exploring the benefits and pitfalls of continuous glucose monitors (CGMs) with hayden james

Emily Field (00:00:00) – Welcome to episode 26 of the Macros Made Easy podcast. I’m your host, Emily, and today we have a fantastic episode lined up for you. We’re talking about all things continuous glucose monitors or CGMs. We’ll explore what CGMs are, how they differ from traditional glucose monitoring methods, and the benefits they offer for managing diabetes and beyond. We’ll discuss why CGMs are gaining traction among non diabetics, and how they can be insightful for anyone looking to optimize their nutrition. Plus, we’ll hear some fascinating stories from Hayden’s experiences and insights working with this technology every day. So whether you’re an athlete, someone managing diabetes, or just curious about the latest health tech, stay tuned for an enlightening conversation with Hayden James. Welcome to Macros Made Easy, the podcast that takes the confusion out of tracking macros. I’m your host, Emily Field, a registered dietitian that specializes in a macros approach. In each episode, I help you learn how to eat in a way that supports your health, body composition, and athletic performance goals. We’ll cover the basics of macronutrients how to track for various goals, the role of macros in your health, and how to make sustainable changes to your habits.


Emily Field (00:01:04) – I’ve helped hundreds of people experience more food freedom and flexibility while navigating their nutrition. So whether you’ve tried macros and it just didn’t stick or you just heard the word macros yesterday, I can’t wait to help you too. Joining us is Hayden James, a board certified sports dietitian, diabetes educator, and multisport athlete. Hayden has dedicated nearly a decade to the field of dietetics and boasts almost 20 years of experience in road and trail racing, from one mile sprints to 50K marathons and even multi-day mountain adventures. Not only is she an endurance athlete, but she’s passionate about backcountry and resort skiing, rock climbing, and weightlifting. In addition to her diverse athletic background, Hayden runs a successful sports nutrition private practice where she primarily works with endurance and mountain athletes. She also contributes her expertise as a diabetes educator in adult endocrinology, assisting individuals with type one, type two, and gestational diabetes. So Hayden is here. I’m so excited to talk to her. Tell me a little bit about your experience with using CMS. Hayden.


Hayden James (00:02:08) – Hey, thanks for having me on. Yeah, so I work in an endocrinology clinic, so I am viewing CGM data 32 hours a week. I mean, not all 32 hours a week in my clinic is looking at just that data, but quite a lot of it is. So I’m viewing blood sugar data on a lot of folks, mostly with diabetes. Type one, type two. Rarely. I’ll look at CGM data for someone with prediabetes, and then I have worn one personally, just on and off over the years that I’ve worked in diabetes. Like we have reps that come by bring samples. You always want to know what’s going on with the newest product and like be able to know how to use it so you can teach someone how to use it for one.


Emily Field (00:02:53) – Absolutely. So tell me, for somebody who’s just introduced to this topic, I would love to know, like your basic answer for this, what does a CGM actually monitor and how real time is that data coming through for somebody?


Hayden James (00:03:06) – Yeah.


Hayden James (00:03:07) – So a continuous glucose monitor is monitoring interstitial sugar. So I think a lot of times this gets confused or it’s used synonymously as blood sugar. So it’s another way to monitor the sugar level in your body besides using like a fingerstick glucometer the interstitial sugar. So that’s kind of the area around the cells. It’s not in your blood. That sugar actually changes a little bit slower than your blood sugar. So a lot of times it’s said to be a little lagged, like a little delayed from a blood sugar. Like those numbers are never going to align. If you check your blood sugar at the same time as wearing a CGM. Like it would be luck if you got the exact same number.


Emily Field (00:03:51) – Okay, that’s really good to know. So some people probably have experience watching a friend or a family member track their blood sugar with a quick fingerstick and then sticking it into a handheld monitor. But a CGM is something that you wear all the time. It kind of goes right onto your belly or the back of your arm.


Emily Field (00:04:07) – I think we’ve seen and that’s measuring something different. So those numbers are going to be a bit different. We’ll ever reach as high as your as your blood sugar. That interstitial glucose will ever reach as high as like a regular fingerstick.


Hayden James (00:04:19) – That depends too on the CGM that you’re using. So the ones that were made for diabetes, they will read very high, they will read up to 400. And then glucometer actually will max out at like 350 or 400 just depending on the brand. Okay. But some of the CMEs that have been made that are marketed towards people without diabetes, they don’t have them read as high because they, in theory, don’t need to because the blood sugar is only going to spike so high.


Emily Field (00:04:48) – So let’s talk about that. Let’s talk about the CGM use in non diabetics because it kind of sounds like I mean it really does feel like it’s really taken off in the last 5 to 8 years. What do you know about that. Why has it taken off in Non-diabetic populations I.


Hayden James (00:05:03) – Think a couple reasons. Number one, weight loss. It’s a huge industry. It’s one more thing that and we can get into getting into this, but that it’s being touted as helpful potentially for weight loss. So that’s one area. And then there’s this other area where certain people are suggesting that we shouldn’t ever have our blood sugar spike, and that from a longevity perspective and an anti-inflammatory perspective, that we just keep our blood sugars flatlined and that is healthy. So those are two of the areas I kind of see it going into. A third area up and coming is more for high level athletes using this to gauge like intra workout, particularly endurance sports fueling to keep blood high.


Emily Field (00:05:49) – So depending on the context of how you might learn about a CGM, maybe that would dictate whether or not you would want to use one. And if it feels right for you. I mean, I think about it from the perspective of nutrition education. I’ve been using this like idea of pairing proteins, fats, and carbs together in a meal for balanced blood sugar for a very long time.


