon for healthy people to have occasional dips below the preset hypoglycemia threshold, but as long as you're not having symptoms then there's no cause for concern.

I also talked to a doctor who complained that she had multiple patients showing up with concerns about their glucose numbers for various reasons after trialing CGMs, but they had similar spurious and unimportant problems (brief excursions out of range, etc.).

So if you're going to experiment, at least familiarize yourself with what's truly problematic. It's easy to misinterpret the data if you don't know what it means.

dreewf• 2 years ago

Freestyle libre has a lot of hypoclyemia events due to pressure on the sensor. If you roll over at night, or lean on the sensor it reads way too low. It’s very annoying since you can’t disable the alarm, I have to turn off the Bluetooth at night. Similarly when you go into very cold water it will read lower incorrectly.

coldcode3• 2 years ago

I found out I was barely in the diabetic range a couple of months ago; hopefully, with diet changes and Metformin, I will see my A1C at a better number in a month or so. Otherwise, I would like to try a CGM to see what I am missing.

sdo726• 2 years ago

I think I would recommend the opposite unless you are diabetic or pre-diabetic. Using this may make people think eating high GI food causes diabetes.

epistasis3• 2 years ago

Prevention of diabetes or even of pre-diabetes is well worth the experiment. At least for folks in the US, where metabolic syndrome is hanging over the head of a huuuuuge percentage of the population.

Hiding information from people because they might misinterpret it is not a successful medical strategy, the better strategy is to educate, see if the information will be welcome, then provide the information in the context of what it means.

I wasn't technically pre-diabetic, but did have a few higher-than-expected resting glucose blood tests, and the CGM showed me that I'm actually really close to pre-diabetes.

That was the kick I needed to clean up my diet (specifically eat less), exercise 5-7 days of the week, and I'm feeling better than ever.

Anecdata, of course, but there is no single intervention that has been discovered to improve people's weight and metabolic problems in the US (except perhaps the new GLP-1 inhibitors). Adding a CGM, at least for people interested in it, can be very effective, and we should use all the tools we have to improve the population's health.

RecycledEle4• 2 years ago

I assume you mean you experimented with another CGM, since this one is not on the market yet.

simple10• 2 years ago

Experimenting with GCMs is by far the most useful and fun biohacks I've tried. I was part of the early beta for Levels Health.

Even if you don't suspect underlying health issues, the data provided for health optimization and gamification is worth it.

I used the GCM for 4 weeks and mostly tested how my body responds to various types of foods and meal timing. I also used an Oura ring to track sleep.

Main lessons learned: fat loading in the morning with a bulletproof (ghee) coffee didn't spike glucose and provided sustainable energy. Carbs for dinner helped with sleep but only if the meal was several hours before bed, allowing enough time for the double glucose spikes to return to baseline.

And Japanese sweet potatoes massively spike my glucose unless they're slightly undercooked. Cooking methods significantly changed how my body responded to the food.

mikenew3• 2 years ago

Can you share a little about the "additional labs" you did?

I wore a CGM for about a month. Also found that my glucose numbers were not nearly as good as I would have expected, especially considering that I'm quite active and not overweight. But it's the "what next" that I'm stuck on.

smallerfish• 2 years ago

Check out Peter Attila's book. He has a couple chapters on metabolic syndrome that should be helpful.

anonfornoreason4• 2 years ago

https://www.ultalabtests.com/

https://www.ultalabtests.com/test/advanced-cardiovascular-he... https://www.ultalabtests.com/test/hormone-health-men-compreh...

Front page has 20% off coupon. This should get you a pretty wide view. You can add on extras, but this should get you most of what you want to understand. But, this level of lab work is going to require 20+ hours of research to understand, and even more if you pop funny values and want to figure out why. Have fun....

FigurativeVoid• 2 years ago

I'm a T1 diabetic, and CGMs are a great tool for blood sugar management. Combined with a closed loop system, they are literally life changing.

I am glad to see an increase in access to live changing medical care for a disease that is mostly just bad luck.

thecosas10• 2 years ago

T1D here too. Fun to see others having an interest in CGMs :-)

chx• 2 years ago

I got the dexcom g6 three years ago via a simple online order in Canada. Is Canada more lax? What's the difference?

coldcode3• 2 years ago

In the U.S., until this one, you needed a prescription to buy one. Many countries allow them to be purchased without.

moralestapia• 2 years ago

Great news. Reading through their website and just found out they're disposable(!).

Anyone knows if there's a reason for this? I don't want to think is just a money grab. Perhaps the patch wears off?

coldcode3• 2 years ago

All CGMs only work for a period of time, like a couple of weeks or so. Then you get a new one. To keep the size reasonable it can't be too big.

mapkkk2• 2 years ago

The patch does wear off but the main reason is because there's a finite amount of enzyme (glucose oxidase) on the filament that does the actual glucose measurement on the sensor. So over time the enzyme is "spent". That, and of course it's lucrative. There are clever ways people have come up with (particularly from low income regions) where you can trick these sensors or the apps to reset and apparently you can get way longer lifespans like that (for the dexcom you also have to file down the bluetooth transceiver so that you can get at the battery within) at the risk of no longer being able to trust the readings.

There's one company that's experimenting with an implantable CGM that will supposedly have a 6 month lifespan, with a bluetooth powered patch that you apply on the skin overlying the implant.

EMCymatics• 2 years ago

It can help your health but I'm concerned how often the data will get abused.

galago2• 2 years ago

I'm currently wearing the Freestyle Libre 3. It communicates with the app every minute. I have something between pre-diabetes and diabetes so I have a slight chance at being able to treat my condition with diet/weight/exercise. Its definitely changing my behavior--I'm aware that it is not as accurate as the stick test but I have a plot of my blood sugar throughout the day. Currently I'm consuming very little carbohydrates. I've learned from my own data what foods will cause my blood sugar to spike.

