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Hey Sugar! Let’s Shake Things Up!(Blood Sugar and You)

Hi Friends,

With holidays, gatherings, and entertaining coming up, it’s a great time to learn how you can track your glucose (blood sugar). With new technology by using a continuous glucose monitoring system, accuracy has never been better!

It’s the perfect time to get set up, so that you can feel empowered around your food choices and avoid gaining the dreaded 5 pounds of holiday fat!

37 million Americans have Diabetes and 90-95% have Type 2, which is preventable with making dietary and lifestyle changes.

What is Blood Glucose?

Glucose is the body’s most common source of energy. It is a form of sugar that the body can absorb after breaking down the food you eat. When you consume glucose, the pancreas will respond by releasing a hormone called Insulin. Insulin lowers blood glucose levels in the body and acts like a key to let the glucose into cells.

Fruit for example, has both fructose and glucose and the glucose will raise your blood glucose levels. Therefore, eating a piece of fruit with a protein or fat, such as a nut butter, will help slow that release of glucose even more. Fruit juices are a mainline of glucose to the body because they are missing the fiber and are usually consumed by themselves. Of course they are better than refined sugary drinks, but it's best to avoid them and stick with a piece of fruit in order to avoid the spikes of glucose and insulin in your body.

While blood glucose levels naturally vary throughout the day, it is usually lowest after long periods of fasting or sleeping, and highest after eating or immediately after high exertion exercise.

The goal is to keep your glucose within a certain level and avoid the high or low spikes throughout the day in order to be in optimal health.

Elevated glucose levels can damage blood vessels and other parts of the body. Therefore, people with Diabetes have a greater risk of Cardiovascular Disease, kidney failure, nerve damage, eye damage and more.

Insulin is a hormone that has inflammatory properties on its own and can drive disease as a result.

Accurate Continuous Glucose Monitoring (CGM) Systems

You don’t need to wait until you have Diabetes to be more engaged with your body and your glucose “sugar” levels. In fact, measuring your glucose is a key way to prevent Diabetes and other metabolic diseases.

The idea of using a CGM is to help you prevent disease and reduce your risk factors, including but not limited to Diabetes. The CGM can help you gain more knowledge about what you are eating and how certain foods, stress and even aggressive exercise can affect your blood sugar levels.

Using a CGM can give you real time progress on how making lifestyle changes with different food choices and modifying your daily exercise can impact your glucose in a positive way.

Traditional ways to measure glucose have been a finger prick, called blood glucose monitoring (BGM), which are painful, cumbersome, and less appealing than using this modern technology of CGM.

Learning what might spike my glucose may be different from what spikes your glucose, therefore this is as individualized and customized as medicine gets!

How CGM work

The CGM will have a sensor, which measures glucose levels in the interstitial fluid (substances that leak out of capillaries) at 1 to 5 minute intervals. There is also a transmitter that collects and forwards glucose values to a third component, which is a receiver that is responsible for displaying data to you.

Accuracy: Mean Absolute Relative Difference (MARD)

The best sensors you should use need to have an accuracy of 10% or lower.

The MARD compares sensor data with reference measurements and measures for errors. The small # indicates readings are close to reference glucose values and larger MARD # indicates greater discrepancies.

The accuracy of CGM have improved significantly over the past years and so there has never been a better time to start measuring your glucose using CGM!

Blood testing levels

  • Glucose levels “fasting” should be <86 on traditional blood work

  • HgA1C (measures glucose over 3 months in red blood cells) is optimal when <5.4 The PreDiabetes range is 5.7-6.4 The Diabetic range is =>6.5

  • Insulin levels "fasting" should be <7

CGM measurements

Fasting glucose should be 70-86

Post meal glucose should be 110-120 and no higher than 140

2-3 hours after the meal you should return to average baseline about 100

Long periods of Fasting can drop glucose under 70, which is okay unless you don’t feel good.

