Taming our diabetes monsters may seem like only a metaphor for what we try to do every day, but now there's a fun new app for that.
Just launched in the U.S. for the first time on June 4, the MySugr Companion app was created a few years ago by a team of fellow PWDs (and some non-PWDs) over in Austria. A key to what makes this new app unique is that it lets us PWDs play with a "diabetes monster" every time we enter data, so that the experience of monitoring our blood sugars, exercise, insulin and food -- along with mood and behaviors -- can be a little fun!
In just a couple of weeks of using this app, I'm hooked.
Sure, there are multitudes of apps for everything these days and diabetes management is no different -- you can find more than 600 diabetes apps on iDevices and 1,000 for the Droid, but really finding one that's useful for you personally sometimes feels like searching for a needle (or a lancet?) among the digital online haystacks. So what makes this app so different?
In my eyes, this new MySugr app is different because it not only gives me the tools to log my health data, but makes that information actionable and keeps me engaged. It's not just logging. Rather, behavior modification is what is behind MySugr.
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OK, I will say it: this new app makes me actually want to log my data (!).
That's where others have fallen short, for me. In my time using this app, I have found myself modifying my behavior and actually living healthier as a direct result of playing with this MySugr app on my iPad.
All thanks to my Blood Sugar Bumble (or BG Bumble for short), the name that I've assigned to my D-Monster... because really, that's how I roll -- I'm often just bumbling along when it comes to my blood sugars and diabetes.
The coolest thing is the gamification approach to keeping tabs on diabetes data. The app offers a "monster companion" that each person names and tries to "tame" each day by logging data, staying in range, or just being active. The more points we get for these activities, the better we tame the D-Monster by literally putting a ball and chain on the monster so that it's not running rampant and wrecking our potentially healthy lifestyles.
This short little video clip is a MySugr Companion 101, complete with the voice of fellow type 1 and D-Advocate Scott Johnson who's been consulting with the company and helping them reach more of the DOC:
From the start, I'll admit to being a fan. Sure, the data entry is something you have to do by hand. There's neither a wireless connection nor cable connection offered to download your data directly from your D-devices to the app. But that doesn't bother me because they've made data entry easy and fast, with the quick scroll-and-click approach of a smartphone or iPad keyboard (I don't have an iPhone and it's not yet available on Android phones). It's very user friendly. When setting up the app, you just have to enter some key pieces of information, like your type of insulin therapy, target range, and Low and High thresholds. And for food entries, you can choose to use either "exchanges" (remember those?) or just grams for carb counts.
Entering data is easy. You push a big + button up on the top part of the screen, and another screen opens with all the prompts to fill in date, time, and location. You can add mealtime tags or any notes relating to how you feel, like "Tired" or "Stressed" or if you're having "Hypo" feelings. There are also many other features that allow you to enter details on food, boluses, temp basals, exercise and other activity, and other notes. Some faves of mine include being able to hit the "Alcohol" tag or that there's a "Traveling" or "Driving" ones as options, too!
Once you hit the check-mark to save the data, the D-Monster (my Blood Sugar Bumble) offers some feedback on your BG level, offering an "Ouchie" if you're High, and if something like, "OMG! Eat something, will you!?" is you are Low. When I'm in range or the Bumble seems to be happy with what I've done, it offers a laugh and "Oooo!" for reassurance.
Like any good D-data logging software, you also can get an average and reports showing standard deviation, total food you've eaten and exercise you've gotten, and even how many Hypos/Hypers you've had based on the data you've entered. Colors change respectively based on where the BG levels are at (red is bad, orange is mediocre, and green is good).
I also like the fact that you can search the app, for pretty much anything to base your decision-making on. For example, I can search the tags or look for "beer" or places I've eaten, to see how I calculated everything and what impact it had on me. Very cool.
