My son does something similar. In Vietnam, only the Freestyle Libre 1 is available, so we got the aftermarket MiaoMiao transmitter for it. The transmitter talks to an iPhone running xDripForiOS (https://github.com/JohanDegraeve/xdripswift) which, in turn, pushes the CGM data to nightscout (https://nightscout.github.io). We can then follow that data on nightscout using xdrip on our own phones.
It's been a real life changer. Before I'd have to stay up at night to check his blood a couple of times, but now I no longer need to. We've been able to flatten his curve and keep him in a sane range by adapting his basal rate based on the data. I can see when he is dropping low at school and inform them to correct the situation.
I'm not sure why the author isn't using nightscout data for his complication though. Great article, none the less.
I HATE the Freestyle Libre. The concept of continuous glucose monitoring is life saving, but this particular product is very very bad. The hardware design is awful. I've received 9 of them and 5 have broken before their expiration date, for a variety of reasons. Two of them broke immediately at first application.
Glucose monitors in general are expensive ($100+ retail) products that are meant to be disposable every two weeks, which itself is insane. I understand the design constraints that the Libre is under, and they are onerous, but they just have to make a more reliable product.
We've found them to be pretty reliable here. They tend to lose accuracy for extreme highs and lows, but when it's within 80-250 it's pretty spot on with our blood meter.
xDrip also has a feature that will calibrate the libre with pokes which increases the accuracy.
We never bolus off the libre's readings though, but it's fantastic for trends and seeing spikes and crashes in real-time. For example, I can see that my son is high af between 8am to 11am (post breakfast spike), so I've tweaked his basal rate a few times so that he's always in range now during that time period with no crashing afterwards.
I mean, I would love a dexcom over the libre any day of the week, but I'll take what I can get here in Vietnam.
Same here. They just up and die. Abbott has replaced a few for me. And I think the only way they’re going to get more reliable is if you force Abbott to cover the cost of the dead unit vs you/me.
I had some ideas on how unreliable all nutrition research is but nothing prepared for the flood of bad advice once I was diagnosed with diabetes T2. I now trust one thing and one thing alone and that's my Dexcom G6. If it shows a spike eating the same meal twice , that meal is off the list. That easy. I deleted normal flour, potatoes and rice from my life and per three month blood checks I do not even count as prediabetic now. (Of course, the system is still very much not okay: I ate a slice of brown bread in Vienna thinking it might be okay, it wasn't okay. Luckily, I am not getting seizures from it, phew!)
It must've been really, really hard navigating this minefield without it. Speaking of minefields, grocery stores are one. There's sugar in everything the sugar industry made Americans into sugar addicts, it's absolutely shocking and horrifying just how much of it is in bloody everything.
As wonderful a medical innovation dexcom is, their website is absolutely terrible. I am Canadian but I run an AT&T SIM because it's cheaper -- in 2018, AT&T removed North American roaming restrictions, they know and they are fine with us using it 100% in Canada. Now, the Dexcom app uses the gsm.sim.operator.iso-country Android system property to determine which country you are in. If it finds US then it registers you to https://uam1.dexcom.com/ otherwise https://uam2.dexcom.com/. There's absolutely no way to user select this. However, the browser uses IP geolocation... because of course it does. So you can't log into your own account unless you figure the above uam discrepancy out and manually go to the correct one. And for Canadians there is a store account which is neither of the above. It's an independent third. Because of course it is. There's nothing on the dexcom website or app which would mention any of this and their tech support won't say either. It's been a nightmare trying to figure it out.
Is there a way to get this device without a prescription? I tried phone apps that use the FreeStyle Libre and make it into a CGM (e.g., https://www.levelshealth.com/).
(Merely as I was curious last year about the effect various foods had,) I just ordered all the equipment on Amazon (though, it probably helps that I dated a type I diabetic for many years and have another type I friend that uses the Dexcom and so I knew everything I needed to get).