The app is missing some obvious features, and people are right to complain, but its way better it seems than devices that came before.

NelsonMinar• 2 years ago

So glad to see medical monitoring made available to people. Different problem but an O2Ring continuous blood oxygen monitor was a big help to me in understanding my sleep apnea and getting it treated.

sdo726• 2 years ago

I don't know why modern days we get so many problems wrong.

A -> B, then B -> A => incorrect

In a fire, we see firefighters, that doesn't mean firefighters cause fire. In diabetic patients, we see high glucose level. That doesn't mean eating high GI food causes someone to have diabetes.

If we look at the Blue Zone, many people eat mostly carb. So carb/high GI food definitely doesn't cause diabetes.

Devices like this will make other people fearful of high glucose and think they're getting diabetes. People without the disease shouldn't focus on monitoring the glucose level, focus on eating healthy instead. And of course eating healthy is another complex topic.

migro232• 2 years ago

In a fire, we see firefighters, that doesn't mean firefighters cause fire. In diabetic patients, we see high glucose level. That doesn't mean eating high GI food causes someone to have diabetes.

This is correct but probably not in the way you think. It is not the glucose in and of itself that is the problem but the level of the hormone insulin circulating around your system that is at the root of Type II diabetes. Glucose and insulin are highly related. Insulin is released by the pancreas to help control the level glucose in our blood.

Virtually no insulin is required when metabolising fats, a small amount is required for protein and a larger amount of insulin is required when dealing with glucose dense carbohydrate based foods. The faster a carbohydrate is metabolised the greater the dose of insulin required to quell the resulting glucose rush in the blood.

What does the insulin do? As a hormone it has many functions. The presence of insulin in the blood signals to all cells to burn sugar (glucose) rather than fats (ketones) for their energy. It prompts the cells in the skeletal muscles to store up glucose in the form of glycogen for later use and it signals the liver to store excess glucose that is not immediately needed. Once the liver and muscles are full then the liver then converts any excess to triglycerides.

Where do the triglycerides go? They get stored as subcutaneous fat all over but largely in the belly (in men) and bum/upper legs (in women). What happens when subcutaneous stores are full? Then the triglycerides are shoved anywhere and everywhere. Fat is pushed into muscle cells as well as the cells in individual organs. The fat molecules present in cells in organs are particularly pernicious (visceral fat) but any cells that contain these triglycerides seems to disrupt the insulin signalling within the cell. This results in insulin resistance i.e., the ineffectiveness of insulin to signal to the cell to take up excess glucose.

When sufficient threshold of insulin resistance is reached, you will get higher blood sugar readings and a higher A1C at which point your doc will say you have prediabetes or full on type II diabetes.

Insulin is the master key variable that unlocks the type II diabetes puzzle. High blood sugar levels are just a symptom. The problem with modern day Type II diabetic care is they consider the high blood sugar as the root problem. So this is treated with meds such as metformin and eventually MORE insulin. Understanding type II diabetes as a disease of too much insulin sheds the disease in a very different light.

Anyway, you are correct, the high glucose level per se is not the cause, but high levels of insulin constantly circulating around your system is the big problem. Of course an effective way of doing that is to continuously eat foods dense in glucose and fructose that are metabolised very quickly e.g., cookies, ice-cream, orange juice etc.

If we look at the Blue Zone, many people eat mostly carb. So carb/high GI food definitely doesn't cause diabetes

Blue Zone areas such as Okinawa, you do find people eating carb rich foods but they are also high in fibre e.g., root vegetables, sweet potatoes etc. look at books by Robert Lustig to learn more about the importance of fibre in relation to metabolism and diabetes risk.

sdo726• 2 years ago

Thank you for the detail :). And yes, I do believe lacking of fibre is one of the key important factors causing many kinds of diseases, and the modern diet is totally missing lots of fibre.

ravenstine3• 2 years ago

Glycemic index is only sort of useful for people who actually have diabetes, where blood sugar dysregulation makes insulin regulation equally as precarious. For anyone who doesn't have diabetes, GI doesn't really mean anything other than that their insulin may or may not spike in a short period of time related to a food. Glucose spiking, hence insulin spiking, is not something you want, but this also doesn't mean that something with a lower GI score is better for you and doesn't cause you to release as much insulin. Whether it's table sugar or whole grain pasta, they'll become glucose that the body will use or store in one way or another. Fasting glucose will still remain higher.

Devices like this will make other people fearful of high glucose and think they're getting diabetes.

Elevated glucose is exactly what causes type 2 diabetes. Take away the glucose supply, and you don't have elevated insulin. Fear of glucose that is too high too often is entirely justified and is not something that should be going on if people can avoid it. Sugar molecules are damaging to cells and are related to other things like cardiovascular calcification.

If we look at the Blue Zone, many people eat mostly carb.

So-called "Blue Zones" are not science. They are anecdotal, cherry-picked, uncontrolled, and can't be tested. Also, some of those zones, such as Okinawa, are mythical. Okinawans historically have eaten a lot of pork, and still eat a ton of pork. They also used to not keep much in the term of birth records, so there was really no way to know how old any of those people were back when they were studied.

So carb/high GI food definitely doesn't cause diabetes.

Propose a model of type 2 diabetes that doesn't involve dysregulation of blood glucose and come back to us.

4624363473• 2 years ago

Elevated glucose is exactly what causes type 2 diabetes. Take away the glucose supply, and you don't have elevated insulin. Fear of glucose that is too high too often is entirely justified and is not something that should be going on if people can avoid it. Sugar molecules are damaging to cells and are related to other things like cardiovascular calcification.

