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Medscape
10 hours ago
- Health
- Medscape
S3 Episode 6: Type 2 Diabetes and Continuous Glucose Monitoring
This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider. Carol H. Wysham, MD: Welcome to season three of the Medscape Type 2 Diabetes podcast series. Today, we'll discuss continuous glucose monitoring (CGM) in practice. First, let me introduce my guest, my dear friend, Dr Grazia Aleppo. Dr Aleppo is a professor of medicine in the Division of Endocrinology, Metabolism, and Molecular Medicine at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois. She is also the medical director of the Northwestern Medicine Diabetes Training and Education Podcast. Dr Aleppo, welcome to the Medscape InDiscussion Type 2 Diabetes Podcast. Grazia Aleppo, MD: Thank you, Dr Wysham. It's a pleasure to be here with you. Wysham: You have been at the forefront of the use of CGM in patients with diabetes. In the early days, could you even imagine the impact that CGM has made in the care of our patients with diabetes? Aleppo: This might sound so strange to you, but I was a fellow when the first CGM with the cable was introduced to the market. Cupid's arrow struck my heart, and I thought, this is it. This is going to make a humongous difference in people's lives. I had no idea that CGM would become so very useful, user-friendly, and ready to be used without cables. The fact that we could see numbers and trends and make the invisible visible was amazing. I hoped CGM would become better and better. But this really exceeded my expectations. I'm so happy that CGM is going so far in medical care. Wysham: We want to thank you for all the research that you've done to support the use of CGM in our practice. Thank you. So, let's start with the newest recommendations that were outlined in the 2025 ADA Standards of Care for patients with diabetes. Will you review the latest recommendations? Let's start by focusing on the language about patients on insulin. Aleppo: I had the opportunity and the privilege to work on the professional practice committee for the past 3 years. I've seen the development and the changes in the guidelines in the technology section. This last year, we decided that it was time to put together all the insulin users without specifying the type of diabetes they have or whether they are youth or adults. The 7.15 recommendation states that people with diabetes on any type of insulin should use CGM. That is very important because we need to start understanding that CGM isn't going anywhere. Not only that, it's actually expanding. The point is that everybody who uses any type of insulin doesn't have to have multiple belly injections; it can be basal, it can be correction only, and they can and should use a CGM. Wysham: Your last point is really important. Correction-only insulin is common as we pull people off multiple daily injections, and they may be on basal plus a GLP-1 or a GLP-1 alone but still have the insulin for correction. Many people don't think of that population as being appropriate for CGM, and I agree with you. How about changes in the language about using CGM in patients with type 2 diabetes who are not on insulin? Would you review those recommendations? Aleppo: Indeed, I'm very proud of 7.16. It took a while to separate this. I had to dig into the literature to make my case and say there is enough data today to state that CGM is an option. Remember that the recommendation states to consider using CGM, and the recommendation is level B, which is pretty high. Level A grade is the gold standard of randomized controlled trials. Level B is just below it. The reason why we wanted the recommendation was that the data is there. We need to be aware that CGM in people without using any insulin is paramount. It's so important because this patient has never used a glucose meter. They have no idea what their glucose levels are. And here comes the CGM, and they say, oh my gosh, I never thought that this or that could be a response to a meal, stress, sickness, exercise activity. And so that, for me, was a hugely important thing. Now we're hoping, of course, that we could have a recommendation "A." But I also want to mention that these clinical trials better be done soon, because very soon, it won't be fair to do a clinical trial and take people off of CGM. Who would want to do that? Wysham: In my clinical practice, I have a lot of patients who are not on insulin on CGM, and they cannot imagine not having it. They are so in tune with what affects their glucose levels. As you know, patients with type 2 diabetes, not on insulin with no instructions, can improve their glucose control just by what they see on the CGM. Aleppo: More than that, patients in my clinical practice were able to come off of insulin, stay on GLP, and maintain a very high timing range. So I asked a patient, why do you want to stay on CGM? You no longer take insulin. She said, 'Oh, I'm not going to give it away, ever. It really changed my life.' I believe her, because patients really have been able to own their diabetes. It's no longer the doctor, the provider, or the clinical practitioner saying do this or that. The patients are saying it to themselves every day. We see patients twice a year, three times a year. It's not possible to make changes in their motivation with just one meeting. But when they see the immediate feedback in the moment, they can say, I can do this to change and make a better choice for myself. That is huge. Wysham: I agree. I know this isn't in the standards of care, but in your opinion, do you think all patients with gestational diabetes should be on CGM? Aleppo: I think so. I have a strong belief that these patients are at very high risk for everything: macrosomia or the risk of peri labor, but also, when they have delivered, they are at risk for diabetes. Why do we wait for week 28 to give patients this huge amount of sugar, give them a stress test on their beta cells, and then want them to eat nothing without any feedback? It's not possible. We should really try to accomplish what the Hyperglycemia and Adverse Pregnancy Outcomes study showed us. The glucose should really be lower. We can't think about these sorts of arbitrary numbers in the oral glucose tolerance test. I'm thinking about the woman with gestational diabetes. This person has so many stressors. They are supposed to have this very strict meal plan without any feedback. That becomes very difficult for them to do, let alone go on insulin. I feel that we should really consider placing gestational diabetes patients on CGM as soon as we can. We'll have better results and better outcomes for the mother and the baby, less macrosomia and fewer complications during labor and delivery, and also knowledge of the person who has the CGM to understand how to manage these very tight glucose levels. It's very hard to achieve. Wysham: I find that CGM helps patients with CGM understand when it is time to start insulin. People accept it more when they actually see it with their own eyes. You are in a university-type setting. Can you describe the patients you see in the clinic who have diabetes? Which patients will you prescribe a CGM or suggest it for your patients? Aleppo: We have a tertiary center, a referral center, but we also see a lot of urban patients because some hospitals closed in Chicago. We have a lot of patients on Medicaid, Medicare, and, of course, commercial insurance. We have a very diverse population with people who don't even speak English. About 99% of our patients with type 1 diabetes are on CGM. For us, that is a given. I don't remember seeing a glucose meter in type 1 diabetes. For type 2 diabetes, we've been very engaged in trying to put a patient on CGM. Mainly because, in Illinois, Medicaid covers CGM for people on insulin. We're trying to maximize the