[HN Gopher] Apple Makes Major Progress on No-Prick Blood Glucose...
___________________________________________________________________
Apple Makes Major Progress on No-Prick Blood Glucose Tracking for
Its Watch
Author : mfiguiere
Score : 191 points
Date : 2023-02-22 17:42 UTC (5 hours ago)
(HTM) web link (www.bloomberg.com)
(TXT) w3m dump (www.bloomberg.com)
| ortusdux wrote:
| Others have demonstrated optical sensors for blood pressure and
| blood alcohol content. 24/7 monitoring of HR, Resp., glucose, BP,
| & alcohol will be interesting.
|
| https://www.mdpi.com/1424-8220/21/12/4076
|
| https://www.nature.com/articles/s41598-021-99294-w
| v8xi wrote:
| add sweat ion concentration(s) to the list!
| swamp40 wrote:
| I'll bet you could heat up the skin to get it to sweat.
| Projectiboga wrote:
| Frankly I bet there will be be a cure for Type 1 diabetes of some
| sort before this tech ever materializes.
| onepointsixC wrote:
| A breakthrough would be well welcome, but I would stress for
| everyone who reads any potential news about non invasive blood
| glucose monitoring from a small wearable to be very skeptical. It
| is an extremely difficult task, one which numerous startups have
| attempted and failed using Apple's approach of optical absorption
| spectroscopy. I'd wish anyone working on the project the best of
| luck, as it would be truly ground breaking if it could work, but
| I fear that it will take many, many, more years if it's even
| possible to do so with any real reliability.
| modeless wrote:
| Any news on the feasibility of continuous blood pressure
| monitoring? That's the one I'm interested in.
| manv1 wrote:
| Hmm, there's one that isn't for sale in the US yet:
|
| https://aktiia.com/blood-pressure-monitoring-app
| BrianHenryIE wrote:
| If anyone has a Dexcom and a jailbroken iPhone, I've written some
| code for MITMing the Bluetooth messages received, I'd like to
| test it out.
|
| I did a proof of concept with a Bluetooth scales so this should
| work. I'll add a README after work:
|
| https://github.com/BrianHenryIE/tweakdexcomg6
| jwoglom wrote:
| Are you familiar with Loop? I believe they are currently just
| intercepting the Dexcom notifications rather than connecting
| directly over BLE by default for the G6/G7. However the xDrip +
| xDrip4iOS projects have gotten the G5/G6 BLE protocol to a
| state of being fairly well understood.
| BrianHenryIE wrote:
| Oh neat. I wrote that bit of code last July and I couldn't
| find anything then. I'll take a deeper look at this later.
| braingenious wrote:
| Out of curiosity, why do that? The Dexcom app already has the
| ability to generate detailed logs that you can just email to
| yourself. It's actually a very handy feature.
| insane_dreamer wrote:
| You can see why Dexcom seems to ramping up their marketing now
| (at least I'm seeing more of their ads where I never saw them
| before); will be a big blow to them if Apple incorporates it into
| the watch (unless they're using Dexcom tech inside)
| bedast wrote:
| They stepped up marketing because the G7 released February 17
| in the US.
| Alex3917 wrote:
| > You can see why Dexcom seems to ramping up their marketing
| now
|
| I'm not convinced this is really going to matter. I'd love to
| be able to measure how much different foods affect my blood
| sugar. But because I don't have diabetes and am not at high
| risk for diabetes (based on my A1C), the Dexcom is absurdly
| expensive as just a toy to satisfy my curiosity. But if I could
| buy a $19 thigh strap for my iPhone to do this then I'd jump on
| that in a heart beat.
| v8xi wrote:
| For $19 you might be able to get the elastic band, but this
| is Apple we're talking about...
| epicureanideal wrote:
| The PR/marketing win of the decade would be to sell this
| specific feature for cost.
| insane_dreamer wrote:
| Do you know whether Apple is planning on making the glucode
| detection on the watch suitable for patients with diabetes or
| will it be more of a "non-medical informational" feature.
| lakeshastina wrote:
| Are there not similar products already in existence? I was
| looking to buy "FreeStyle Libre" for this very purpose.
| gerash wrote:
| The device itself is a one time use device that has a this
| mechanical mechanism to inject a thin needle underneath your
| skin and lasts for a couple of weeks
| __jf__ wrote:
| Yep the FreeStyle Libre 2 is great. I bought one a few weeks
| ago to satisfy my curiosity. I'm a non-diabetic. It was around
| EUR 70 including shipping and lasted exactly 2 weeks. Sensor
| insertion was easy, quick and painless. 1-minute resolution
| with 8 hour memory between swipes. Curiosity satisfied!