No, it doesn't: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602127/

sdo726• 2 years ago

Every response you have don't relate to my comment! and I believe you have incorrect info in your responses as well.

4624363473• 2 years ago

If we look at the Blue Zone, many people eat mostly carb. So carb/high GI food definitely doesn't cause diabetes.

While obesity is known to be the greatest risk factor for T2DM, you can induce insulin resistance in weight-stable individuals just by shifting the macro composition of their diet towards saturated fat:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291812/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171936/

Sugar, amusingly, doesn't seem to have the same effect.

Given that the typical recreational CGM wearer (in my experience) is a low-carb/keto type (who ruined their insulin sensitivity), you should probably take the comments in this thread touting CGM use with a grain of salt.

hnburnsy• 2 years ago

Hope this integrates with Garmin...

https://www.garmin.com/en-US/blog/health/how-garmin-and-dexc...

fgkramer• 2 years ago

I’m currently wearing a CGM from Lingo (https://www.hellolingo.com/) which is pretty much the easiest way I’ve found to get my hands on one without a prescription (as I’m not diabetic).

So far it’s shown me that the sluggishness after a carb-heavy meal its heavily correlated with the glucose spike and how good my organism copes with it.

Can’t wait for the day we have our own Fallout style Pip-Boys!

autoexec2• 2 years ago

It'd be pretty interesting to see that kind of data, but it looks like this product violates my policy on not buying hardware that requires a cell phone app to use, and my policy on keeping as much of my medical information as far away from my mobile device as possible. I'm not sure exactly who the app itself sells/leaks the data being collected to, but even having that kind of data on the device would make me uncomfortable.

A quick read of their privacy policy suggests that the mobile app is full of personalized ads and they use your data for "direct marketing" as well as "research". They offer your data to third parties for both "marketing" and "analytics" reasons. They'll send your data overseas whenever it suits them, even to places where your data will not have the same protections, and they'll keep the data they collect forever unless you submit a request for them to delete it and they are actually required to do so by law.

Since I'm only mildly curious to see what the numbers would look like, I'm fine with waiting until someone puts one on the market that saves its data to storage that can later be copied over to an offline PC.

spc4762• 2 years ago

My girlfriend as the Libre 3, and she has both the cell phone app, and a stand alone unit to store results. You can only use one or the other, not both at the same time (the Libre 3 uses Bluetooth). We have the stand alone unit because of insurance reasons.

xen2xen12• 2 years ago

Dexcoms also have small cell phone like devices you can use. I've never put a wifi password in I can recall.

mlsu8• 2 years ago

They sell the data to nobody. It's considered PHI so covered by HIPAA. Dexcom has to trace custody of the data from the sensor to app to wherever it goes, so it is encrypted the whole way.

Nobody has access unless the patient wants them to.

autoexec2• 2 years ago

Their own privacy policy says they share data for marketing purposes. I don't think they'd do that without any compensation and their app includes personalized ads.

HIPAA only covers "protected health information" and not all of the data collected by their products.

They also state: "You can ask us not to use or share certain protected health information for treatment, payment, or our operations. We are not required to agree to your request"

Once a year you can also request that they send you a report on who they shared your data with and why without paying them for it, but it will not include anything involving "treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make)."

see https://www.dexcom.com/notice-of-privacy-practices

bsilvereagle• 2 years ago

For the Freestyle Libre 3, you can use it without an account. That does not mean that Abbott is not still sending your readings to the cloud, but at least your name is not attached to it.

It takes some work, but you can "liberate" your data from the app without the cloud account: https://frdmtoplay.com/freeing-glucose-data-from-the-freesty...

darreninthenet• 2 years ago

My wife already buys a Libre Freestyle over the counter here in the UK... are we talking the same thing? Why are (or were) they prescription only in the US..?

alexnewman• 2 years ago

CGM is cool but it interferes with my ability to swim in the ocean on the reg

dansitu• 2 years ago

If you find this field interesting, Know Labs is working on a non-invasive continuous glucose monitor using RF spectroscopy:

https://www.knowlabs.co

huytersd2• 2 years ago

Non invasive would be a golden goose. I don’t think I want to have something sticking into my skin for weeks on end.

teleforce• 2 years ago

This is a promising non invasive glucose sensor namely GlucoRx Wearable BioXensor using microwave technique [1]. For the technical background how the sensor work and the clinical trials results please check this paper (paper also available from their university website) [2].

[1] Meet the inventor: Professor Adrian Porch from Cardiff University:

https://www.med-technews.com/medtech-insights/latest-medtech...

[2] Microwave Noninvasive Blood Glucose Monitoring Sensor: Human Clinical Trial Results:

https://ieeexplore.ieee.org/document/8058721

thecosas10• 2 years ago

T1D here who has been using Dexcom G6 for many years now. Interesting to see the differences between Stelo and G7 which are built on the same platform.

Curious if anything is driving the increase in wear time other than battery life savings from reporting back fewer readings.

  CGM:                   G7 / Stelo
  Wear time:             10 / 15 days
  Time between readings:  5 / 15 minutes

user_78327• 2 years ago

I seem to remember there was a "trick" with the g6 where you remove and reinsert the transmitter to get it to last longer... I suspect the time estimates are quite conservative.

thecosas10• 2 years ago

Yep, I've definitely used my G6 for two sessions using "tricks". It would definitely get wonky towards the end of that time period, but it worked.

jonlucc• 2 years ago

I'm not sure how much I can say; I don't work for a CGM company, but my company is very interested in diabetes. There are non-device reasons you can't use a CGM indefinitely. The site becomes less reliable over time, and it varies from peron to person. I'm not sure if the Stelo has addressed any of those, or if the G7 was overly cautious, or something else, but there are biological things happening at the site that affect the time too.

thecosas10• 2 years ago

Ah, that makes sense. I'm certain we'll never "know" but just found it interesting and was curious if people knew other trade-offs they may have been making for increased wear time, especially given that would offer a sharp reduction in cost over time for patients (and their insurance companies, etc).