Emily Field (00:06:08) – And just teaching someone that concept of where does where is protein found, where’s fat, where’s carb found? And aiming for a mixed macro meal can be very helpful for your blood sugar. But then when you take it one step further and say, maybe we can have some almost real time data to show how our body is responding to a mixed macro meal versus carbs alone that can be basic nutrition education, really illustrating the concept that we’ve been trying to teach as dietitian. So I think in that way that, you know, it’s kind of coming around as well.


Hayden James (00:06:39) – Yeah, absolutely. And I will say one of the things that makes me very CGM hesitant for folks without diabetes is especially a lot of these companies that are coming out that are marketing to people without diabetes, they are creating their own blood sugar targets within the apps that aren’t evidence. Ace. Interesting tips because I have someone wearing one right now that’s not one that I normally see in clinic, and giving some interesting tips that aren’t necessarily evidence based about their blood sugar.


Hayden James (00:07:15) – So yeah, that’s just something that I recently learned I didn’t even think about. Like these other companies being able to say, create their own targets within their apps for where they think your blood sugar should be and how they’re getting those numbers.


Emily Field (00:07:30) – Yeah, that’s super interesting. I had a similar experience with a different kind of wearable device or a device where you blow into, and they made their own assumptions about what was found in my breath or what fuels I was metabolizing. It’s called Lumi. Lumi. That’s the one I used. And it was fascinating because I agree with you as a registered dietitian and someone who knows metabolism more than the average person, it was very interesting to be like, oh, is that what you’re gathering from this? That’s what you’re deducing from this information is I must be eating too much fat, or I must be eating too much carb, and then taking these arbitrary numbers that, you know, it’s very flawed, in my opinion, of how they got this information, how we are going to use it.


Emily Field (00:08:12) – So it sounds like it’s happening with CGM tech companies as well.


Hayden James (00:08:15) – Absolutely.


Emily Field (00:08:17) – Well, on the opposite side of that, you know, so we’re not super anti CGM. You obviously are using these devices in the population that needs it. So a prediabetes or diabetes person, somebody with diabetes, do you want to tell us a little bit more about what benefits those people are experiencing by wearing a CGM versus like pricking their finger every once in a while or multiple times per day? Yeah.


Hayden James (00:08:38) – So one of the best things about a CGM is that you don’t have to prick your finger a million times a day, and when you prick your finger, you’re getting an isolated number. What is my blood sugar right in this moment? Whereas a CGM that is generally connected to your phone via Bluetooth is giving you blood sugar data every minute or every ten minutes, depending on what CGM it is. So you’re getting to see actual trends, and you’re getting to see all those numbers in between the finger sticks. So it has, you know, besides insulin, besides some of these other type two diabetes medications, CGMs have been probably the best thing to improve care for people with diabetes because we can get more data.


Hayden James (00:09:24) – We used to look at solely like hemoglobin A1, C, which is average blood sugar as a marker of. Is your blood sugar in a good range? Is it in a bad range where long term we’re gonna potentially see complications from that. Now we actually can use that CGM data as another marker of okay, where are you at blood sugar wise from a risk perspective. So they are absolutely lifesaving. And I think everyone with diabetes should wear one for sure.


Emily Field (00:09:56) – Yeah, I mean the cost has come down and the tech has become more simple. So I’m hoping that that is more in reach for people that really need them.


Hayden James (00:10:04) – Yeah, absolutely. And I think they’re valuable for people with prediabetes too. I think at least temporarily, with the education of them being able to see. And for the provider, where’s the abnormality here in the blood sugar, like what’s happening so that we can get more detailed information about where specifically, what time of day does the blood sugar tend to be elevated or what things tend to be a bigger trigger.


Hayden James (00:10:32) – How does changing the food changing exercise influence these trends? So super valuable?


Emily Field (00:10:38) – Yeah, I can see how that would be incredibly valuable for a health coach or for a registered dietitian or a practitioner if they had that information. Be able to like, isolate the time of day or the activity or, you know, the period of time where they’re not eating, instead of speaking on something or educating on an area that doesn’t need to be touched on, you can really go right to the heart of it and, you know, really tackle like the problem area, where is that person bleeding out that we need to help them? There, and then we can move on to other different things. That’d be so cool to see.


Hayden James (00:11:06) – Yeah, it’s really fun to look at blood sugar data. A lot of people ask me to look, I’m working in diabetes and I’m like, well, I do like helping people and people with diabetes need a lot of help. Yeah, it is really fun to look at blood sugar data.


Emily Field (00:11:19) – Yeah, I would imagine. Yeah. I mean, there’s so much to speak about. You know, there’s so many points of entry for nutrition education there with that CGM data. That’s amazing.


Hayden James (00:11:28) – Yeah for sure.


Emily Field (00:11:30) – I would love to know. Do you have a client story that comes to mind how like CGM data has helped make significant changes in their health or make significant changes in their nutrition habits, whether that’s an prediabetes, diabetes, or even a non-diabetic person. I’m curious if you have like a story time you can share with us about that.


Hayden James (00:11:47) – Yeah, maybe I will share someone that I’m working with now that has prediabetes. the diabetes part. I could talk about a million different people. Yeah, but I think she’s an interesting case because she doesn’t fit the. Typical mold of someone with prediabetes. I’m working with an ultra athlete, so she runs 50 K, which is about 33 miles. Trail races 50 mile. I don’t know if she’s a runner. 100, actually, 52 years old.


