Four years ago, my life changed after a heart attack at the age of 33. While a quick coronary angioplasty meant my heart was mostly fine, the tests conducted at the same time revealed a bigger chronic problem: I’m a diabetic. Since that diagnosis — which I expected at some point in my life given my family history of type 2 diabetes — I’ve worked hard to change my life and diet radically, and a continuous glucose monitor (CGM) has been instrumental in achieving that.
Unless you’re an advocate for health tech or a diabetic like me, you may not have heard of Dexcom or Abbott, the two companies that form an oligopoly in the CGM space. Yet, you’re probably here because you’ve seen or heard something about the Dexcom Stelo or Abbott Lingo. These mark the first time a CGM has been widely available over-the-counter without a prescription, but like all things that sound too good to be true, surely there’s a catch?
After spending two weeks with the Dexcom Stelo, it’s an incredible product for everyone interested in diabetes. However, before you rush off to buy one, it’s worth noting that it’s not the most ideally placed if you’re a diabetic, especially if you’ve used a previous Dexcom product. Here’s why.
Why a great CGM is so valuable to diabetics
I hear you ask, why would you be interested in a CGM? Can’t you just check your blood sugar via a fingerstick measure? The answer is yes, you can, but a CGM solves the biggest problem with fingersticks: context.
A finger stick reading gives you a single snapshot at that exact moment in time, but it doesn’t tell you if your sugar is rising or falling. Crucially, a check first thing in the morning before eating — which is recommended by every doctor — also doesn’t provide any information on the day before.
I noticed during my first few months of finger-sticking that this lack of context meant I was often adjusting food or medication according to a number that was out of date within 15 minutes. My first six months as a diabetic only led to a slight drop in my average blood sugar despite following all the recommendations, leading me to explore alternative ways to track and measure my blood sugar.
A brief look at my CGM history
To understand the context around my Dexcom Stelo experience, it’s worth understanding my overall history with CGMs. For many years, U.S. health care providers would not cover Dexcom CGMs — mostly because they required two parts and were far more expensive — so like most people, my first CGM experience was the Freestyle Libre.
First, there was the Freestyle Libre 14-day, then the Libre 2, and finally, the Libre 3. At the same time, Dexcom was building its own fully integrated CGM solution, and the final result was a game-changer: the Dexcom G7 (more on this later).
Having used a total of five different CGMs, I’ve noticed the key information that matters to long-term diabetes care, and while the Dexcom Stelo — and Abbott Lingo — offer most of this information, there are little snippets that are missing. It turns out these snippets matter much more than you might think, but only to people like me. For most people, these over-the-counter CGMs will change their lives, much like CGMs have done so for me.
Why the Dexcom Stelo is great for most people
Before we get into the little things I’m missing, it’s worth mentioning why the Dexcom Stelo will be fantastic for most people. Its core premise is to offer most of the Dexcom G7 features at a lower price without needing a prescription. It uses the same hardware and applicator — quite literally from my experience using both — differentiated only slightly by software, packaging, and materials. Ostensibly, it’s the best of the Dexcom G7 at a considerably lower price, and crucially, without the need for doctors or insurance companies to be involved.
The latter point is key: in the U.S., U.K., and many other countries, it can be tough to get a CGM under your local health plan unless you have a medical need for it. The Stelo resolves this problem, and as someone who travels a lot, we should eventually be able to walk into pharmacies around the world and buy an additional sensor with no problems. At least, I hope.
The Stelo app is virtually identical to the G7 app. It provides crucial context on current glucose numbers — synced directly from the sensor via Bluetooth every X minutes — as well as whether it’s trending up or down, past historical data, and useful insights. The latter, in particular, sets it apart from the Dexcom G7 in both good and bad ways.
The key differences between the Dexcom G7 and Dexcom Stelo
I was very excited to get stuck into the Dexcom Stelo, as adopting that over the G7 would save me thousands of dollars yearly. It turns out, however, that there are key differences that make the Dexcom Stelo outstanding for most people but make the Dexcom G7 better for my specific needs.
Like most instances, data is only as good as what you do with it. Both CGMs provide enough contextual data to be useful, but once you dig into it, you realize the key difference: the Dexcom Stelo is a more user-friendly version of the Dexcom G7. This means lots of useful insights on nutrition and how glucose works, but it also means many of the features I rely on don’t work either.
Four years after my diagnosis, my blood sugar still spikes heavily after meals. I’ve become accustomed to mentally keeping an eye on the final high point, but while the G7 allows me to track this to 400 mg/dl or higher, the Dexcom Stelo is limited to 250 mg/dl. Above this number, it can’t provide any more information. This doesn’t matter to most people — and conforms to conventional wisdom about how much your blood sugar should spike two to three hours after a meal — but it doesn’t work for my unique circumstances.
Similarly, the Dexcom Stelo doesn’t allow you to customize your specific target ranges and instead asks you to choose from two, both of which conform to international wisdom: 70-180mg/dl for diabetics or 70-140mg/dl for prediabetics or those without diabetes. This fits most people’s needs — and target ranges are the best way to track blood sugar over time — but the ability to further customize the height of the graph and see numbers above this arbitrary amount makes the Dexcom G7 better at managing diabetes for those with more unstable sugar readings.
There are also no urgent low or urgent high-sugar alerts, the former being super important to me as my body often goes super low overnight when it’s most dangerous to do so. The Stelo alerts also don’t show the numbers, prompting you to open the app to understand. The Dexcom Stelo also lacks the home screen widget for iOS and the ability to sync your Apple Watch directly to your CGM sensor.
The Dexcom Stelo is ideal for all but the nerdiest diabetics
The key reason to buy the Dexcom Stelo is not just price, although this plays a big part. The Stelo offers excellent information designed to help you learn more about diabetes, blood sugar, and how to control it.
In many ways, the Stelo offers the perfect entry point into diabetes and glucose monitoring, which is expected to blow up considerably over the coming years. Unlike Abbott Lingo, it also retains the same terminology used across all of its sensors and solutions, making it far easier to make the jump between the different products.
Dexcom recently announced an investment and partnership with Oura, and starting next year, the Oura Ring 4 will sync your blood-sugar data to help provide a holistic overview of your entire health. This is one of the biggest and most exciting developments in glucose monitoring for years. Whether you use the Dexcom Stelo or opt for the more advanced Dexcom G7, there’s never been a better time to get into glucose monitoring. When you do, I highly recommend Dexcom.
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