Like the rest of the D-community, we've been dreaming for a long time about a hands-free way to observe what's happening with our blood sugars -- either non-invasively, without having to even prick our skin, or at least with some kind of "smart watch" viewer that allows us to see our BG levels with just a flick of the wrist.
But from the untimely death of the early GlucoWatch and Glucoband to the unclear possibilities of Apple's rumored iWatch to the futuristic Glucose Glass concept that could display our data literally in front of our eyes, it's all been a dream somewhere down the yellow brick road, up to now.
As we ease on down that road, we've found a couple of engineering whizzes right here in our own D-Community who have actually developed working wrist watches that track blood sugars or chart data from devices already being used (your fingerstick meter or continuous glucose monitors or insulin pumps)!
One is a D-Dad with a young son diagnosed in 2012, and the other's a longtime type 1 diagnosed more than three decades ago. What they share is engineering prowess to develop smart watches with capabilities far beyond what is commercially available now. Their work signals that it is quite possible to "hack diabetes devices" to accomplish better data integration, even with garage-created makeshift gadgets.
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This is home-grown diabetes device design at its best, and since that's right up our alley here at the 'Mine, we jumped right in to explore the stories behind these inventions.
John Costik: "We Could Do a Lot More..."
With backgrounds in software and mechanical engineering, husband and wife John and Laura Costik in New York found themselves flooded with information after their son, Evan, was diagnosed in August 2012 at the age of 4. They had some quick hospital D-training and went home with Evan starting on insulin shots, not using an insulin pump or CGM right away.
Almost immediately after diagnosis, John says the couple knew "we could do a lot more with the tools available. They simply needed integrating. Between the two of us, we saw tremendous opportunity to improve Evan's health and his quality of life, as well as for ourselves and our daughter."
John set up a Google site that allowed the daycare staff to log fingerstick meter checks, carb intake and insulin bolus data, and he set it up so that one or both of the parents would get emails and text messages when that data was entered. Followup was pretty quick and easy, he says, and in most cases the daycare staff could react as needed based on the care plan the couple had in place for Evan.
Then in February 2013, Evan started on the Dexcom G4 and in April, he began insulin pumping.
"It would be great if I could see his blood sugars all the time," John remembers thinking.
Using the Dexcom Studio software that the CGM company offers for free download online, John and Laura figured out how they could pull data from the G4 receiver hooking it up to a laptop and putting the computer in Evan's daycare room so he could be monitored during the day. The diabetes data would then be uploaded to the existing Google website, and John created an iOS app that both parents could use to keep track of their son's health -- pulling blood sugar readings, test times and trends so that they could quickly intervene with a phone call or message to the daycare staff.
Prepping for kindergarten this fall, John says he wanted to basically "create a mobile solution that could be carried around" or a custom ambulatory monitoring system, as it might officially be called -- something he was surprised didn't already exist! They built a case that holds both the Dexcom G4 receiver and the smartphone connected by an open source USB, and that sends the data to the cloud so it can be accessed from anywhere.
And then, John integrated the whole system into a Pebble smartwatch that he bought earlier this year, allowing him quick access to his son's D-data with just a glance at his wrist! When any new data is sent via the iOS app to the cloud, it sends a message to the custom Pebble watch app and then the watch will respond accordingly, with customized patterns of alerts or vibrations.
"It will really get my attention when Evan goes low or goes double arrows down," the dad says. "The alerts on the watch app mirror those setup in the iOS app. In addition to simple alerts based on BG value, it can alert based on trend and value. For example, if Evan's CGM shows 120 and double arrows down, it will alert me. If he was flat at 120, it wouldn't trigger the alert. Also, if we get the dreaded '???' it will also alert me. Such an alert does not exist on the G4 receiver, and it has already come in handy. I am a huge fan of having a simple, glance-able look at Evan's BG. Yes, the phone app provides the same, but with the watch, it is always available within a split second. As an overprotective father, I love it."
John says he thinks more is possible in the future, where pump data and meal nutrition data could be integrated into a single database and be communicated just as easily. That could allow for even more D-data analysis, like figuring out the effects of what their son is eating, and how a particular meal's fat content might react to a particular bolus.
"What it comes down to is: I love my family. If I can keep T1D from taking any more from him, from all of us, I will," John says. "With this system, we can give him a non-diabetic A1C without hypoglycemia. With this system, we can sleep at night, and Evan can spend his days being the rowdy, active, happy little boy he's always been. If the work we've done can help others, I'd love to see that happen, too."
John says that Dexcom and Medtronic (pump brand Evan uses) have both been very supportive of the family's work, and he's interested in talking more about how this could be further developed and used to help the broader diabetes device world.