Classic foods that spike sugars Sugary drinks Alcohol Refined sugars Carbohydrates such as breads, cereals, white rice, corn, potatoes and many fruits Low Carbohydrate substitutes Swab rice for cauliflower Zucchini noodles and starchy veggies instead of pasta Berries, grapefruit and green apples with a protein instead of most other fruits Egg white wraps instead of tortillas Bake with almond or coconut flour instead of wheat flour Use Monk fruit, stevia and erythritol sweeteners instead of sugar (no aspartame as it is toxic to neurons) or even Allulose, a sweetener from fruit. Ideas to promote better glucose management

  • Daily exercise of at least 30 min per day (incorporating HIT training and weight training is key too).

  • Increase Fiber

  • Hydration (drinking half your weight in ounces per day)

  • Sleep at 6-8 hours per night

  • Reduce stress

How exercise helps reduce sugars: The pancreas' release of insulin will prompt the liver and muscles to take up glucose from the blood and store it as glycogen. Glycogen will then be stored in these areas and released at different times with different needs, such as exercise. The body will ask the pancreas to release glucagon to trigger the conversion of glycogen into glucose for release into the bloodstream. Glucose will be utilized as fuel for the muscles when we exercise, therefore decreasing overall blood glucose levels.

Benefits of using the CGM

  • Empowering you to be aware of how your dietary choices directly impact your health

  • Decreases risk of high or low (hypoglycemic) episodes

  • Reducing glucose, insulin and HgA1C

  • Reducing body fat

  • Reducing Inflammation (drives disease)

  • Improves energy and vitality

Choices of CGM The two most common and easy to find CGM are the FreeStyle Libre and Dexcom G6 Abbot Diabetes Company has updated their FreeStyle Libre system to a 3rd generation model (first model came out in 2017) and with it there is increased accuracy. The Libre 2 had a 9.3 MARD score and now the Libre 3 has a 7.9 score! Yippee!!!! (This may not be compatible with all devices and certain pharmacies may not have this model yet) The FreeStyle Libre system comes with a 14 day sensor and is worn on upper arm with sticky adhesive to keep it attached to skin. One manually swipes the reader or phone app over the sensor to get your glucose reading and you can do this as frequent as every 1 minute. You can set up alerts to notify you of high and low readings. This CGM is the most accessible for those who live locally in Boulder. Dexcom has been working on CGM since 1999 and their Dexcom G6 has a MARD score of 9.0 (which was superior to the Libre until the 3 system came out). DexcomG7 is coming soon to Europe with a MARD score of 8.7% from their early clinical trials, ahead of its release. Dexcom is more expensive than the Libre systems. Dexcom comes with a 10 day sensor (packet of 3 for 30 days) and is worn on the abdomen or upper buttock. This sensor has readings every 5 minutes automatically. Similar to the Libre systems; you can set up alerts and it is water resistant. Nutrisense is an online company that has an “all-inclusive plan” where you can subscribe for 1 month ($350), 3 months ( $250 per month), 6 months ($225 per month ) and 12 months ($199 per month). They currently use the Freestyle Libre Systems 2. They provide great service and you have access to their online Dietitians.

*RECEIVER: If your phone is not compatible with the DexcomG6, Costco has the best deal. Costco's price is $196.49 Amazon Pharm is $388.32 Potential Interference for Accurate Results: Massage therapy- Avoid aggressive massage therapy near sensor Taking steroids will increase glucose and give false readings Taking Vitamin C over 500mg per day while wearing the sensor may falsely raise glucose readings Imaging -Remove the sensor before MRI or CT scans (not affected by XRays) Thank you to patient and colleague Krista H who found the Amazon coupon and passed along this information to me and now you! All are available using Health Savings Accounts (HSA) *CGM are only available with a prescription. Talk to your PCP about this or you are welcome to make an appointment with me to discuss in more detail (no orders will be written without an appointment)

May you feel healthy, youthful and energetic! Yours in Health, Carrie Ballas and BIH Team

Studies and Research References

“Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review with Meta-analysis of randomized Controlled Trials

MARD is the sensitivity score “accuracy” study

“Landscape of Continuous Glucose Monitoring (CGM) and Integrated CGM: Accuracy Considerations

“Benefits and Limiations of MARD as a performance parameter for CGM in Interstitial Space

“FDA authorizes first fully interoperable continuous glucose monitoring system, streamlines review pathway for similar devices”

“Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes”

“Dexcom shares clinical data on G7 CGM ahead of next-gen showdown with Abbott”


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