New member, looking to use CGM to get feedback on meals & activity

Quantified Self QS newcomers
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I used to follow Quantified Self research about a decade ago, then got busy with TechShop and drifted away. But now I’m interested in testing how different foods, different times of eating/sleeping, and activities affect my blood sugar. I just don’t know how to get a prescription for a CGM and I can’t afford enough test strips to get enough data.

About 6 weeks ago, my doctor announced that I have crossed the threshold into pre-diabetes. She and the medical center diabetes dietitian can’t agree on the definition of a “low carb diet” or how often to test blood glucose. However, the doctor says Medicare isn’t buying more than one test strip a day (true) and I just need to test at different times of day and track the trend. She believes that my A1C will tell her everything I need to know about how well my lifestyle changes worked. Except I won’t know how strict I need to be for acceptable results, and I don’t want to fall into orthorexia worrying about A1C.

I have a history of agreeing to go on low carb fad diets for bogus quack reasons that seemed credible at the time because I didn’t know biology. So I don’t want to go down the rabbit hole again of being obsessed about carbs and eating so little that I slow down my metabolism. Everyone I know with Type 2 says I don’t need to make big changes, but apparently “eat more healthy stuff like beans, grains, fruit, and plain yogurt” how I got to be pre-diabetic (and so did a friend’s husband).

What I would like is an individual counselor who would take everything into account, but I suspect I can’t get that. Another idea is to get blood glucose feedback data. Frequent measurements would let me know how strict I need to be, and how lazy I can be. Sometimes I’m having a bad day with my other disabilities and making fresh food isn’t going to happen or the weather or air are too bad to exercise. Also, how to tell if I’m really hypoglycemic vs. hungry for no reason, since I’ve always had an appetite like a Labrador and my blood sugar can be anywhere between 65-99 when I’m sure I’m starving.

I could probably learn a lot if I got a Freestyle Libre 24-day for $60 at Costco and started taking food pictures to guestimate carbs and mark times. But I don’t know how to get a prescription.

My doctor thinks I’m making too big a deal even to ask for help planning a diet around my limitations. She just said after I had problems with the dietitian that all she meant was “Stop eating big pieces of chocolate cake and no more white bread.” Ok, so does that mean small pieces of cake are ok? How often? Could I eat half a loaf of whole grain rye bread in a day? All the fruit I want? I’m guessing not, but there’s a huge gap between what she said and what an actual low carb diet looks like or even the clinic’s handout. I think she’s making assumptions based on my weight, and I’m already shopping for a new doctor.

And I have a limited budget for low carb food (lean protein, fresh veggies) once PUA ends. Eating bread and pasta was how I made sure I didn’t starve, and my grocery spending is up 5-6x what it was before. Food banks rely on white flour to keep people fed on a budget–if you’re at Grocery Outlet, take a look at that “$5 donation feeds a family for a day” display. Ramen, spaghetti, etc. plus rice and beans which are not part of the diabetes diet from my clinic in significant quantities, either.
VMC my plate- english 1.pdf (677.0 KB)

Anyway, I don’t know how to get a prescription. I looked at some online doctors and they are pretty expensive, and I don’t even know if they’ll agree this is a good enough idea to prescribe it. Does anyone have experience with this?

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Hi Kathryn,
It took me a while to get a CGM (Freestyle Libre), but it has been one of the biggest helps I’ve encountered yet. You figure, reading what people say here at at Levels, they are probably off, but self-consistent. I’ve been spot comparing with my Keto Mojo and it seems the two monitors are most similar when my BG is most stable – meaning fasting, as in first thing in the morning.
I signed up with Wild Health since I knew they were big advocates of a CGM. It seemed like once I had one, that was an opening to get a prescription from my PCP (an NP). So now I’ set. Insurance does not pay, but I expect they ultimately will. My cousin, who is pre-diabetic and a State retiree, DOES get her Libre covered. So I have hope for this particular common sense innovation.
You are correct that self-financing is a barrier to entry into health optimization. I find that that very frustrating. If you went the route I did Wild Health would minimally be about $100/month. They have other services besides just facilitating CGM access as well. I get the monitors themselves from ShopRite pharmacy, $75 for two (a 28-day supply). I was using Good Rx, but ShopRite beats their pricing in my locality, much to my surprise.
If you can swing it at all, you seem like you would really benefit from the CGM. It has taken me several months to figure out what I can and can’t eat, and how much. I was amazed at how any different foods I actually eat!
Good luck,
Manon

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@kathryn_hedge & @mmschladen I’m sorry I missed this discussion while I was away, I’ve also faced issues like this. One reassuring factor is that I learned a lot from just two weeks of using Freestyle Libre; I did not feel like I needed to wear it continuously for months. I was able to get a picture of my typical patterns, and use this to develop some strategies. Specifically, while I was wearing the Libre I also tracked my hunger by just recording any times when I felt irresistible hunger pangs. I found that these tended to occur not at low blood sugar moments, but at times when my blood sugar was falling a couple of hours after a high peak (but not necessarily at a low level in an absolute sense). A small snack, then a waiting period of 15 minutes, would often take care of these hunger pangs, even though at the moment I was eating the snack I felt like I could eat 10x as much. I’m not saying this approach will work for you; my point is just I was able to learn something from a relatively brief exploration with the Freestyle Libre.

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Thank you, that’s what I hoped.

But I can’t get my doctor to write a prescription because Medicare won’t cover it and she doesn’t think I need to know this information.

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This was my experience as well. Though, I was dealing with my Health Insurance provider, not Medicare. I ended up self-paying for the Medtronic device. It was that important to me. And, almost two years later, I’m still happy with my decision.

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But how do you get it in the US without a prescription?

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I’m sorry! That’s where it got even more expensive. My in-person Doctor absolutely refused to sign the Rx paperwork Medtronic provided. So, I signed up with SteadyMD for a year and that Doctor signed it. I had (and remain) unsatisfied with my local Doctor, so I had been curious about SteadyMD. This was an opportunity to test them. I’ve since dropped SteadyMD. They weren’t any help when I broke my leg, nor were they helpful with eczema.

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Yikes!