What's the deal with continuous glucose monitors?

23:02Emily Oster:Your science class was much better than mine. Fair enough. Go ahead. And so, yeah, I mean, you need glucose to survive. I think what's relevant to continuous glucose monitors is that glucose is kept in a very narrow range in your blood because glucose itself can be toxic. so it's necessary but it's also sort of evil and things that are necessary and yet evil tend to be regulated in like very narrow bands in the human body and it's insulin that does that and so your blood sugar for example which you know normal blood sugar let's say is 90 milligrams per deciliter or something that's corresponds to about a teaspoon's worth of sugar being dissolved in your blood at any given time.

23:46Emily Oster:So that's not much, right? Like put a teaspoon of sugar in my coffee this morning. That's all the sugar in your blood, which should tell you how much is going on in your body to like, pull it out of your blood and put it into cells and put it into storage and make glycogen, which sits in the liver as like a warehouse for glucose if you need it in the future. And so it's highly, highly regulated. And when it becomes dysregulated, that's what we call diabetes. And obviously that's one of the major chronic health conditions of our time. Great. Okay. So the idea behind these CGMs is that they will tell you in more real time what your blood sugar is.

24:27And let's sort of get the diabetes piece of this out of the way, because I think this is a place where it's very clear this innovation has made huge strides for people living with diabetes. So one of the core issues, whether you have type 1 or type 2 diabetes, is monitoring where your blood sugar is. So you can both think about which, you know, foods cause your blood sugar to rise above levels that are safe. And so you can make sure your blood sugar doesn't fall too low. And for people with type 1 diabetes, they need to dose with insulin or possibly get more sugar if their blood sugar drops too low before a continuous monitoring.

25:07You're taking finger sticks very frequently. That is both unpleasant, time-consuming, and also subject to quite a lot of noise because, of course, you're not continuously pricking your finger. This is effectively a way to be continuously pricking your finger without the pain and discomfort of doing so. And so we have a lot of evidence that, you know, for type 1 diabetes, This is clearly very beneficial and especially for kids. Lowers the risks of hypoglycemia, which is in blood sugar drops too low. It improves anxiety in parents. It's a kind of follow on. But we just have a lot of evidence type two and type one diabetes from RCTs that people are spending more time in the appropriate range, that their A1Cs are going down.

25:53Like all of the metrics you would have for successfully managed diabetes are improved with this kind of monitoring for reasons that seem totally obvious to me.

26:03Emily Oster:Yeah, I mean, it is a slam dunk for type 1 diabetics. It is pretty darn close for type 2 diabetics. One of the cool things for people with type 1 diabetes is that some of the prescription continuous glucose monitors actually integrate with insulin pumps. And so not only is it measuring the glucose in your, you know, interstitial fluid, which is close to your blood, it lags behind the blood by about 10 minutes, but it's getting relatively updated glucose measurements, but it can also control how much insulin is being released by the pump, which is, it's like, you put those two things together and you basically have a pancreas.

26:38Emily Oster:I mean, it's not perfect, but like, that's more or less what the pancreas is doing. And it's been a total game changer. You know, I think the other, the other piece of this is in people with type two diabetes, even if they are not insulin dependent, or even people with pre-diabetes, there is some evidence that this can help people basically manage their food intake in a way that keeps their blood sugar more even because you're getting a continuous set of feedback and different foods raise people's blood sugar different amounts. There's a kind of general sense that like refined carbohydrates, like those thin mints that you're definitely going to eat halfway through this episode, that those raise your blood glucose quite fast and sort of slow processing carbohydrates or protein raise it more slowly.

27:23but that's not true for every individual in exactly the same way. And so these are a way for people to kind of both get real-time feedback, but also figure out kind of what works for them. And there's some evidence that can help people keep their blood sugar in the range that you're looking for, which is something like sort of 70 to 140 is the range people are typically looking for over the course of a day.

27:47Emily Oster:Right. And for people with prediabetes, CGMs have been shown in some studies at least to delay the progression or even prevent the progression to full-blown diabetes, which is obviously an important outcome. And so for these people with disorders of insulin metabolism, right, so from prediabetes through diabetes, there's something disordered about this highly regulated system where a window into how that system is working can help you engage and behavioral changes to keep things working well for longer. But where the rubber meets the road then is like, what about all the people for whom the system is already working as intended?