fact that there is coverage. Some patients of mine, even those who don't speak English when they are placed on a CGM, have made such dramatic changes. I have a specific patient that I'm thinking about right now, who told me, 'My family is better, my glucose is fine now; I've changed my meal planning. My wife and I go for walks, and without this tool, I was convinced I couldn't eat any different because of my cultural choices.' So that's one type. Then, I have the patients who start with us with very high A1C. They're placed on CGM because of using insulin. They have never seen their glucose because we have something called the tune-up pathway where we have patients who are with high A1C from primary care coming to us in education for endocrinology, and they've never seen their glucose before, and they don't understand why anyone sees that. And then these patients very often come off of insulin. They go to a GLP, maybe SGLT2, and by the time they see us in the following 6 months, they are not taking any insulin. It becomes a challenge for payers, but we see that they might need PRN, and that's the correction: There's still quote-unquote insulin, but it is not an everyday necessity. They do very well. I have some barriers, and those, of course, are for patients where there is a specific policy in their insurance coverage where they have to be on some insulin. I don't get much resistance from patients except for those who feel that it's not going to be better for them. If they allow me to do a professional CGM, I can prove to them that this is not the case. But I need to work with the patient. And very often, I work with patients over time. Just recently, I had a patient who's been using insulin, a GLP, and an SGLT2, whose A1C is going up. I said you need to go on CGM. I've said this many times. A month ago, he said I need to be on CGM. Can you please write the script? He finally understands that he has no clue why his glucose is fluctuating. He doesn't understand why one day, he wakes up at 220, one day it is 140. And so now, it's going to be so much easier for him to be on CGM. And he actually asked. So, you need to work with the patient. Be patient with your patients, because you need to guide them. They might not know what this is. Sometimes, they come to you and say, 'I want the thing on my arm.' And they come to you with this statement, and you say, sure, no problem. You work with every individual where they're at. Wysham: There are many patients in my practice in whom it took 2 years, 3 years before they would actually agree to go on CGM. One of them came and said, 'This is so helpful. I can't believe I didn't do this sooner.' So I agree. You do have to present the data and the benefits. The professional CGM, which I'd like to get to in a minute, is sometimes really helpful, as you pointed out. Can you explain how and when you use professional CGM in your practice? Aleppo: Right now, because we have so many patients on personal CGM, we use professional CGM when the patient goes for diabetes education. It's a great opportunity. They come to us; we have no idea where the glucose levels are, and there is an expectation to fix them. What am I going to do? I don't have any data. So our educators put the patients on professional CGM themselves, they interpret the data, I look at them, and come up with a plan, and we have a place to start; otherwise, we wouldn't know what to do with them. I try to do them, unblinded as much as I can, with the caveat that sometimes some people shouldn't see their glucose because they're going to get so upset and they're going to feel bad about themselves. In those situations, when I know the patient is going to be really upset where they feel guilty about their diabetes, I would use it blinded, but it's the minority. And then the instructions are don't freak out. Don't be worried. Just look at the numbers for the first few days. And then change a few things. Take notes. When you come back in 10 days, we'll discuss what you've changed. And we can see on the screen the results of your choices. And so that's how I use it. But I use it less than before because of our desire to expand CGM to as many people as possible. Wysham: I think that's appropriate. I have a patient who had a professional CGM, and I tried to convince him just to do his normal things for a few days. He did it for one day. He changed everything in his diet, and his A1C went from 9% to the estimated A1C on the CGM of 6.9%. It was in 2 weeks. We can't see the A1C change in that time, but it was really dramatic. What are some practical tips for using professional CGM in practice? It is helpful. It's well reimbursed by almost everyone. Is there a specific brand of CGM you use? Do you know how the whole ordering process happens? The medical assistants (MA) can put it on in the office. You don't need to be an educator to actually start the process. Aleppo: That's right. We also talk about this with our colleagues in primary care and we say you need to have a champion in your practice. Anybody can place a CGM. Because of the choices of having the ability to do blinded and unblinded, I've been using the G6 Pro. We order them, and we always have them on hand. We order a bunch at a time, and then we make sure we use them all out before they expire, of course. That's what we've chosen to do for the ability to do both blinded and unblinded, because sometimes you want to have the patient see numbers so they can get the knowledge and say, 'Okay, it's what was missing before.' It helps to overcome the resistance when they say, I don't need education, I don't need this, I know better when they, in fact, actually need a lot of help. I would suggest for primary care or any other practice that doesn't have an educator, have an MA understand how to put it on, help the patient to put the app on, and it will be so simple. When the patient comes back, you can bill for that. It's all a billable service. And you get so much more information from your patient. You don't waste 3-6 months just wondering what is happening. You know what's going on, and you can implement a plan. When it comes to patients with diabetes, I always feel I am behind because they come to us already with high A1C, high glucose for a while. I already think of them as at risk. So, I'm always in a hurry to help them out, because I want to try to stop the continuation of the glucose toxicity and the insult to the body that can cause complications later on. To me, it's like the sooner we get there, the better. Therefore, if somebody comes to you with a high number, a high A1C, you need to know what to do. It might be postprandial hyperglycemia, it might be fasting, it might be both. Without that knowledge, you might put a patient on a very high dose of long-acting and get nowhere because their meal time is not covered. So that's where it helps the provider in any setting, any location — whether private, public, primary care, or endo — to get a plan for the patient fast. Wysham: I want to get back to something that you referred to earlier, and that is the state coverage that you have for CGM for patients on insulin. That is a state-by-state regulation, and it behooves all of us to address the people making the decisions on our state Medicaid plans for coverage. People want to hear our voices, and we need to speak for our patients to make sure we can get those. Aleppo: It was a long process, but it was worth it. We really were so dedicated and motivated. We spent a lot of our own free time, but now they can get CGM in primary care on any insulin, and so that is a huge advantage. Our state has been very good at understanding CGM. Wysham: You're very lucky. Now, I want to get to a controversial topic. Do you think CGM could replace traditional testing for diagnosis of pre-diabetes or diabetes? Aleppo: Oh boy, that is such a