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.
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.
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.
You can silence the expiration warnings in Settings > Alerts > Scheduled, disable Always Sound. You will still be alerted for critical lows and actual sensor failure. I know you moved to Freestyle but other Dexcom users might be reading.
Yeah, I think they're a huge advance for people who are already used to stabbing themselves. But they're still invasive in the sense that they have to keep the probe inside your body for 2 weeks. If Apple can nail the light-through-the-skin approach, the audience size jumps by 1-2 orders of magnitude.
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.
I'm not so confident on this bias claim. Biasing high would be an extremely risky decision for a glucose monitoring company, because it encourages insulin dosing which could be deadly.
Biasing low would be the move if scared of risky downsides.
When performing calibrations I typically found my (accurate) blood finger prick monitor to be 1 mmol/L lower.
It’s not enough of a difference to be deadly, as the sibling comment suggests, and the clinician guidance is to always eat something if you are feeling hypo, and at or near that level.
The upshot is that I set my CGM-linked pump to target 1 mmol/L higher to compensate.
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:
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:
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:
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:
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.
It's no longer watch-sized. The Freestyle Libre3 monitor is precisely the same size as a pair of stacked pennies (US). I'm wearing one right now. The previous Libre2 sensor was much larger, and you had to tap your reader device against the sensor in order to transmit data via NFC.
In contrast, the Libre3 transmits via Bluetooth, and does so once per minute, without me having to do anything else. The non-insurance retail cost is about $70 per sensor. With insurance, it can be much lower.
For me, the size difference is a real game changer. This thing is so much easier to wear and live with.
For me, the automatic update once per minute is also a real game changer. I don't need to tap the sensor with my phone to get a reading, I just open the app on my phone and the data is already there.
By all accounts, the Dexcom G7 is about the same size, and because Dexcom plays nicer with other devices, that's the way you want to go if you're trying to close the loop on the CGM plus automatic insulin dosing.
For now, I'm super happy to have the Libre3. The app needs some improvement, but this is already a World Series + Super Bowl winner.
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.
If the disposable layer transmits wirelessly in a close range (possibly being powered by the watch itself), then the watch is free to move around a bit and you get accurate measures.