What? It is pretty well established that continuous glucose monitoring is the go to method for avoiding potentially invasive diabetes and heart related surgery.
Diabetes, obesity and heart disease are often caused by excessive amounts of glucose in the bloodstream which causes your body to react to this emergency by spiking insulin which crams all the glucose into your fat cells and if those are full into your muscle and organ cells. At some point there will be inflammation in your blood veins which leads to plaque blocking the blood stream. That's when your heart will struggle to pump blood through your body.
Total tangent, but having moved to Germany from the UK, one thing I can’t find is (what in the UK we’d call) granary or seeded bread. The Germans have lots of lovely bread… but even the dark brown stuff is very smooth with (I assume) refined flour and no major seed/grain content. This might explain your blood sugar spike from brown bread?
Denns biomarkt does have a few specialized breads which are OK. Mainstream things are not. Why, I do not know. In North America, Carbonaut is the only one that works.
Yes - fair point - we've tried that, and that's a counter-example to my generalisation. However, I'd discounted/forgotten it because the versions I've tried almost don't count as bread in my mind, as it's so seed-heavy that it doesn't have much structural integrity and falls apart very easily!
Looking back to when my father was alive with diabetes T2 in the late 80s/early 90s, nearly all the nutritional information turned out to be total bollocks. I would go as far as saying the information was seriously harmful. We still have a good way to go, but things are definitely night and day compared to 30 years ago.
The app tries to predict blood glucose in the future (drawing on CGM, food intake, lots of parameters and other data) and based on that either automatically injects insulin, or asks the user to confirm.
People need to compile the app themselves because the liability in the case of adverse effects is insanely high.
It’s a highly driven community. I’ve seldom seen such a useful and well supported application of modern tech.
Source: I worked for a company in the diabetes app space.
Reminds me of Barnaby Jack [0] who in 2011/2012 "demonstrated that he could wirelessly hack the insulin pump from a distance of up to 90 metres using the high-gain antenna". That was based on the hardware and not even all kinds of smart cloud-connected apps having bugs to exploit.
I'm actually part of a research team working on using a wrist mounted spectrometer to actually measure glucose continuously and non-invasively. Turns out it's a really really hard problem.
If you crack it is there anything preventing using the same tech to get a whole host of measurements like vitamin levels or other blood components? I'm imagining you are going down the same path as oxygen saturation meters except it's way easier measuring elemental content than complex molecules. What's the hardest problem, if I may ask?
All I keep hearing is that Apple is pouring a fortune into cracking this problem. They've certainly been snapping up every prominent person in the industry in the last decade.
Friend of my wife, type 1, just 2 weeks ago died in his sleep from mismanaged blood sugar. He was only 37 and was otherwise very healthy - it was shocking, I never knew it was so dangerous and that mis measuring or forgetting before going to bed could have such dire consequences. I though it was like sleeping with your contacts in. This is a gap this tech could close, I hope it’s widely available soon - hopefully an artificial pancreas is near as well.
That's really sad and tragic. There are like 50, or some other large number, things that affect blood glucose levels and we control 2 or 3 of them(insulin, food, and exercise). Your wife's friend may have done everything correctly and still had blood glucose that was too low.
This is why I sleep so much better since getting a CGM, it's life changing because one can make data driven decisions that minimize risk and be alerted when it's time to pay attention. It helps take away cognitive load that lessons the risk of burnout too.
I can't imagine what it was like as a T1 before them.
I was diagnosed T2 about 2.5 years ago, and worse a Freestyle Libre (not technically a CGM, but very close) for the first 6 months or so. Very useful for figuring out how I'd react to certain things, and I've got things pretty well under control now (A1C ~5.5)
That's awesome. Yeah, like anything using the data to make better decisions is the way, otherwise there's no point. Even as a T1, if my BG is high, I will generally(not always) eat less carb or none for a meal. Plus the changes in insulin dosing. It's just easier and injected insulin is so much slower than what the pancreas can do(both in time to react and duration)
I'm sorry for your friend. Truth is even a lot of doctors don't appreciate how difficult controlling type 1 diabetes can be. Having lived with it for over 20 years I'm still shocked at how ill-prepared I was once I came home from the hospital.