hot topic. You can have somebody with pre-diabetes and see their progress to diabetes. I do know that you need to get a plasma glucose because sometimes CGM might over-read or under-read. I understand that. But I also feel that people with prediabetes are so lost. They have nothing, only metformin and lifestyle changes, and nowhere to say, my goodness, my glucose is going so high after eating a meal. I think that this should be considered. And if I may say, the over-the-counter biosensors are very helpful for that. They really show you those fluctuations that people without diabetes or prediabetes do not know they have. Is it time to substitute? I would try to remove the A1C if I could for management because it's not helpful. For diagnosis right now, I think 6.5% is too high. We need to do this earlier because 6.5% can have glucose in the 200, 230, and so it depends. It's not just a number. It's the progression of the day, the time they spent between 70-140 rather than 70-180. A very good paper from Nicole Spartano was just published recently. It was like a normative for how much time people spend in glucose level. People without diabetes spend about 3 hours a day over 140. People with prediabetes spend 5 hours a day over 140. That's almost double. And then people with diabetes go to 13 hours. So between 5 and 13 there are a lot of hours you spend above target. So why not try to do this earlier and keep people healthier sooner? Wysham: The information that a person with prediabetes can get is really important even if they wear the unblinded professional for 2 weeks and just start looking at the different aspects of their diet. You can do that periodically throughout the time. Sensors are really helpful for pre-diabetes, but again, getting payment is one thing. Are there any other points that are important for our audience to hear about your use of CGM or your views of CGM in practice? Aleppo: I would like to say that we need to stop comparing CGM to blood glucose monitoring (BGM). They have nothing to do with each other. We should forget that in people with type 2 diabetes, not on insulin, BGM didn't work. Of course, it didn't work. It didn't tell us or the patient anything. CGM is a new frontier, well, not so new. It's 25 years old. So we need to accept that it is really the best way to address glucose management to a patient with type 2 diabetes, especially when they're early in the disease, they can actually go and maybe go into remission. Why do we have to wait until they need insulin? Why are we wasting 5 years of their lives and putting them at risk for complications sooner than just saying, get this done now? We would never think this way about cancer. We need to understand diabetes is a serious disease. The sooner we make our patients healthy, the better their lives will be. Wysham: That is a really important concept. You talked about comparing BGM to CGM, and I always tell patients the accuracy of BGM is very close to that of CGM. There are some specifics where it's maybe a little bit more accurate. However, when people do it in real practice, they have more chance to screw up the results on a BGM by not having the appropriate preparation of their fingers than the CGM. And so I do the same thing. I say just except for low blood sugars or really unexpected highs, just don't even check. It's too confusing. Aleppo: Yes, and just as a way to look at the trend, stay in the zone. The minutia, the number per se, is not what matters. It's the overall pattern. Can you identify a specific pattern that you want to change? That's what matters. Wysham: Yes. That's right. Well, today, we've talked to Dr Grazia Aleppo about the use of CGM in clinical practice. Thank you for tuning in. Please take a moment to download the Medscape app to listen and subscribe to the podcast series on type 2 diabetes. This is Dr Carol Wysham for the Medscape InDiscussion Type 2 Diabetes podcast. Listen to additional seasons of this podcast. Standards of Care in Diabetes—2025 7. Diabetes Technology: Standards of Care in Diabetes-2024 Hyperglycemia and Adverse Pregnancy Outcomes Diabetes Requires a Village: Northwestern Medicine's Diabetes Tune-up Pathway Program Testing the Real-World Accuracy of the Dexcom G6 Pro CGM During the Insulin-Only Bionic Pancreas Pivotal Trial Continuous Glucose Monitoring for Prediabetes: What Are the Best Metrics? Defining Continuous Glucose Monitor Time in Range in a Large Community-based Cohort Without Diabetes Medscape © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: Continuous Glucose Monitoring in Clinical Type 2 Diabetes Practice: Benefits, Accessibility, and Patient Resistance - Medscape - Jun 25, 2025.
CNET
2 days ago
- Health
- CNET
Oura Ring Can Now Use AI to Monitor Blood Sugar Levels. I Tested It For a Week and Got These 3 Surprising Takeaways
I've used my Oura Ring daily for the past few years to track my sleep, recovery and stress, but it recently unlocked a new insight I didn't know I needed: blood sugar levels. I'm constantly experimenting with the latest health tech, so I was naturally intrigued when I learned that Oura Ring partnered with Dexcom's Stelo, a continuous glucose monitor designed for people without diabetes. The goal of this collaboration is to help everyday people like me understand how food and general eating habits impact blood sugar and overall health. "By combining Stelo data with Oura's existing insights, we're empowering members to better understand the cause-and-effect relationships between eating patterns, energy, mood and recovery -- and ultimately make sustainable, science-backed lifestyle changes," Maz Brumand, vice president of product for Oura, told CNET. I tested the Stelo CGM with my Oura Ring for two weeks, and I can say that it changed the way I eat and move, and I think this type of biofeedback is helpful for everyone, even if you do not have diabetes. What is continuous glucose monitoring, and why is it important? Your blood sugar, or blood glucose, refers to the measurement of sugar in your blood. According to the Cleveland Clinic, glucose is the main source of energy for your body -- it's what powers your muscles, brain and even your cells. When you eat certain foods (particularly carbohydrates), your glucose rises, and your body responds by releasing insulin to shuttle that sugar into cells for energy or storage. On the flip side, if you experience frequent spikes or crashes (even if you don't have diabetes ), it can impact your energy, sleep, mood and even long-term metabolic health. When your body doesn't need glucose immediately, it stores it as glycogen in your muscles and liver. For people with diabetes, monitoring glucose levels is crucial. But is it important to do the same for the rest of us without a diagnosis? To an extent, I think so. Monitoring your blood sugar throughout the day and seeing how your body reacts to different foods can reveal a lot about your cravings, sleep and metabolic health. "Glucose is a real-time window into metabolic health, which underpins how we feel day to day -- our energy, focus, mood and sleep -- and how resilient we are over time," Brumand says. Oura With the rise of wearable glucose sensors like Stelo, those without diabetes can now get insights into how their eating habits impact their bodies (without finger pricks or a prescription). What is a 'normal' glucose range, and are spikes bad? Before using a CGM, I thought blood sugar was either stable or erratic, with no room for in-between spikes. Once I began tracking my glucose daily, I quickly learned that spikes are completely normal, especially after meals and snacks. Most people will see glucose levels rise and drop throughout the day. According to the American Diabetes Association, a general target range for adults without pre-diabetes or diabetes is between 70 and 140mg/dL (note that Oura also follows