Of course, the Costiks aren't the only ones out there pursuing this kind of diabetes device integration into a smart watch concept...
Don Browne: Hacking a "DexWatch"
Type 1 PWD Don Browne in Massachusetts was diagnosed 33 years ago at age 12, so he's seen the evolution of diabetes tech through the years -- from the introduction of home glucose meters and insulin pumps to CGMs, and now all the software programs and smartphone apps enabling data logging and analysis.
Don's also been fooling around with electronics since he was a kid and even had a ham radio license back in the day. He says he dropped all that when he got a driver's license, and then after college worked in biotech for a few years before realizing that he could better use the skills picked up in his teen years in the field of computer programming -- where he's now been for the past 20 years.
Although he hasn't used an insulin pump, Don says he stumbled upon the Dexcom CGM a few years ago when he was Googling for improvements in monitoring tech. He switched docs to get a CGM, and that led him to pursuing something he'd long been wanting: a blood sugar watch.
"I've wanted my glucose readings on a watch for years," he says, pointing out that he tried the GlucoWatch and considers it "a complete fraud" for what it claimed to be.
"I thought about creating something using a heart rate monitor watch or a Garmin Forerunner in the past. Then I saw a write-up on the TI Chronos (reference design for smart watch apps), and realized that this was the ideal technology."
A few years ago, he "hacked" a computerized cycle trainer to program rides into Google Street View and he used that same model to communicate with his Dexcom. Like the Costiks, Don says he used program coding to open up the Dexcom Studio to send BG data to a file and then to the watch, so that he'd be able to wear that watch while riding his motorbike in off-road Enduro events. The TI Chronos platform was the breakthrough he was looking for.
In explaining it to me, there was a lot of tech talk -- sniffing out data packets, serial traffic between the Dexcom and program, and communicating various codes. Don says he had originally tried a few different ways a couple years ago using the Dexcom 7+, but couldn't make sense of the data coming from the serial port and so he didn't aggressively pursue it. But several months ago, he upgraded to the Dexcom G4 and so he used his old 7+ as a "victim" to experiment on.
After a couple months of burning the midnight oil, Don got what he was after. First, he used a Texas Instruments watch, the eZ340-Chronos, to connect to the CGM but has since switched to a MetaWatch -- as that's the only waterproof one he's found. His G4 connects to a Raspberry PI Linux computer and communicates via Bluetooth with the smartwatch.
With his DexWatch, Don is able to see single and double up or down arrows right on his wrist, and the watch also vibrates once he's below 80 mg/dL or above 180.
"It works great, and displays what's on the (G4) device," he says. "The watch shows the minute of the last Dexcom reading, so I can tell if things have stopped.
Unlike the Costik's smartwatch that shows trends and graphs, Don says his doesn't because he was only interested in having real-time readings and immediate alerts. But he says he could easily put that trend info into a second window on the watch, allowing the user to see the full graph just by pushing a button.
Right now, the only issue he has is the battery life -- it's good for only a couple of days, unlike the first Chronos watch that had a six month or more life.
Don's been writing about his tech-creation over on an appropriately named blog, Dex Watch, and his entries go into detail about the engineering aspects of making this wearable device that displays diabetes data.
A Wristband Sleep Solution
Note that a wristwatch-style device called the Diabetes Sentry actually started shipping in the U.S. just last week... 10 years after the FDA had initially approved it! You may remember this as the Sleep Sentry before the two prior companies developing it dropped interest and went dormant, eventually leading the Minnesota-based Diabetes Sentry Products, Inc. to where it is now -- claiming to offer "the only non-invasive device currently on the world market for the detection of hypoglycemia symptoms." It's meant to be worn overnight, "when the life-threatening effects of hypoglycemia can easily go unnoticed."
It basically detects perspiration and/or a drop in skin temperature, and sounds a loud alarm to wake you up to do a fingerstick test. Not a bad idea, but the cost is $495 and it's not clear if there's any insurance coverage. Plus sweating overnight for other reasons could set it off... Still, it could provide important protection for some diabetics, both kids and adults.
On the whole, it's exciting to see these clever innovations emerging from all corners -- making us less dependent on the huge Pharma Establishment for tools that make life with diabetes easier. After all, who understands our needs better than PWDs themselves?
We know there are probably many more diabetes device and data hackers out there than we've heard about. If so, please introduce yourselves!
And btw, for the first time ever, this year we'll be hosting a gathering for just this crowd, the D-device & data hackers, the day prior to our upcoming DiabetesMine Innovation Summit. So on World Diabetes Day, Nov. 14, about 30 brilliant D-developers will gather at Stanford for what we're calling the DiabetesMine D-Data ExChange (John Costik will be attending, too). More on that soon!