| wpietri wrote:
| Did you learn anything from the 2 weeks of data? E.g., did it
| inspire dietary changes?
| __jf__ wrote:
| I was primarily struck by the awesomeness of this whole
| autonomous glucose regulation thing. My last meal is
| usually around 18:30 in the evening and during the night
| glucose would fluctuate around 4.5 mmol/l between 4.0 and
| 5.0 in 1 hour periods, like a crappy PID controller that
| needs a firmware update. Other nights it would be flat
| instead of fluctuating, but unfortunately two weeks were
| too short for a controlled experiment, meal repeats and
| figuring out what caused the difference. Some nights it
| would show a couple of hypo's where glucose would drop to
| 3.5, quickly to be countered by an increase. I didn't
| notice a thing.
|
| Additionally every morning before my alarm went off, I
| could see my glucose increasing, most likely preparing for
| wakeup, all by itself. Amazing!
|
| It gave me a new-found respect for these otherwise
| invisible processes happening in this fleshy vessel on
| autopilot with closed cockpit doors. I only got to peek
| through a small window during 2 weeks.
| beardface wrote:
| Now imagine having that entire responsibility yourself,
| having to do it all manually. That's what we type 1
| diabetics do every day!
|
| The nighttime fluctuations could be legit changes in
| glucose level, but could also be weird sensor issues. The
| sensor will often give low readings when lying on it in
| your sleep. These are referred to as 'compression lows'.
|
| The morning glucose spike you noticed is called the 'dawn
| phenomenon'. I inject a little insulin every morning to
| counteract it.
| notshift wrote:
| For me, I found that sleep quality was correlated with my
| blood sugar levels dipping too low during sleep (which I
| was able to address by eating fewer low quality carbs
| during the day).
|
| In general you'll be able to basically see in real time the
| glycemic impact of all the foods you eat. Which would
| probably be helpful to a lot of people - you can find all
| the info online, but having the physical real time stats in
| front of you makes a difference.
|
| But mostly its what you'd expect. High carb, fast digesting
| meal -> blood sugar spikes, then drops in accordance with
| you feeling tired afterwards. Eat keto -> blood sugar is
| mostly stable.
| lozenge wrote:
| There's a startup that combines a 2 week FreeStyle sensor
| with some blood tests, online courses and other things
| aimed at improving your diet.
|
| https://joinzoe.com/
|
| Now that I know how little the sensor costs, I would say
| that's definitely the better option...
| benguillet wrote:
| Where did you get one?
| notshift wrote:
| I think they might have been able to get one because
| they're in Europe, while in the US it requires a
| prescription. But you can just find a doctor who will
| prescribe one for you. (You will still have to pay out of
| pocket regardless).
|
| Could be wrong on the above but that's been my
| understanding/experience.
| __jf__ wrote:
| I ordered directly on Abbott's FreeStyle website.
| sithlord wrote:
| no, not anywhere close, they are all inserted, and disposable.
| MBCook wrote:
| Those are actually invasive in that they require something
| inserted into the skin. It's extremely small and is supposed to
| be painless, but it's still invasive.
| ubermonkey wrote:
| I desperately want to make a Theranos joke here, but I'm not sure
| we should put up with even a tiny drop of that sort of snark.
| Apocryphon wrote:
| No need to cause bad blood.
| jpolitzki wrote:
| Any SWEs working in this space. People at Nephra.ai are looking
| for people to develop for Potassium monitoring.
| boringg wrote:
| Using microneedles as per competition currently?
| criddell wrote:
| I don't think that would be called no-prick.
| boringg wrote:
| Do microneedles count as a prick? I know it sounds like it
| should but I honestly don't know if the current competition
| considers themselves to be a prick.
| v8xi wrote:
| Considering that, despite knowing for decades that pulse oximetry
| gives inaccurate results for people with darker skin, Covid
| showed us that we still can't/don't properly account for skin
| pigmentation during treatment[1]... I am not hopeful that they
| will be able to solve the challenge of measuring something MUCH
| more difficult and in a consumer format. Then again, Apple Maps
| shows us they might just release it anyways...
|
| [1] - https://hms.harvard.edu/news/skin-tone-pulse-oximetry
| lamontcg wrote:
| > Then again, Apple Maps shows us they might just release it
| anyways...
|
| Apple Maps has been working entirely fine for me.
|
| For this glucose monitoring the early product that Apple ships
| will almost certainly be grossly inferior to the product 10-20
| years later.
|
| I don't understand why this is a problem.
| simondotau wrote:
| Things like Apple Maps are a special case, where improvement is
| driven by public exposure. Yes, Apple's maps were full of
| errors upon initial release, but improvement was fairly rapid
| (albeit entirely opaque, unlike a typical open source project).