this range, and it's what users can expect to see in their graphs). It's also worth highlighting that 70 to 100mg/dL is considered normal for fasting (particularly in the morning before having food), and under 140 mg/dL is common, especially after meals. "Clinical studies show that even in healthy individuals, a moderate glucose spike (rise above 140mg/dL) can occur on a daily basis. In fact, research suggests that healthy adults will live above 140mg/dL for about 30 minutes, up to 2 hours a day, which is usually 1 to 3 short-lived glucose spikes", says Renee Fitton, registered dietitian and director of education at L-Nutra, a nutrition technology company. Oura Fitton further explained that the number and frequency of glucose spikes depend on various factors, primarily what and when you're eating. These spiked can also be affected by other factors like stress level, exercise, dehydration and even whether you have a sunburn. Many glucose monitors use a custom range that adapts to your body's baseline and patterns over time. When looking at your graph, it's important to keep in mind that context and trends matter more than one-off spikes. For example, seeing a spike after dessert isn't a sign that something is wrong. It's a sign that your body is doing its job. What matters most is how quickly your glucose returns to baseline and how often your levels stay elevated over time. "I would not see signs for concern for occasional (one to three times per day) moderate spikes (less than 160mg/dL) that resolve within about 30 mins. When reaching more frequent, especially if they are higher spikes (for example, above 180mg/dL), that take a long time to resolve (over 60 minutes), then there may be concerns about metabolic health," Fitton explained. "A completely flat glucose curve is not something that we aim for; you want some gentle ups and downs as a sign of healthy metabolic flexibility." How I set up the Stelo monitor with my Oura Ring You can order the Stelo sensor through ($99 for two sensors). I received a small box with the sensors and easy instructions. Applying it to the back of my upper arm took less than 2 minutes and was surprisingly painless. And yes, there is a small needle involved. I'm terrified of needles, so I spent some time mentally preparing to prick myself, but to my disbelief, I didn't feel it at all. The sound the ejector makes is pretty loud, though. I sometimes think the sound acted as a diversion to my brain, and that's why I didn't feel anything. But, nonetheless, it was a pretty pain-free experience. Once in place, I paired it to the Stelo app, and it automatically reflected within the Oura app. Each sensor tracks your glucose level 24/7 for up to 15 days. Left Image: CGM in the self-injector. Right image: CGM on the back of my right arm. Nasha Addarich Martínez/CNET From the Oura app, I could see how my glucose levels fluctuated throughout the day. You can easily access it at the top of the app, where you also see other data metrics like sleep, heart rate, activity and readiness score (a personalized score, ranging from 0 to 100, that provides a snapshot of how well your body has recovered from the previous day's activities and sleep). How even my 'healthy' food choices raised my blood sugar (and that's OK) One of the most eye-opening parts of my testing was seeing how some of my favorite healthy staples played out on the glucose graph. A great example of this was my favorite pressed juice. I had a pressed juice in the morning that contained pineapple, beets, carrots, ginger, cucumber and lemon. It's nutrient-dense, but it also spiked my glucose above what's considered my healthy range for about 6 minutes (a small window and still considered optimal for my age and overall metabolic health). This was enough to make me rethink how and when I consume fruit-heavy beverages. The next day, I experimented with having a fruit smoothie instead of juice. I made a homemade smoothie with berries, banana, plant-based protein powder, peanut butter, soy milk and oats. This smoothie kept my glucose completely in range (zero minutes above my personal threshold). The added protein and fiber from the fruit, oatmeal, peanut butter and protein powder helped slow the absorption of natural sugars into my bloodstream. Nasha Addarich Martínez/CNET What I learned: Even natural fruit juices can cause glucose spikes, especially when consumed on an empty stomach and without any protein or fiber. Smoothies that include protein, fat and fiber can help keep spikes at bay and help stabilize your energy levels. Balance your meals with protein, fats and fiber Nasha Addarich Martínez/CNET Later that week, I had sushi rolls with a side of edamame for dinner. To my surprise, my glucose levels stayed within range the whole time. Oura Advisor (Oura's AI coach) even pointed out that this food combination offered protein and fiber, which likely contributed to the steady glucose levels. This moment was really encouraging for me. It made me realize that I don't need to drastically change what I eat. By just being more intentional about how I pair my foods, I can drastically improve the impact they have on my blood glucose. Pairing your foods with healthy fats like avocados, nuts, seeds and olive oil can also slow digestion and therefore the absorption of sugars. Fitton explains that this is primarily due to what happens in our digestive tract, even before the nutrients get to our bloodstream. Protein, fiber and healthy fats work in their own way to slow the absorption of simple carbohydrates into the bloodstream, making a slower, more gradual release of sugars into the blood. These factors turn what could be a glucose spike into a steady rise that your body can clear gradually. "The biggest area of concern when managing our blood sugar levels is limiting refined carbohydrates. When you do choose a refined-carb item (a plain cracker, white flour tortilla, cookies, etc.), try to pair it instead of eating it solo: add cheese, nut butter or a handful of edamame to blunt the glucose rise, and choose a higher-fiber version of your carbohydrate source when possible (for example, whole-grain crackers) so the carbs come packaged with their own speed limit," Fitton says. Cake and a walk equal steady blood sugar? One of the more surprising things I learned was that blood sugar stability isn't just about what you eat. It's also about what you do after you eat. One afternoon, I had a slice of cake for a snack. No fiber or protein added, just the cake (I had lunch a few hours before). Instead of my blood sugar spiking, my glucose levels remained steadily in range. The caveat? I took a brisk walk after having my dessert. It wasn't anything strenuous, just a short 15-minute walk around my neighborhood. But it was enough to help my body process and use the glucose more efficiently. "The body knows that exercise demands more energy, and so it helps open up our cells to soak up sugar (energy) and remove it from our blood. A 10-minute walk burns about 30 to 40 calories, and your body will get that energy from circulating glucose or stored glycogen," Fitton explained. After eating cake and going for a walk, my blood sugar saw a slight spike, but stayed within range. Nasha Addarich Martínez/CNET Taking a walk after meals has long been recommended by experts for metabolic health, but seeing the effect in real time made it click for me. I do think that having the cake after having a balanced meal with protein and fiber also contributed to my steady levels of blood sugar. Sometimes, it's not about completely eliminating our favorite treats or carbs, but more so about timing, food pairing and movement. 