28:29Emily Oster:Is there marginal benefit there? And the vast majority of people who are using these over-the-counter continuous glucose monitors are really those types. So I think that what people really want to know is like, okay, I'm not diabetic. I don't have pre-diabetes. I don't have, you know, the metabolic syndrome, which is a risk factor for diabetes. But I see these things out there and there's influencers online telling me that like, I need to use this to lose weight. I need to lose this to get my muscles better. I need to. I think a lot of the messaging is even much more specific than that. It's not like this is going to help you lose weight or get your muscles better.

29:06Although that that's out there. It's just like, you should use this to keep your glucose in a rate, like you should use this to not have glucose spikes and to sort of do various things to make your glucose. Like there's this idea that like the optimal glucose is a flat line at 90, like all the time somehow, like, and we're all, we should be like navigating our diet. So our line is flat at 90 all the time. Oh my gosh.

29:31Emily Oster:Yeah. So, so, so important. No. And actually, as I was researching this study and I was looking at some of these things, you know, you see all these people being like, I had no idea how much my glucose spiked after I did X, Y, or Z. And I think there's even like the onomatopoeia of the word spike. It's just like, that sounds bad, right? Pointy, sharp. We don't like spiking things. And so I, but I wanted to dig into the literature a little bit just to like check my priors and be like, wait, is that bad? Like, is it bad that, you know, after you eat something that has a lot of carbohydrates in it, the glucose level in your blood goes up.

30:08Emily Oster:And of course it turns out that like, well, of course the glucose level in your blood goes up when you eat carbohydrates, because that's what they do. That's what they do there. And that's what you want them to do. So for people who are thinking about this, let's just like level set. What is it that one acquires in, in doing this? So you can go on the internet and you can purchase from a couple of different companies. Abbott makes one, Dexcom makes one. You can purchase one of these monitors. You can purchase it for like a long-term subscription, or you can actually buy them for like 50 bucks.

30:40You can get this for two weeks. And it's like a two-week single-use monitor, and they ship it to you. And I've done this, so I can tell us. Tell me what happens. They ship you like a little thing. You stick it in your arm. It doesn't really hurt. It's like a tiny needle. It goes into your arm. It sticks on your arm, and it links up to an app. and the app will tell you in something close to, you know, real-ish time, kind of how your blood glucose is moving around. And that's it. Then you like look at that app at different times and use it for some kind of decision-making and there's a little line and that's it.

31:20Emily Oster:Okay. One of the problems we have in research where we have frequently sampled data, take a hospitalized patient's blood pressures. Okay. So we have a patient in the hospital, they have blood pressure measured every 15 minutes or something if they're in the intensive care unit, right? So we have all this data. We always have the question of like, how do I collapse that into a meaningful number? Like when it comes to a bunch of glucoses, is it the high that matters? Is it the low? Is it the variation, right? Like the coefficient of variation. Are the apps breaking that down or is it just like here's your line and like it turns red when it's above 140?

31:56Yeah, it's more of the second thing I would say. you know, they're not in this use case, they are generally not trying to provide people, I think, with much beyond like, here's how your glucose changes with, you know, around the day. And I think it's partly because the pitch people are getting is like, you can see which foods raise your glucose. So you can put in like, here, I did this activity, you know, I ate this, whatever. So the, I think the idea is in principle, you could combine this with activity or food consumption tracking and then see, you know, when I eat rice or when I eat cookies, my glucose goes up more.

32:36And then when I eat, you know, eggs, it doesn't go up as much. And that that would be in some way informative to, again, achieve this goal that I don't think anyone health wise really should be achieving of like a flag glucose. So I think that's the that's the kind of idea of the of the app. But there's not and there is some summary measure, Like they'll be like, your glucose is fine. You know, it's fine. Yeah, yeah.

32:58Emily Oster:I want a green box or something like that if I get it. There are, of course, companies now, actually including a company founded by Casey Means, who we played at the beginning of this episode, which will not only sell you, you know, it's a repackaged continuous glucose monitor from one of these companies that you already mentioned, but coupled with their own app that is supposed to, you know, use AI and combine and give you give you all sorts of health advice, you know, and this is part of the problem with kind of access to too much data, like, like, we have so many ways to monitor ourselves, right?