|
| Today, I find that while Waze does the best driving navigation
| and Google Maps is unbeatable as a modern yellow pages, Apple
| Maps is equal to or superior in nearly every other way. It's
| walking and public transport modes are, in my experience,
| consistently superior to anything else.
| dpflan wrote:
| Along this topic of Apple Watch, does anyone have a
| "killer"/"can't live without now"/"actually makes the watch more
| useful" app they use (other than watchOS defaults)?
| todd3834 wrote:
| Mostly defaults for me. Music and fitness tracker.
|
| Closest is when I'm trying to do a workout circuit and I don't
| have my phone I use Seconds.
| https://apps.apple.com/us/app/seconds-pro-interval-timer/id3...
|
| However I prefer to use Seconds on the phone so I can see the
| timer without looking at my wrist.
| tehnub wrote:
| Repeat Timer Pro. It lets me set 25 second timers every 25
| minutes, for as many intervals as I want. I use it to encourage
| myself to rest my eyes and stretch my legs for 25 seconds every
| 25 minutes. It notifies me with just a little vibration. I
| think it cost $5, but there are probably free apps that do this
| too.
| threeseed wrote:
| * AutoSleep - sleep tracking.
|
| * Stocard - gym / loyalty cards.
| ASalazarMX wrote:
| I tried to use it as a sleep monitor, but you have to plan
| your charging carefully because it won't last a full day and
| night on a single charge. Also, despite it knowing I was
| sleeping, it would randomly vibrate when I received whatsapps
| during the night, so I needed to remember to put it to sleep
| before sleeping myself.
|
| Speaking of messaging, I monitored several whatsapp groups,
| but I don't need to answer all messages. I did that on my PC;
| if I received a notification in my PC, but didn't interact
| with it, my phone would ding a few second later, and if I
| ignored that too, my watch would ding/vibrate a few seconds
| later. This is probably Meta's implementation, but getting
| triple notifications made day-to-day a bit more annoying.
|
| I also tried to use it to track exercise, which I usually do
| at home. I saw no advantages compared to regular timing and
| counting, and didn't find the gamification of exercise
| engaging, because I was already doing it.
|
| I got the watch during the pandemic, primarily for the
| oxymeter and ECG in case I had COVID (which I had). The
| oxymeter worked well, but the ECG wasn't enabled in my
| country until late 2022.
|
| Maybe it's become better now, but I sold mine before it
| became too old. Except for the automatic health monitoring,
| it made things a bit more of a hassle instead of making them
| simpler.
| justusthane wrote:
| Huh. I wore a Series 3 for years (just finally sold it last
| week) and never had an issue with charging/sleep tracking.
| I was in the routine of plopping it on the charger for 90
| min or whatever as soon as I got home from work.
|
| Also, mine would automatically go into "Sleep Focus"
| (previously "Do Not Disturb") during sleep time, which
| muted notifications. Not sure why yours wouldn't do that.
| boringg wrote:
| New watch has multiple days on battery charge + super fast
| charging. Autosleep is pretty helpful to be honest.
| dwighttk wrote:
| Re triple notification...
|
| Do you want to get those notifications in all three places
| in case you only have one of the devices with you? I'd just
| turn WhatsApp notifications off everywhere but my computer
| if I were you (if I were me I'd just turn them ALL off ;)
| ASalazarMX wrote:
| That was kind of my solution, muting all but a couple of
| critical groups.
| Aloha wrote:
| The bigger issue I had was it not playing alarms on my
| iPhone, and allowing me to cancel them from my watch,
| which I apparently could do in my sleep.
| officeplant wrote:
| Can't say I've found anything. Even the default apps leave a
| lot to be desired (like lacking note dictation to Siri on
| default watch apps)
|
| I like that the watch provides some benefits like sleep
| tracking + vibrating alarm for a calmer wakeup, and buzzing on
| my wrist while using maps on silent to remind me a turn is
| coming.
|
| I can live without the benefits the watch provides. Sometimes I
| take it off for days because I find wearing watches
| hurts/annoys my wrists (I had pocket watches until
| cellphones/PDA's took over for this reason). Although I am
| amazed that it's more comfortable than other smart
| watches/fitness bands I've tried to wear in the past.
| jmull wrote:
| There are multiple apps I "can't live without" but they are all
| default apps.
|
| (Not really "can't live without" but that, to me, justify the
| cost of buying and the routine of wearing.)
|
| I do sometimes want to track or do some things in a certain way
| that the default apps don't... but I can ever seem to find an
| existing app to do it either. The apps exist but don't work the
| way I want any better than the built-in ones.
|
| (Since I'm a developer, I sometimes whip up a prototype watch
| app myself, though I have to admit that while some have proved
| useful for a while, none have become a killer app for me, no
| matter how much I thought I wanted it originally. I do like my
| couch to 5K app.)
