In this article I share with you my personal experience on monitoring the effects of diet, frequency and timing of meals, exercise, and stress on my sugar. I used the Free Style Libre monitor and sensor on two separate 14 day cycles. You never have to prick your finger to know your sugar. All you do is attach once and wear the sensor in back of arm for a cycle of 14 days. The sensor and monitor are very easy to use. You press the sensor containing tiny plastic filament into back of the arm. It does not hurt. After one hour the monitor is able to pair with your sensor and display the sugar levels that your tissues are experiencing in real time. You just bring monitor close to the sensor underneath your arm and voila there is a reading.
I set my normal sugar range to be that of people without diabetes, between 50-70 mg/dL (low range) and 150 mg/dL (high range). After a meal there is normal and expected increase in blood sugar to give all your tissues energy. At that same time insulin gets released from the pancreas to help your liver store the excess sugar as glycogen. This process takes usually 1-2 hours. So that sugars naturally fall back to a low baseline within that time. The stored glycogen in the liver is ready to be formed back to sugar as you needed during day activities, while fasting. The liver can store up to 12 hours of energy for the body in the form of glycogen. after this time your energies start to come from stored fat. This is why having 16 hour periods of fasting or intermittent fasting can be helpful for weight loss.
In terms of social acceptability, I wore the sensor while attending social events, swimming, playing tennis, etc., including attending a wedding. Some people were curious to learn that I was monitoring my glucoses even though I am not a diabetic. They were intrigued to learn that this can be a great self-monitoring and self-training device to guide one to make choices that support maintaining our sugars within a healthy and personalized normal range.
There is clearly a circadian cycle to sugars throughout the day. Sugar peaks after meals are higher in the morning and significantly lower after much higher caloric evening meals. This is due to the day-night cycle of cortisol by the adrenals. Cortisol is highest in the morning and lowest at night and this affects how sensitive your body is to insulin before and after meals. For example, My sugars are highest in the morning and particularly if I add sugar to my latte. Stevia does not increase sugar significantly. I did not try other sweeteners. In the evenings my sugars are significantly lower despite a quantitatively larger evening meal. At this time my cortisol levels are coming down for the night.
Regarding the effect of particular foods on my sugar, these are my findings. Sugar or processed carbohydrates such as banana bread, gluten-free crackers, any thing with any flour, breads (yes even sourdough bread), gluten-free pasta, roasted potatoes, all caused large and immediate increasing glucose above the 150 mg/dL range/ which is my upper goal for a normal post meal glucose peak. Therefore I will avoid these foods in general and indulge only occasionally.
Bananas or ripe figs sadly cause a big spike of sugar for me. Whereas an orange, or berries, or a peach cause slight bumps in the system. Fresh cut vegetables eaten with tuna or egg salad it does not increase the glucose very much. In addition avocados, nuts, and berries do not cause significant sugar increases.
I normally have one meal a day in the evening. Most of my usual meals include a protein and vegetables. These meals do not increase sugar significantly. Since I was on vacation during this self-monitoring period, I had the chance to study in-depth chocolate, ice cream, and wine. ☺️Fortunately these three foods do not increase my sugar significantly when trying them around the evening meal. However, eating multiple meals a day created multiple small sugar peaks and on those days my baseline average sugar was much higher, even though my choices were generally healthy.
There is data which shows that individuals responds differently from each other when presented a same meal with fixed caloric load. Some will have high peaks of sugar after bagel with cream cheese and other just digest this without a significant sugar rise. However each individual is consistent and shows their own unique sugar response pattern after the same meal is presented on a separate day.
What about exercise and stress?
My usual daily walk after my latte brings sugars down right away. However, I discovered that during more intense or competitive exercise my sugar rises. I believe this is because high muscle activity requires adequate glucose intake by the cells. The liver which has been storing the nutrients after a meal is able to produce this extra need of glucose at the time of exercise by a process called gluconeogenesis. However I think I also had performance stress at a tennis clinic- not wanting my team to lose and wanting my individual return shots to go perfectly.😂
I also found that stress in general has a significant effect in increasing sugars during the day of the stress and creating a different and broader sugar peaks. For example my sugars were at a higher that normal baseline while I was preparing to give a dinner party for 16 people that I love and have known for years.
This effect of stress and performance anxiety was glaringly obvious to me during the time I was delivering a presentation at the national Age Management Medicine Group Meeting his last April. The issue was that I was to give this particular academic presentation in Spanish (my native tongue) and I had never given an academic talk in Spanish. All my talks in the past 35 years have been in English. I believe my subconscious perceived great alarm and my adrenals responded. They kicked into flight and fight mode, and released extensive amounts of cortisol and adrenaline as if was just about to fight a large dragon!
I think this is all very cool and very humbling… We are all human and our biology does not lie. I clearly need to chill out and meditate even more!! But as you can see that in my individual case there are foods that are better for me than others. Low glycemic diet is good for me. I see that is best not eat more food or cave to cravings when I am stressed as my sugars are already high and will only increase more if I add more food at that time. It is better for my biology to have my largest meal later in the day. It is also good for me that I have maintain my pattern of only one healthy meal a day.
I share all this because I want to help us all prevent disease like obesity, diabetes.
A potential problem I see in everyone doing this is that 1) you need a prescription, 2) insurance does not pay for this unless you are a diabetic, 3) if you get this through insurance you are likely to be tagged as a diabetic, even if you are not and thus may impact your future insurability. For all these issues I recommend that if you are not a diabetic and you ca pay for the monitor and sensor personally do it. The sensor cost me around $45. The monitor was about $80. Also someone else can use the monitor sequentially if the have a new sensor. I also understand that you may download app for cell phone and monitor this way. I feel it takes 14-28 days of self monitoring to identify your unique patterns and dietary needs.
I have included photo with this blog showing the quarter sized sensor attached to my arm.
Be well, Dr. Beatriz