Hayden James (00:12:16) – Has now had prediabetes for about six months and just really doesn’t fit the mold. Blood pressure is normal. Cholesterol is normal. She’s quite lean. She’s got a strong family history of diabetes. Parent who has had her a onesie in the pre-diabetes range for 25 years, which also kind of begs the question of who, like her daughter, who’s following in this similar vein, what was really helpful for her to be on a CGM was for us to see exactly where is the blood sugar elevated. And what we determined is that after she eats blood sugars, what we call the postprandial blood sugars were completely normal. And that’s what I would expect out of someone who is running 15 hours a week on top of strength training twice a week, and right when you run 15 hours a week, that’s not me in the gym for two hours and I’m taking ten minute rest. That is 15 hours of continuous running a week. she’s an athlete. Yeah. And her overnights were a little elevated. Like, that’s what’s skewing all this data.


Hayden James (00:13:25) – And what we actually could see is that whether this was the CGM, her laying on it or not, I think sometimes it was affecting it, but her blood sugar would actually be falling and then popping back up and fall, popping back up in a way that to me showed the blood sugar is having a hard time staying up. And is she just having like a weird response to perhaps like under fueling? Like I just kept falling down and then popping back up? Maybe the body was just being a little too aggressive at releasing glucagon to raise blood sugar, and it was just skewing the average. So we actually it’s I actually increased your carbs. Like where everything might tell you, oh, she’s prediabetes. Let’s pull back on carbs. it’s really helped to actually even out her overnight blood sugars. Absolutely.


Emily Field (00:14:18) – So for people, I mean, I would I’m so thrilled that she’s working with you, because just what you said, I mean, if you were going to do a quick Google search about what to do about prediabetes and try to educate yourself, or maybe even worse, use the CGM app to dictate your choices about what to do about higher blood sugar she may be putting herself into, you know, even higher risk of developing diabetes because she’s going to be holding back on carbs, really demonizing carb rich foods.


Emily Field (00:14:44) – And for somebody as active as she is, it’s the last thing she needs to be doing. So I’m thrilled that you’re working with her. You added those carbs in likely at night, and so it’s helping her body be a bit more stable in that overnight fast where she’s not consuming.


Hayden James (00:14:59) – Yeah, and you’re right, she was restricting carbs. And it’s funny that carbs get demonized so much when we know, like really high fat intake is associated with type two diabetes and high fat intake is associated with even like transient insulin resistance. So I’ve actually even seen this on someone with diabetes who does the keto diet, and they reintroduce carbs and they’ve got the longest blood sugar responses, like blood sugars going a little too high because they still have that transient insulin resistance from that high fat diet. But then it leveled out. And so she was going a lot higher fat. And it’s like, well, we could actually be making this problem even worse. Like getting to the underlying insulin resistance.


Emily Field (00:15:43) – Yeah. I mean, at a cellular level, by having that much fat, you wonder if the cells are just less receptive to up taking that glucose, or it’s making it less receptive to, taking all nutrition or vitamins, minerals, things like that.


Emily Field (00:15:55) – Because we think about we know our cells are that fatty layer. And so having more fat in your diet or less fat in your diet could definitely influence that fatty layer. Yeah.


Hayden James (00:16:05) – And she’s one that I referenced. She was the first one that I’ve seen like a non icy Libra in Dexcom and Medtronic. That’s a sensor that hooks to a pump for people with diabetes. And so she was using a sensor that I had never heard of. I never reviewed the data. And it was telling her that like high end of her blood sugar needed to be 118 and that she should only be in the 70 to 118 range. When we can spike pretty high, we can go 180, even upwards of 200 without diabetes. And it’s like, how quickly is the blood sugar coming down? Like what is an hour or two hours after we eat? What does that blood sugar look like? And then when I was looking through her data and it just like pops up these random little tips, and one of the tips was, if you don’t spike your blood sugar above x, then you’ll lose weight.


Hayden James (00:16:58) – Oof, that’s not necessarily accurate. I mean, yeah, like if you just don’t eat, you just don’t eat. Never spike your blood sugar at all, then sure, that’s the case, but it’s like, no, you can be in a caloric deficit and be eating a high carb diet, right? And having your blood sugar spike and using weight. So those are. Two problematic things I saw on her app.


Emily Field (00:17:18) – Yeah, I’m imagining who this person is. She’s absolutely dedicated. She’s very structured in her exercise routine, she follows through and on goals that she sets for herself. These are the type of people that are interested in more data. They’re interested in wearing something like a CGM to learn more about themselves and to follow through to give them some sort of edge. Right? Yeah. When we have clients like that, which we we love working with people like that, it can be one of the most rewarding things as a dietitian, because we provide suggestions and they run with it, and sometimes they can become blinded, however, because they’re really being led by the data and not by feeling.


Emily Field (00:17:56) – So I’m wondering if you know the CGM niche that is being created by these companies or by these influencers that are being paid by these companies to, you know, hand out or hand out codes for CGM for non diabetics. We’re actually creating a problem because that person likely could have fell much better on higher carbs, but she would never have done that on her own because the app is telling her, here’s how to beat diabetes. Here’s how to lower your blood sugar by keeping with this very, very narrow range, which is not appropriate for her. So I worry about that a lot.


Hayden James (00:18:27) – Yeah, absolutely. And so that also led me to thinking, okay, anyone that wants a CGM, maybe we go with one that is made personal diabetes like the Freestyle Libre, the Libre three. That’s probably the popular CGM because it’s $35 a sensor, but you need a description. So it’s a 14 day wear sensor. It’s $75 a month. This guy was paying 150 to $175 a month for her CGM. And we’re like, this isn’t even meant for someone with diabetes, but somehow charging double.


Emily Field (00:19:06) – Yeah.


Hayden James (00:19:07) – I thought was interesting.