| ghaff wrote:
| I can't help but feel there could be a better hiking app out
| there but I've tried the usual suspects and end up just
| coming back to the default exercise app.
| bern4444 wrote:
| My take is the watch is more successful because I don't need
| any special apps to take full advantage of it.
|
| I love what apple has built around it - health and fitness
| monitoring primarily but also siri integration (setting
| reminders, alarms, timers etc).
|
| Generally on the health and fitness aspects the only
| accessories I find useful are a connected scale and connected
| blood pressure monitor (both from withings). The data is shared
| from the withings app to the health app (and I don't let the
| withings app read any data from health) so I can see that info
| along with everything else.
|
| I do wish either the health or fitness apps on iPhone had
| better analytics, data visualization, and comparison tools or
| made them easier to find. They do have some good ones but it
| takes more taps than I'd like and I wish there were more
| breakdowns.
| dpflan wrote:
| Agree. You're using products from
| https://www.withings.com/us/en/ ?
| bern4444 wrote:
| Yup! I have one of their scales and BP Monitors.
|
| Makes it very easy to track this data over the longterm
| automatically - especially BP which I can then show my
| doctor at my annual physical of how I'm doing especially
| since white coat syndrome can affect readings they take.
|
| I find having this data very motivating and I can use it to
| calibrate my days and weeks.
| [deleted]
| voisin wrote:
| Podcasts via Overcast. Though syncing sucks. I just find the
| app much better than Apple Podcasts.
|
| What do you think is preventing more development for the watch?
| madeofpalk wrote:
| APIs and connectivity suck. Apple Watch strongly prefers
| getting it's internet over bluetooth from your phone rather
| than faster wifi, so save energy.
| rhinoceraptor wrote:
| I believe Marco (Overcast creator) said if you disable
| bluetooth on your phone (likely in settings, not from control
| center), the watch will stop trying to sync slowly over
| bluetooth, and switch to wifi.
| seanmcdirmid wrote:
| Mobile payments. Just tap my watch to the NFC terminal. That
| alone is worth it, although other phones could do that. Apple
| key is also useful, just in case I forget my key fob.
| xxs wrote:
| pretty much any half-decent watch can do that nowadays. I'd
| not trust a no name brand w/ bank card details but the
| feature is not exclusive in any way.
| syzarian wrote:
| I don't like carrying a phone around and have a cellular plan
| for my watch. For me that is the killer feature.
| pasc1878 wrote:
| Yes that.
|
| But also nice to allow the watch to act as a wifi hub so that
| I can if needed carry an iPad if I need to look at things.
| dcdevito wrote:
| [dead]
| theshrike79 wrote:
| Cellular calls that actually work are amazing for the watch,
| especially on vacation. I can call my SO from the pool to bring
| more bee... sun tan lotion.
|
| I can also use the watch to pay for stuff anywhere. I can go on
| a jog and reward myself with ice cream half way (stupid: yes,
| fun: also yes) without needing to carry my phone or wallet with
| me.
|
| That combined with a list of curated apps that can notify me on
| the watch help me not check my phone as often. If my watch
| vibrates it's something I actually need to take action on, and
| it's easier to quickly glance at it compared to a phone.
| MrFoof wrote:
| Deliveries. Getting the bong on my wrist that something (and
| what it was) was dropped off has always been super useful, and
| it's the exact kind of thing where being interrupted is useful.
| kstrauser wrote:
| WorkOutDoors is brilliant for offline mapping. I'd used it as a
| running tracker until very recently when I went back to the
| builtin Workout app (just because it's simpler and builtin).
| The builtin Compass app is decent now for setting waypoints and
| tracking your hikes so you can find your way back. WorkOutDoors
| is great at both of those, but also allows you to upload maps
| from your phone so that you still get good trail coverage even
| when you're out in the middle of nowhere, so long as you've
| planned ahead a little.
| browningstreet wrote:
| WorkOutDoors is also my answer to this question. I can
| provide more controls to my runs and hikes than the native
| apps. I do heart rate zone running, and can set low and high
| heart rate alerts. Loading GPX files for hikes is also really
| handy.
|
| Ping authentication is really nice.. I can leave my phone
| anywhere in the house and still validate VPN authentication
| requests.
|
| Wallet -- wrist tap to pay.
|
| These alone would keep the watch on my wrist.
|
| That Google doesn't let me authenticate Gmail app 2FA by
| phone seems.. silly (does it? have I missed that?).
| officeplant wrote:
| >That Google doesn't let me authenticate Gmail app 2FA by
| phone seems.. silly
|
| Do you mean by watch? From what I'm aware google prompt
| only works in the google/gmail applications for iOS.