A 50% increase in wear time is HUGE in my opinion.

mangoman• 2 years ago

I recently had an unusual health event that resulted in me passing out. My wife, who is a physician, thought it might be hypoglycemia, since i'm at high risk for diabetes. She found a super friendly endocrinologist who put me on a CGM for two weeks. I never hit the hypoglycemia range during those two weeks, so it didn't really explain what my issue... but honestly the data was SUPER interesting. Just observing the various spikes made me make healthier choices, or noticing when I was feeling extra tired and seeing if that correlated to not having eaten for little while, or eating something sugary before.

It's sort of like tracking your steps when you first get a smart watch. It may not have been the reason you got the device, but seeing the data, people are encouraged to act on it, even if you don't have an acute issue. since I didn't have a prescription, I couldn't get one here (didn't want to go through some sketch online site). I tried to get one from my family in India, but the prices were really high and they couldn't get the fancier one that tracks straight to your phone, so I didn't get one.

I think this could be a god send for preventing pre-diabetic people who would take preventative steps if it weren't such a pain in the ass to measure consistently.

lr4444lr• 2 years ago

What kinds of food intake/non-intake habits aside from the obvious culprits surprised you?

rodly• 2 years ago

Long-term they will likely make no changes because human desire, habits and behaviors are rarely unknown to us.

The parent comment mentioned feeling tired after consuming something with a lot of sugar, was that really a mystery prior to using CGM? I doubt it.

Sure it's interesting to correlate to your perceived wellness (or lack thereof) with a wearable spitting out data but after the novelty of this discovery wears off my guess is that people will simply stop caring to check what they already know to be the case.

temp_praneshp2• 2 years ago

The ones on diabetic warehouse don't work well enough (https://www.diabeticwarehouse.org/collections/continuous-glu...? Or is that site sketch for you? I think you can just get one if you are willing to burn $500 (not cheap, but only in the price range of a higher-end smartwatch)

vlabakje90• 2 years ago

Keep in mind that a single sensor will work for only a week or two, depending on the type. So it's not exactly right to compare the price to a smartwatch.

cheriot• 2 years ago

Thanks for confirming. Normal feedback on health habits is delayed by months/years and hard to trace back to specific actions so your story makes a lot of sense.

I might have to get over my dislike of needles :|

mikenew3• 2 years ago

It's more akin to a finger prick than a needle. Might still be a bit psychologically challenging but I've done it and it's really not bad at all.

jxramos2• 2 years ago

definitely, catching the "quantified self" bug is a real thing!

dkarras• 2 years ago

how is having low blood sugar a sign of pre-diabetes? I get frequent bouts of hypoglycemia.

murukesh_s• 2 years ago

At some point a person's body may become resistant to insulin and start to need more insulin to have normal functioning (pre-diabetes), sometimes this causes large variation in glucose levels, though not as drastic as taking a medication. Eventually your body would adapt to it when you reach the diabetes phase.

keymasta• 2 years ago

It could be related but I also want to weigh in here and say this. Hypoglycemia can occur with no relation to the other side of diabetic symptoms, i.e, hyperglycemia. In other words there are people who suffer from hypoglycemia without ever getting high blood sugar, and so they are not "diabetic" which would mean you can have issues from both directions.

bakedoatmeal2• 2 years ago

What is the connection between being at risk of diabetes and hypoglycemia? Wouldn’t a pre-diabetic be very protected from hypoglycemia?

ijustlovemath2• 2 years ago

No, diabetes is fundamentally a lack of ability to control your blood sugar. This means you get lots of highs but also lots of lows. It's a common misconception that diabetes just means your blood sugar is always high; rather, your sugar is high because your body no longer controls it actively.

veryfancy• 2 years ago

Wondered this too. Diabetics are at risk for hypoglycemia because of the insulin they take, not the diabetes itself. Maybe metformin for a prediabetic could have this effect?

code_duck• 2 years ago

There is something called reactive hypoglycemia.

https://en.wikipedia.org/wiki/Reactive_hypoglycemia

It can occur for various reasons. Personally, I was developing adult onset type 1 (LADA) for a couple of years before I was diagnosed and I had all sorts of effects. While it was of course mainly effects of chronic hyperglycemia and shortage of insulin, I also had some episodes of hypoglycemia. Now that I’m on insulin, I’m very familiar with hypoglycemia resulting from an imbalance of exogenous insulin and carbohydrates. However, I looked back and realized this happened to me a few times before I was on insulin. I recall waking up a few times at night, sweating and shaking, and having a strong urge to consume food. I’d drink some juice or eat chips, feel better in 20-30 minutes and go back to sleep. This occurred after drinking alcohol, which makes sense as alcohol intensifies the effect of insulin and also prevents your body from releasing chemicals which raise your blood glucose level. I didn’t think much about it at the time but now I can see it was related to T1 onset.

My understanding is that essentially the body’s systems which regulate blood glucose are disrupted. This happens a with type 1 in general - not only problems with the system that produces and releases insulin to lower blood glucose by allowing it into cells, but also the part that does the opposite and release glucose to raise blood glucose levels. Sometimes the glucose-raising system doesn’t work at all while other times it’s inappropriately in overdrive. The same is true for the insulin releasing/glucose lowering system as it fails.

necovek2• 2 years ago

I personally wouldn't mind having the data if a need comes up, but this is simply overtracking for no particular purpose.