Emily Field (00:19:08) – Well a lot of times people think like the more expensive the better the tech. And that’s obviously not true here. In this example.


Hayden James (00:19:15) – I honestly didn’t even think about that. But that’s a good point. Yeah, yeah.


Emily Field (00:19:18) – I most recently had this happen with a client who was interested in getting one of those, like bioelectrical impedance, like Bluetooth smart scales for at home. She wanted to have a way to measure her fat loss in lean muscle gain, and I applaud that. Like looking at, you know, deeper than scale weight. But there are scales out there that can come 300, 400, 500 bucks. And it’s the same exact tech as something that’s 30 to $50. It’s interesting.


Hayden James (00:19:42) – Oh wow. That’s wild.


Emily Field (00:19:44) – So if we circle back to your client who is using the CGM still and you’re looking at that data, you’re obviously educating her to increase her carbon. Take, you know it sounds like her blood sugars are falling back to maybe more normal.


Emily Field (00:19:56) – They’re not seeing spikes in the evening. Can you tell me a little bit more about like the resolve of adding carbs there?


Hayden James (00:20:02) – Yeah. So her blood sugars are stabilizing right now. This has been about three weeks, so we’re still a little early. She’s supposed to get some labs done, I think in another like three ish weeks, something like that. So she’ll get an actual hemoglobin A1. See number two to see what the average has been. So I’m excited to see that.


Emily Field (00:20:24) – So will you encourage her to continue wearing a CGM, or do you think that you’ll help her get off of that once those blood sugars are stable? What do you think the future is with that? Because you know, she isn’t the typical person you would normally see with a CGM, and she obviously did this on her own to buy it. But yeah, I’m just curious what the future looks like with her.


Hayden James (00:20:41) – Yeah, I would say for if her numbers have normalized, then I would say, let’s get off of it because it’s served its purpose.


Hayden James (00:20:48) – And now we can maybe use these fueling concepts, and she’s going to be following up with her doctor yearly to get that fasting plasma glucose and the hemoglobin A1, C. So we’re going to still be able to monitor blood sugars, but maybe it won’t be quite as much. But I think it just depends how much her labs normalize. I will probably recommend at least take a break from it for a little bit, just because it’s a lot.


Emily Field (00:21:16) – Yeah, well, and if you’re I say this all the time too, with people who are tracking macros and maybe they’re using an app like MyFitnessPal and similarly to a CGM app, they’re, you know, providing recommendations, nutrition recommendations, and then maybe the best way possible, they’re really trying to get people to stay on their app or keep with it, keep with the tracking. But my Fitness Pal is so frustrating sometimes because it will bark at you if you are over your limits for a certain macro, or if you’re over on sodium or you know it’s it can be very predatory to engage with that app all the time, and it’s kind of running in the background of your mind.


Emily Field (00:21:51) – And I don’t think people realize this, that once you stop tracking or you move to an app that’s a bit more neutral, it’s really for data purposes and data purposes only. There’s no good or bad or failing or succeeding there that’s integrated with the tech. That can be really, really freeing. So I’m wondering if maybe she moved to a different CGM that didn’t have that much. I don’t know. They’re trying to provide some recommendations there between.


Hayden James (00:22:12) – Yes.


Emily Field (00:22:13) – You know, that might be a better experience for her. Or because she’s just not having that chatter in the back of her mind.


Hayden James (00:22:19) – We definitely are actually going to get her move to the Libra. Her doctor. I have no idea why we won’t get into the weeds about this. Her doctor wouldn’t prescribe it for her, and that’s why she went and got this thing on her own. And I don’t know why I would speculate that. Maybe the doctor didn’t want that data to get weaponized. You know that. You know, not all data is good data, right? Sometimes.


Hayden James (00:22:43) – Is it going to cause undue stress for her? But I would think as a provider and as a, you know, internal medicine provider. Yeah. Let’s let’s have you wear a CGM. Let’s come back and let me see what is going on with your blood sugars. So that was a little, little disappointing. But she told the doctor she was working with a diabetes educator. And so the doctor like, finally gave her a prescription and she just had already re-upped, I think for like two months for the CGM.


Emily Field (00:23:12) – Do you find that to be true? A lot of times. I mean, it sounds like in your clinic you’re working mostly with people with diabetes or prediabetes. So maybe it’s not as hard to get that prescription for a CGM. But how often does that happen where a provider is not willing to write that script?


Hayden James (00:23:26) – It’s very rare for me, and I don’t know if the difference is I work for a giant healthcare entity, and so most of the people that I’m seeing are within my company.


Hayden James (00:23:38) – And so I’m seeing the same doctors refer. And I think there’s a level of rapport there that if I’m recommending they get a CGM, I can just electronically propose that to the doctor and they accept or deny and they just always accept.


Emily Field (00:23:53) – Nice. You’re used to seeing that. Yes.


Hayden James (00:23:55) – Yeah. So I don’t know if it’s just because of. Yeah. Of, of just working in this same company. it’s like a mutual trust there or what.


Emily Field (00:24:04) – Well, so you did say that you have experience yourself wearing a CGM. You’ve tried many different models because the reps will want you to have some experience with their tech. But I’m curious about your experience with CGM. Good, bad. Ugly. You know, can you tell me some of the highlights that it has shown you since you have worn one?


Hayden James (00:24:21) – Yeah, it was very boring. It was very boring when I the last time I wore I think the last time I wore one was two years ago. I have a new one in my. We’ll talk about that because it’s kind of fun.


