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.

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

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

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)

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”

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)

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

“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

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