Basically, our bodies go through much "turmoil" over the course of any day, and watching over one too many parameters is like getting hooked to TV or a video game.

Generally, medical science can mostly tell you what averages or most common patterns are, so if you do not line up with them and don't understand this, you can get overstressed.

So unless you are really someone who can objectively consider your readings combined with effects you might be seeing, I'd say don't do it.

necovek2• 2 years ago

And reading further, there is evidence of people getting worked up about what are not problematic readings in this very thread.

TylerE11• 2 years ago

More importantly for life style monitoring A1C is the more important number anyway, and doesn’t require wearing anything, just a simple blood test. It’s basically a 3 month moving average.

whatshisface• 2 years ago

Getting hooked on smooth blood sugar changes sounds like a possible counterweight to what our brains are designed to get hooked on... Oreos.

cleandreams2• 2 years ago

I am prediabetic and I have one. It's partly covered by insurance. By the metrics my estimated average glucose has gone down from 129 to 98 or so (normal). I haven't had my HbA1c in awhile.

I think they are amazing. It's been SO HELPFUL. However I don't think it makes sense for normal people. I am on a reddit group for prediabetes and it's not unusual that people who are underweight (anorexic?) and have completely normal metrics come in and post in an utterly freaked out state. These are people who are somewhat compulsive and anxious. I think that if you are normal for blood glucose having access to all this data can make you compulsive and anxious.

However, for me as a prediabetic, it is really useful. It tells you what’s going on with your blood sugar in real time with no ideology. In the beginning I was spiking from things that a nutritionist would say was OK. I found whole grains didn’t work for me. I was shocked at how much I spiked from oatmeal. What causes blood glucose spikes does not map directly to number of carbs and also every body is different.

After 6 mo of lowered carbs, weight training, and getting down to normal BMI, I can now eat SMALL portions of things like brown rice. My health has improved. It's great. IMHO all prediabetics and diabetics should have one, covered by insurance. It would really improve health and reduce complications.

TylerE11• 2 years ago

What’s also surprising is what doesn’t. I’ve found for instance, that potatoes, even French fries, don’t do a whole lot to mine.

michaelcampbell3• 2 years ago

I was shocked at how much I spiked from oatmeal.

Was it oatmeal, or what you ate oatmeal with (milk, sweetener, etc), or do you know?

lawlessone• 2 years ago

However I don't think it makes sense for normal people.

I agree , but if it's anything like gluten free foods, having more people buying that don't need to, might push prices down for you.

aledalgrande2• 2 years ago

I actually just got one of these CGMs after listening to Peter Attia's (audio)book Outlive and started monitoring my glucose and experimenting with meals and exercise to see what effects they have. Apart from the weirdness of having something attached to your skin, it's like having another watch and you won't notice after a while. It's pretty cool and a lot more people than just diabetics would benefit from this knowledge.

Like I just learned for example about resistant starches, of which one is cooled potatoes: I ate the exact same dish but the first time, right after cooking, my levels shot up (not abnormally but you should ideally never have spikes, so your body doesn't have to keep pumping insulin), and then the second time, reheated, it was like I didn't eat anything. I was surprised so I researched and found https://www.webmd.com/diet/what-to-know-resistant-starches

Everyone is different so I definitely suggest to try them out for a month and see what gives you spikes in your diet. Then try to get rid of those spikes.

technological• 2 years ago

can you post link to the device which you brought

droopyEyelids• 2 years ago

You got me real curious about why this is.

I know there are waxy and starchy potatoes that have higher rations of amylopectin vs amylose starch respectively.

One interesting thing is that if you continuously mix an amylopectin potato, it turns into a gooey, ropey substance that we don't use much in western cooking but is how some Chinese mashed potatoes are supposed to be prepared. I wonder if that transformation affects the resistance of the starch.

I also wonder what exactly is making the cooled potato tougher to digest.

melagonster3• 2 years ago

Excuse me, this is stupid question. but can't you buy Freestyle Libre?

TylerE11• 2 years ago

Yes, but need a prescription.

seesaw• 2 years ago

Were you able to find out what may have caused you to pass out ? I had a similar incident with no root cause. But that did set me on the path to become more healthy.

oldgradstudent• 2 years ago

My wife, who is a physician, thought it might be hypoglycemia, since i'm at high risk for diabetes.

Isn't hypoglycemia a side effect of insulin and other glucose lowing agent rather than of the diabetes itself?

zxienin• 2 years ago

I use Abbott Freestyle Libre 3 and it has been deeply insightful about my progress with T2D. An increase in fasting glucose over 2-3 days tells me I need course correction (more movement, choice of food). I also noticed consistent correlation between bad sleep days and raised glucose levels over the day. Made me internalize how important sleep is.

I believe, next major uptick will come from CGM in wearables like Apple/Samsung watches [1][2]. I hope, even non diabetic folks use it to improve their health.

[1] https://www.macrumors.com/2023/09/14/apple-watch-blood-gluco... [2] https://www.macrumors.com/2024/01/23/samsung-racing-to-beat-...

thecosas10• 2 years ago

Just noticed this line in the press release from Dexcom [1]:

  Stelo will be available for purchase **online** without a prescription starting summer 2024.

I wonder if that means that this will be direct-to-consumer in addition to retail channels (CVS, RiteAid, Amazon, etc).

[1] https://investors.dexcom.com/news/news-details/2024/Stelo-by...

lhl• 2 years ago

I’d highly recommend anyone considering trying one out to give it a pin. I’ve used a CGM multiple times besides being a great feedback mechanism, it also can give you really interesting insights. Here’s one interesting tidbit showing that having an ice cream cone in between an hour-long walk actually caused no postprandial glucose spike compared to an earlier “healthy” meal served with no activity (at a metabolic health conference) https://fediverse.randomfoo.net/notice/Aafczv5LO83OOwXrbU

daveisfera• 2 years ago

I haven't seen price info anywhere, but anyone have info on what that will be?

metabagel2• 2 years ago

I put something like this on my cat, because the vet thought she may be pre-diabetic, but stress response can also cause blood sugar to spike, so we needed to see what her blood sugar was like multiple times per day.