Hayden James (00:24:33) – But that was the last time I wore one. And I think because of having that good understanding of like normal versus abnormal blood sugar spikes, I just found it really fun and interesting and I even I so I work in diabetes, a lot of my coworkers have diabetes like most of them have like type one. And so one of my friends who is my coworker, like I was like, I just want you to chug like 32oz of soda or lemonade or something. And so I live in Utah soda shops or like a thing here like this, but like the fancy soap where they put the syrups and the cream and all that good stuff. And I remember getting, like, a 32 ounce and chugging it and my blood sugar, I think it spiked like one 8190, but it seemed like it came right back down, even though I was still drinking it like the blood sugar didn’t like, stay high or keep spiking because I was nursing this 32oz of drink over, like, you know, 10 or 15, 20 minutes or it took me to drink it.


Hayden James (00:25:31) – But yeah, I, I honestly didn’t find it, like, too exciting.


Emily Field (00:25:36) – Yeah, that’s exactly what you would expect. You or somebody who doesn’t have an issue with insulin or glucose or your pancreas in any way. So your body is responding to the stimulus of having more sugar. And so it’s executing as you would expect it for sure.


Hayden James (00:25:50) – Yeah, I would say one of the interesting parts about wearing it was so I do a lot of skiing. And one morning this was like 6 a.m.. So it’s like single digits. Keep in mind, when ski touring with some friends, I kind of try to guesstimate how many carbs I ate before I had like 75g of carb worth of two small scones, blood sugar spikes. I was like, oh, this is great. Spiking right before I’m about to be active. And then like 15 minutes into ski touring, my blood sugar plummets to 54, which technically still kind of normal, but that amount of spike and that fall is abnormal. But I was not symptomatic at all and I just waited it out.


Hayden James (00:26:33) – So I was like, well, it’s no skin off my back. My my blood sugar is probably going to do what it needs to do. And it just walked right back up.


Emily Field (00:26:39) – So would you say that’s an indication of what you’re saying about the interstitial fluid maybe not being as accurate? Or do you think your body you actually did plummet that low. It read that low and your body responded the way it should.


Hayden James (00:26:51) – I’m not sure. So part of the issue could be that I don’t know if the cold, how cold it was, even though I had layers on, did that affect it? We know that the skin temperature, like different things, can affect CGM readings like even I think like pH levels can affect the CGM reading placement. Like I think lag reads. Is it higher? I wrote this down because leg reads lower values typically than the arm. But yeah, oxygen concentration, pH levels, skin temperature can affect it. So I’m like, well did it just get really cold and like and it’s reading lower because it was just even though it’s not blood sugar.


Hayden James (00:27:30) – But if there wasn’t a lot of blood flow there.


Emily Field (00:27:32) – Yeah that’s a really good point. Yeah.


Hayden James (00:27:34) – Or did I actually go that low? And I had a little bit of rebound hypoglycemia where I spiked my blood sugar with a lot of sugar, and I just had too good of an insulin response. So much insulin was released, it pulled too much sugar out of the bloodstream and cause hypoglycemia, a combination of those things. I thought it was interesting, but then it popped right back up to normal and that was it. Yeah.


Emily Field (00:28:01) – So overall, you’re saying it’s boring. You know, you wearing a CGM is pretty boring just because your blood sugar responds the way that you would expect it. Are there any times that you’ve done any experimentation with like liquids versus solids or mixed meals versus isolated carbs? I mean, you just said you did like refined sugar in order to spike your blood sugar on purpose before exercise. Like what kind of experiments, if any, did you do?


Hayden James (00:28:25) – Yeah. So I did the lemonade thing and that was 32oz of lemonade.


Hayden James (00:28:28) – And I was just sitting at work like I was sitting all day and it spiked, but it came right back down. Which. Right. That’s what it’s supposed to do. If someone doesn’t have any sort of insulin resistance going on, then we expect that to happen. Just like as we age, we get a little more insulin resistance. So 45 years or older, yes, I would expect things to be a little bit higher than a 20 something year old or early 30 something year old. But yeah, that was my experience. Yeah.


Emily Field (00:28:59) – I wore a CGM as well. It’s probably been about 18 months or two years ago as well. I was gifted the tech and I can’t even remember which company I was not should find that information circle.


Hayden James (00:29:12) – Or was it a rectangle?


Emily Field (00:29:13) – It was a oblong little rectangle.


Hayden James (00:29:16) – Oh, it was probably a Dexcom. Dexcom?


Emily Field (00:29:18) – That’s exactly what it was. Yes. And I found, you know, as a data interested person, you know, I say this all the time, like somebody who’s kind of attracted to a macro tracking sort of world is interested in data.


Emily Field (00:29:30) – And I think I got caught up in that. All data is good data framework. And it’s that’s not true. I think I loved running experiments. You know, liquid carbohydrates versus solid carbohydrates. You know, I did like refined foods versus maybe more whole foods eating with or without exercise, eating and then being sedentary and then eating and then doing exercise, mixed meals versus like carbs alone. That was all fun and dandy. But to your point, it really performed exactly the way that I thought it would. And then I think I was probably like six weeks in to using this. I did it for three months, and I just found myself to be a bit more hyper obsessive than I thought I would get. And I wish I could remember if it was giving me alerts, or if it was like sending me information about how to control my blood sugar, how to keep it as low as possible, how to get my blood sugar down as quickly as possible. It kind of made me feel a bit paralyzed, so I think that was my caution.


Emily Field (00:30:26) – And that always is my caution to people who do not have diabetes. And they want to wear something like this. Sometimes seeing that data and watching it real time might not be a healthy behavior, but you might not just need to know yourself. And I thought I did, and I do know myself very well, but it was just an interesting time where I was just I think you’re just inundated with those numbers. What is that phrase like? What you focus on grows. And I was really focused on that. And that kind of grew my attention in a way that I didn’t love.


