We came up with the idea of having a place where nerds could come together to hang out and learn from each other and we decided to call the concept "Hacker Dojo". I had a sign laser engraved in 2002 at a state fair to memorialize the idea but we didn't actually get to open a Hacker Dojo until 2009.
There's a conference room in it called Kaminsky.
Dan was not a very good roommate but man, his brain worked in weird and wonderful ways, and it was inspiring how he could just rabbit-hole on stuff other people didn't find interesting until he MADE it interesting and found things nobody else had.
I wasn't sure how specific to be in my comment, but I'm glad the people who knew him know who it is. Speaks a lot of the man. I'm also 100% ready to believe he was not a good roommate by the condition of his car ;)
Sorry about your friend. This kind of news hits very differently when you know someone who might have benefited from it. Hopefully continuous ketone monitoring becomes as ordinary and accessible as CGMs are becoming.
While this 1/2 typology is incomplete, diabetic ketoacidosis is a phenomenon generally relevant to type 1 family of conditions.
Normally (even with pure type 2!) glucose-ketone levels move in opposition: to put it simply ketone production is activated by low insulin, which is activated by low glucose. Ketone bodies are then consumed instead of glucose or excreted and generally homeostasis ensures that ketone levels do not approach anywhere close to ketoacidosis levels.
In cases where insulin production is broken (Type I diabetes, monogenic diabetes, mody) despite exogenous carbs raising blood glucose levels ketone body production is still active, however in most cases glucose is the preferred energy source, which leads to broken homeostasis of ketones, ketones accumulating and resulting diabetic ketoacidosis.
Type II family is characterized by high insulin. Some call it insufficient insulin, some call it insulin resistance, but the result is that insulin remains high and ketone production low. Regardless if the person is nominally healthy or has insulin resistance, the only way to trigger ketone production is to get insulin low for extended period, which is caused by lack of exogenous glucose. So either ketogenic diet or full-blown fasting.
Advanced and prolonged Type II diabetes (even if treated with insulin) can cause insulin production to drop along with insulin resistance, so the patient could develop Type I-like symptoms and risks, including DKA.
Automated glucose control will be the next frontier in so many areas of healthcare. I'm still skeptical that anyone will be able to noninvasively and accurately sense blood sugar, but I'm glad people (especially kids with T1) will have one more tool to help them. I hope they can figure out the reimbursement side to get it into the most hands possible!
I'm in biotech and if I had a dollar for every engineer I've met who dreamed of or worked-at-a-place-that-tried or even tried-in-their-freetime to make a non-invasive glucometer, I'd have at least enough to buy a coffee, which is a lot.
There is an ever-growing bodycount in the NIO-GM graveyard [0], but I too hope that one day, it'll get figured out. My old roommate and good friend was T1 and monitoring one's glucose and remembering not to eat too much/little is half your life.
That is a very bad article. Most, if not all non-invasive blood glucose projects had no peer reviewed publications.
Anyway, this problem, to measure blood glucose non-invasive, is solved now. A product should be on the market very soon. And while I am not involved anymore, I once submitted an SBIR grant application to the NIH with this technology. A specific item that this technology used would be a few hundreds bucks if produced in quantities. I also wrote this in the grant application. The examiner googled this thing, and a top-notch single item for lab measurements was 50 grand. Obviously, too expensive. So the thing I learned:
An idiot and Google are a very dangerous combination. Even at the NIH.
PS: Neither the start-up, nor their technology is mentioned in the paper. All the mentioned technologies have been tried and are bound to fail in my opinion. At least the examiner gave me a very high score on "innovative".
Minimed 780g user here, it is not perfect. For a true closed loop we need a system that can give glucagon as well.
The current closed loop only gives you insulin to lower your blood glucose. When it gives too much it wakes you up and asks you to treat it.
You also have to accurately count carbs of meals you eat, enter when you exercise.
The sensors are also not quite reliable so sometimes it freaks out and you calibrate and go manual.
For a closed loop we need insulin and glucagon in conjunction to keep the bg stable without user intervention.
If the large studies are to be believed, you could save hundreds of thousands of lives and many billions in excess expenditure, because stable blood glucose shortens length of stay. People with diabetes alone account for 60% of hospital expenditure, so improving their care improves the system in a big way.
