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The tiny piece of tech to help lower your risk of type 2 diabetes
Metabolic syndrome affects one in three people over 50 – can tracking your blood sugar reduce the risk?
The small circular device attaches to the back of my arm like a limpet. It contains a tiny needle, but is painless to wear, and constantly measures my blood sugar levels.
For people with diabetes, a continuous glucose monitor (CGM) has been a life-changing invention, allowing them to monitor blood sugar without the need for a finger prick. But something interesting has happened with this seemingly unsexy medical device. It’s become a wellness flex for the non-diabetic; a status symbol to show that the wearer is optimising their health by managing blood sugar spikes.
I spent several weeks wearing a CGM and monitoring my results through an app from metabolic health brand Levels, which has tens of thousands of users in the US and launches in the UK this summer. I learned much about my body’s response to food, exercise, stress and tiredness.
But first thing’s first: what exactly does it mean to have good metabolic health?
It’s easier to describe the opposite of it. Metabolic syndrome is a combination of diabetes, high blood pressure and obesity, putting you at greater risk of heart disease and stroke. The condition affects a staggering 1 in 3 adults over 50 in the UK. And the British taxpayer spends more on the treatment of obesity and diabetes than we do on the police, fire service and judicial system combined.
“The metabolic health epidemic is truly a global problem,” says Mike DiDonato, head of member success at Levels. “And it goes beyond diet and nutrition. Sleep, stress and exercise also significantly affect our glycemic variability.”
It’s not only the conditions above that you might expect from poor metabolic health. Dr Jenna Macciochi is an immunologist and author of Your Blueprint for Strong Immunity.
“Metabolic health is crucial to our immune system,” she explains. “Chronically high blood sugar levels can lead to chronic inflammation, which impairs your ability to fight infections and is a proxy for numerous conditions of poor health. Obesity and metabolic syndrome can also negatively impact immune function by causing chronic low-grade inflammation, which can impair the ability of immune cells to respond to pathogens.”
So poor metabolic health weakens your defences against everything from viruses to cancer. As someone who finished treatment for primary breast cancer last year, this is big, since I’d do anything to avoid being back in that chemo chair. I don’t want to scaremonger, because there are many varied causes of cancer, including genetics and “just bad luck” (as one oncologist said to me). But glucose and insulin play significant roles in many cancers’ growth and spread, with breast, prostate and endometrial cancers particularly exacerbated by metabolic dysfunction.
Perhaps you’re not worried about some future condition that may or may not affect you. As someone who had zero interest in “how not to get cancer” before I got cancer, I can relate. But the benefits of good metabolic health can also be felt immediately, in terms of increased energy, reduced anxiety and a clearer head.
You might be thinking, this is all very well, but can’t we just eat more healthily and exercise? I’d argue, if it were that easy, everyone would do it. “Dietary research and information is often inconclusive and confusing,” says DiDonato, explaining that we each have different metabolisms, microbiomes and processes. “One-size-fits-all solutions don’t work for most things, and certainly not something as complex as nutrition.”
Understanding how your body works is important. It’s why companies like Levels and Zoe, a British brand that also uses CGMs, know the future of health is about personalised insights. What appealed to me about Levels was an endorsement from physician, podcaster and patron saint of preventative medicine, Dr Rangan Chatterjee. “The technology Levels is enabling in the UK will help people better understand how their lifestyle choices impact their health,” he says. “Our national healthcare system faces greater challenges than at any time in history; with the magnitude of preventable chronic disease, it’s more relevant than ever to shift healthcare towards prevention and health optimisation.”
Wearing a Levels CGM is pleasingly intuitive. The app allows you to input what you eat, then has graphs showing the impact on your blood sugar levels. You scan the sensor with your phone, similar to using Apple Pay, and watch the graph rise or fall in real time. Then you receive a daily metabolic report, showing how different foods and activities cause blood glucose levels to peak. You also get food swap recommendations.
Reassuringly, I learned my body handles carbs well, and my graph comprised more gentle fluctuations than dramatic spikes. Sweetcorn fritters for brunch caused a spike (or “glucose excursion” to use the lingo). Another one after corn chowder – more significant than after chocolate – confirmed that sweetcorn is not my friend. A chana masala spike led me to experiment with the order of foods, and saving the rice and bhaji until after several forkfuls of chickpea curry did help flatten the curve. As a rule of thumb, eat plants first, then proteins, fat and finally carbs or sugars. The fibre slows the release of glucose into the bloodstream.
Walking after eating smooths out spikes, as does a shot of apple cider vinegar before a carby meal (a trick popularised through @glucosegoddess’s Instagram). I found the process fascinating. But is there a downside?
Dr Nicola Guess is an academic, dietitian and researcher at the University of Oxford, specialising in the dietary prevention and management of type 2 diabetes. “People may make food choices based on lowering glucose,” she says. “But in doing so put their cholesterol up to a degree that increases their risk of cardiovascular disease.”
It’s an important point. You could live off, say, red meat and cheese and have minimal glucose spikes, but you wouldn’t be healthy. “It’s not about removing every carbohydrate from your diet to score perfectly,” says DiDonato. “That’s not the point here. We’re not demonising carbohydrates. We want people to have a healthy relationship with food.”
The app celebrates healthy choices, popping up to congratulate you on eating micronutrient-rich veg or going for a walk after lunch. But it’s true that a CGM can only tell part of the story. “There are lots of important markers of metabolic and cardiovascular health, including triglycerides, circulating fats, insulin, blood pressure …” says Dr Guess. “Why are we not measuring these with wearable devices? Because that technology doesn’t exist. We’re measuring glucose because we can.”
However, science is evolving all the time. “Of course, a CGM doesn’t tell us everything,” says DiDonato. “We’re excited for the future.” He cites early research into continuous measurements of ketones, lactates and alcohol. “The holy grail would be a continuous insulin or hormone measurement. We’ll be there eventually.”
In the meantime, this can be a powerful tool to learn about your body, particularly for those of us that love accountability. The proliferation of CGMs on otherwise healthy people has coincided with the rise of wellness wearables. A Fitbit, Whoop or Oura Ring will provide insights on everything from your quality of sleep to your heart rate variability.
The concept of an old-fashioned health kick has been rebranded as “biohacking” or optimising health for longevity. Inevitably, it doesn’t work for everyone. I love how my Oura Ring encourages me to prioritise sleep by gamifying it. Others feel overwhelmed and stressed by constant monitoring. Dr Guess cites anxiety about blood glucose rises as another issue with non-diabetics wearing CGMs. You have to know what works for you.
Checking your data after each meal might not be strictly necessary but, for those of us who love wellness stats, there are worse compulsions. And I enjoyed being part of the CGM club. After spotting another wearer in my yoga class, we spent a happy 10 minutes chatting about how different breakfast options affected our numbers.
The main benefit for me was learning how certain foods affect my physiology. I found that eating to minimise glucose spikes gave me more energy, and less of the rush-and-crash rollercoaster that many of us are used to. It would be of benefit to anyone at risk of metabolic syndrome, or who has been warned of pre-diabetes at their midlife health check. In the long term, I hope that what I’ve learned will also reduce my risk of many conditions – not least cancer.