Hayden James (00:30:52) – That makes a lot of sense. Especially three months is a long time to wear a sensor. I think if I were a sensor for that long, I would end up going that direction. I either go that direction or I would end up just completely like ignoring it, ignoring it.


Emily Field (00:31:07) – And so then what’s the point exactly?


Hayden James (00:31:10) – One of the two.


Emily Field (00:31:11) – Yeah, I really enjoyed it for the exercise piece, like you said, like doing strength training, you know, going on my walks with my dog or doing something like biking for long bouts.


Emily Field (00:31:20) – And it was really cool to be able to see the body in, well, it’s not technically real time. There is a lag with a CGM, but it was really fun to see it kind of spiked during exercise because it’s your body is working correctly, it is helping you utilize the stored fuel that you have in your liver and your muscles to fuel your exercise. And so somebody who doesn’t know that might be a little alarmed by that, though. They might be like, well, I’m exercising. My blood sugar should be going down right now, but usually that’s going to happen a bit later or after that exercise. Would you agree that that was probably what was happening exactly?


Hayden James (00:31:53) – In fact, I pulled up a little example for this because I thought we might chat about this. There’s a great writer for outside magazine. I think he’s he has his PhD. I don’t know if it’s exercise physiology, but he wrote an article for outside magazine about CGM use. Oh, I love that. Yeah, I’ll send it to you.


Hayden James (00:32:10) – It’s really good. So a professional runner wore one, and this guy’s fast. One hour and 31 second half marathon.


Emily Field (00:32:19) – Oof! Yeah.


Hayden James (00:32:20) – He’s quick, very quick. Yeah. So his blood sugar maxed out the sensor throughout the whole race. It was so I wouldn’t even read it. So this is an elite athlete. Probably very lean right. As a lot of elite runners are very fit and had his blood sugar spiking over 200 during that high intensity race.


Emily Field (00:32:42) – Because he was fueling properly. And he was he fueled properly before that race. And his body’s utilizing those carbohydrates that are stored in real time. That’s really cool.


Hayden James (00:32:52) – Yeah. And it’s like the body’s trying to mobilize. It knows that the working muscles need fuel. And if we need to mobilize as much fuel sources as we can. So we’re dumping a lot of sugar into the bloodstream to extra fuel where it needs to go.


Emily Field (00:33:06) – So in that article, we can link it in the show notes to if people want to take a look at it, what was maybe the conclusion around athletes in CGM or did they not really go there?


Hayden James (00:33:15) – Yeah.


Hayden James (00:33:16) – So I know there’s some ongoing research in it, but we don’t have data yet. I’m Super Sapiens, which is owned by Abbott who makes the. Ray. They are actively doing research. According to this article, they have a team of 70. I’m doing research on CGM use, I think, for the purpose of can we use real time blood sugar data for intra workout fueling? But the jury’s still out on that. I’m a little skeptical. I have some healthy skepticism, but also very intrigued, mostly because, like. We’re using fuel from other areas, like our blood sugar isn’t going to be the only piece of the fueling puzzle. So I think there’s some active research looking at blood CGM use in detecting under fueling, which kind of makes sense if athletes have very low carbohydrate availability and the body is having to work really, really hard to maintain normal blood sugar. Are they going to just run low? Normal is the body’s going to say, okay, I don’t have a lot of fuel here.


Hayden James (00:34:16) – I’m going to run my blood sugar bare minimum normal to help keep me alive. I think that’s another interesting area of research.


Emily Field (00:34:25) – I love to see that we’re doing that. I’d love to see that we’re putting great minds behind it and learn more. Yeah.


Hayden James (00:34:30) – I can use it outside of diabetes is still very, very new. I think there’s going to be a lot of updated information on prediabetes, updated information on what is normal versus abnormal blood sugars. As these are out, longer and more research goes into non diabetes. Yeah.


Emily Field (00:34:51) – Well I think that’s kind of where it was like wondering your personal opinion on this or maybe even professional opinion because you work on this work with this all the time. But what are some maybe potential risks or downsides for non diabetics to be using CGM other than kind of the ones we kind of already talked about the lag time, maybe not as accurate as a fingerstick, maybe getting hyper focused on the numbers, you know, don’t really maybe matter. But I’m curious if you have any other risks or downsides you would alert people of if they’re considering a CGM?


Hayden James (00:35:21) – Yeah, I think the question is like, why does someone want to wear the CGM? Like, what are they hoping to get out of it? Is this I want this to help me with weight loss.


Hayden James (00:35:31) – Is this I want this to help me as an endurance athlete. Feel my workout. Is this like what? What’s the purpose? Because I think the biggest downside is if you don’t have an understanding of what normal or abnormal blood sugar spikes are, then it could scare you to eat anything that spikes your blood sugar. I think there is a narrative that gets touted out there that says, oh, you know, we don’t want our blood sugar to spike and to have a crash. It’s like, well, actually, if you really think about if insulin is doing its job, our blood sugar should come down pretty darn fast after we spike it. So in a sense, okay, yeah, maybe I don’t want to use the term crash for that, but that’s what it needs to do. We don’t want to spike and stay high and just hang out there. We want it to spike and come right back down.


Emily Field (00:36:24) – Actually, having me question the way I you I use language when I coach clients around like what normal healthy blood sugar balance looks like.


Emily Field (00:36:31) – That’s a really good point. You know, if you do not have diabetes, that rise and fall might be pretty rapid. And that’s okay, especially if you’re overall a well-rounded, you know, kind of healthy person. Yeah.