| kstrauser wrote:
| Apple Watch + WOD/Workout + Wallet + Air Prods Pro + Music
| is go good for runs. I have music, I can say "Hey Siri,
| remind me to..." when inspiration hits, and I can stop to
| buy a bottle of water if I want.
| hangonhn wrote:
| The cellular modem plus Workout app plus Airpods Pro have been
| amazing for me. I can either talk to my friend while running.
| He's running in NYC and I'm running in the Bay Area so we do
| virtual running together. The accountability keeps each other
| honest. I've been able to consistently run nearly every
| Saturday for over a year now because of this. I'm a weight
| weenie when it comes to running and don't want to have to carry
| my phone with me.
| ChrisMarshallNY wrote:
| The most important thing, for me, is the ability to keep my
| phone on silent, and to respond to calls.
|
| I've written Watch apps (It's a pain in the ass). I haven't
| really found a compelling driver for it, though.
|
| That might change, as the hardware improves.
| bjtitus wrote:
| I could live without, but these are the main non-Apple ones I
| use everyday:
|
| - SmartGym for tracking reps without my phone.
|
| - Paprika with my grocery list. Much easier to flip over my
| wrist while pushing a cart than pull a phone out.
|
| - Pocket Casts for selecting podcasts on a dog walk.
|
| Honestly, none are worth buying an Apple Watch for but the
| notifications & built-in fitness tracking are really the
| selling points anyway.
| Razengan wrote:
| I just like wearing a watch that's more than just a watch.
| tullidil wrote:
| AutoSleep has been invaluable to me. To the best of my
| knowledge stock watchOS won't track sleep unless you set or
| schedule the Bedtime mode, which is annoying -I might forget to
| toggle it each night, or the schedule will kick in when I plan
| on staying up. AutoSleep automatically detects whenever I go to
| bed and wake up, along with history/metrics for a flat fee and
| no subscription.
|
| I don't deeply trust many of the metrics but anecdotally it's
| very accurate for the amount I'm sleeping, which is mainly what
| I'm concerned with
| pmarreck wrote:
| I can second the utility of AutoSleep for sleep sufferers
| ghaff wrote:
| I had a Beddit which was a device made by a company that
| Apple bought. I find the sleep tracking and general activity
| tracking at least vaguely interesting. Though if I have a bad
| night's sleep I know it--sometimes better than the Watch
| indicates. But the more we can track things and be aware of
| those things changing, the better I guess. With the Ultra's
| battery life I have found using the Apple Watch most days and
| nights a more matter of habit experience.
| [deleted]
| mydogmuppet wrote:
| I used the Libre FreeStyle 2 system for 6 weeks. A revelation
| about diet, especially carbohydrates and blood sugar levels. Not
| sure it picked up my only Hypo and erratic data capture/loss over
| the whole period. Unexplained by Abbott. I'm Type 2 self
| inflicted. I'd like to use but not sure it's value at GBP 1500
| per annum.
| troydavis wrote:
| Headline aside, it sounds like the real news is just how
| difficult this problem is - even for Apple. Back in 2020-2021,
| the rumor was that a Watch might include Rockley glucose
| monitoring[1], possibly in 2022-2024. If this article is correct,
| Apple is nowhere near that:
|
| > Apple's system -- more than 12 years in the making -- is now
| considered to be at a proof-of-concept stage, said the people,
| who asked not to be identified because the project is
| confidential. The company believes the technology is viable but
| needs to be shrunk down to a more practical size.
|
| > Engineers are working to develop a prototype device about the
| size of an iPhone that can be strapped to a person's bicep. That
| would be a significant reduction from an early version of the
| system that sat atop a table.
|
| ...
|
| > Before shifting to TSMC, Apple had worked with Rockley
| Photonics Holdings Ltd. to develop the sensors and chip for the
| technology. In 2021, Rockley publicly disclosed its work with
| Apple, stoking interest in the supplier. Apple later ended the
| partnership, and Rockley filed for bankruptcy last month.
|
| [1]: Related conversations:
| https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
| tpoacher wrote:
| on the contrary, I wouldn't be too surprised to find that this
| burst of innovation is happening to coincide with a bunch of
| patents held and buried by big pharma coming near their
| expiration period.
|
| up until now there has been zero financial incentive for
| stakeholders to promote a method of blood glucose measurement
| which bypasses the need for consumables, and every incentive to
| prevent such a solution.
| snowwrestler wrote:
| You can't bury patents, a patent is a public record. That's
| the whole point of patents: an incentive to disclose your
| invention.
|
| If we knew how to do this, but valid patents blocked the
| broader commercialization of it, then we would not be reading
| stories about breakthroughs in basic implementations. We'd be
| reading stories about how companies have products ready to go
| once the countdown timer hits zero.
| MengerSponge wrote:
| This isn't a 3d-printing type problem where the problem was
| basically solved twenty years ago but locked behind patent
| protection. It's really an incredibly hard problem. C8 sold a
| battery-powered miniaturized Raman spectrometer that strapped
| to your belly about a decade ago. It was a technological tour
| de force, but it went under. Battery tech is better, but
| we're just waiting for some particularly clever team to
| figure out a different optical stack that is small enough to
| wear comfortably, delivers enough power to be effective, and
| is robust enough to wear 24 hours a day.
| joezydeco wrote:
| It's interesting you mention that because Abbott (maker of
| the Freestyle sensor) is trying to hire like crazy for a
| project named Lingo. It's pretty much the same technology
| that will be offered to _non_ -diabetics to offer health
| monitoring via blood chemistry.
|
| https://www.fiercebiotech.com/medtech/abbott-ceo-ford-
| unveil...
| rrrrrrrrrrrryan wrote:
| This is still an invasive consumable.
| rrrrrrrrrrrryan wrote:
| > it sounds like the real news is just how difficult this
| problem is - even for Apple
|
| I've worked in this space for 5 years now, and this is not news
| to any of us. Today, a tiny, noninvasive device, that is
| accurate enough to make insulin dosing decisions, is pure
| science fiction. It's probably not _impossible_ , but we'll
| literally be able to use stem cells to regrow human pancreases
| and straight-up cure people of diabetes before this tech
| becomes a reality. (We're _much_ further along that path.)
|
| What is interesting about this though is the possibility of
| using this device for non-diabetics who don't need extremely
| accurate glucose readings. A rough approximation of someone's
| blood glucose levels is enough to learn how your body reacts to
| different types of foods and exercise, and would be helpful for
| amateur athletes who can't afford to purchase real continuous
| glucose monitors, as well as pre-diabetics for whom CGMs aren't
| covered by insurance.
| crazygringo wrote:
| I'm fascinated by the fact that this seems incredibly hard,
| yet not so impossible that Apple is trying.
|
| Is there an ELI5 of the basic principle of how it would work
| (or at least the direction being pursued), and what the main
| obstacle is, and why we think we'll be able to overcome it to
| _some_ degree?
|
| Besides athletes, I can't help but think it could be a _huge_
| step forwards for weight loss as well. I 'm aware of the
| concept (for non-diabetics) of only eating once your blood
| sugar is below a certain level, and never eating so much that
| it goes over a certain higher level.
| kamens wrote:
| Important nuance here is the difference b/w the parent
| poster's "accurate enough to make insulin dosing decisions"
| criteria (extremely difficult+risky)
|
| vs
|
| "useful enough signal for general population / those at
| risk of type 2 diabetes / those with diabetes who don't
| require insulin treatment / etc" (much larger market for
| Apple w/ greatly reduced requirements)
| [deleted]
| onepointsixC wrote:
| I don't think anyone who is in the know would be surprised
| about that. Noninvasive blood glucose monitoring is a multi
| billion dollar product, should anyone be able to figure it out
| at all. It's fiendishly difficult, and quite possibly
| impossible to do it sufficiently accurately, even more so over
| long periods of time. C8 MediSensors was trying to do it 10
| years ago, but ultimately went under. Even with Apple's budget,
| it's a herculean task.
| akiselev wrote:
| You're underselling it. Measuring blood at millimoles per
| liter precision through skin on a watch sized device is
| Theranos-esque physically impossible product-market fit.
| Tricoder level of science fiction.
| copperx wrote:
| I wonder whether there are any shortcuts like ingesting a
| substance to make the glucose visible by the sensor.
| Cshelton wrote:
| Bingo.
|
| Noninvasive, with any sort of accuracy that can be used
| for anything, is most likely impossible.
|
| So back to "invasive"... what can we do... embedding a
| device under your skin, right around where your watch
| goes, that can be powered and communicate with the watch.
| While also making sure the device is not rejected by the
| body and stays in place.. AND has no other adverse side-
| effects. I think this is where it'll ultimately end up
| for the people who want it. sub 10 min procedure to put
| it in and should last for quite some time (maybe
| dissolves after 5 years for upgrades?)
| blendo wrote:
| Add heart rate, blood pressure, and blood oxygen level.
| Have the Apple Watch call 911 if things go pear-shaped.
|
| Profit.
| Nekhrimah wrote:
| > Profit.
|
| Well yes, but also substantial life saving interventions
| become possible.
| Spooky23 wrote:
| They should profit. That will save millions of lives.