The device worked for 5 days until she had managed to dislodge it enough so it wouldn't get a reading. The skin glue lasted another 5 days before the device fell off. Since then, she has had a "crop circle" behind her shoulder where her fur was shaved away, and which is ever so slowly filling in.

Her readings were fine, so we are feeding her low carbohydrate food, because the vet thinks she may become diabetic in the future.

Unfortunately, I had to place the reader device almost directly on the sensor, which was a pain, because my cat likes to hide under the bed. So, I had to squirt her with water to get her out, which was undesirable, but didn't seem to affect the readings.

The device was the Freestyle Libre 2.

https://www.freestyle.abbott/us-en/products/freestyle-libre-...

mzs• 2 years ago

I wonder what the price will be: https://www.dexcom.com/en-us/stelo

apatheticonion• 2 years ago

I currently sticky-tape my Fitbit Inspire 3 to my tricep to get continuous low effort health/sleep tracking.

I used sticky tape as an experiment because there are no arm bands for Fitbit products. That was a year and a half ago and have worn it like that every day since.

I can't wait until trackers can be implanted under the skin, track blood glucose, and improved accuracy.

Let's gooooo

UI_at_80x242• 2 years ago

It's worth mentioning that in Canada, you do not require a prescription to get a CGM. However only the Abbot Freestyle Libre series is available here. It cost ~$100 and last 2 weeks.

I've found it to be mostly accurate.

Placing it on the back of the arm was always a problem for me, it was constantly getting knocked/pulled, and otherwise disturbed. I had to buy adhesive patches that covered the entire unit. I later discovered that another decent place to apply them in on my chest between my collar-bone and shoulder-joint but lower (towards the nipple). I always had decent reliability/accuracy there. It also hurt less (from the adhesive) then on the back of the arm.

Having a CGM is amazing, and if you have medical coverage that will pay for it then you should get it.

elevaet• 2 years ago

Can you give the elevator pitch on why someone should get one?

UI_at_80x242• 2 years ago

With a CGM you always can know what your instantaneous, average and trending blood glucose readings are. With a test-strip you know your instantaneous reading are. With a test strip, a pad of paper, a calculator, a calendar, a watch, and a good enough memory to take reading 100+ times a day you can get the same results.

With the test strips, I measured myself AT MOST, 7 times a day. Often just once or twice.

THAT is what makes them worthwhile. It keeps measuring so you don't have to.

One helpful thing that I don't worry about: Low blood sugar alarms. Hypoglycemia is a real concern, and just as serious as hyperglycemia. A CGM will alter you when your sugar gets too high OR too low.

I'm poor. I can't afford a CGM anymore. So I have been going months now without measuring. Because I keep forgetting. A CGM doesn't have that limitation.

I was really hoping that Apple was going to announce a CGM. I avoid the Apple ecosystem, but I would have invested in that.

cooldevguy• 2 years ago

I am diabetic type 2 and I've used the Abbot Freestyle Libre 2 for a few years now. You don't need a prescription in Mexico to get it, but it is expensive ($1548 MXN ~= $91 USD). The data you get is pretty interesting but at least on my experience, the difference between readings from the CGM and actual blood test can vary from 10 ~ 40 mg/dL so you have to have that in mind. However it was really helpful to discover that, while I'm pretty active since a few years ago it was troubling for me to wake up on readings over 140 mg/dL which thanks to this turned out to be just that my body does it naturally and my blood sugar spikes while asleep and an hour or so before I wake up, which my endocrinologist just attributes to my body getting ready to work out.

Even as an experiment, I'd say most people should get one just to understand their bodies, and their specific responses to certain foods, once in a while.

NoPicklez2• 2 years ago

These are so interesting and not just for diabetics who benefit from them the most.

Top athletes have been using them for exercise to make sure their blood sugar remains in the correct ranges.

But Diabetics are using them to help identify how particular foods impact their blood sugar levels (obviously). The reason being is that whilst some foods might be considered high/low in sugar, each of us reacts differently in how we absorb those foods or drinks. So a bagel you eat might not spike your blood sugar like someone else, or conversely it does. You can then correlate that spike or reduction in blood glucose with how you're feeling throughout the day, how your blood sugar levels impact exercise.

Also it allows you to see how combinations of foods and the order that you eat them in impacts blood sugar. If you eat a chunk of white rice without any fibre you might find it spikes, if you each a bunch of vegetables in the bowl before hand you might find it doesn't rise as high or give you a steadier release of blood sugar.

I'd use one for a few months just to see how foods impact my blood sugar and how I can make different choices. It's one thing to interpret a label, but it's another to see it's impact on your body in real time.

briandw2• 2 years ago

I did this for fun using the veri.co service. It was interesting how little my diet immediately affected my blood sugar. Non diet things were much bigger. Do hard exercise -> spike. Take a hot shower -> spike. Fast for 48 hours -> blood sugar still rises in the morning.

Walking was by far the most effective way to keep blood sugar down after a meal.

