As a tech narcissist, I’ve been for years in how know-how can ship a “quantified self,” or information about myself and how I stay. But I can’t say that the information I’ve collected so far, from step counters to sleep screens, has actually taught me something actually helpful — till I attempted out Dexcom’s newest monitor. It turned out not solely to be a very good well being care story but additionally an important information story.
The Dexcom G6 Pro gave me insights into how my physique was behaving second to second, and how I can take cost and management how I really feel. For me, this was a type of educational fascination. But for Ric Peralta, for instance, a 47-year-old man who has been residing with diabetes for 12 years, it makes an enormous distinction in how conveniently he can monitor glucose ranges and handle life-or-death conditions.
This type of perception that we each acquired from information is one thing I’d anticipate to study from a Star Trek Tricorder. But it’s out there in the present day, and it’s why Dexcom has a inventory market worth of $40 billion and gross sales near $1.5 billion a yr.
Glucose screens measure the extent of sugar in your blood. For diabetic patients, that is crucial. Diabetes affects more than 34 million Americans and is the seventh main reason for loss of life within the United States. The conventional commonplace of care for glucose monitoring has been a fingerstick meter, which is painful as some patients want to check their blood by pricking their fingers as much as 12 instances a day.
In a affected person with Type 1 diabetes, the pancreas can’t produce the hormone insulin, which helps the physique soak up sugar and take away it out of your bloodstream. For Type 2 diabetes patients, their physique could not have the ability to produce or course of insulin successfully. Either situation means folks should inject themselves with insulin to take their glucose ranges down. But they’ll solely do that if they’ll precisely measure their blood sugar ranges in actual time, one thing that hasn’t been attainable or handy till lately.
More lately, COVID-19 patients with poor glucose management have had unhealthy problems resulting in greater fatality charges. “We got an emergency approval from the FDA to use [glucose monitors] in hospitals,” Dexcom CEO Kevin Sayer stated in an interview with VentureBeat. “They saw the glucose problems COVID-19 patients were facing. Many of them have diabetes or have high glucose variability.”
Dexcom has been making glucose screens for years. Each one has been getting smaller and extra handy, consistent with the march of Moore’s legislation — the notion that digital units get higher each couple of years. Intel chairman emeritus Gordon Moore foresaw within the 1960s that the variety of parts on a chip doubled each couple of years. That made electronics cheaper, quicker, and smaller. And the legislation has held up for a long time, resulting in advances similar to far higher glucose screens.
Dexcom has ridden this wave. It was based in 1999, debuted its first short-term monitor in 2004, and went public in 2005. It launched new glucose screens in 2009, 2012, 2015, 2017, and 2018. The newest G6 Pro debuted in 2020. People can now connect the monitor to an insulin pump, and a software program algorithm will determine how a lot insulin to launch into their bloodstream to counter an increase in blood sugar.
As the electronics turned cheaper, Dexcom was in a position to create cheaper, more practical, battery-operated screens that measured glucose ranges and transferred the information wirelessly in actual time, Sayer stated.
The smartphone period
Peralta, the diabetes affected person, has observed the distinction. When he began utilizing Dexcom’s G5 monitor a number of years in the past, he needed to manually calibrate it each 12 hours. That meant he needed to prick his finger twice a day and analyze the blood to see if it matched the monitor’s outcomes. It was additionally considerably bulkier than the present mannequin. The newer G6 mannequin is way smaller, and it will possibly mechanically monitor Peralta’s sugar ranges 300 instances a day and ship the information to his Apple Watch.
“This was mind-blowing for me. A dramatic, immediate change for me,” Peralta stated. “The fact that I no longer have to constantly calibrate is a huge game-changer for me.”
The Dexcom G6 Pro, which got here out this yr, is the primary system authorized for non-diabetic customers. For non-diabetics, the Dexcom G6 Pro is OK to make use of in blinded mode. That means real-time glucose information is hidden from the affected person and reviewed retrospectively with their well being care skilled on the finish of the monitoring interval. In unblinded mode, diabetic patients can see their glucose information all through the 10-day sensor put on to achieve insights and make therapy selections in actual time. (With that stated, a supplier might decide that an individual may profit extra from seeing the information in actual time, so there are eventualities the place a healthcare supplier may prescribe a G6 Pro off-label and allow an individual with out diabetes to put on it in unblinded mode. In that approach, my utilization of the Dexcom G6 Pro could possibly be authorized).
The screens are nonetheless costly at round $900. But roughly 98% of medical health insurance suppliers cowl the usage of these screens for diabetic patients. It’s going to take a number of extra spins of Moore’s legislation to make such units reasonably priced to the lots. But the latest fashions are rather a lot much less invasive, so patients usually tend to put on them on a regular basis. And in addition they have a sharing function that’s crucial for caregivers.
Sayer relates one story a buyer advised him. A younger girl shared her glucose monitor outcomes along with her mom, who lived in Australia. One day, the younger girl went to mattress early throughout a modeling gig in New Orleans — and she didn’t get up. Her mom noticed the alert from the monitor on her smartphone. She known as the paramedics, and they broke down the door of her daughter’s lodge room and saved her.