3 ways I learned to flatten my glucose curve without sacrificing my favorite meals Before using the glucose sensor with Oura, I assumed blood sugar spikes were mostly about foods and how they impact your body. I also thought the only way to manage them was to cut carbs or drastically change my diet. But over these two weeks, I experienced firsthand how and when I eat (and move) matter just as much as what I eat. I learned that these three strategies helped keep my glucose levels in check. Pair carbs and sweets with protein, fiber and healthy fats When I had a berry smoothie with protein powder and soy milk, my glucose levels stayed steady. In contrast, when I had a fruit smoothie earlier that week, my blood sugar levels spiked and crashed more quickly. Takeaway: Carbs on their own, especially refined and processed carbs, can spike blood sugar quickly, but adding protein or fat slows digestion and leads to a more gentle spike. Food pairing examples: Apples and peanut butter, toast with avocado, rice with beans or another it out (especially after sweets) When I had cake as a snack, I was sure my graph would spike dramatically, but it didn't because of my walk (and eating a balanced meal before). A simple walk, even just 10 to 15 minutes, can help offset blood sugar spikes. This small but simple habit helps me now enjoy treats without the crash later. Timing your food matters I also noticed that when I ate higher-carb foods earlier in the day, my body processed them better than when I had them later at night. Breakfast smoothies and bowls kept my levels stable, while the same smoothie after 9 p.m. caused more spikes. "When it comes to blood sugar management, we see that in the morning our body usually has a spike in cortisol (a stress hormone) that can actually help our body take up sugar very quickly and quickly manage blood sugar. Eating in the morning will also calm the cortisol response, reducing the stress on your body. If you wait too long to eat, excess cortisol can create inflammation and also produce larger glucose spikes when you do eat," explained Fitton. Fitton further explained that, conversely, in the evening, the sugar management systems in our bodies start powering down and are not as good at helping blood sugar get into the cells. So it is important to try not to eat too late; otherwise, you'll probably see blood sugar go up and stay up for longer. That doesn't mean you can't eat carbs or treats at night, but eating them earlier in the day when insulin sensitivity tends to be higher can make a real difference.
CNET
7 days ago
- Health
- CNET
Oura Ring Can Now Track Blood Sugar. I Tested It For a Week and Got These 3 Surprising Takeaways
I've used my Oura Ring daily for the past few years to track my sleep, recovery and stress, but it recently unlocked a new insight I didn't know I needed: blood sugar levels. I'm constantly experimenting with the latest health tech, so I was naturally intrigued when I learned that Oura Ring partnered with Dexcom's Stelo, a continuous glucose monitor designed for people without diabetes. The goal of this collaboration is to help everyday people like me understand how food and general eating habits impact blood sugar and overall health. "By combining Stelo data with Oura's existing insights, we're empowering members to better understand the cause-and-effect relationships between eating patterns, energy, mood and recovery -- and ultimately make sustainable, science-backed lifestyle changes," Maz Brumand, vice president of product for Oura, told CNET. I tested the Stelo CGM with my Oura Ring for two weeks, and I can say that it changed the way I eat and move, and I think this type of biofeedback is helpful for everyone, even if you do not have diabetes. What is continuous glucose monitoring, and why is it important? Your blood sugar, or blood glucose, refers to the measurement of sugar in your blood. According to the Cleveland Clinic, glucose is the main source of energy for your body -- it's what powers your muscles, brain and even your cells. When you eat certain foods (particularly carbohydrates), your glucose rises, and your body responds by releasing insulin to shuttle that sugar into cells for energy or storage. On the flip side, if you experience frequent spikes or crashes (even if you don't have diabetes ), it can impact your energy, sleep, mood and even long-term metabolic health. When your body doesn't need glucose immediately, it stores it as glycogen in your muscles and liver. For people with diabetes, monitoring glucose levels is crucial. But is it important to do the same for the rest of us without a diagnosis? To an extent, I think so. Monitoring your blood sugar throughout the day and seeing how your body reacts to different foods can reveal a lot about your cravings, sleep and metabolic health. "Glucose is a real-time window into metabolic health, which underpins how we feel day to day -- our energy, focus, mood and sleep -- and how resilient we are over time," Brumand says. Oura With the rise of wearable glucose sensors like Stelo, those without diabetes can now get insights into how their eating habits impact their bodies (without finger pricks or a prescription). What is a 'normal' glucose range, and are spikes bad? Before using a CGM, I thought blood sugar was either stable or erratic, with no room for in-between spikes. Once I began tracking my glucose daily, I quickly learned that spikes are completely normal, especially after meals and snacks. Most people will see glucose levels rise and drop throughout the day. According to the American Diabetes Association, a general target range for adults without pre-diabetes or diabetes is between 70 and 140mg/dL (note that Oura also follows this range, and it's what users can expect to see in their graphs). It's also worth highlighting that 70 to 100mg/dL is considered normal for fasting (particularly in the morning before having food), and under 140 mg/dL is common, especially after meals. "Clinical studies show that even in healthy individuals, a moderate glucose spike (rise above 140mg/dL) can occur on a daily basis. In fact, research suggests that healthy adults will live above 140mg/dL for about 30 minutes, up to 2 hours a day, which is usually 1 to 3 short-lived glucose spikes", says Renee Fitton, registered dietitian and director of education at L-Nutra, a nutrition technology company. Oura Fitton further explained that the number and frequency of glucose spikes depend on various factors, primarily what and when you're eating. These spiked can also be affected by other factors like stress level, exercise, dehydration and even whether you have a sunburn. Many glucose monitors use a custom range that adapts to your body's baseline and patterns over time. When looking at your graph, it's important to keep in mind that context and trends matter more than one-off spikes. For example, seeing a spike after dessert isn't a sign that something is wrong. It's a sign that your body is doing its job. What matters most is how quickly your glucose returns to baseline and how often your levels stay elevated over time. "I would not see signs for concern for occasional (one to three times per day) moderate spikes (less than 160mg/dL) that resolve within about 30 mins. When reaching more frequent, especially if they are higher spikes (for example, above 180mg/dL), that take a long time to resolve (over 60 minutes), then there may be concerns about metabolic health," Fitton explained. "A completely flat glucose curve is not something that we aim for; you want some gentle ups and downs as a sign of healthy metabolic flexibility." How I set up the Stelo monitor with my Oura Ring You can order the Stelo sensor through ($99 for two sensors). I received a small box with the sensors and easy instructions. Applying it to the back of my upper arm took less than 2 minutes and was surprisingly painless. And yes, there is a small needle involved. I'm terrified of needles, so I spent some time mentally preparing to prick myself, but to my disbelief, I didn't feel it at all. The