Another fun part of the MySugr app is something called "Challenges," which are basically little games weaved into the bigger game that allow you to earn extra points by helping yourself become more healthy -- more exercise, frequently data logging, and so on. One of the challenges I've got going right now is the "Vampire" challenge that pushes me to check my blood sugars 7 times a day, "before a vampire gets the chance!" Another that I recently completed was the "Sweat For a Cure" that encourages exercising for at least 30 minutes on two consecutive days in order to collect points.
I've been one of a handful of DOC'ers invited to take a trial-run of the basic system that's available for iOS devices for free. There's also a paid "pro" version of the app, but I've not used that and the founders say the real difference is only that it offers unlimited amounts of data in the few places where restrictions are in place on the basic version. They also have a MySugr Junior app for kids overseas, but that's not here Stateside yet.
Worldwide, there are about 14,000 people using the system -- mainly in Austria, Germany and Italy at this point. But by the end of 2013, the MySugr team of 16 that includes several PWDs working on staff hopes to grow its customer base to 60,000. The recent Statewide launch is a key part of that, of course.
Now, the app is impressive on its own - but what's also very impressive is that members of the MySugr team, including two of the co-founders, have been living with type 1 diabetes since they were kids. VP of product management Fredrik Debong of Vienna, Austria, was diagnosed about three decades ago at the age of 4 (same year as me in 1984!), and the CEO Frank Westermann was diagnosed as a teenager about 15 years ago.
During a recent Skype chat, I found myself relating to Fredrik's story about how he rebelled in his D-life many years ago -- long before this MySugr app venture was even a gleam in his eye, but a foundational point for how it came to be. Fredrik mentioned how he "simply let go" at the age of 20, after living with D for about 15 years. He stopped checking his sugars and wasn't taking care of his health for about three years, something I can personally relate to. Fredrick notes that in those times, he pretty much just took six units of insulin no matter what he was eating... that's just the way it was then. That's what happened to me; the denial and burnout became overwhelming, and I just turned my eyes away from diabetes even though it wasn't going to leave me.
Like me, what brought Fredrik back to paying attention were small things that he started doing differently -- rewarding himself in small ways for checking his BGs or carb-counting more frequently, and getting back into a routine.
"Mini games helped me get out of my diabetes burnout," he says. "We have to motivate ourselves, make it fun as much as we can."
A few others in the Diabetes Online Communiy have shared their thoughts on this new app, including Scott Johnson and Christel and Fredrik even appeared over on DSMA Live. Those I've heard share thoughts on this new app seem to like it.
We see a huge gap in the D-Community about logging blood sugars, exercise and diabetes data overall. Some want the simple, convenient, interconnection of just syncing a smartphone and having all the info travel wirelessly to an Internet cloud somewhere. Others like the write-it-down approach, despite all the manual legwork (or handwork?) that might take and the hassle of keeping a paper logsheet on hand.
That is what I like most about MySugr, it allows me to stay accountable by manually tracking and taking ownership of my own data all at the tip of my fingers by iPad app.
MySugr is working with Diabetes Hands Foundation, the JDRF and some other diabetes industry players to not only make a difference in individuals lives, but in the broader community as well. Each challenge gives you points, which add up and go toward MySugr donating money to the specific charity (the more people play and use the app, the more money's donated!).
That's pretty cool, I think.
Room for Improvement
While I've found this app great overall, there are some aspects I'd like to see improved. This is what I've told the developers so far:
- It could be beneficial to have a mood/behavior option for "Hypo Overtreating" or "Hypo Rage Treating." So many of us face this, and find ourselves eating half the kitchen instead of just the needed amount of carbs (and waiting the 15 minutes for them to kick in and boost us up). This could be helpful to track, to see if patterns emerge and to monitor how much food we're actually eating at those tough times.
- A SWAG (Scientific Wild Arse Guess) option could be great for those times when we just don't know exactly how much food or insulin might have been eaten or taken. This tag could give us an idea of how often we are guessing on carb counts and probably off to some degree. I actually did this a year or so ago in a paper log sheet, and was shocked to see myself SWAG'ing almost 50% of the time! I quickly cut that down, but not sure if I would have if not for keeping close tabs.