“There’s nothing more powerful than a story like that for someone with Type 1 diabetes,” Sayer stated. “The game-changer for us has been the connection to the phone.”
Pretty quickly, this measurement know-how and real-time monitoring — the stuff of goals for quantified self practitioners — will grow to be related to somebody like me, who in any other case had no real interest in the units.
I don’t have diabetes, luckily. As I agreed to check the monitor, I noticed that I used to be going to get a glimpse inside my physique that most individuals by no means get an opportunity to do. I discovered, as Sayer noticed, that I might use this information not as a affected person, however as a shopper. I might take a look at what I used to be doing and what I used to be consuming and determine what the impact was on my blood sugar.
It was fairly non-invasive. A nurse confirmed me find out how to connect it to the left aspect of my stomach. There was a tiny pin prick once I activated the system, which poked a needle into my pores and skin. After that, I couldn’t really feel it anymore. The monitor itself was a little bit over an inch lengthy and it was glued to my pores and skin. I used to be in a position to put on it for 10 days and take showers with it. It mechanically uploaded the measurements of my blood sugar in actual time to my iPhone. It by no means fell off.
I used to be astounded to study that consuming a giant pile of spaghetti was one of many issues that might push my blood sugar stage off the charts and even put me above the 180 milligrams per deciliter threshold that medical doctors thought-about to be excessive.
At the identical time, once I went for a jog, I discovered my glucose ranges dropped a lot that it dipped under 70 milligrams per deciliter and triggered alerts for me, as if I had been in peril of fainting. My common glucose stage was 124 milligrams per deciliter, which was inside the vary of regular, in accordance with an analysis by Dr. Daniel Katselnik, a diabetes and metabolism specialist in Texas.
The vary of numbers for sugar ranges is what diabetes patients should comply with very intently.
“The more a person stays within the range, the better quality of life they will have,” Sayer stated. “People can stay engaged with their status. You can eliminate hospitalizations and save money. Doctor visits are efficient.”
If somebody like Peralta spikes above his restrict or falls under the decrease threshold, he faces large well being dangers. If his blood sugar is too excessive, it will possibly injury his blood vessels. The lows, often known as hypoglycemia, can result in starvation, trembling, coronary heart racing, nausea, and sweating. It also can improve the danger of different issues like coronary heart illness, stroke, nerve issues, and kidney illness. It is a lethal downside, presumably resulting in coma or loss of life. An injection of insulin can head it off, however Peralta stated that, previously, the quantity of insulin to inject was typically a guessing recreation.
The app shared the information with Dexcom’s Clarity app and the physician, Katselnik, was in a position to entry my information after I shared my account code with him. He acquired it in a matter of seconds, and we in contrast the numbers that the app recorded to my notes on what I used to be doing on the time. He famous proper off the bat that 94% of my outcomes had been inside the instructed vary.
But 5% of the time it was excessive due to what I ate. And once I was out of the vary, I acquired an alert on my iPhone. I discovered a kind of nights was the large spaghetti dinner. Another day I had a spike after a lunch. I observed once I drank a cup of orange juice, the sugar stage went as much as 145. When I had numerous carbs to eat, I acquired sleepy, because the sugar stage had been beginning the spike upward.
Sayer, who typically assessments new units, stated he purchased doughnut holes for his grandkids and ate a few them. He famous that his glucose stage was up 10 factors throughout the day as a result of they had been so sugary.
“You learn about what you eat, the timing of your meals, and how everything makes a difference,” Sayer stated. “You can see here are some meals that may not have been good for you.”
Help for prediabetics
Even after carb binges, my blood sugar returned to common as a result of my pancreas was working effectively, in contrast to in a diabetes affected person. The physician stated I might forestall diabetes sooner or later by controlling my food plan, like decreasing my consumption of carbs. Eating carbs with protein and fats reduces the spike. You’ll discover the affect of various meals in your blood sugar. Alcohol may have a particular impact in making your blood sugar spike, although I didn’t do this.
Katselnik additionally advised me that when your blood sugar is spiking, you may deliver it down quick by exercising.
That’s a short-term answer. Over the long run, exercising rather a lot will assist cut back the spikes in blood sugar. Katselnik famous that the Dexcom G6 Pro is an efficient sensor with FDA approval, with an accuracy stage that’s inside 9% of lab testing accuracy. I used a single-use disposable system. There’s a model that has a transmitter that may final 90 days. This is far simpler than pricking your finger hourly.
“This is clearly a leap. It’s accurate. It’s easy to use out of the box,” Katselnik stated. “You don’t have to calibrate it or do anything along those lines. So you get all the information you want. And the nice thing is you can do it remotely. This is a life-saving device for a fair amount of people, and it’s a standard part of care.”
You can substitute the transmitter and hold utilizing it. The sensor lasts about 10 days, so you need to substitute that and pop within the present transmitter if you do this swap. Doctors use the Dexcom screens on common diabetes patients, Katselnik stated. He makes use of it on dozens of diabetes patients in addition to prediabetic patients who’re borderline for having the illness.