sound the ejector makes is pretty loud, though. I sometimes think the sound acted as a diversion to my brain, and that's why I didn't feel anything. But, nonetheless, it was a pretty pain-free experience. Once in place, I paired it to the Stelo app, and it automatically reflected within the Oura app. Each sensor tracks your glucose level 24/7 for up to 15 days. Left Image: CGM in the self-injector. Right image: CGM on the back of my right arm. Nasha Addarich Martínez/CNET From the Oura app, I could see how my glucose levels fluctuated throughout the day. You can easily access it at the top of the app, where you also see other data metrics like sleep, heart rate, activity and readiness score (a personalized score, ranging from 0 to 100, that provides a snapshot of how well your body has recovered from the previous day's activities and sleep). How even my 'healthy' food choices raised my blood sugar (and that's OK) One of the most eye-opening parts of my testing was seeing how some of my favorite healthy staples played out on the glucose graph. A great example of this was my favorite pressed juice. I had a pressed juice in the morning that contained pineapple, beets, carrots, ginger, cucumber and lemon. It's nutrient-dense, but it also spiked my glucose above what's considered my healthy range for about 6 minutes (a small window and still considered optimal for my age and overall metabolic health). This was enough to make me rethink how and when I consume fruit-heavy beverages. The next day, I experimented with having a fruit smoothie instead of juice. I made a homemade smoothie with berries, banana, plant-based protein powder, peanut butter, soy milk and oats. This smoothie kept my glucose completely in range (zero minutes above my personal threshold). The added protein and fiber from the fruit, oatmeal, peanut butter and protein powder helped slow the absorption of natural sugars into my bloodstream. Nasha Addarich Martínez/CNET What I learned: Even natural fruit juices can cause glucose spikes, especially when consumed on an empty stomach and without any protein or fiber. Smoothies that include protein, fat and fiber can help keep spikes at bay and help stabilize your energy levels. Balance your meals with protein, fats and fiber Nasha Addarich Martínez/CNET Later that week, I had sushi rolls with a side of edamame for dinner. To my surprise, my glucose levels stayed within range the whole time. Oura Advisor (Oura's AI coach) even pointed out that this food combination offered protein and fiber, which likely contributed to the steady glucose levels. This moment was really encouraging for me. It made me realize that I don't need to drastically change what I eat. By just being more intentional about how I pair my foods, I can drastically improve the impact they have on my blood glucose. Pairing your foods with healthy fats like avocados, nuts, seeds and olive oil can also slow digestion and therefore the absorption of sugars. Fitton explains that this is primarily due to what happens in our digestive tract, even before the nutrients get to our bloodstream. Protein, fiber and healthy fats work in their own way to slow the absorption of simple carbohydrates into the bloodstream, making a slower, more gradual release of sugars into the blood. These factors turn what could be a glucose spike into a steady rise that your body can clear gradually. "The biggest area of concern when managing our blood sugar levels is limiting refined carbohydrates. When you do choose a refined-carb item (a plain cracker, white flour tortilla, cookies, etc.), try to pair it instead of eating it solo: add cheese, nut butter or a handful of edamame to blunt the glucose rise, and choose a higher-fiber version of your carbohydrate source when possible (for example, whole-grain crackers) so the carbs come packaged with their own speed limit," Fitton says. Cake and a walk equal steady blood sugar? One of the more surprising things I learned was that blood sugar stability isn't just about what you eat. It's also about what you do after you eat. One afternoon, I had a slice of cake for a snack. No fiber or protein added, just the cake (I had lunch a few hours before). Instead of my blood sugar spiking, my glucose levels remained steadily in range. The caveat? I took a brisk walk after having my dessert. It wasn't anything strenuous, just a short 15-minute walk around my neighborhood. But it was enough to help my body process and use the glucose more efficiently. "The body knows that exercise demands more energy, and so it helps open up our cells to soak up sugar (energy) and remove it from our blood. A 10-minute walk burns about 30 to 40 calories, and your body will get that energy from circulating glucose or stored glycogen," Fitton explained. After eating cake and going for a walk, my blood sugar saw a slight spike, but stayed within range. Nasha Addarich Martínez/CNET Taking a walk after meals has long been recommended by experts for metabolic health, but seeing the effect in real time made it click for me. I do think that having the cake after having a balanced meal with protein and fiber also contributed to my steady levels of blood sugar. Sometimes, it's not about completely eliminating our favorite treats or carbs, but more so about timing, food pairing and movement. 3 ways I learned to flatten my glucose curve without sacrificing my favorite meals Before using the glucose sensor with Oura, I assumed blood sugar spikes were mostly about foods and how they impact your body. I also thought the only way to manage them was to cut carbs or drastically change my diet. But over these two weeks, I experienced firsthand how and when I eat (and move) matter just as much as what I eat. I learned that these three strategies helped keep my glucose levels in check. Pair carbs and sweets with protein, fiber and healthy fats When I had a berry smoothie with protein powder and soy milk, my glucose levels stayed steady. In contrast, when I had a fruit smoothie earlier that week, my blood sugar levels spiked and crashed more quickly. Takeaway: Carbs on their own, especially refined and processed carbs, can spike blood sugar quickly, but adding protein or fat slows digestion and leads to a more gentle spike. Food pairing examples: Apples and peanut butter, toast with avocado, rice with beans or another it out (especially after sweets) When I had cake as a snack, I was sure my graph would spike dramatically, but it didn't because of my walk (and eating a balanced meal before). A simple walk, even just 10 to 15 minutes, can help offset blood sugar spikes. This small but simple habit helps me now enjoy treats without the crash later. Timing your food matters I also noticed that when I ate higher-carb foods earlier in the day, my body processed them better than when I had them later at night. Breakfast smoothies and bowls kept my levels stable, while the same smoothie after 9 p.m. caused more spikes. "When it comes to blood sugar management, we see that in the morning our body usually has a spike in cortisol (a stress hormone) that can actually help our body take up sugar very quickly and quickly manage blood sugar. Eating in the morning will also calm the cortisol response, reducing the stress on your body. If you wait too long to eat, excess cortisol can create inflammation and also produce larger glucose spikes when you do eat," explained Fitton. Fitton further explained that, conversely, in the evening, the sugar management systems in our bodies start powering down and are not as good at helping blood sugar get into the cells. So it is important to try not to eat too late; otherwise, you'll probably see blood sugar go up and stay up for longer. That doesn't mean you can't eat carbs or treats at night, but eating them earlier in the day when insulin sensitivity tends to be higher can make a real difference.
