I really hated the Libre 2 continuous glucose monitor (CGM.) A friend asked for some detail about why, which lead me down a long-winded story about the last five years of my health journey. About halfway through I thought “this should be a blog post.” So…
EVERYTHING
Like my mother before me, I’m a type 2 diabetic. I have tried just about every common intervention known to humankind. If it exists, and a doctor knows how to prescribe it, I’ve probably taken it.
The most successful intervention I ever discovered was a combination of intermittent fasting, long fasts, and “not really keto but sort of basically keto.” I had an 8-hour daily eating window, occasional fasts that ranged all the way up to a week, and cutting the added sugar from just about everything but not going wholesale anti-carb.
I lost a truly fantastic amount of weight, was able to stop all my diabetes-related medications, and was generally the healthiest I’ve been as an adult.
Despite hitting my lowest adult weight and the general level of my success, I was not at a weight my doctor considered ideal, and so he encouraged me to try semaglutide. I’m not here to throw him under a bus, I think I have a pretty good doctor and he’s been thoughtful and supportive all along. However, the promise of not having to work quite so hard to maintain this house of cards lead my entire non-pharmaceutical intervention strategy to crumble. And I mean, really crumble. Roman empire level of collapse.
Semaglutide didn’t work for me. I mean it did, sort of technically, but not in the way one would want it to. I gained weight the entire time I was on it, but slower than I would have if I were left to my own devices. It had an effect, just not enough of one. Slowly, over the course of about a year, I regained all of the weight I lost. A new job during the time period and its associated stresses couldn’t have helped.
EVERYWHERE
Around December of this year we decided to try switching me from semaglutide to tirzepatide. I know lots of people who’ve had truly amazing results on tirzepatide. My insurance company did what insurance companies do. They couldn’t outright deny the prior-authorization. I fully qualify by their own standards. So they wrapped me up in so much paperwork trying to prove it that I decided fasting would be easier. Congratulations American healthcare system, you won.
Late March I decided to try a new fasting protocol that I had encountered called rolling fasts. Roughly 90 hours of fasting followed by a “re-feed” meal, followed by a new fast. This actually works great for me, for many reasons, and I think I probably won’t go into all of them.
Shortly after I started I had some concerning symptoms that I will spare you the details of. It was enough to be concerned maybe the fasting wasn’t safe. A couple months of fits and starts and diagnosis, we figured out it was unrelated and the problem passed. Ever since, I’ve been happily maintaining a rolling fast without significant issue.
One of the things I like about rolling fasts is that I only eat once every four days, and that means I’m rarely needing to figure out dinner at the last minute, which leads to making much better decisions about what to eat. And I’m not saying perfectly healthy by any stretch of the imagination. But I am saying that I never run out to Taco Bell right after work because I forgot to buy groceries and accidentally falling mouth-first into a pile of spicy potato tacos.
I get a few days to really figure out what I’m craving, and then whatever it is I get to go have it. Honestly? It’s the healthiest emotional relationship with food I’ve ever had.
ALL AT ONCE
Yesterday was my mid-year blood draw, and the results for my blood sugar aren’t exactly grim, but they’re not where I’d want them to be. This has prompted some introspection. The main problem as I currently see it is that I don’t have a good and reliable way to monitor my blood sugar during the fast and re-feed. And that’s how we get to the topic of CGMs.
I don’t mind a finger poke, but I think that method is highly susceptible to the games one can play with when they choose to check. Before a meal, fully fasted? Great! Perfect numbers! An hour after the only meal I’ll have that week? High! But for how long? Who knows! My sense of blood sugar is that one of the things that really matters is how long it takes to come back down to a normal level after eating, and that’s the kind of data one really only gets through a CGM. It matters a bit how high it spikes, but I’m mostly not eating cake for dinner. What really matters is if I’m spending the first two days of a four day fast just waiting for my blood sugar to come back down to a fasted state.
So I think I need to get back on a CGM, which I plan to talk to my doctor about at our next appointment. But I’d like to try some of the other options that aren’t the Libre 2, which as I mentioned, I hate. Loathe. Despise entirely. Some searching indicates the Libre 3 might not have any of the key problems that frustrated me, and the Dexcom Stelo is supposed to be coming sometime this summer.
The important thing from my perspective is to find a source of reliable data from which to act. I can’t diagnose the machine if none of the sensors are working.