In healthcare, we are often measuring numbers related to your health: blood pressure, cholesterol, pulse rate and blood sugar. In diabetics, blood sugar is a very important reading, as diabetics lose their ability to control their levels. Developments in health technology have lead to machines that can continuously measure blood sugar levels - continuous glucose monitors (CGM). These machines reduce the number of times a diabetic needs to prick their finger to work out how high or low their blood sugar is.
CGM’s are a small machine that inserts a fine needle into the skin. It measures the blood sugar levels in the fluid that bathes cells, called the interstitial fluid. The machine transmits the reading to a device that the patient can read to work out their blood sugar level. As a result they can tailor their medication (often insulin) accordingly. The concern is that the blood glucose in the fluid around the cells may have a slightly different reading to the blood glucose in the veins and thus the machine needs to be calibrated approximately twice a day (depending on the device). This is to ensure that an accurate reading is obtained such that an accurate dose of medication can be given. Getting this wrong can be fatal.
The WHO states that the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
It also states that a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
But what is a healthy diet? The traditional model of healthcare promotes a one size fits all approach and the advice often changes. In the past a low fat diet was advocated, to more recently, a Mediterranean diet. No doubt this advice will change in the future. Taking onboard current changes in medicine, can we apply the principles of digital health to improve your diet, to reduce your risk of diabetes? Remember those 4 pillars of digital health?
If you are willing to Participate, we can try and Prevent you from developing diabetes by Predicting the effect of types of food on your body with a Personalised plan?
So how can we do this? At the moment your physician can do a finger prick blood test to work out your current blood sugar level - this is just a snapshot of your level and does not show any trends unless done regularly. Or they can measure your HbA1c which is your average blood sugar over the past 3 months, but can you remember what you ate every day for the past 3 months?
It would be useful for you to know what effect a particular food has on your body: if you eat white bread as opposed to rye bread, or if you eat white rice as opposed to brown, it will make your blood sugar really high. But we already know this, I hear you say! True, but sometimes seeing the numbers can really focus you in changing your patterns of behaviour. Seeing your blood sugar shoot up to 12 mmol/L (that is high) after a bowl of white rice can be quite alarming. Also how one individual reacts to a particular food compared to another will also vary. It is all about understanding your body to decide what foods are best for you.
This is why it is worthwhile considering the CGM in people who do not have diabetes to calibrate their bodies and work out exactly what effect a particular food has on your blood sugar levels. This can be done with the help of a dietician who can structure a plan of foods to eat across the dietary spectrum, whilst you are using the CGM. You can then know exactly the effect the foods have on your body, be they good or bad and then tailor your intake accordingly. Calibrate yourself on an annual basis and have the knowledge to make a change before problems arise.
CGM’s are expensive - I am fully aware of that but their price should come down in time. The great concern in the use of CGM’s with diabetics is an inaccurate reading that may lead to an incorrect dose of insulin being given, which could be very dangerous. Mechanisms are put in place to prevent this and diabetics around the world are seeing better control as a result of using these machines. However, in a healthy individual who does not take insulin, that concern is reduced. It is still important to obtain an accurate reading but no medication is being given. We are just trying to understand the effects of particular foods on your body. Knowing these effects accurately however, will be the goldmine of information that enables you to change unhealthy habits that may lead to illness in the future.
Blog post written by Dr Khurram Akhter.
Khurram is an experienced primary care physician and a thought leader
in the field of digital health.
Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor.