How an Amateur Race Car Driver Decided on a CGM
Lance Bergstein, 28, a New York City real estate investor and amateur race car driver who has had type 1 diabetes for 23 years
Carol Levy, MD, director of the Mount Sinai Diabetes Center at the Icahn School of Medicine at Mount Sinai
When Lance Bergstein went to see Carol Levy, MD, last spring, they both knew he had to make a change. Bergstein had owned a continuous glucose monitor (CGM) for the past seven years, but he found the sensor difficult to insert, so he wasn’t using it consistently.
Although Bergstein was able to keep his glucose levels within a reasonable range, Levy thought he could achieve more-precise control with consistent use of a CGM.
But there was another, pressing reason for Bergstein to use a CGM. As an amateur race car driver, it was imperative that he mount a CGM receiver on his dashboard to constantly monitor his glucose during races.
“Lance was about to do his first 24-hour race, so stopping the car to do a finger stick simply wasn’t an option for him,” says Levy. “We really needed to know what was going on minute by minute, in real time, so that he could take steps to adjust his glucose levels as needed. It was crucial that his glucose stay in the perfect range.” If it dropped too low during a race, it could possibly lead to an accident.
Levy outlined various options for Bergstein. The FreeStyle Libre would require Bergstein to scan the sensor to get a reading, which wasn’t realistic during a race. Both Medtronic’s and Dexcom’s CGMs would sound an alert any time his glucose started rising or falling—a key feature for Bergstein. But at the time, Medtronic’s devices all contained a built-in insulin pump, which he didn’t need. (Since then, Medtronic has released the Guardian Connect, a stand-alone CGM that sends glucose data to a smartphone.) So Bergstein zeroed in on the stand-alone Dexcom G6 system.
“It has several clear advantages,” says Levy. “It requires no finger sticks, which would make it much easier for Lance to use; it has a revamped sensor, which would make it much easier for him to insert; and it automatically transmits readings to the CGM receiver every five minutes, so all he’d have to do was take a quick look to make sure his glucose levels weren’t getting too high or too low.”
Both Levy and Bergstein decided the Dexcom G6 made the most sense. “After each race, we sat down and analyzed the sensor data to figure out what Lance needed to do before and during the [next] event to ensure his glucose remained stable,” says Levy.
His new CGM has been invaluable in allowing him to participate in 24-hour races. During an event, he has a live feed of his blood glucose in two places in the car. When he sees his glucose beginning to drop, he sips juice (two straws feed into his helmet, one carrying water and the other juice) to make sure it rises again. “This way, I prevent a low from happening at 200 miles per hour,” he says.
The benefits of his CGM extend beyond racing. Since Bergstein doesn’t have to deal with finger sticks, and because the sensor has a one-button applicator that makes insertion less painful, he is more willing to use it on a consistent basis.
As a result, his A1C has dropped by almost a full point since he began using it last May. “He has been able to monitor himself so much more carefully,” says Levy.
Now that his numbers are constantly in front of him and he’s regularly reviewing the data for trends, Bergstein finds it easier to pay attention and keep his blood glucose levels in his goal range. “It allows me to see not only live data, but historical data, which helps me figure out dosing for different foods,” he says. “For example, if I have a slice of pizza, I can see how it impacts my blood sugar over the next few hours so that in the future I can better time when I need to take my insulin.”
It’s also enabled him to exercise more strenuously at the gym and improve his overall physical fitness. “Every morning, when I’m on the treadmill at 5:45 a.m. completely blurry-eyed, I can keep tabs on my glucose and, as soon as it starts to drop, sip some juice to keep it stable,” Bergstein says. “But I’ve also learned that when I lift weights, my glucose levels rise slightly, so I’ve been able to tweak my insulin dose on those days when I do strength training.”
Levy sees the value of CGMs continuing to grow. “Over the last several years, new models have come out, which are even more accurate and much easier to insert,” she says. With the Senseonics Eversense implantable CGM, for example, “users don’t have to worry about changing it for three months. In my experience, virtually all of my patients who have type 1 diabetes benefit from wearing a CGM.”
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