Let’s talk gadgets.
Usually I can hold off getting things with buttons and displays. I’m a guy whose “smartphone” is an unlocked multi-band phone from the middle of the last decade that we took to India and that now mostly sits in my bag
uncharged unused. It has a camera and Bluetooth, and I can play Monopoly on it (using a Java virtual machine) but that’s pretty much it. Fancy MacBook Pro laptop (from 2006)? Yes. 4th-gen iPod (ca. 2007)? Also yes. iPad/iPhone/Android/everything else? Not so much. After that decision to get an overpriced HP iPAQ hx4700 with a short shelf-life in early 2005, I’ve been reluctant to get many expensive, shiny things.
I’m definitely not opposed to gadgets, though. After thinking about the experience of recording my diabetes events at the end of last month, I’ve decided that I would like one shiny, new thing. Unfortunately, what I want — an awesome, new blood glucose meter — doesn’t exist yet. What would such a sugasheen have?
First off, it would be part of an integrated system. It would work with my pump, sending BG readings to it, similar to the way my OneTouch Ultra Link does with my Minimed Paradigm pump. It would also accept sensor data from a CGMS.
It would be easy to get data off of it. We’re talking as simple as docking an MP3 player, preferably using a standard USB connector. The data should be open and sharable. I hate that Medtronic’s software lets me download all of my pump’s events — including suspensions, temporary basals and bolus wizard suggestions — but then stores them in a password-protected Microsoft Access database that I can’t open because they won’t share the password or let me change it. And unlike the Freestyle connection cable, Medtronic won’t provide the API calls that I could use as an application developer to retrieve the data from my pump/meter. It’s my data. They don’t own it. It’s my life I’m trying to improve. Meter manufacturers should help me do that, right?
It would be open. There are lots of ways to slice and dice and visualize data if you have access to it. I should be able review my data, get averages, display events, and plot my activity in a billion different ways: time series, modal day, statistical box plots, histograms, even pie charts. Basically, if you can think of something to do with BG data, it should be possible to get the data and do it. That doesn’t have to happen on the meter itself, but it could. Wouldn’t that be sweet?
It would have lots of metadata. My Freestyle meter didn’t have any metadata at all. My OneTouch has two axes: before/after meals and a limited set of comments. But I find the events don’t often describe the reading I’ve just taken. “Not enough food” and “too much food” might describe the experience of people with type 2 or those unfortunate souls still on NPH, but I find myself wanting something like “miscalculated carbs” and “infusion set change.” I would love to be able to define my own events — especially a “WTF?!” comment — and be able to tag particular readings for follow-up with my endocrinologist or her nurse.
I would love to be able to type short, free-form notes to myself about my BG and bolus events: “Bolus wizard said 5.0 units, but I took 4.0 because of exercise” or “Had some ketones.” We’re talking Twitter-length here (140 characters) not Anna Karenina. Since a lot of diabetes is tweaking things, the perfect meter software would let me remember what I’ve tried and try it again or change it up next time.
As long as we’re talking about notes and readings and metadata, let’s talk sharing. I would love to be able to e-mail a portion or all of my log to my healthcare team for consultation. There’s no need to post my results to Twitter, but then again, why not?
Switching to the nuts-and-bolts, getting-the-BG-reading level, let’s try to think beyond blood and consumables: The ultimate BG meter would take blood and test strips out of the picture. Strips are expensive and have to be disposed. Pricking fingers isn’t exactly painful for me (I know it is for some people) but it is a bit 20th century. How about something that uses subcutaneous light scattering or UV “tattoos” that change depending on BG levels? However it might work, we’re talking about something noninvasive that doesn’t require another trip to the pharmacy every month in order to buy something I’m going to bleed on and (responsibly) throw away.
And, of course, it would be very accurate. None of this ±10% nonsense. We’re occasionally making life-or-death decisions with those BG readings, especially when deciding how to treat a high BG. The values should be precise and accurate enough that we can’t overcorrect because we’re in the margin of error.
It would also be possible to use this meter at night. LEDs are cheap. Use them. Put one in the front so that I can see my finger and another behind the display so that I can read the results w/o blinding myself at 4:00AM.
And for the love of g-d, if you’re going to require batteries, use normal ones that you find at a gas station on the NJ Turnpike or at the Eiffel Tower gift shop. AAAs would be nice.
Since blood glucose self-monitoring is the first step in a decision-making process, the ideal BG meter would help me with the rest of the process. Get a BG reading, add in the name and amount of the thing I’m going to eat, and voilà the carbs show up for the bolus wizard. I should be able enter in foods that I frequently eat as well as downloading nutritional information for those place we won’t tell our nutritionist about. If I’m going for a bicycle ride, the decision-support part of the system could remind me what works and suggest some snacks or insulin pre-gaming that I need to do based on my own history. It could even point my attention to the fact that I’ve been going high around 4:00 most afternoons for the last month and suggest that I bring it up with my healthcare team.
Finally, it would be at least as small as my current meter. If it has to be a separate device, it should fit into a stylish case that won’t get nasty after a year of constant use. But . . .
Look at this:
The data ports on the iPod and iPhone are perfect for attaching something small that can communicate with the software on the device. The ultimate BG meter would just attach to an iPhone or iPod Touch (or Android device), adding the BG reading capability to a platform that is perfect for everything else. Basically, I want a smartphone with “an app for that,” where “that” is diabetes.*
BG database with flexible journaling? There’s an app for that.
BG results analysis? There’s an app for that, too.
Bolus wizard support using a food database? E-mailing results? Decision support? Apps for them, of course.
These devices already have a backlight for those late-night readings and wireless connectivity to integrate CGMs and insulin pumps.
And we already carry them around. Or at least I would go buy one now if this were available. I’d probably buy two.
* — Look at what Apple has already done with the point-of-sale (POS) system in their own stores. “Running an Apple supply chain? There’s an app for that.”