Glycemic Excursion Minimization/Glucose Everyday Matters (GEM) FAQs

Your BG can rise the morning for two reasons:

1. You ate something late at night, and your BG goes the next morning.
2. Your insulin resistance goes up in the morning, letting your BG go up “on its own”- this is called the “Dawn Phenomenon”

Remove the sensor immediately. Here are some possible solutions for preventing skin problems as well as treating them:

https://www.pantherprogram.org/_files/ugd/29eb34_1840dd3f122244b6b1d9bfcc16e160b7.pdf

Laying on the sensor can cause an error and there can be false readings as well. Unless you are on a diabetes medication, you can turn this alarm off.

Yes

You can set this to alert when your glucose is higher than you want, or you can set it to alert when your glucose is close to your personal upper limit.

Looking at your Reader or app before you eat might guide what to eat or possibly to delay eating. Looking at your glucose 1-2 hours after you start eating might indicate whether your food choices did or did not achieve your goal, and whether you do or do not want to be more physically active.

Technology is not perfect! You may get errors from time to time. If you can measure your blood glucose with a finger-prick meter, see if you get similar readings.  If you do not have a glucometer, or don’t get similar results call Libre and ask for a new sensor: (855) 632-8658.

Wash with soap and water to remove oils and lotions. Wipe with the alcohol pad if you have one.  Make sure your skin is completely dry! There are several types of tape and non-tape solutions that you can read about at: https://www.pantherprogram.org/_files/ugd/29eb34_1840dd3f122244b6b1d9bfcc16e160b7.pdf

The Libre2 very accurately tracks change or trends in BG. Some sensors may consistently underestimate BG by around 15%.  So, instead of telling you your BG is 115, it might tell you your BG is 100. Try to focus on the trends and what happens when you eat different types of food or exercise rather than the actual number.

Remember to “Start Low and Go Slow” if you are just starting out! Try a five minute walk at a slow pace and then increase from there. Sometimes shorter and quicker steps can help. Supportive and well-fitting shoes may help. Seek medical attention if pain persists.

Ankle and wrist weights put extra stress on your joints and are generally not recommended.

A filled water bottle is always a good idea, especially if it is warm and you are going for a longer exercise session.

A shoe that is wide enough, comfortable, and light weight is a good start. Do not use shoes with high heel elevation as that puts stress on the knees and hips.

The best time to walk or exercise is when you are most likely to do it and get into a routine. If you have a choice, exercising after eating should lower your blood glucose the most.

Once you build up to it, at least 10 minutes of continuous moderate activity, for a total of 30 minutes per day.

The American Diabetes Association (ADA) recommends at least 150 minutes/week of moderate (like brisk walking) to vigorous (like jogging) activity.  This comes out to about 30 minutes most days of the week, but you should also add movement throughout the day.

Try to think exercise as fun movement. Listen to music or a book, talk to a friend on the phone or do it with someone else. Think about it as strengthening your muscles while lowering your BG. For some people it helps to think about exercise as your medication for prediabetes. It is low cost, has very few side effects, and it can often be effective like taking pills!

Experiment to see what might be fun- turn on music and dance, go for a hike, try new things!

Resistance training is physical activity that is designed to improve muscle tone by moving against resistance, like stretching exercise bands, lifting weights, or moving furniture. The ADA recommends resistance activities 2-3 times per week.

Any activity is good activity, even things as simple as dusting the furniture, riding a bike, chair, or water exercises. If illness limits your activity, please seek guidance from your medical provider.

Take breaks. Get up, stretch, take a quick brisk walk or do deep knee bends. You can also do isometric exercises while sitting by tightening and holding individual muscle groups then relaxing them. Look for hidden ways to exercise- park farther away, take the stairs, be creative!

If a meal comes with starch, like potatoes, rice or pasta, ask to substitute it with a vegetable.

Look at posted nutrition facts, then choose wisely and remove the bread and bun.

https://fastfoodnutrition.org/

Set a rule: “only one serving.”  Eat off a small plate. At a restaurant, ask for a to-go container when the food comes and put aside half right away. Get protein at all meals to help you feel full. Also, you can split food with a companion.

GEM focuses on food and activity choices that keep your blood glucose from going up after eating and drinking.  Ketogenic diets focus on reducing carbohydrates to about 20-50 g/day or until your body is producing ketones and you are burning fat. Ketogenic diets are difficult for some, but most people can adhere to GEM.