33:37Emily Oster:It started just with step counts, but now we have our heart rate variability and our sleep quality, and we could potentially do continuous glucose monitoring. That's really outpaced our knowledge of what to do with that information, which is why these people who are selling you like, oh, we're going to use this to give you the answer about your health are fundamentally lying because that data just doesn't exist yet. Like you can make recommendations about eating healthier and that's fine. And I suppose if seeing big deviations in your glucose convinces you to, you know, eat some more protein instead of eating that chocolate chip cookie, then that's like good biofeedback, but we don't really have outcomes.

34:15Yeah. So I think this is the real question for the data, I think it's kind of two questions. So one is when we look at, you know, trials of people in the general population who use them, these, which is actually not a huge space, but we don't really see much evidence that the use of these improves outcomes very much. Would you say that's your read of the data?

34:37Emily Oster:In people without diabetes, yes, that is my read. In terms of hard health metrics, there's not much. But I think there's a second question, which is, is this predictive? So one, there's a policy question, which is if you gave everybody a CGM, would they be less likely to have diabetes? And I think the answer is probably no, at least from what we know so far. There's a second question, which is, as a person who's concerned about your health, could you learn something from this that would be predictive, that would say, you know, well, you actually are at a higher risk for diabetes, you know, relative to your demographics, because something is going on with your blood sugar.

35:19And I think that's like, in some ways, the data there is like a little bit more complicated. So, you know, they've done, there's a, there's a study from the Journal of Diabetes Research, which looks at non-diabetic people using these CGMs. And some of them develop diabetes. There's, of course, strong predictors here of age and BMI, which we know predict development of diabetes. But there's also some evidence that people who spend more time in a high blood sugar range above 130, there's some predictive capacity. It's not very good, but it does sort of suggest that maybe these could pick up something about insulin resistance that would be a little bit predictive.

36:01I think is like the best, that's like the best case argument.

36:04Emily Oster:Yeah. So, but this is a classic correlation versus causality issue that, that we often face in this podcast. So there, there are multiple studies which show that among people who do not have diabetes response to an oral glucose tolerance test, which is literally like you come in fasting, we measure your blood sugar, we give you really sweet drink to drink, and we measure how high your glucose goes up. Like the people who go up higher in that test are more likely to go on to have diabetes. It could be that spending time at high glucose values, you know, flogs your pancreas enough such that you start becoming insulin resistant.

36:46Emily Oster:It also could be that what we're doing with all this, these testing is just identifying the type of person who already has some insulin problems. And the test is revealing that or the continuous glucose monitoring is revealing that you have some subclinical insulin resistance and that's it. And the reason that this matters is because if those spikes of glucose, right, that you're seeing on your glucose monitor, if those are causing downstream, bad downstream effects like diabetes, then limiting those spikes will limit the downstream effects of diabetes. And we should be telling people like, oh, yeah, you don't want those spikes.

37:30Emily Oster:The spikes are bad. However, if the spikes are just a sign that you're at risk, you don't know that limiting it changes that risk profile at all. And yeah, then you could say, OK, well, is there some other action that people should be taking? If you knew you were at higher risk for this, would you want to be more cautious about various kinds of health choices that you make or more monitoring or so on? Now, of course, most of the people who are doing these things as a recreational activity are already doing all the other things which are going to, you know, prevent diabetes. So I think it's a little bit, it's a little bit tricky there.

38:02Emily Oster:But the way to tease this out, of course, is to do randomized trials. And one tip for people who are looking at influencers in this space and hear some, any remarkable claim is always just to, you know, quickly Google the thing they're talking about, randomized trial, and the claim that they are making, and you'll often get a better sense of the truth than whatever people are saying. I wanted to bring up a meta-analysis, which is a summary of trials that randomized people without diabetes to continuous glucose monitoring versus no continuous glucose monitoring. And this actually showed that the people who use the CGMs did have a lower mean blood glucose than the people who weren't assigned to use CGMs.

38:49Emily Oster:This is a bit of a self-fulfilling prophecy. It's sort of like if you give someone a step counter, they end up taking more steps. Like you just, yes, you do. It's like a Hawthorne effect, basically. I'm watching you. You're watching you. You want to, you know, at least in the short term, you're incentivized to like achieve whatever is the thing you're looking for. Exactly. And so that's good, at least it's like, OK, there's some conceptual basis here. But but there was no difference in their body mass index at the end of the trial. And so, you know, this is an example of, yeah, okay, you got your blood sugar, your mean blood sugar down a little bit because you were watching it like a hawk and you were kind of like, oh my God, no, I'm not going to eat that cookie because it's going to give me a spike.