| MengerSponge wrote:
| Eversense sells something similar to this already:
| https://www.ascensiadiabetes.com/eversense/
|
| I'd get a tattoo, but I'm not interested in anything that
| has to be _removed_
| yazaddaruvala wrote:
| My understanding is this isn't possible because of the
| size/invasiveness.
|
| We need significantly better power sources that are
| either have lots of energy capacity, xor some energy
| capacity and able to charge while inside the body.
|
| Either version they need to be small enough that the
| procedure is cheap and the body doesn't reject the
| device. Additionally, anything like this would need to go
| through regulatory bodies for medical devices, and would
| not be approved for "healthy people" (i.e. significantly
| reduced adoption).
|
| Roughly putting us back to non-invasive.
| mortenjorck wrote:
| The article mentions pre-diabetes screening as a potential
| application - could that plausibly be accomplished with
| less precision than is required for a bolus calculation?
| kerpotgh wrote:
| [dead]
| TylerE wrote:
| I mean, it's the no stick part that's tricky. Small,
| watchface size glucose monitors that transmit wirelessly
| exist. They're just...disposable. Wear it for about 14
| days... stick on another $150 device.
| wpietri wrote:
| There is also the "invasive" part. If you're talking
| about CGM devices like Freestyle and Dexcom, they include
| a probe that pokes through your skin.
| inetsee wrote:
| I have the Freestyle Libre system. The probe that "pokes
| through your skin" only happens once every two weeks, and
| my experience is that inserting a new Freestyle sensor
| hurts less than the average finger stick blood test.
| Before I got the Freestyle Libre I was doing finger
| sticks 4 or more times a day. With the Freestyle Libre I
| am checking my blood glucose an average of 20 times a
| day, and if I download the data from the Reader I can see
| glucose readings every 15 minutes, 24 hours a day.
| Projectiboga wrote:
| I'm waiting to go back to them, a bit of a juggle to get
| insurance to pay until the current sensor or maybe
| transmitter runs out. I got angry at their customer
| service when I knocked a sensor off, so I tried the
| Dexacom g6, but their software is insanely bad. On top of
| that their sensors are only for 10 days which is much
| more of a scheduling hassle. And after all the pain of
| their icky software the killing point is they have an
| unsilenceable "6 hours to sensor expiration" alarm that
| can and will go off in the middle of the night, unless
| you actually power down the device or your phone. I hated
| their device and the phone connected anyways. The
| Freestyle had much better software with sophisticated
| graphs showing trends over long time periods to spot
| typical low and high time periods.
| davidthewatson wrote:
| Apple has an amazing opportunity given the history of
| these devices.
|
| Another T1D here with 2 decades direct experience with
| Medtronic, Tandem, Dexcom, and Abbott. I'm an outlier,
| but that doesn't make this story less empirical. I've got
| many years of data to prove it and while I can't match
| real autonomy's millions-of-points-per-second firehose, I
| do have years of hundreds of point-per-day.
|
| It's n-of-1 for sure, but one way of looking at that is
| just that there's a lot of latency on the data gathering,
| particularly in emerging stories in healthcare where the
| entire system is weaponized against the truth reaching
| wide audiences, but I digress. Back to the objective
| facts vs. the subjective reality.
|
| I'd just like to confirm the findings here in that it's a
| wicked problem, just like T1D:
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529400/
|
| The fact that CGM or non-invasive requirements follow
| suit should be of little surprise to anyone.
|
| It's challenging enough that I wore 2 CGM's concurrently
| over the past year: Dexcom G6 and Freestyle Libre 2. They
| both have poor data veracity, particularly at the times
| that I need them most - when fasting; that would be
| sleep, and exercise. Both critical periods for any
| diabetic. I should know because the former put my T1D
| brother-in-law in an early grave.
|
| I realize that some people have great success with these
| devices and that's something we should celebrate.
| However, we should not celebrate the fact that there are
| legitimate lawsuits against these companies. I've been
| outspoken about the risks given my family history,
| exercise, and experience working in medical devices that
| have a history of injuring patients:
|
| https://en.wikipedia.org/wiki/Therac-25#Problem_descripti
| on
|
| https://www.11alive.com/article/news/investigations/the-
| reve...
|
| The amount of time that I spent on the phone with Dexcom
| support was excessive and frequently at all hours of the
| night since the problem would present with alarms that
| cannot be disabled and are able to disable do-not-disturb
| mode on the smart phone and sound like an alarm system
| from the Austin Powers series.
|
| That leaves the patient with two choices: tolerance
| (which is unrealistic at 3 AM) and powering the phone
| completely off, which silences it while having the side
| effect that alarms can't save the patient from
| potentially life-threatening hypoglycemia given that
| alarms emanating from the Tandem t:slim X2 alone are not
| sufficiently intense to wake me.