Hayden James (00:36:43) – And and I think sometimes too, maybe the blood sugar crash piece also gets mixed with hunger. You know, actually, I forgot to mention this was something that I found very interesting about the CGM when I wore it. So there have been times where I thought maybe my blood sugar was low. I was kind of shaky, I was sweaty, I was ravenously hungry. These are like classic symptoms of low blood sugar. I’m going to CGM and I had those instances happen. Sometimes blood sugar was completely normal.


Emily Field (00:37:12) – Yeah I totally remember this happening to me too.


Hayden James (00:37:15) – And then it’s not low blood sugar. It’s I’m hungry. But sometimes the narrative can be like oh well your blood sugar is just low. It’s like, well, maybe, but probably not like have normal blood sugar response, normal insulin response.


Hayden James (00:37:31) – So that kind of language I think can sometimes maybe it could, could confuse people. Yeah. You could have a low blood sugar or when you’re shaky sweaty you could just be really hungry.


Emily Field (00:37:41) – Yeah. Normalize eating in regular intervals and normalize recognizing hunger. Maybe not just blaming it on a blood sugar issue all the time. I like that if somebody is considering wearing a CGM and they do not have diabetes, what are some differences in the way that you would consume that information versus somebody who has diabetes? In other words, is there differences in how those CGMs perform in non-diabetic versus diabetics?


Hayden James (00:38:06) – Oh, that’s such a good question. I’ve actually not read the data on how different the CGM read for people with or without diabetes. Well, one of the reps kind of explained to me in layman’s terms was that because people without diabetes or blood sugar is so much more stable that somehow the CGM, it’s harder to read because we have less peaks and valleys? somehow having more stable blood sugar is harder for the sensor to read.


Hayden James (00:38:36) – I can’t tell you why it doesn’t make sense to me, but that’s what I heard from a rep, and I’m not a anything beyond that.


Emily Field (00:38:43) – So that really just furthers the point if you. Are considering getting a CGM and you do not have diabetes. It might not be helpful or usable data because it’s just reading so frequently, every minute, every five minutes, and because you’re not having peaks and valleys, because you have a you have normal working insulin and normalize cell sensitivity, you know, how how usable is that data even?


Hayden James (00:39:04) – Yeah, I think that’s the big elephant in the room with these. I do think that if someone wants to use one and they don’t have diabetes, work with someone who understands what the blood sugars are so that you’re not left in the dark of figuring it out yourself because they, you know, no tech is perfect, right? With anything. And I even pulled up, you know, every CGM has like a margin of error and they all vary between. I think that I looked at the new Freestyle Libre three.


Hayden James (00:39:36) – The margin of error is like just under 8%. Dexcom advertises 8.2%. I don’t know what all these other companies, yeah, these.


Emily Field (00:39:45) – Ones that are probably not even testing for their margin of error.


Hayden James (00:39:48) – Yeah, yeah, maybe. Or I think some of them like the one my client was using, I think they buy Dexcom CGM and then they use, they built their own app to connect to that. how many of them are doing that? Like, I just I’m.


Emily Field (00:40:05) – Sure there’ll be more and more companies popping up that are going to, like you said, maybe once we get more data on athletes using CGM for intra fueling, intra workout fueling, or maybe even a new angle, we don’t even realize yet, there will be new tech to match it because that’s the world we live in, right? We create niches wherever we want, and then create a product to feed that need of that niche for sure.


Hayden James (00:40:24) – Absolutely.


Emily Field (00:40:25) – So I guess what we’re saying is that CGM technology is absolutely beneficial to somebody who has diabetes or even prediabetes, because, again, it can help you, that person with diabetes or pre-diabetes, the practitioner who’s helped like helping to educate you and heal that condition, or a dietitian who wants to educate you or can help educate you about how to, you know, make mixed macro meals or to spread your meals out differently or educate on food content like, I mean, that seems like net good.


Emily Field (00:40:55) – It seems like a net good technology for people who really need it, who have some dysregulation in their blood sugar. Would you agree?


Hayden James (00:41:02) – Absolutely. Unquestionably. It’s awesome tech.


Emily Field (00:41:05) – and when it comes to somebody who doesn’t have diabetes and is really using it for just curiosity’s sake, or because they think it will help them get an edge for weight loss, we would maybe say yellow light, maybe not necessarily net good or net bad, but we really have to do some examination of why we are using that tech or wanting to use that tech, and to really consider who we use that tech with. Like maybe we consider working with a registered dietitian, somebody that really knows what they’re looking for to help you through those tougher challenges that could come about by working with that app.


Hayden James (00:41:37) – Absolutely. I like to use a phrase that information can be a tool or it can be a weapon.


Emily Field (00:41:43) – Yeah, that’s very true with this tech for sure. Thank you so much for being here, Hayden. This is really enlightening.


Emily Field (00:41:48) – I learned a lot and it kind of renewed my curiosity for CGM. So I’m like, yeah, maybe if I had talked to Hayden before I worked with mine or maybe even worked with you alongside my own CGM experience, I could have learned even more. So thank you for sharing all this today. I’m really curious if you could just share a bit about where to find you, where to follow you, and if you have. I know you work with clients one day a week. If somebody wanted to work with you, where would they go?


Hayden James (00:42:12) – Yeah, so I own a private practice. It’s called satiate nutrition satiety because that is a very hard word to spell. You can find me on Instagram @SatiateNutrition or my website, satiatenutrition.com and I work with all kinds of athletes. My niche is endurance and ultra endurance though, so if you run ultramarathons, long mountain biking races, you rock climb. That’s my favorite sports.


Emily Field (00:42:44) – Yeah, I love watching you and your ski adventures.