Most baked goods and pasta raise blood glucose a lot. There are special low carbohydrate breads and pastas that may not raise your blood glucose as much. Read the nutrition facts for grams of carbohydrates and fiber/serving.  Then see how your Libre 2 responds.

Usually, no.  Even though it may not have any sugar, it can still have a lot of carbohydrates that will increase your BG. It can also contain sugar alcohols which can cause diarrhea.

Sugar is a carbohydrate, and all carbohydrates raise your blood glucose (except fiber and alcohol).  So “sugar free” can be very misleading. They can also contain sugar alcohols which can cause diarrhea.

Always read Nutrient labels.  For example, a “low carbohydrate” bagel may still have 37g of carbohydrates that could raise your blood glucose 148 points. 

No. Read the nutrient content and calculate the Net Carbohydrates (Total Carbohydrates - grams of fiber). Ideally, this should be 10 or less.

The longer fruits sit around, the more their fiber gets converted to sugar, which makes their net carbohydrates go up. It is usually better to eat fruits when they are firmer/harder.

Consider increasing the portion size of your meal’s fat or protein a bit. Make sure you eat until you're satisfied at every meal, not stuffed. Have low-fat, low-carb snacks like a string cheese or vegetables.

Beware of “low fat” foods. They often have extra added sugar or sweeteners.

Sugar is one kind of carbohydrate. All carbohydrates should be reduced, but it is impossible to avoid all carbohydrates. Even whole grain carbohydrates raise blood glucose.

Processed fats such as margarine, corn oil, vegetable oil, and trans fats.

Olive oil, tree nut oils, avocado oil

When you eat carbohydrates your insulin level is high and that leads to storing fat. When you aren’t eating carbohydrates your insulin level is lower and you are burning fat. 

Mindful eating means slowing down eating and enjoying food.  This involves stopping between bites to look at and smell your food, its color, texture and taste.

Remove, avoid, or respond differently. Remove tempting foods and drinks from your home or workplace. Divide a large restaurant meal in half and put it in a to-go bag before starting to eat. Respond to triggers with healthy choices in food, activity and social interactions.

Generally speaking, mustards, mayonnaise and salsa are low-carb condiments.

Ketchup, BBQ sauces and Miracle Whip have a lot of sugar in them. Always read nutrient labels for net carbohydrates.

Sugar is only one kind of carbohydrate, so while sugar will raise your blood glucose, so will all carbohydrates. That is why you should focus on total carbohydrates.

Fiber is a non-digestible carbohydrate that won’t raise your blood glucose. That is why you subtract the total grams of fiber from the total grams of carbohydrates to get Net Carbohydrates.

Sugar alcohol is a sweet carbohydrate that looks and taste like sugar but partially resists digestion and acts like fiber. You can subtract this from Total Carbohydrates like fiber. Large amounts can cause bloating or diarrhea in some people. There are different sugar alcohols, like Xylitol, Erythritol, Sorbitol, Maltitol.

A good rule-of-thumb is that 1 g of net carbohydrates raises blood glucose 4 mg/dL.

High blood glucose allows sugar to stick to your nerve cells and damage them. Since nerves control everything in your body, nerve damage from diabetes can affect almost any part of your body- your eyes, kidney, feet and more!

Your Libre can display your average blood glucose reading.  You can use the below to estimate your A1c

Average BG   Estimated A1c

         98                   5.0

        112                  5.5

        126                  6.0

        140                  6.5

        154                  7.0

        169                  7.5

        183                  8.0

        197                  8.5

        212                  9.0

        226                  9.5    

The American Diabetes Association recommends keeping A1c below 7 for most people.

A1c 6.5 = prediabetes
A1c below 5.7 = normal (not prediabetes or diabetes)

Although no one wants to be diagnosed with prediabetes, it is an opportunity! Your body has started to develop insulin resistance and your blood sugars are beginning to rise. But it is very unlikely that any lasting damage has been done to your nerves or body yet. If you take action, you may be able to stop or slow the progression of prediabetes to type 2 diabetes. You can do this!

Type 1 diabetes is an autoimmune condition where the body attacks the cells in the pancreas that make insulin. People with type 1 diabetes must take insulin to live. Even if they change their diet or lose weight they will still need insulin.

People with type 2 diabetes still produce insulin, sometimes a lot of insulin, but the insulin does not work very well because of insulin resistance. Over time, people with type 2 diabetes may need more and more medication, including insulin.