CNET
16-06-2025
- Health
- CNET
I Tracked My Glucose Levels With My Favorite Fitness Tracker. These 3 Takeaways Surprised Me
As a wellness editor and writer, I'm constantly experimenting with the latest health tech, so I was naturally intrigued when I learned that Oura Ring partnered with Dexcom's Stelo, a continuous glucose monitor designed for people without diabetes. The goal of this collaboration is to help everyday people like me understand how food and general eating habits impact blood sugar and overall health. "By combining Stelo data with Oura's existing insights, we're empowering members to better understand the cause-and-effect relationships between eating patterns, energy, mood and recovery -- and ultimately make sustainable, science-backed lifestyle changes," Maz Brumand, vice president of product for Oura, told CNET. I've used my Oura ring daily for the past three years to track my sleep, recovery and stress. But it was the first time I heard that a fitness tracker can monitor blood sugar levels. I tested the Stelo CGM with my Oura Ring for two weeks, and I can say that it changed the way I eat and move, and I think this type of biofeedback is helpful for everyone, even if you do not have diabetes. What is continuous glucose monitoring, and why is it important? Your blood sugar, or blood glucose, refers to the measurement of sugar in your blood. According to the Cleveland Clinic, glucose is the main source of energy for your body -- it's what powers your muscles, brain and even your cells. When you eat certain foods (particularly carbohydrates), your glucose rises, and your body responds by releasing insulin to shuttle that sugar into cells for energy or storage. On the flip side, if you experience frequent spikes or crashes (even if you don't have diabetes ), it can impact your energy, sleep, mood and even long-term metabolic health. When your body doesn't need glucose immediately, it stores it as glycogen in your muscles and liver. For people with diabetes, monitoring glucose levels is crucial. But is it important to do the same for the rest of us without a diagnosis? To an extent, I think so. Monitoring your blood sugar throughout the day and seeing how your body reacts to different foods can reveal a lot about your cravings, sleep and metabolic health. "Glucose is a real-time window into metabolic health, which underpins how we feel day to day -- our energy, focus, mood and sleep -- and how resilient we are over time," Brumand says. Oura With the rise of wearable glucose sensors like Stelo, those without diabetes can now get insights into how their eating habits impact their bodies (without finger pricks or a prescription). What is a 'normal' glucose range, and are spikes bad? Before using a CGM, I thought blood sugar was either stable or erratic, with no room for in-between spikes. Once I began tracking my glucose daily, I quickly learned that spikes are completely normal, especially after meals and snacks. Most people will see glucose levels rise and drop throughout the day. According to the American Diabetes Association, a general target range for adults without pre-diabetes or diabetes is between 70 and 140mg/dL (note that Oura also follows this range, and it's what users can expect to see in their graphs). It's also worth highlighting that 70 to 100mg/dL is considered normal for fasting (particularly in the morning before having food), and under 140 mg/dL is common, especially after meals. "Clinical studies show that even in healthy individuals, a moderate glucose spike (rise above 140mg/dL) can occur on a daily basis. In fact, research suggests that healthy adults will live above 140mg/dL for about 30 minutes, up to 2 hours a day, which is usually 1 to 3 short-lived glucose spikes", says Renee Fitton, registered dietitian and director of education at L-Nutra, a nutrition technology company. Oura Fitton further explained that the number and frequency of glucose spikes depend on various factors, primarily what and when you're eating. These spiked can also be affected by other factors like stress level, exercise, dehydration and even whether you have a sunburn. Many glucose monitors use a custom range that adapts to your body's baseline and patterns over time. When looking at your graph, it's important to keep in mind that context and trends matter more than one-off spikes. For example, seeing a spike after dessert isn't a sign that something is wrong. It's a sign that your body is doing its job. What matters most is how quickly your glucose returns to baseline and how often your levels stay elevated over time. "I would not see signs for concern for occasional (one to three times per day) moderate spikes (less than 160mg/dL) that resolve within about 30 mins. When reaching more frequent, especially if they are higher spikes (for example, above 180mg/dL), that take a long time to resolve (over 60 minutes), then there may be concerns about metabolic health," Fitton explained. "A completely flat glucose curve is not something that we aim for; you want some gentle ups and downs as a sign of healthy metabolic flexibility." How I set up the Stelo monitor with my Oura Ring You can order the Stelo sensor through ($99 for two sensors). I received a small box with the sensors and easy instructions. Applying it to the back of my upper arm took less than 2 minutes and was surprisingly painless. And yes, there is a small needle involved. I'm terrified of needles, so I spent some time mentally preparing to prick myself, but to my disbelief, I didn't feel it at all. The sound the ejector makes is pretty loud, though. I sometimes think the sound acted as a diversion to my brain, and that's why I didn't feel anything. But, nonetheless, it was a pretty pain-free experience. Once in place, I paired it to the Stelo app, and it automatically reflected within the Oura app. Each sensor tracks your glucose level 24/7 for up to 15 days. Left Image: CGM in the self-injector. Right image: CGM on the back of my right arm. Nasha Addarich Martínez/CNET From the Oura app, I could see how my glucose levels fluctuated throughout the day. You can easily access it at the top of the app, where you also see other data metrics like sleep, heart rate, activity and readiness score (a personalized score, ranging from 0 to 100, that provides a snapshot of how well your body has recovered from the previous day's activities and sleep). How even my 'healthy' food choices raised my blood sugar (and that's OK) One of the most eye-opening parts of my testing was seeing how some of my favorite healthy staples played out on the glucose graph. A great example of this was my favorite pressed juice. I had a pressed juice in the morning that contained