|
| Dexcom has responded to this crisis by following the
| letter of the law: since I first reported the problem,
| they have replaced 2-3 dozen sensors under warranty while
| following the typical corporate communication playbook of
| not admitting design flaws or any legal culpability while
| not admitting the rather serious problem of the fact
| that, when the G6 is used in concert with a hybrid closed
| loop system such as the Tandem t:slim X2, inaccurate
| sensor readings on the low side have the potential to
| underdose the patient, and inaccurate sensor readings on
| the high side have the potential to overdose the patient.
| This is because near-autonomous, near-realtime basal rate
| adjustment is responding to sensor measurement that can
| often be at odds with reality and not closely monitored
| at times like sleep and exercise.
|
| This isn't just theory!
|
| I've seen both of these scenarios play out while
| exercising and sleeping - two events that cannot be
| precluded, are frighteningly difficult to handle given
| failures in the aforementioned design of the alarm
| system, and no one at either Tandem or Dexcom seems to
| admit, document, or address which is distressing given
| that these are FDA-regulated devices in markets that
| aren't Therac 25 but have the potential to end badly in
| large populations.
|
| I've tried to alleviate the problem by wearing two
| different CGM sensors concurrently. I wore an Abbott
| Freestyle Libre 2 from spring through fall 2022 in
| addition to my Dexcom G6 where I have little choice given
| the joint venture design chosen by Tandem. That has done
| little to alleviate the problem since both sensors tend
| to move in parallel showing the same inaccurate readings
| in fasted states around sleep and exercise.
|
| Worse, the only evidence I've seen that anyone in the
| mobile software design side of equation understands the
| problem is xDrip and the various people working in
| OpenAPS:
|
| https://scholar.google.com/citations?user=rt1_gOgAAAAJ&hl
| =en...
|
| https://jamorham.github.io/
|
| I don't believe they are getting the attention, credit,
| or remuneration they deserve.
|
| I hope that the situation does not turn out like American
| insulin pricing, where the first person to perish not
| being able to afford insulin was documented several years
| ago:
|
| https://www.snopes.com/fact-check/alex-smith-died-
| couldnt-af...
|
| If we think social media needs regulated, I'm pretty sure
| what we call healthcare in the United States qualifies
| for better regulation than that given FDA's lack of
| oversight.
| efficientsticks wrote:
| Type 1 diabetic here, they're not close to as invasive as
| insulin pumps and a lot of people use those. Honestly the
| real problem with CGMs is they aren't accurate enough,
| and they bias high - I suspect so they can pretend they
| eliminate hypos more than they do. (Having said that,
| CGMs are well worth it even with those drawbacks. They're
| only invasive on the initial application.)
|
| But I do applaud the team for working on the technology
| nonetheless.
| fwungy wrote:
| Any info on how much they're biased?
| TuringNYC wrote:
| I wouldnt mind a disposable/consumable layer at the
| bottom of my apple watch that provides CGM capabilities.
| Apple watches are already way smaller than traditional
| fashionable watches, and i'm more than happy to wear
| something bulkier/sportier that has integrated CGM
| capabilities.
| lern_too_spel wrote:
| How would you feel about wearing a watch that is stuck in
| place in order to interface with that consumable bottom
| layer?
| pavlov wrote:
| There's a startup named Movano Health trying to build a
| glucose monitor sensor chip that uses RF energy:
|
| https://www.wareable.com/wearable-tech/movano-ceo-on-its-
| rf-...
|
| Movano plans to ship an Oura-style smart ring this year, but
| it won't have the glucose monitor. (One might suspect the
| "moonshot" glucose RF chip story is meant to keep investors
| excited through the zero-revenue stage until hopefully the
| more ordinary smart ring takes off.)
| caycep wrote:
| Granted, at least they make progress and have actually health
| products. I had a colleague who left UCSF to work for
| Verily....we were all quite impressed at the time. But now, I
| realize I haven't heard heads or tails from him for 4-5 years
| now...
| bilsbie wrote:
| I'm more interested in seeing my insulin levels than blood sugar.
| But I guess that's not happening anytime soon.
| v8xi wrote:
| Insulin being a protein (which all look ~similar
| spectroscopically), it is not possible to measure in a no-prick
| format as you need physical access to it for
| separation/measurement (e.g. via antibody-like molecule or
| activity assay)
| lvl102 wrote:
| I'd not take anything from Bloomberg seriously.
| Me1000 wrote:
| Mark Gurman is an incredible reporter who has covered Apple for
| years and has many inside scoops and sources. I couldn't say
| one thing or another about the publication, but anything Mark
| writes I take seriously.
| krmbzds wrote:
| https://archive.is/NmPhf
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