“The big use in the future is for patients who are prediabetic or maybe at risk for diabetes, so they can get the data and change their behavior so they don’t become diabetic,” Katselnik stated.
Actionable information for diabetes patients
For medical doctors and patients, these Dexcom screens are godsends in comparison with the older machines. Peralta used to should prick his finger and draw blood and put it into an analyzer to get his sugar stage. That concerned numerous time. The new glucose screens ship this info immediately, and medical doctors can take a look at it immediately. In reality, caregivers can take a look at somebody’s information and name an ambulance in the event that they see the individual is having an episode. Patients’ lives are being saved in consequence.
“This is true continuous information,” Katselnik stated. “The only thing that is comparable is heart-rate data, and that’s super simple compared to blood sugar data. The data can be used to change medications and dosages. We’re in an exciting time. We have fully embraced it at our office.”
Peralta stated that his personal endocrinologist may be very happy with the outcomes utilizing the Dexcom G6. Peralta is performing some fine-tuning along with his routine as he nonetheless has some occasional lows. Those instances had been scary, as Peralta knew he needed to do one thing. One time, he misplaced his imaginative and prescient and his skill to talk, however he was nonetheless aware. While he couldn’t say something, the app might ship an alert to his spouse. She might then interact with him and do one thing to assist him out.
Now Peralta is aware of that if he’s going to go for a strenuous stroll within the woods, he has to eat one thing forward of time to maintain his blood sugar excessive sufficient in order that his numbers gained’t drop too low. Since the app works with the Apple Watch, Peralta can flip his wrist over to see the place his blood sugar is at throughout the day, giving him reassurance or reminding him he has to train or eat or use his insulin photographs.
“As a Type 1, that’s just part of your daily routine, as you are constantly worried about your numbers,” Peralta stated. “With the old fashioned way of the fingerprick, it’s basically you’re gonna burn through more strips than the insurance will provide if you’re constantly checking. And so you’re constantly guessing. ‘How does my body feel? Am I high? Am I low? Am I going up or down? I think I feel this way.’ Instead, I can see exactly where I am now.”
The information is totally different from the standard information that we get from our units in the present day. It’s actionable.
“There’s no question that, moment to moment, this completely changes your life as a diabetic,” Peralta stated. “As a Type 1, we are living our lives basically, constantly on this fight to just try to keep ourselves alive. If I didn’t have this equipment, if I didn’t have insulin, I would not be here right now. It’s as simple as that. And anything that allows me to approach living a normal life is a powerful tool that is worth having. I can plan out hikes and I can plan out trips.”
The way forward for the quantified self
Katselnik thinks that body-hacking folks and skilled athletes may even eat up this information and change their habits in consequence. Athletes who face low blood sugar discover that they’re fully out of vitality. That’s why they should monitor their vitality and drink issues like Gatorade to remain at excessive vitality ranges.
Back in 2012, Sayer famous an Olympics biking crew used the glucose screens and discovered one specific athlete was working out of vitality. They requested her what was occurring and she stated she was weight-reduction plan as a result of she felt she was greater than the opposite athletes. The trainers put a cease to the food plan and advised her that her expertise, not her physique form, was what acquired her on the crew. Once she began consuming correctly, she was in a position to carry out significantly better.
Over the long run, Peralta stated he also can make good use of the information for his personal self-service.
“As long as I have been doing this, I’m starting to notice through some of the other apps that I’m just finding new ways of micromanaging,” Peralta stated. “If I’m starting to trend in a certain direction, then I realize that if I just give myself an insulin dose I can flatten that curve a little, but not so much that I’m going to drop off like a rock and be crashing in an hour. After I do this for months, I can see exactly what I need. And I’m definitely having far fewer peaks and valleys.”
Sayer stated future merchandise that use this core sensor know-how will have the ability to assist folks in quite a lot of methods. You could, for occasion, look to your blood sugar for why you’re in a foul temper. You can do one thing about it, like eat a snack. Artificial intelligence might come into the image as effectively and deal with numerous the care so the affected person gained’t should be so attentive.
“If I am snippy and biting someone’s head off, I can see it,” Peralta stated. “‘Oh, this is why I’m like this. This is why I’m in a bad mood.’ And I started apologizing for what I did and saying, ‘Look, I’m sorry, but this is why.’”
He’s grateful for the know-how. “I think I can come pretty darn close to living a normal life,” Peralta stated.
At some level, the quantified-self followers will seemingly be a market alternative, as the corporate will have the ability to make cheaper screens for those that are simply interested in their our bodies. “What’s more important about that use case is giving them a meaningful experience, like developing analytics engines around that for somebody who is not a diabetic,” Sayer stated.
A sliver-thin Dexcom G7 system is concerning the dimension of a nickel, and it is going to have its personal transmitter constructed into it. It’s within the product pipeline for 2021. I’m ready for the day when a monitor will take a look at my breakfast and inform me to not eat the bagel that’s on my plate.
“We obviously have to take the cost out of this to get it to the mass market,” Sayer stated. “This is real health care. This is life and death stuff. We have a lot to do. It makes it very easy to go to work every day.”