39:31Emily Oster:But in terms of something that maybe matters more in terms of outcomes like your BMI, no effect. Yeah, I guess my – I have a very simple like takeaway. If somebody came to me and they said, I'm thinking about getting one of these, like what – like should I? I think the question is, what is the information for? The same question I would ask if they told me like, I'm going to get a very complicated blood panel with like a hundred things in it. Okay. But what will you be doing? What, what action will you be taking differently based on this information? And then, you know, what are you like, what's the information you're looking for?

40:05Is this going to deliver that? And I think we can talk about whether there are situations in which, I think there are some in which this information could be valuable potentially, potentially but that is the question as opposed to just I'm interested so I can like see where this number is which is like okay yes when you eat things it's going to go up when you're hungry and you're like in the middle of the night it's going to go down I promise you will learn that

40:27Emily Oster:but like then what yeah so what did you learn like give me your personal story you wore this thing for two weeks how did it change your behavior why did you want it in the first place okay so I I actually had a reason for this so one reason is I'm a person who enjoys self-tracking and I was curious. But the main reason was that I had had as part of like a standard blood test, I had had a glucose test and my glucose even not fasted was quite, quite low. And so then there was a question of like, should I like, is it so low that I should be worried about it? And so I wore this thing and, and I learned like two things.

41:08One is that my glucose is sometimes like below the bottom of the range is 55. And like, I'm frequently dropping like under the, like, it like graze out at the bottom of the range. So I like sometimes have very low glucose, but I also then learned I have no symptoms of that. And so my doctor was like, I don't know, some people, it's a problem. That was an example of something was like, why did I know that? It's totally irrelevant. They did learn one actionable thing, which was about how I respond to eating carbohydrates while I run, which is that I respond quite a lot in a positive way. And so I like, you can sort of see when I'm, I could see when I was running, like when I took a gel, these running gels have like a very, like a very, very concentrated amount of like sugar.

41:57It's like, you know, like 40 grams of carbohydrates, like into like, and so I started taking those earlier in my run. I moved my gel fueling timing from four, 8, 12, 16 to 2, 6, 10 on the mileage. And that's, that's what I learned.

42:12Emily Oster:You lost me at, Oh, that's the number of miles. Jesus, Emily. Oh my God. You're such an athlete. So when you say like you timed it better, you're watching it and you're like, you're running and your glucose is kind of coming down or something as you run. And then you're like, I didn't watch it while I was running because I, you would bump your head into something. Afterwards, I could see like basically that I was like that, like there was a reason that at three miles I was often feeling tired, which is like, I could see my glucose was like at 50 or something. And then even if I did nothing, this is part of like the body system, even if I eat nothing, it will come back up.

42:49But if I took a gel at two miles rather than waiting to four miles, then I could basically stave off that low point because the glucose would maintain at a higher range.

43:01Emily Oster:You're no out aware of this, but the fun physiology here, this hitting the wall of physiology is when you deplete all your liver glycogen stores. So, you know, as I said at the beginning, there's actually very little glucose floating around your blood at any given time, like a teaspoon's worth. So obviously not enough to sustain a long run, but your liver converts glucose into glycogen, just sticks a bunch of glucoses together, basically, which sort of, it's like, it's like the running gel of the body. Like it can be quickly delivered back into the bloodstream and broken down into glucose um but there's a limited amount of it and typically yeah after a depending on what kind of athlete you are and how much you've eaten and all that kind of stuff and carbo loading and things like that you'll deplete your liver glycogen and you know let's say two or three miles and then you do you switch to what's called gluconeogenesis which is creating glucose from other stuff right breaking down protein breaking down fats so on and so forth and you do feel that difference like Like, you know, athletes like yourself probably know that feeling of like, I'm running, everything feels fine.

44:03Emily Oster:All of a sudden I'm like dragging a little bit. And, you know, if you're very in tune with your body, maybe you know that you feel that coming and you take your glucose gel. But maybe if you're not, a CGM would be useful here. And this is actually, I will say, in the endurance sports space, people use these for this exact reason, which is to sort of figure out what is the timing and approach to fueling that allows them to maintain a high level of glucose throughout a long distance endurance sport activity. Okay. Because that is like the easiest way to like, you basically don't want to get into that well, because then you can't move your muscles as fast.