- As I've said, I do love the Diabetes Monster and the feedback he gives me. And I like being able to tame him each day. But something I haven't seen (forgive me if I've just overlooked this!) is an overview of how often I've been able to tame him. I'd like to be able to look back on the past week and see when I've tamed the monster -- and at a particular time of day -- X out of 7 days during that week. I've found that my taming usually happens right after dinner time, and it might be worthwhile to note that time to track.
- There is an option to log "Hypo" feeling, and also one for "Tired" and so on, but I found it interesting that there isn't one for the other extreme on the "Hyper" side. Sometimes, if I'm 250, I do feel those sluggish/tired/irritable feelings that can also mirror Lows, but at other times I don't. I wonder if there are any patterns here.
- There could also be a ketones tab... this could not only help explain some of the stubborn high blood sugars, but also help motivate to actually test for ketones (something I'll admit to slacking on, in part because the only box of ketone strips in my medicine cabinet expired back in 2004!)
Of course, one of the most noticeable things MySugr is currently missing is a sharing component. Like many of the apps and programs out there, there isn't a way to connect with others on Facebook or Twitter or share your successes with people in your social networks. That's something Fredrik and his team say is in the future, but not just yet. They want each PWD to be able to take action in their own lives, before connecting with a broader community about that.
Gaming + Feedback = Good
To me, the difference is gamification and that's what lets this app rise where so many others have fallen short.
For example, there's the Glooko app, which is actually a work-around to D-device interoperability. They recently launched their latest version that still involves a clunky connection cable to suck the data out of your glucose meter (so no manual entry required). One of the Glooko execs put this chart together for us, explaining what's new about this latest version compared to what they had before...
OK, so lots of logging functionality, but Glooko doesn't actually motivate me to change my behavior.
As Fredrik says on the MySugr blog:
In a normal diabetes journal/logbook, you plug in the numbers and are rewarded with, well... just a list of numbers really. That's just so '80s, and about as useful to us as a submarine in the Sahara desert.
What a great analogy!
There's no feedback, which is something I really like in this MySugr app. With most other tools, I'm just looking at another set of charts and graphs that represent my diabetes data. That really doesn't inspire me to do better.
When it comes to changing behaviors and making PWDs healthier, it's all about motivation! That and eventually getting more medical professionals to embrace these resources and ultimately prescribe them to us as part of our D-Management regime. Fredrik tells me that's in the works, as they have doctors stateside who plan to promote the app with patients. And in Germany, there's a patient who recently submitted his MySugr Pro purchase to his insurance company for reimbursement -- there's been no response yet, but we believe that's where the future lies.
Take the news from last week about WellDoc launching a new product called BlueStar, which will be the first mobile health product to secure reimbursement as a diabetes therapy. In essence, it'll be added on as a pharmacy benefit like any other prescription, although the pricing details haven't yet been disclosed. What is known is that this new WellDoc BlueStar will eventually be available to employees at a number of Fortune 500 companies, such as Ford, Rite Aid, and even DexCom that's decided to offer it as a reimbursed program for employees and their dependents with diabetes! Yes, BlueStar will be added to prescription benefit plans, but a health care provider will still have to prescribe it...
Which brings to mind another recent program we've heard about, from HealthTap. This new program is called AppRX, and it involves a new feature for the already-popular mobile health app that lets doctors recommend certain medical apps to patients. More than 40,000 doctors are apparently using this, and now some are able to actually prescribe apps.
All of this brings to mind something Amy said late last year at the MedicineX conference during a presentation on mhealth:
Patient networks need to be part of the Rx. Patients need more than instructions. @AmyDBMine says at #medx
— DiabetesMine (@DiabetesMine) September 29, 2012
We're on our way there.
It's only a matter of time before more apps do the job of helping us be inspired to change our health behaviors for the better, and the medical profession and payer system are willing to embrace that.
In the meantime, the best we PWDs can do is keeping trying to tame our Diabetes Monsters with the resources we have... bumbling along on our BG management every day.