Levels Continuous Glucose Monitor (CGM)

Amir Alrubaiy

So, I’ve been using a Levels Continuous Glucose Monitor (CGM) for about a month now. Why? I’m in the 99^th percentile of fitness for the general population, let alone my age. To look at me and what I do, you’d expect me to be a paragon of health. I thought so too…until I got an A1c reading of 6.1 at a recent checkup. For reference, anything between 5.7 and 6.4 is at risk for pre-diabetes. Above 6.4, and you need help. Below 5.7, you’re good. Since the typical “loose some weight and get more exercise” advice for fixing this would clearly not work for me (I’m a strength and conditioning coach, athlete, and competitive mountain biker), I had to wonder if what I thought was a “healthy” diet was messing me up. 

Enter the Levels CGM.

 

A little background. Your A1c is a measure of the average level of glucose in your blood over a 3-month period. For that reason, it’s a good gauge of your overall metabolic health. A good or bad day at the time of the reading doesn’t matter much. 

When your blood sugar is high over an extended period, it starts to mess with your body in some significant ways. It will irritate your blood vessels causing your body to fix the damage with cholesterol build up. It can contribute to a persistent state of general inflammation that will jack with your immune system and lead to a host of downstream problems. And finally, if left too high for too long, it can create problems for your kidneys. All these things are components of conditions called Insulin Resistance and/or Metabolic Syndrome.

Typically, all these problems manifest in uncontrolled weight gain and visible poor health. However, of the millions of Americans who have insulin resistance, about a third to a half are not overweight. After some digging, I discovered a body of research that indicates athletes (particularly endurance athletes) are susceptible to IR, in large part because of our carb-heavy diets. Apparently, this diet is mostly fine when you’re fueling training and performance…less fine outside of that. Beyond that, it appears that many people operate just fine on a carbohydrate rich diet, and others (me), do not. Because of this personalized variability, a CGM is a perfect tool to track and understand how your body reacts to certain nutrients as well as their sequence and timing.

So, what is a Levels CGM?

Levels is one of a few companies that offers a CGM/app service. The system essentially consists of a small sensor that you wear (usually) on the back of your arm, and an app that you use to plot and track your glucose levels. When you sign up for the service, you receive two sensors that each last two weeks. Applying the sensor is a little intimidating at first, but I assure you, it is totally painless…like seriously painless. You do need to be mindful of where you put the sensor, because if you get it into the meat of a muscle, it can get uncomfortable after a while. 

Levels offers two versions of how to interface the sensor with the app. The version I opted for requires you to periodically scan the sensor whenever you want a reading. I went with this because I had some experience with another CGM that operated the same way, and I wanted a more direct comparison. Alternatively, you can opt for a sensor that has a continuous Bluetooth connection that will send data to the app without your scanning. I don’t have experience with that version, but the advantage, beyond convenience, is that the sensor can notify you if your glucose is going too high or too low, so you can adjust your behavior in real time. Go for a walk or eat something! I was diligent about scanning and monitoring, so I decided on the version that wouldn’t pester me.

The app is very easy to read and understand. The primary visual is a running line of your current glucose level across time. You can see where you’ve dipped and spiked, and with a few of their other tools, surmise why. The main screen also shows you your current average glucose level (somewhere between 75-105 is a good number), as well as a score for your variability. This number is important, because while your average may be low, you also want your line to be as flat as possible. Too many large peaks and valleys are tough on your system and are an indication that your body can’t metabolize glucose very well. 

The app has a pretty simple food log built in, so you can see how each of your meals affects your metabolism. It also interfaces easily with other health tracking apps to reference data about workouts and sleep. I had mine associated with my apple watch which gave it information about the duration and intensity of my workouts, as well as my sleep and activity. It was interesting to discover that, while Zone 2 endurance workouts dropped my blood sugar (as I expected), high intensity efforts (intervals, anerobic efforts, etc.) had the opposite effect. I know now that this is because your liver answers the call for more energy by releasing glucose…huh!