44:44So, uh, the cycling Peloton, uh, like the guys who ride the tour de france they were using these to like try to optimize their fueling and then they got banned and i always feel like when something is banned in the cycling peloton you know that works right because these guys are like they're looking for the one percent you know uh i buy that

45:04Emily Oster:metric but just to say it out loud do we have any harder evidence than uh doping bans for endurance athletes in the use of of cgm is there any harder evidence than doping bans for anything um yes we have a little bit more harder evidence in sports so they've done some stuff in cyclists uh and runners who are doing like longer efforts and they basically find that if you give people a cgm it is helpful at optimizing their carbohydrate intake so they don't drop below 70 milligrams so it's not like there's just like a direct feedback exactly the thing i described which is for obvious reasons. If you use this to then inform your fueling, then you can do better at refueling.

45:52Emily Oster:I think it's interesting though, that like the best use case maybe we've come up with so far for people without diabetes or prediabetes is not keeping your glucose from getting too high. It's actually like watching out from getting too low while you're consuming a lot of glucose in your muscles. Yes, that is maybe what we learned. Okay. Are there any, I think the last thing I want to talk about here. So like to sort of put a pin in that, I think the question people can ask themselves is, you know, what am I planning to do with this? And not everybody's going to have the like I'm running for two hours version of this.

46:28But I think there are cases for saying, you know, I'm feeling really tired or really draggy in different times of the day. Like maybe there's some information in here that could be that could, you know, in some way be helpful.

46:41Emily Oster:Yeah, it feels like though your point about like a two-week$50 investment may be okay just to like play around and get a sense of your body. I'm not feeling like, oh, yes, and therefore you need the monthly subscription and like – No, I think I would never – I think there's almost no case for someone to do anything other than get 50 – spend 50 bucks for two weeks. And I think for most people, there's no case for that either. but the idea that you're going to endlessly wear one of these you know i will say i wore this like three days and i was like okay i've learned something and then it you know a weekend or 10 days and it fell off when i hit it with the laundry machine door and so then i just was like no that's probably enough information we should talk about some potential risks yes because nothing is nothing is risk-free um obviously it's breaking the skin you know some theoretical risk of infection.

47:36Emily Oster:And of course, there's the risk of spending money, which you have other things to spend your hard earned money on. But there is a new psychological condition is not yet made it all the way to the DSM, the Diagnostic and Statistical Manual, which are all the official psychiatric conditions, but it's called orthorexia nervosa. Have you heard of this? Yeah, it's like a over obsession with health. Yeah, eating healthy behaviors. Yeah, exactly. So orthorexia nervosa has been documented in several studies. Again, not an official psychological diagnosis yet, but it's basically people who become so obsessed and continuous glucose monitors can play into this with like maintaining that perfectly flat line that it starts to consume them.

48:22Emily Oster:And every psychological condition that does end up in the DSM always has a criteria that's like, and it interferes with your daily life, right? Like so, you know, alcohol use disorder, it's like you're drinking alcohol and it interferes with your daily life. And so there are people for whom things like this, the CGMs, even sleep trackers, that's called orthosomnia, like get so obsessed with kind of perfecting those metrics that their relationships suffer, their jobs suffer. It's all they can think about. If you feel like you're that type of person, do not put one of these on your body. I agree.

48:58And I think the other piece of this is I do not think people should fear foods. And there's a little bit of a sort of space in here. And you see this in the wellness influencer space. It's like, you know, I wore a CGM and I learned that I can never eat rice because when you eat rice, your glucose spikes in this way. You can only rice if you also put chicken on it. It's like it's fine to eat chicken with your with your rice. But I don't think that – I worry that people will sort of over-interpret just like basic variations in glucose that are totally normal. And physiology. And the basic physiology as some kind of like I'm broken because my blood sugar went to 130 after I ate a bowl of rice, which is a totally normal, regular thing to have happen.

49:48Emily Oster:And just to say, even larger spikes, well-documented spikes up to 160, 170, 190 after a meal, even up to 200 in healthy individuals can be normal depending on the amount of glucose that you ingest. And it doesn't mean that you're necessarily insulin resistant or broken in any way. It just means your body really efficiently broke down those carbohydrates and gave you a bunch of glucose. and then your body's going to do the thing that your body does, which is take all that excess glucose and stick it in the liver in the form of glycogen so that when you go on your run, you don't fall down flat. Exactly.