CGMs can make all the difference in the world, and I hope they continue to get better.
(context: my son is DT1) We learn (in France) that hypoglycemia can lead to unconsciousness, but cannot be fatal as the liver will eventually take over and release glucose to the organism, as it always does for healthy persons. Glucagen injection is the way to get this release to happen fast, but it can be delayed if necessary.
Rockley Photonics is partnered with Apple and medical device makers, developing a spectrophotometer on a chip for devices like the Apple Watch and other medical wristbands. Their sensors can measure multiple biomarkers in the blood in addition to glucose, like alcohol, hydration, core body temperature, lactate. They are presenting at the Baird investment conference Monday morning. https://www.yahoo.com/now/rockley-photonics-present-baird-20...
I saw similar products at Nokia bell labs ~3 years ago. Super stoked to see this stuff actually on the market in ~2030. Kinda wish it were sooner, but if you fuck up, someone probably dies.
there are several r&d companies like rockley trying to bring contactless optical measurement to market, e.g. https://www.diamontech.de/home
Most are based on quantum cascade lasers. go science :-)
I was looking into this the other week, I couldn't find a CGM supplier in the US that would sell dtc. I don't need it for any medical reasons. Im just interested in the data. Anyone know of a supplier?
You need a prescription, since it is a medical device. Ask your doctor and you can probably get a starter kit. You will have to wear it in order to generate the data you want. Each sensor only lasts 10 days or so. Transmitters last 3-4 months and you can hack in a new battery. Without insurance, the sensors run $300 for a 3pack. And transmitters are $150.
You might be better off finding a diabetic friend if you just want to capture data and reverse eng protocols
I got mine from Levels. They use the same sensor as mentioned in the article, and wrap it with their own app. Very easy to deal with. They are trying to limit demand so you need an invite code, but you can find one on Google in 5 minutes.
Veri/Levels as others mentioned if you dont mind paying $$ and want the fancy data viz and UI ...or just sign up for a free (15$ really) trial of the freestyle libre here: https://www.freestyle.abbott/us-en/myfreestyle.html . It'll ask you if you're a diabetic and you just click yes
Are there any apps that can read the NFC data from the FreeStyle libre? I don't want to deal with yet another device that you need to use to read data + upload.
Freestyle Libre has their own app. I havent tried it yet though but its supposed to be not great. I assume its good enough to watch trends for a non-diabetic seeking glycemic feedback on their meal
The author has done a lot of work, but the title of this article is very misleading. There's no monitoring happening on the watch, it's just used
to display the results that are collected by another device.
Agreed, I would have preferred a title like 'receiving glucose readings on watch'.
I already have my readings being sent from my Libre sensor to my phone, but thought this was going to be a story about true non invasive monitoring (many companies have been supposedly developing tech to read glucose from the skin surface, though afaik none actually work yet)
Well even if another device is collecting the data, it is being monitored on the watch.. if it was being fed to a computer it would just be being watched on a monitor.
The Dexcom G7 (not yet released) is supposed to be able to connect directly to the Apple Watch. The current G6 requires the phone but does have a watch complication that displays your current trend and trend graph.
It is technically possible to connect the Apple Watch directly to the FreeStyle Libre glucose sensors as demonstrated here: https://github.com/gui-dos/DiaBLE
Unfortunately, in this case you need to pay for a certificate for signing the app, build it yourself and so on
To add to this, it can be configured to also buzz your wrist while you’re asleep if you go low (eg at 70) before it starts making noise for a very low alert (eg 55). Really convenient to not wake up a partner. Your phone still has to be in Bluetooth range though.
With the open source app xDrip, any Android watch has been able to act as a collector since G4 days already. With AndroidAPS you can even dose insulin directly from the watch.
They're extremely helpful for anyone who has diabetes period. Aside from finger pricks, which no one wants to do every 5 minutes (that's how often they usually update your BG level), there's no other way (yet?) to monitor/track blood glucose levels.
The real breakthrough will be when diabetics can stop worrying about ANY monitoring at all, and we just make the pancreas start creating insulin again. I'm hoping the developments out of Michael Levin's lab at Tufts will lead to many medical breakthroughs by controlling cell function and differentiation at a high level.
Are these devices (Free Style Libre) safe for contact sports? I wanted to wear one and even got a scrip for one as i am pre-diabetic. I do BJJ 4x a week and am concerned about the device on the arm getting dislodged or broken. I thought about neoprene arm sleeve, etc.
Anyone have experience with contact sports and such devices?
When I was doing a lot of sports (though nothing quite as high contact as grappling), I'd put a couple of strips of kinesiology tape over the sensor which helped a lot with keeping them on.
You need to put something non adhesive between the back of the sensor and the tape though, to avoid pulling it off when you change the tape.
“Google was working on (and then cancelled [0]) a contact lens that measured glucose levels in the tears and then communicated those levels with a small LED in the lens itself.”
It's a really hard problem. There are perhaps a dozen experimental noninvasive methods to get a rough approximation of glucose levels, but none that work consistently enough and accurately enough to make insulin dosing decisions. For that you need fingerpricks or a subcutaneous CGM.
I don't think we'll ever have safe CGM that isn't minimally invasive. Proteins are weird and you really need to measure blood, not a picture of blood through skin. We are only recently getting CGMs that don't need frequently recalibrated via a finger stick. I hope someone prove me wrong but it would be quite the leap forward in tech.
Opening up the API on wearables is going to be the real change in digital health. The last 2 years was a flood of poor investments. Natural Cycles is a digital/non-hormonal birth control that will be awesome
Sounds cool if i didn't have to have micro needles in my arm. Anyone wear one of these things? I figure it useful for a month then after that you have a sense on what impacts your glucose…
As a t1d who's been using a cgm for like 8 years at this point, having it there constantly is objectively better, and you normally don't notice the needle (needs a bit of fat though). Fairly routinely, I'll go a couple of days without because the installation is a bit of a pain, and my blood sugar is invariably worse on those days. A big part of it is the reduction in cognitive load devoted to managing your blood glucose. You don't have to estimate what it's doing, just decide on the right action to take. It can wake you up when you're going low, which is much better then waking up in a cold sweat and devouring your kitchen refrigerator from the hunger.
Also, the alternative is pricking your finger so it bleeds, which is much less pleasant.
One thing op doesn't talk about is close loop systems, which automate some of the insulin delivery using the sensors. They're still in the very early days, but they're generally good at dealing with random variation or overnight highs.
It's crazy that we've kind of been capable of this for almost a decade now. You can buy all the parts to make an artificial pancreas, and use open source software from GitHub to get them to talk to each other, but none of the biotech giants want to put the parts in a box and sell it as an artificial pancreas because the liability would be insane. One little firmware glitch could literally kill a ton of kids in their sleep.
My 10 year old is a type 1 diabetic and wears a Dexcom CGM. It isn't really a needle that's in your skin (for 10 days in this case), it's a flexible filament. It is delivered/inserted into you skin via a special insertion device.
There's so many things that can affect your blood glucose level that it can be maddening to deal with as a diabetic. Mood, activity level, time of day/night, different foods take longer/shorter to raise your blood sugar, etc.
I had an IV needle stuck in my arm for a couple days when I had appendicitis. If it weren't for the tube hanging off it, I would have hardly known it was there. I barely felt it going in, either. I'm quite sure a CGM is even less obtrusive.