What was very interesting to discover was how different foods, and even their timing, can affect my blood sugar. This is where the CGM earns its money. While it is very common in the fitness world to espouse the benefits of this or that diet, the CGM clearly shows that what is metabolically good for one person can be a sugar bomb for someone else. For example, an apple, about which no one would argue the “healthiness”, is a metabolically stable food for me…not much of a rise in levels. However, for another of our gym members who is also wearing a Levels CGM, she might as well have a doughnut. Further, for me, you take that same apple and eat it with peanut butter, and I often see my glucose drop slightly. A little bit of fat and protein make a lot of difference. 

So, what do I like, and what do I wish for with the Levels CGM?

Let’s start with my wishes.

While the food tracking functions are simple, I wish there were a more robust way to track serving size and macros in the app. It’s simple to do this in other apps, but doing so requires you to track your nutrition in multiple places. Which can be a bit of a pain. This complaint may be moot however, since the word from Levels is that the next version of the app will significantly upgrade its nutrition tracking capabilities. My second gripe is that because of the way the sensor interfaces with the app, you need to run each scan through a scanning app, and then sync the data with Levels. Again, not a huge deal, but a bit clunky. However, if you opt for the Bluetooth version of the sensor (which I didn’t do), it appears that the data interface is much simpler.

 

Here are the things that I dig.

The data display of the app is very well done and easy to understand. You get all the information you need about the current state of your metabolism, and no extra fluff. Your historical data is very easy to access, and trends are very clear. Cross reference this information with your sleep, nutrition, and activity, and you’ve got a good picture of how your metabolism operates.

As an athlete, I also appreciate that the app differentiates between a glucose spike due to strenuous exercise, and one initiated by food. When you go hard, your body responds by releasing glucose from your liver. Spikes like that are perfectly normal, and very different than meal spikes, so the app doesn’t count them against you in calculating your stability score.

Finally, I really like the price. Levels has a $199 one time set up fee, and then $199 a month recurring. This is about $100 cheaper than competing apps, and that money can really add up. If you’re like me, and you’re working to stabilize your metabolism and get your A1c down, you’ll be tracking this data for a while. I expect to keep using the CGM for about a year. That translates into $1200 saved. 

Overall, using a Levels CGM has been a remarkably illuminating experience. What I thought was a well balanced and nutritious diet for me, was pretty far off. Turns out I used to eat a lot more cookies and chips than I thought…it really helps to have the unit “watching” me. I’ve been using the CGM long enough now, that my nutritional patterns have settled into a new normal, and the ways I used to eat feel weird and scary. 

For me, the Levels CGM has been an invaluable tool in my efforts to get my metabolism right. As I’ve learned over the last few months, there are a lot of us athletes walking around out there with elevated glucose levels, without knowing at all. My strong advice to all of you, is to go get your bloodwork done, and if its off…go sign up for Levels and get right!!

 

Amir Alrubaiy

“I didn’t want to work at Pizza Hut, and I didn’t want to join the Army. So I just decided to go out and be awesome.” – Henry Rollins.

I never knew what I wanted to be when I grew up; I just knew I wanted it to be rad. That simple pursuit has directed most of my life. Dad started me skiing at 5 yrs old. I got a skateboard at 11 and an electric guitar at 12. My first mountain bike at 18 squared the circle of passions.

I was a competitive freeskier during the salad days of the U.S. Extremes. I lived through the evolution of fat skis and twin tips and saw the backcountry explode with the invention of the BCA Trekker.

I’ve also been riding, racing, and wrenching on mountain bikes since the early nineties. I’ve raced the Leadville 100 a few times and lined up at my share of XCO and CX races. Suspension forks on road bikes…not new. Tubeless tire plugs…ever heard of a rubber band?

Finally, teaching architecture and design at The University of Colorado for 13 years helped me develop a keen appreciation for the simplicity and effectiveness in all scales of products. I’ve seen a lot of technology come, go, and come back again. The new stuff is great, but I still regularly wear the green windbreaker I got in ’96…stuff that works is better.

The radness, for me, now runs through Axistence: Training For A Life Of Adventure, where I help coach an amazing community of athletes in functional fitness. Preparing them with strong, resilient bodies so their gear breaks before they do. Hefty doses of Van Halen and barbells can prepare you for nearly anything.

Performance and products come and go…radness is forever.