Emily Field (00:42:47) – Your run adventures, trail running adventures, all that you have going on on your Instagram. It’s really fun to see. Thank you.


Hayden James (00:42:54) – Yeah, well, I appreciate you having me on. This has been super fun.


Emily Field (00:42:57) – Yes. Thanks so much. As we wrap up this episode with Hayden James, we’ve explored continuous glucose monitor and their impact on both diabetics and non diabetics alike. From understanding how CGMs work to discussing their benefits for managing blood sugar levels and optimizing nutrition. Hayden has provided insights and practical advice. We hope you found this discussion as fascinating as we did, but now I’d love to hear your thoughts. Are you curious to try out a CGM yourself? Do you think you’ll leave this tech on the shelf after our conversation? Let us know your thoughts and experiences on Instagram and thank you, as always for tuning in to the Macros Made Easy podcast. Thank you so much for listening to the Macros Made Easy podcast. If you enjoyed this episode, take a screenshot of the one you’re listening to right now to share it on your Instagram Stories, and tag me @EmilyField so that more people can find this podcast and learn how to use a macros approach in a stress free way.


Emily Field (00:43:51) – If you love the podcast, head over to iTunes and leave me a rating and a review. Remember, you can always find more free health and nutrition content on Instagram and on my website at EmilyFieldRD.com. Thanks for listening and I’ll catch you on the next episode.

Have you ever heard of continuous glucose monitors (CGMs)?

This technology is transforming how we approach nutrition, offering real-time data that can lead to significant health improvements.

In this episode, I had the pleasure of sitting down with Hayden James, a seasoned sports dietitian and diabetes educator. Hayden James and I discuss the broader applications of CGMs, from weight loss to optimizing athletic performance. Our conversation includes client stories, the importance of evidence-based recommendations, and the need for thoughtful consideration when interpreting CGM data. 

If you’re a health data nerd like me, this episode is one you won’t want to miss. Join us for our discussion to learn more about:

what are CGMs?

Continuous glucose monitors are devices that track glucose levels in real-time by measuring interstitial sugar levels. Unlike traditional finger-prick tests, CGMs provide continuous data, allowing users to see trends and patterns in their blood sugar levels throughout the day and night.

how do CGMs work?

CGMs consist of a small sensor inserted under the skin, typically on the abdomen or arm. This sensor measures glucose levels in the interstitial fluid and sends the data to a receiver or smartphone app. The data is updated every few minutes, providing a comprehensive picture of glucose fluctuations.

benefits of CGMs for diabetics

Eliminating frequent finger pricks

For individuals with diabetes, CGMs offer a significant advantage by reducing the need for frequent finger-prick tests. This not only minimizes discomfort but also provides more comprehensive data for better blood sugar management.

Real-time data for better management

CGMs provide continuous data, allowing for real-time adjustments in diet, exercise, and medication. This can lead to improved blood sugar control and reduced risk of complications.

Identifying patterns and triggers

By analyzing CGM data, individuals can identify patterns and triggers for blood sugar spikes and drops. This information is invaluable for making targeted interventions and improving overall health outcomes.

client story: the ultra-athlete with prediabetes

Hayden shared a compelling story about an ultra-athlete with prediabetes who experienced elevated blood sugar levels overnight. Through CGM data analysis, they discovered that the athlete’s blood sugar was falling and then spiking back up, indicating a potential response to under-fueling. 

By increasing the athlete’s carbohydrate intake, they were able to stabilize her overnight blood sugar levels, demonstrating the valuable insights gained from CGM data for personalized nutrition interventions.

potential pitfalls of CGMs for non-diabetics

Misleading data and narrow targets

One of the main concerns with CGMs in non-diabetic populations is the potential for misleading data. Certain companies and influencers may promote narrow blood sugar targets, leading to unnecessary stress and obsession over minor fluctuations.

The risk of obsession

Hayden and I discussed the potential negative impact of using CGMs, particularly for those who may become hyper-focused on the data. Constant feedback and recommendations from apps can lead to feelings of stress and obsession, detracting from overall well-being.

For non-diabetics, it’s crucial to understand that normal blood sugar responses can vary. Misinterpreting these responses as abnormal can lead to unnecessary dietary restrictions and anxiety.

Recommendations for using CGMs

Work with a registered dietitian

If you’re considering using a CGM, especially if you don’t have diabetes, it’s essential to work with a registered dietitian who understands blood sugars. They can help you interpret the data accurately and make informed decisions.

Set realistic expectations

Understand that CGMs are not perfect and have a margin of error. For example, the new Freestyle Libre 3 has a margin of error of just under 8%, while Dexcom advertises 8.2%. 

Set realistic expectations and use the data as a tool, not a definitive measure.

Focus on overall health

Rather than becoming overly focused on blood sugar numbers, prioritize overall health and well-being. Use CGM data to inform your decisions, but don’t let it dictate every aspect of your diet and lifestyle.

Take breaks if needed

If you find that using a CGM is causing stress or obsession, consider taking a break. As Hayden mentioned, if your numbers have normalized, it might be beneficial to take a break from using the CGM and monitor blood sugars through other means, such as fasting plasma glucose and hemoglobin A1C tests.

Continuous glucose monitors offer incredible potential for managing diabetes and optimizing nutrition, but they also come with challenges, especially for non-diabetics. By working with a registered dietitian, setting realistic expectations, and focusing on overall health, you can make the most of this technology without falling into the pitfalls of obsession and stress.

Are you curious to try out a CGM yourself? Or do you think you’ll leave this tech on the shelf after our conversation? Let me know your thoughts and experiences on Instagram. Thank you, as always, for tuning in to the Macros Made Easy podcast.

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