I'm not an expert on this stuff, but usually the needle is usually only present while installing the IV. After it's placed, the needle is removed, leaving only the catheter.
I wasn't sure if appendicitis would need something larger perhaps?
Anyways, the Dexcom pods are similar to an IV in the way the insertion needle and sensor go in together then the needle retracts.
Yep I used levels health for a month and it was extremely useful.
Beyond that, I mostly eat the same stuff all the time so I know what it's going to do to my glucose even without the CGM telling me about it.
I still would like to give it another few months to narrow down all the other environmental factors - sleep, exercise, stress, alcohol etc. and see how my blood glucose reacts.
Needle in the skin is a non-issue. You won't feel it at all. It's like keeping a bandaid on for a month.
Yep, but there are a lot of environmental factors that the link above talks about. Stress, Sleep, Alcohol Consumption etc. all matter and the effect varies by individual.
What was incredible was how well the glucose level predicts cravings. I just ate as I usually do and almost every time I had a sugary snack (cookies etc.) I'd notice that my glucose level was low just prior to the snack.
The goal is to find out which food is tasty, provides satiety and keeps glucose from dropping too much.
I eat an Indian + Vegetarian diet with rice being the primary carb. Rice causes pretty sharp rise in glucose and a pretty steep crash after insulin is released leading to cravings etc. One behavioral change that was permanent was that we got rid of one variety of rice that's really bad (Sona Masoori) and replaced it with Basmati. We also mostly eat Quinoa or a mix of Quinoa + Basmati for our primary carb now.
Interesting - thanks for sharing. Also - you don't cook quinoa and basmati at the same time do you? That would be a super time saving way to enjoy those two at the same time.
If you just want it for a month to check out your blood sugar, you can ask your doctor to prescribe you a one-month trial pack. (They're technically for diabetes screening to see if you're diabetic/prediabetic).
If you want them for a longer period of time, and you don't care about insurance covering the thing, you can straight up buy them from a startup like Levels. I think they have a doctor prescribe one for you via video call, but it's more just to explain how to use the thing, and it's unlikely to be covered under insurance if you're not diabetic.
- glucose levels are not always "normal", for instance goes high if we eat something rich in sugar while we are PERFECTLY healthy, the smart-glucometer can't know that;
- a needle, even a micro-set of needles that constantly punch through our skin always in the same place is a recipe for infections and minor issues.
Surely Apple, and not only Apple, like to collect as much health data as possible, perhaps in a not so far future linking them to a new kind of social score "The Life Score" who decide for instance if we need meds what we get, sometimes good ones if we are useful for the society, as decided by those who master the score itself, a small élite, sometimes something to make us die because we are evolved to be useless again for the aforementioned élite.
Oh, BTW such planning-management-erotic-dreams was not much new a guy named adolf from Austria then Germany few years ago have tried a world war measuring how much "soldiers" local women can "produce" to match number of fallen ones... Try looking for Lebensborn project, which BTW means "those born out of love", a curious kind of love anyway...
Is this the society we want for the future? Something like the relatively recent Canadian TV series "Continuum"? for the future distopic part, without the rebellion of course.
Oh sure, we might have some marginal, in some cases potentially life-saving, benefits, but at what price? Do you really prefer being eventually saved at a certain age if you are still useful and you eventually fall ill, trading THE ENTIRE LIFE to be allowed to live under conditions you do not control if you are useful for someone else?
Such ideas have born before the French revolution, perhaps earlier, just to overturn the Revolution itself, maybe it's time to recover a bit of the old good spirit dropping the rest.
It's been a real life changer. Before I'd have to stay up at night to check his blood a couple of times, but now I no longer need to. We've been able to flatten his curve and keep him in a sane range by adapting his basal rate based on the data. I can see when he is dropping low at school and inform them to correct the situation.
I'm not sure why the author isn't using nightscout data for his complication though. Great article, none the less.