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”
