It’s becoming more and more common: whether in a coffee shop in Silicon Valley or in a weightlifting gym in Boulder, Colorado, people without diabetes are using continuous glucose monitors (CGMs) to “hack” their blood sugars, lose weight, and hone their diets accordingly. This article will explore the use of CGMs in the non-diabetic population, what the backlash from the diabetes community has been, and what the call to action should be.
CGMs for More Than Just Diabetes Management?
According to one website that promotes the use of CGMs in a non-diabetic population,
“ Wearing a CGM can facilitate the effort for someone who wants to hack their diet, blood sugar control, and overall health. This technology can go beyond a single blood sugar reading that a blood glucose meter provides. A CGM can provide real-time insight on whether blood sugar is trending up or down.”
What may seem like an innocuous accessory for the upper-class elite has many people with diabetes enraged. CGMs are crucial in providing regular, near-constant blood glucose readings to track time spent in range (TIR), identifying patterns in blood sugars, and anticipating both low and high levels.
The Original Purpose of a Continuous Glucose Monitor
For people with diabetes, they are life-saving, and more and more often are being coupled with insulin pumps that will then increase or suspend insulin according to the blood sugar that a CGM reads. It almost entirely eliminates the need for manual finger testing and has proven to help lower HbA1c levels, reduce dangerous low blood sugars, increase time in range, prevent unnecessary emergency room (ER) visits, and save the health care system money and save many lives. It has quickly become a necessity for tight diabetes management in recent years for many people.
For something so seemingly necessary for most people with diabetes, it clearly isn’t seen that way by industry: 16 states, including California (the most populous), do not have Medicaid coverage for continuous glucose monitors at all. And while most private health insurance plans (and even Medicare) now cover CGMs, affording one without health insurance is nearly impossible: the most popular CGM and the one that most commonly connects with insulin pumps, the Dexcom CGM, costs thousands of dollars out of pocket per month without insurance.
So when someone with diabetes, who is already struggling to afford their insulin, goes to the local coffee shop and overhears two dudes from Crossfit comparing their (perfect) blood sugar readings on their respective CGMs over their non-fat decaf lattes, the inequity of the situation can be enough to make your skin crawl.
Clair from Illinois says,
“The general population using CGM devices trivializes them.”
Cate from Nebraska adds,
“It absolutely incenses me [when non-diabetics use CGMs]. There’s a local doctor in my area who treats patients for weight loss and gives everyone a free CGM; meanwhile, it’s an arm and a leg to refill my own.”
Bonnie from Minneapolis says,
“It drives me absolutely bananas.”
We Are All Just Products of the System
Managing diabetes with a continuous glucose monitor is life-changing, but it is expensive, and living with diabetes in America is anything but easy. We have the most expensive insulin prices in the world, health insurance isn’t compulsory or cheap, and even when you do have a job that has health insurance, necessary diabetes technology is sometimes not even covered or affordable under your plan.
Seeing people use technology that we need can be seen as a slap in the face, but we’re directing our anger at the wrong place. The problem with accessibility in the United States is not a supply issue. The problem with accessibility in the United States is that we use health care as a commodity when it is not. We put health care into a capitalist box when it’s something that should be treated as the human right it is. We’ve priced people out of their lives. We treat things like insulin and insulin pumps and continuous glucose monitors as if they’re elastic goods when they’re 100% inelastic. We cannot negotiate our own pricing for insulin. We can’t haggle down the price or walk away. We need the drug or we die.
People without diabetes see products like continuous glucose monitors as the valuable goods they are and are willing to pay for them. No person who uses a CGM recreationally has it covered by their insurance, and it’s important to remember that.
It’s not a zero-sum game where someone’s CGM that’s paid for out of pocket in San Francisco precludes another person on Maine’s Medicaid program from accessing one of their own, but it feels like it does. Instead of taking our anger out on the gym-rat in Colorado who’s paying thousands of dollars out of pocket for their Dexcom each month (which is stupid, but why question their motives?), we should be angry at the government and systems that created this situation to begin with.
If the United States had a single-payer health care system where everyone who lives here had health coverage, we wouldn’t care what people buy on the free market. If all plans (including Medicaid!) covered CGM use for people with diabetes at 100% of the cost, it wouldn’t bother us what anyone else was doing with their blood sugar levels (diabetic or not). It’s a symptom of a system that denies people with diabetes the proper care and regular, reliable access to proper durable medical equipment that makes them covet these devices as much as we do. There’s nothing inherently wrong with people without diabetes using CGMs, but it does sure feel like there should be.
Photo credit: iStock
Some People Support Wider Use of CGMs
In speaking with others for this story, I found several people who encourage non-diabetics to use CGMs, like Mindy, a registered dietician from Colorado,
“I am pleased that there is adequate supply for people without diabetes who can view the real-time movements and fluctuations of blood glucose. The more understanding there is in groups of non-DMs, maybe we can finally change the direction of people diagnosed with (type 2) in the future.”
Christie, from California, added,
“being mad about someone having a CGM that they bought on the free-market is similar to someone with hypertension being angry over another person having an at-home blood pressure monitor. It just doesn’t compute.”
In a country with nearly 100 million people living with prediabetes, learning to respond to blood sugar trends and figuring out which foods work best for your body can only be a good thing. And although it hasn’t happened yet, the more “mainstream” these devices become, the more affordable they’re bound to become, which would be great for everyone. Additionally, for shy diabetics, CGMs becoming more mainstream can also take away the stigma of having a visible device on your body 24/7. It’s suddenly “cool”.
Benefits for Everyone
Whether or not you have diabetes, a continuous glucose monitor can help with several things:
- Learning how your body responds to certain foods (grapes versus crackers, for instance)
- Identifying blood sugar patterns around mealtime and exercise
- Diagnosing diabetes before the onset of ketoacidosis (DKA) in people at high risk (people who are overweight, obese, live with prediabetes, or who have the antibodies for type 1 diabetes)
- Improving blood sugar to help maximize energy for a workouts
- Helping people lose weight by managing their hunger (which is the result of fewer blood sugar fluctuations throughout the day)
In a country where over 70 million adults are obese and another 99 million are overweight, having more data regarding how our bodies respond to the foods we eat is vital. We have a type 2 diabetes epidemic on our hands that is only getting worse, and wider CGM usage may help curb that, but people need to be careful.
Using them as “wellness gimmicks” may bombard those who truly do not understand the relationship between glucose and blood sugars, leaving users overwhelmed with data and confused, while not making any dietary changes at all. In a true market economy, the greater the demand, the more competition will spring up, the more prices will fall (for both people with and without diabetes).
The real issue that people need to focus on is making sure that everyone with diabetes who wants a CGM can get one, but people without diabetes accessing CGMs on the open market will not prevent that from happening. We need to push for greater coverage for CGMs on the private and public health insurance market with our elected officials and make sure that we inch ever closer to the illustrious universal health care system that other industrialized countries enjoy. We need to make sure that everyone with diabetes has access to affordable insulin, pumps, and supplies (including CGMs), with strong grassroots advocacy to equip people with all the tools they need to thrive. If we achieve universal health care maybe someday everyone who truly needs a CGM can get one, but until then, let the Crossfit bro with his Dexcom sensor alone. Although you can let him know that the caffeine in his latte will raise his blood sugar a few points in the meantime.