pineapple, beets, carrots, ginger, cucumber and lemon. It's nutrient-dense, but it also spiked my glucose above what's considered my healthy range for about 6 minutes (a small window and still considered optimal for my age and overall metabolic health). This was enough to make me rethink how and when I consume fruit-heavy beverages. The next day, I experimented with having a fruit smoothie instead of juice. I made a homemade smoothie with berries, banana, plant-based protein powder, peanut butter, soy milk and oats. This smoothie kept my glucose completely in range (zero minutes above my personal threshold). The added protein and fiber from the fruit, oatmeal, peanut butter and protein powder helped slow the absorption of natural sugars into my bloodstream. Nasha Addarich Martínez/CNET What I learned: Even natural fruit juices can cause glucose spikes, especially when consumed on an empty stomach and without any protein or fiber. Smoothies that include protein, fat and fiber can help keep spikes at bay and help stabilize your energy levels. Balance your meals with protein, fats and fiber Nasha Addarich Martínez/CNET Later that week, I had sushi rolls with a side of edamame for dinner. To my surprise, my glucose levels stayed within range the whole time. Oura Advisor (Oura's AI coach) even pointed out that this food combination offered protein and fiber, which likely contributed to the steady glucose levels. This moment was really encouraging for me. It made me realize that I don't need to drastically change what I eat. By just being more intentional about how I pair my foods, I can drastically improve the impact they have on my blood glucose. Pairing your foods with healthy fats like avocados, nuts, seeds and olive oil can also slow digestion and therefore the absorption of sugars. Fitton explains that this is primarily due to what happens in our digestive tract, even before the nutrients get to our bloodstream. Protein, fiber and healthy fats work in their own way to slow the absorption of simple carbohydrates into the bloodstream, making a slower, more gradual release of sugars into the blood. These factors turn what could be a glucose spike into a steady rise that your body can clear gradually. "The biggest area of concern when managing our blood sugar levels is limiting refined carbohydrates. When you do choose a refined-carb item (a plain cracker, white flour tortilla, cookies, etc.), try to pair it instead of eating it solo: add cheese, nut butter or a handful of edamame to blunt the glucose rise, and choose a higher-fiber version of your carbohydrate source when possible (for example, whole-grain crackers) so the carbs come packaged with their own speed limit," Fitton says. Cake and a walk equal steady blood sugar? One of the more surprising things I learned was that blood sugar stability isn't just about what you eat. It's also about what you do after you eat. One afternoon, I had a slice of cake for a snack. No fiber or protein added, just the cake (I had lunch a few hours before). Instead of my blood sugar spiking, my glucose levels remained steadily in range. The caveat? I took a brisk walk after having my dessert. It wasn't anything strenuous, just a short 15-minute walk around my neighborhood. But it was enough to help my body process and use the glucose more efficiently. "The body knows that exercise demands more energy, and so it helps open up our cells to soak up sugar (energy) and remove it from our blood. A 10-minute walk burns about 30 to 40 calories, and your body will get that energy from circulating glucose or stored glycogen," Fitton explained. After eating cake and going for a walk, my blood sugar saw a slight spike, but stayed within range. Nasha Addarich Martínez/CNET Taking a walk after meals has long been recommended by experts for metabolic health, but seeing the effect in real time made it click for me. I do think that having the cake after having a balanced meal with protein and fiber also contributed to my steady levels of blood sugar. Sometimes, it's not about completely eliminating our favorite treats or carbs, but more so about timing, food pairing and movement. 3 ways I learned to flatten my glucose curve without sacrificing my favorite meals Before using the glucose sensor with Oura, I assumed blood sugar spikes were mostly about foods and how they impact your body. I also thought the only way to manage them was to cut carbs or drastically change my diet. But over these two weeks, I experienced firsthand how and when I eat (and move) matter just as much as what I eat. I learned that these three strategies helped keep my glucose levels in check. Pair carbs and sweets with protein, fiber and healthy fats When I had a berry smoothie with protein powder and soy milk, my glucose levels stayed steady. In contrast, when I had a fruit smoothie earlier that week, my blood sugar levels spiked and crashed more quickly. Takeaway: Carbs on their own, especially refined and processed carbs, can spike blood sugar quickly, but adding protein or fat slows digestion and leads to a more gentle spike. Food pairing examples: Apples and peanut butter, toast with avocado, rice with beans or another it out (especially after sweets) When I had cake as a snack, I was sure my graph would spike dramatically, but it didn't because of my walk (and eating a balanced meal before). A simple walk, even just 10 to 15 minutes, can help offset blood sugar spikes. This small but simple habit helps me now enjoy treats without the crash later. Timing your food matters I also noticed that when I ate higher-carb foods earlier in the day, my body processed them better than when I had them later at night. Breakfast smoothies and bowls kept my levels stable, while the same smoothie after 9 p.m. caused more spikes. "When it comes to blood sugar management, we see that in the morning our body usually has a spike in cortisol (a stress hormone) that can actually help our body take up sugar very quickly and quickly manage blood sugar. Eating in the morning will also calm the cortisol response, reducing the stress on your body. If you wait too long to eat, excess cortisol can create inflammation and also produce larger glucose spikes when you do eat," explained Fitton. Fitton further explained that, conversely, in the evening, the sugar management systems in our bodies start powering down and are not as good at helping blood sugar get into the cells. So it is important to try not to eat too late; otherwise, you'll probably see blood sugar go up and stay up for longer. That doesn't mean you can't eat carbs or treats at night, but eating them earlier in the day when insulin sensitivity tends to be higher can make a real difference.
