May 21, 2019

Dexcom CEO Kevin Sayer: Continuous Glucose Monitors and the Impact of Food, Sleep, and Stress on Glucose – The Peter Attia Drive

Check out The Peter Attia Drive Episode Page & Show Notes

Kevin Sayer is the CEO of Dexcom, a company which specializes in continuous glucose monitors. 

Key Takeaways

• Continuous glucose monitors (CGMs) provide your blood glucose level in real time
• Insurance companies (in the United States) tend to only cover continuous glucose monitors for type 1 diabetics
  • If you’re healthy and want to wear one to keep track of your glucose levels throughout the day, you need a prescription from your doctor and have to pay out of pocket
• “Continuous glucose monitoring has the potential to change the way people eat more than any other technology I have ever laid eyes on” – Peter
  • Why? – It’s real-time feedback which allows to see how certain foods affect your levels
• “It’s not just what you eat, but it’s the physiologic state you are in when you eat”
  • The spike in your blood glucose level will be much lower if you eat something like a bowl of pasta 30 minutes after a hard workout compared to eating it after having not exercised
• Poor sleep will increase your average blood glucose level the following day
• A high blood glucose level too late in the day reduces sleep quality

How do continuous glucose monitors work?

• A small wire (thinner than a human hair) (also known as the “sensor”) is inserted subcutaneously into your tissue with a needle (which is then removed) where it rests
  • The wire is made of a proprietary metal alloy and coated with a number of membranes
  • The membranes generate an electrochemical signal that’s passed to a transmitter
    • An algorithm then coverts that electrochemical signal into a glucose value

Why would you wear a continuous glucose monitor (CGM)?

• If you have type 1 diabetes, it’s necessary to know when your blood sugar (aka blood glucose) rises above/below certain levels
  • With the glucose data, you’d then consume some sort of sugar (if your blood sugar reading is too low) or administer insulin (if it’s too high)
  • By wearing a CGM – you can prevent many hypoglycemic reactions (which sometimes end up in hospitalizations)
• Some people who have type 2 diabetes also wear one (for similar reasons – although not all people with type 2 diabetes need to dose with insulin)
• OR, if you’re just interested in your overall health/wellness and your glucose response to certain foods (like Peter and Kevin – who are both perfectly healthy)

The Extent of the Diabetes Problem

• About 1.5 million people in the United States have type 1 diabetes
  • Only about 20-30% of people with type 1 diabetes use one of the commercially available continuous glucose monitors
  • “I believe that at least 80% of the people with type 1 diabetes should be using continuous glucose monitoring”

Getting CGMs Covered by Insurance

• Insurance companies (in the United States) tend to only cover continuous glucose monitors for type 1 diabetics (and they only cover about 80% of the cost)
• Only a few insurance companies will cover a CGM if you have type 2 diabetes
• For those like Kevin, Peter, and many of Peter’s patients who want to use a CGM to observe their glucose levels in real-time, they have to pay out of pocket
  • (You need a prescription form your doctor and then you work with Dexcom directly to purchase a CGM – Peter estimates it costs him about $9/day)
  • (As Peter is a doctor, he writes his own prescription)

Will you always need a prescription for a CGM?

• Maybe not…
  • If Dexcom eventually wants to sell them over-the-counter (OTC), the FDA is going to insist that their OTC CGMs can’t be used to dose insulin 
•  So Dexcom would have to “dumb down” the device:
  • The information couldn’t be real-time (perhaps it’s presented a day later)
  • They’d probably show glucose ranges and not actual values

The Benefits of Wearing a CGM, Even if You Don’t Have Diabetes

• “I really think that if everybody had a CGM on every minute of every day in some completely fantasy-based way where it doesn’t hurt and doesn’t cost anything, but they had that data…. it just drives such a behavioral change” – Peter
  • “Continuous glucose monitoring has the potential to change the way people eat more than any other technology I have ever laid eyes”
• It’s much easier to notice how certain sugary/carb-heavy foods cause your glucose levels to rise/crash  
  • It’s an immediate feedback loop, which makes it much easier to instigate changes in your eating behaviors
• Peter has noticed that a high nighttime cortisol level will raise his blood glucose level throughout the night and into the morning
• Tidbts:
  • Both Kevin and Peter have noticed that grapes raise their blood glucose levels way more than you might think
  • “It’s not just what you eat, but it’s the physiologic state you are in when you eat”
    • The spike in your blood glucose level will be much lower if you eat something like a bowl of pasta 30 minutes after a hard workout compared to eating it after having not exercised
  • Peter has noticed his glucose levels are much higher throughout the day when his sleep quality is poor
  • Kevin has noticed that if he eats a high-carb dinner (which raises his blood glucose level) his sleep quality will be much worse

Parenting Advice

• You can’t be afraid to let your kids fail
  • “In life, we learn as much from our failures as we do our successes”

Additional Notes

• “Sometimes our failures are our biggest blessings”
• “You’re only as good as those people that are around you”