Most of what I ate didn't cause a problem. However tend avoid sugar and carbs. The worst offender was a PB&J sandwich. That was surprising.

int_19h5• 2 years ago

Both peanut butter and jelly have lots of sugar in them. Modern supermarket bread (in US) usually does, as well, and the carbs in it also turn into sugar quite readily right in your mouth.

eep_social• 2 years ago

hot shower -> spike

Assuming this was a Libre, this is likely reader inaccuracy that does not reflect an actual blood glucose event.

briandw2• 2 years ago

That makes sense and I was wondering if it might be related to the device temp. I should have tried putting a hot pack on the sensor to validate.

jesprenj• 2 years ago

For having participated in a study, they installed an Abott FreeStyle Libre 2 sensor on me for 14 days. I could get minute readings, which is not possible with either the hardware reader nor the official app, using the almost entirely FOSS android app Juggluco.

Another FOSS web tool is Nightscout -- it generates reports and live graphs from data gathered from your CGM via for example Juggluco. My instance is at http://sladkor.4a.si. My sensor expired, so there's no more live data.

glucometerutils is an interesting repo for downloading stored data from hardware readers etc. Abott encrypted the Libre 2 USB communication to force users to use their proprietary software, but hackers managed to extract keys.

http://juggluco.nl http://nightscout.github.io https://github.com/glucometers-tech/glucometerutils http://ni.4a.si./anonymous/freestyle-keys/tree/freestyle_key...

99112000• 2 years ago

I got some FreeStyle Abotts for anyone who wants to hack away at them. Rumor has it Dexcom is cheaper in bulk than Abotts and they are losing hospitals as customers.

davidthewatson• 2 years ago

I'm happy for those who have been helped by these devices.

The FDA approval is only a revelation to the extent that the hidden truth of the extant prescription CGM market is poor data veracity combined with high catastrophic failure of the devices under manufacturer warranty in some patients.

It's difficult to know for sure the size of the patient cohort impacted here since these numbers are not made public. If the market functioned transparently, this knowledge would be of great benefit to consumers.

Given the proprietary nature of these organizations, and the fact that they spend lots of money on lobbyists and lawyers to maintain the status quo, I'm not expecting this to get better, at least in the United States. This leaves the hope that the EU or elsewhere may be more aggressive in regulation, as they have demonstrated recently around Apple and Google.

LSS: there's a ton of room for competition, cooperation, and innovation in CGM's and their slowly evolving ecosystem of software, smart phones, and smart watches, particularly in open source where hacks frequently work around the proprietary limitations in software, i.e. information devices that have little to do with telling time save for putting a date/time stamp on their event stream which is nowhere near the 5 V's of big data in volume, velocity, or veracity.

The two leaders in the space, Dexcom and Abbott both fail at a high rate with some individuals, such as me. Turns out that at the edges, adipose tissue and its interstitial fluid are a poor proxy to plasma blood glucose in some individuals. This is likely due to fluctuations in the composition of that tissue during times of fasting: exercise and sleep.

Sadly, the price of admission for my family has been high given that no one has slept normally for five years with the screeching alarms nightly at 3 AM, which are not adequately configurable. The design failure here is clearly driven by liability.

It's worth considering that the brain's default mode network (DMN) is impacted by glycemia. This has been demonstrated via an fMRI lab at Harvard via Nicolas Bolo, et al using a small cohort of diabetics.

The leap from there to what families of diabetics have known intuitively for decades may be phenomenological, but it isn't difficult.

Put simply: diabetic mood swings may not give rise to psychosis, but the mood dynamics of glycemia have been clear for almost as long: a spectrum from hypomania or nightmares induced by hypoglycemia to hyper compulsivity or depression induced by hyperglycemia.

I'm not certain that a researcher or clinician like Bolo exists to put data behind these glycemic mood associations, but speculatively, the relationship is clear to me from a subjective metacognition perspective, as someone who's been T1D for ~50 years and also has an HbA1c below the diagnostic threshold for T1D and routinely stays functional with accurate plasma BG < 50 and shows no signs of cognitive impairment accruing to these brain states after various neurology studies.

It's worth noting that hypoglycemia itself is a dynamic range, not a constant, and is frequently lower for people who have eaten or trained on the ketogenic spectrum, i.e. ultra marathon runners like Zach Bitter.

My experience has been that the feelings associated with hypoglycemia can be paradoxically awful at BG=80 and no problem at BG=40. If you've never eaten a half gallon of ice cream yourself with no signs of obesity, then you may not understand the zen state it takes to overcome this "beyond hunger" that's immediately familiar to any experienced diabetic on earth, while recognizing that that problem does not occur naturally with the disease. It's the result of insulin overdose, carbohydrate under-supply, or both.

FWIW, Microdosing carbohydrate may be key.

I believe the first use of the term in science was actually in glucagon, IIRC, i.e. the need for yet another syringe of glucagon in emergent insulin pumps that would go beyond the current crop of devices that are near autonomy, but may inadvertently overdose or underdose the patient due to the poor veracity of CGM sensors across the board and the hybrid closed loop devices which dose based on CGM which may be demonstrably inaccurate on occasion to the tune of several hundred points off high and low.

I have n-of-1 empirical evidence of this given the fact that I wore several insulin pumps for twenty five years and used multiple CGMs over that time, some concurrently. All were what we call, "shipping the prototype". Fortunately, beyond Therac 25, that was not an option in other medical device markets; certainly not those under FDA oversight.

henrikberggren• 2 years ago

I've been wearing one for 6 years straight and wrote a post back in 2018 when I first got one. As someone who lives with Type 1 diabetes its been one of the absolute biggest game changers for my health

https://blog.steady.health/the-wearable-that-changed-my-life...

I also started a company focused on CGMs which was too early and didn't work. Maybe its time to try again? :)

squirrel6• 2 years ago

I have been doing CGM for 7 months now and the learning has been invaluable. My metrics were never in the danger zone but I feel like I’ve learned so much about how many different factors play into insulin resistance and have managed to build much healthier habits over time.

patsplat2• 2 years ago

I just heard about a related device from a family member who is an endocrinologist.

https://www.fda.gov/news-events/press-announcements/fda-clea...