50:25Okay, Perry, continuous glucose monitors for non-diabetic individuals. Smash or pass?

50:32Emily Oster:Pass on this one. I think save your money. I don't think you're getting much information from it. Focus on something else. How about you, Emily? I think I'm also a pass even as a consumer. I think for almost no one is this really very useful. And I think a lot of the feedback that you would get from it, you could actually just get from paying attention to how you feel, which is actually more important than what some number is on an app. All right. That's it for Continuous Glucose Monitors, your mailbag question of the week after the break. Who doesn't love warm, carby comfort? Satisfying sandwiches, loaded bagels, rich mac and cheese.

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52:48Emily Oster:Hey, Emily and Perry. This is Adam from Parsippany, New Jersey. I had a question for you about statins and grapefruit. I've heard that you're not supposed to eat grapefruit while you're taking statins, and I didn't know, is it because they won't work as well? Is it that they're bad for you if you do. What's the deal? Thanks so much. Yeah, a lot of people always wonder, you know, it's really weird that on certain medications, it's like, you know, oh, take this with food, take this without food. Don't eat grapefruit while you're having this medication. It feels very specific. And it is and it all has to do with liver metabolism.

53:23Emily Oster:So grapefruit and grapefruit juice contains something called a furanocoumarin, which inhibits one of the enzymes in your liver that's responsible for breaking down some drugs, including some statins called cytochrome P450. And so if that enzyme is inhibited, then when you take a dose of that drug, it doesn't get broken down as fast and it can get to toxic levels more quickly. So it's not just or it's not that it doesn't work, it's that it is actively dangerous. Correct. Yeah, this is one of those things that makes drug levels higher, not lower. But there are other things that interact with the liver too that will increase the metabolism of certain drugs.

54:09Emily Oster:The most famous one of those probably is the interaction between alcohol and Tylenol in the liver. Those are both metabolized by the same receptor leading to something called the therapeutic misadventure, which is when, this is kind of fascinating and sad, when people try to overdose or commit suicide by taking Tylenol and alcohol together, the alcohol is competing for the Tylenol receptor in the liver, the thing that breaks down the Tylenol, and it is the breakdown product of Tylenol that's toxic in high doses. And so by drinking while you did that, you paradoxically sort of saved yourself. We see that from time to time.

54:49Yikes. Okay.

54:50Emily Oster:So don't do any of these things. But to get back to the statins. I'm going to have my, I'm going to have my thin mint now.

55:03Does this mean you can literally, like if you go on a satin for life, you're never eating grapefruit again.

55:08Emily Oster:That's it. Oh, now I'm chewing. Okay. You need to ask that question longer. I love grapefruit. Can I never have them again if I'm on a statin? No, the truth is most of the studies of the pharmacokinetics of these drugs, pharmacokinetics is like the concentrations that drugs get to in your blood after you take them, are based on people drinking double concentrated grapefruit juice in a significant quantity. And so probably like a bit of grapefruit juice here and there is not going to cause a huge problem. And of course, statins aren't particularly toxic at higher doses anyway. So a lot of these risks are more theoretical, but they are there.

55:55But if you were going to plan to be on a statin while also being on the grapefruit diet of the 1970s, which was an exclusively grapefruit oriented. That would be a mistake. That would clearly be a mistake. Okay. News you can use, people. That's it for us today. Stick with us next week when we'll ask, what's the deal with hormone replacement therapy? Wellness Actually is produced in association with iHeart Media. Our senior producer is Tamar Abishai. Our executive producer at iHeart is Jennifer Bassett. Our theme music is by Eric Deutsch. And our content is for educational purposes only.

56:34Emily Oster:If you like the show, help other people find us. Leave a rating and review on Apple Podcasts or your podcatcher of choice. And help us spread the word about the show. You can follow us on Instagram at wellnessactuallypod. And don't forget, we want to hear from you. Head over to wellnessactually.fm and leave us a question for our mailbag or suggest a topic for a future show. We'll let the influencers have the last word. I am not a diabetic but I decided to get my CGM because I wanted to find out what foods affect me. So here are some of the big things that I've learned in the past two weeks of wearing my CGM.

57:09Emily Oster:The food to spike my blood sugar the most was, drumroll please, sushi.

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