I think my CGM readings are too high - what I should I do?”
If you’re concerned about high readings on your CGM, you might find these posts useful:
what values are typically observed in people with normal glucose.
why the usual prediabetes and diabetes cut-offs are not directly comparable to “peak” glucose.
If you’re still concerned, getting an HbA1c test or even an OGTT will give you more definite insight into whether your blood glucose is officially “normal”, or maybe you might have prediabetes or even type 2 diabetes.
If an OGTT or HbA1c test indicates you have prediabetes, the best thing to do is reassess your lifestyle and typically in my practice I recommend some variation of the following:
Weight loss.
More exercise (especially weight training).
Reducing processed food intake, especially highly processed carbs.
Increasing intake of whole plant foods and intact grains.
Sometimes I may also recommend increasing protein.
If an OGTT/HbA1c test (taking into account clinical history) indicates you have T2D, your doctor or practice nurse can help you with the most appropriate course of action. For many, this is an opportunity to reassess lifestyle** and typically in my practice I recommend some variation of the following:
Weight loss.
Increasing protein.
Increasing intake of whole plant foods and intact grains.
More exercise (especially weight training).
Reducing processed food intake, especially highly processed carbs.
What if I fall into that grey area?
As I mentioned, we can’t know with any certainty whether or not frequent glucose excursions to +11mmol/L could cause damage in the long run. And maybe some high CGM readings prompted you to go to the doctor, and your HbA1c came back as 40mmol/mol. So, not quite prediabetes, but maybe creeping up a bit.
I think it’s perfectly reasonable to make adjustments to one’s lifestyle here to limit these rises. Whether you want to do this with a CGM for peace of mind is up to you.
For most people, the following are a bunch of things you could do (you don’t have to do all of them) that would be sufficient to lower post-prandial glucose rises substantially:
Lose weight - we have incredibly strong evidence that even modest weight loss of 3-5% body weight) lowers glucose and prevents the development of T2D*.
Engaging in regular physical activity will reduce your glucose acutely and chronically if you keep it consistent*.
Replace half of your starch (rice, potatoes, bread) serving with veges*.
Switch your starch to a legume based pasta*.
Have a legume side instead of starch*.
Eat the protein component of the meal first.
You’ll notice the key thing about each of these starred recommendations are that they are actions which reduce your risk of CVD and other diseases in addition to lowering glucose.
Another key thing to note about each of these starred recommendations is that they don’t just work acutely to lower glucose. They also address the underlying pathophysiology which is causing the glucose to run too high.
This is in contrast to the advice you see about lowering just the *symptom* of hyperglycaemia without paying attention to what’s actually causing glucose to creep up.
** For a variety of reasons, including genetics, medications may be indicated despite best efforts with lifestyle.
If we are in the gray area or prediabetic range, and follow ALL the recommendations (yes weight loss, exercise, cut processed foods and eat protein), what are we actually accomplishing? Is any amount of “reversal” of insulin sensitivity or of beta cell function possible? Can we expect better glucose responses on the CGM? Or are we just staving off any exacerbation of illness? Just so I know what to expect!
You are so amazing! Thank you so much for this series of posts!!! I can't wait for more :)