First off, he had discomfort with the study methodology. Didn't go into details, but was surprised that the FDA was less conservative than himself in this case.

Secondly, it has been common in his practice for someone to have an unusual event. Someone does something out of the ordinary, they have an unusual circumstances, they don't adjust their treatment, and something goes wrong.

His question was -- does the device have a reset button? Is there a way to restart the management and learning? The answer is no -- the device will learn! But there's no way for the patient or the physician to adjust the treatment. So his answer is -- he would never recommend this device, not the way it's currently setup. It's opaque and there's no means for a person to influence the device's learning.

TylerE11• 2 years ago

This is just monitoring, not a pump. There is no learning or tuning or dosing. If it’s anything like the Freestyle I wore for a while there’s a self calibration process that takes a couple hours, but that’s per-sensor, and those get changed out every two weeks.

patsplat2• 2 years ago

You are correct, I think he was talking about a different device:

https://www.fda.gov/news-events/press-announcements/fda-clea...

xattt• 2 years ago

But there's no way for the patient or the physician to adjust the treatment.

This does not parse. This device is for patients that are managed with oral meds and not insulin. Yes, sulfonylureas carry some risk of hypoglycemia, but not as much as insulin proper and its fast- and slow-acting friends.

If someone is on a pump, they sure as heck will be using prescribed equipment.

jablongo3• 2 years ago

This is great news for the healthcare system because it is going to drive down costs for people with diabetes who really need these things. Well done Dexcom!

This OTC model limits the measurements to every 15 mins instead of every 5 for the prescription version; this will limit its ability to be integrated into open source automated insulin delivery systems. Not sure why they made this choice as the hardware looks the same as the Dexcom G7. In theory they could be doing it to increase battery life or allow for cheaper batteries to be used in the consumer version.

ijustlovemath2• 2 years ago

Glucose control is my particular area of expertise; if anyone has any questions about it, I'm happy to be a resource!

arisbe__• 2 years ago

This could lead to a large amount of helpful preliminary signals that eventually pan out into some new knowledge.

nobrains• 2 years ago

A family member uses Abott Freestyle libre 2 CGM and buys it OTC. In UAE.

AbstractH24• 2 years ago

From what I understand, the next step after this is a device that continuously measures ketones as well.

Very interested in that

antirez• 2 years ago

I'll be that guy to say that if you don't have a diabete problem, you don't need a CGM: here in Italy there is this crazy fashion of wearing one if you are into sports or alike. It's much better to eat clean, check your weight, and don't care about your physiological parameters all the times.

maxehmookau• 2 years ago

I'm gonna go against the grain here and say that I tried a CGM for a few months and found it fairly unhelpful. (I'm not diabetic.)

Yeah, eating stuff that's bad for me caused a blood sugar spike and made me feel crummy. Eating healthier foods did not cause the same spike and I felt better.

I didn't need to spend money to tell me that.

komposit• 2 years ago

My son was diagnosed with diabetes about 4 weeks ago. The first two weeks we were measuring him through fingersticks multiple times daily. Now we have the cgm it has become so much easier to manage his condition.

The interesting thing to observe is to see in real time the metabolic spectrum of the foods we consume. Liquid sugars cause glucose spikes within 6 minutes. Solid carbs 30-120 minutes depending on carb complexity etc. Proteins 3h+. Fats can be six hours or more.

The thing is there are a variety of insulins available, some of which are rapid acting and others act more slowly. So to keep my son in range with multiple daily injections you are playing this game of giving him the right mix of foods where his carb digestion matches the profile of his rapid acting insulin.

Pizza is an interesting case study. It is by far the most carb rich deal we've tried and it is almost impossible to manage. With so many carbs it's hard to get the insulin dosage right, and once he is high, once he is coming down from that the digestion of the fats kicks in and he remains high through the night.

I think it would be a great thing for people to wear even just for a couple of weeks.

phasetransition• 2 years ago

My 3 year old has type 1, and CGM has kept us out of the ER for surprise lows multiple times.

It also has informed family diet change, in the direction of keto practices, that has compressed the baseline to high delta for our son.

It's a relief to know that an OTC product exists as a backstop to our prescription CGMs.

rapnie• 2 years ago

This article reminded me of a recent item on Dutch national news, about an artificial pancreas device for diabetis type 1 sufferers.

https://www.dutchnews.nl/2024/03/artificial-pancreas-offers-...

JoeAltmaier• 2 years ago

Some of us can't be trusted with continuous stat reporting. I hit Update on HN often enough. I don't even wear a watch, I kept looking at it every twenty seconds and then realized I still didn't know what time it was, it was just a reflex.

I learned to leave my phone someplace else, upstairs, wherever, just check it a couple times a day. Else I'd go crazy.

I took the speedometer off my bike, I was looking at it more than the road.

So I understand my limits and take steps to keep my self from compulsive behaviors. I guess(?) other people do better and can handle these things.

SeanAnderson• 2 years ago

Hah, what a small world. I was just talking to my friend yesterday while we worked out together. He was applying for a 6-mo dev contract at a company making a 15-day wearable glucose monitor. He was a little concerned that it hadn't been approved by the FDA yet, though.

...guess that concern is no longer an issue!

dbbljack• 2 years ago

you guys sound like yuppies, using a CGM to come to the conclusion that rice and soda cause sharper insulin spikes than proteins, and exercise is good for you! Could have gotten the same info from a $10 book of glycemic indices or a $20 traditional glucose test kit. If you aren't diabetic, a CGM is widely useless and you're just manually deriving basic facts about metabolism you could have just... read.

FDA clears first over-the-counter continuous glucose monitor

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