>People with diabetes alone account for 60% of hospital expenditure
That number seemed too large to be true, and I think you might be conflating some numbers...
The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states:
>For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes.
So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself.
Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications.
Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related.
Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here.
Blood glucose levels affect lots of health functions. Diabetes represents an extreme end of the spectrum where the body's ability to regulate these fluctuations fails, but just because your body can get your levels in control eventually doesn't mean you won't suffer from the negative effects of it needing to do so.
Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out.
Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.
sample of 1, but yeah changing my diet (very low sugar, more veggies) did alter my health visibly and rapidly. to the point that if I eat something too sweet too fast i have a very mild headache soon after, my system readjusted to not seek levels i grew up with
if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail.
other signs of digestive problems in this area may include:
- a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like)
- feeling generally flushed and hot after eating food (more histamine!)
- waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine)
- often having an upset stomach, and lots of stomach acid
- increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge)
- generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters)
- serious nasal congestion contributing to sleep apnea, and extreme fatigue
now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them!
(and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)
> it's also the sort of condition that might sometimes has an instant miracle cure
I assume that by this you mean figuring out some kind of dietary restriction?
I also struggle with a lot of those things (also ADHD) plus other inflammation-related issues (ezcema), and noticed a very specific pattern of fatigue during the day that improves at night. It's hard to tell what might be effective or not since keeping stability in my routine is a struggle, but I've mostly came up empty on explanations/solutions so far.
It may be worth getting checked out for fructose malabsorption. It means the main pathway for fructose absorption is not working and your gut only has less effective (and easily disrupted, looking at you Sorbitol) transport pathways with single digit grams capacity. Anything more and you will get symptoms. It is extremely hard to avoid fructose to get down to that level without careful attention so it is significantly under-diagnosed.
Wearing a glucose monitor for a while showed me that some veggies are worse than the usual suspects: 80g of rice with fish gave me a glucose spike higher than a Nutella sandwich. Other veggies, like beans, surprisingly low.
Potatoes are vegetables? Rutabaga? Pumpking? Carrot? Turnip? They also punch high, and are consumed a lot by people that believes just "eating more veggies" would solve all their problems. And lets not talk about some fruits.
Rice is not a veggie ffs, its not very healthy even in its best forms. Just a lot of simpler sugars. You are not doing anything healthy by eating it, and that glucose spike is very much expected just like from other junk food.
Rice is consumed a lot, and it has more things than "a lot of simple sugars". In fact, any "veggie" book would include many of recipes with rice, rice flour or rice noodles, as they are usually based in Asian cuisine. Also, as the current hell is gluten, some recipes suggest replacing wheat with rice.
It is common knowledge in the vegan world to pair lentils with rice, as they complement (rice is low lysine, high in methionine, lentils the other way). Lentils includes fiber that lowers the glycemic index of the overall meal, but also rice eases the otherwise heavy digestion of lentils. They both pair in other micronutrients (iron, zinc, selenium, magnesium, potassium).
What happens is you lose carb tolerance if you don't take them regularly.
I had really high carb tolerance but doing keto for many years has plummeted it and I'm very sensitive now (can still train it). Another example doing keto for many years you also have lower alcohol tolerance.
Recall that GLP-1s were originally designed as next-generation long acting insulin modulators; they're a form of passive control. The CGM gives you data to act on, or at the very least observe. I find, from my experience wearing them as a person without diabetes, they give really interesting insights into my own life by giving numbers to stressful moments, which can be good insight to have. That's called stress induced hyperglycemia. Everyone has a unique and continuously evolving glucose system, so YMMV.
I am confident that blood glucose has a lot to do with mood regulation as well.
Having been diagnosed with bipolar since 1997, when I began mainlining insulin last year I immediately took notice of how calm and docile I became. I have anger issues and taking insulin turned me into a lamb. I also immediately began sleeping peacefully and restfully, which had been elusive for a decade.
I currently take a calcium channel blocker for hypertension, and Metformin for the glucose, and I monitor with Stelo. But I would give anything for that calming effect of fast-acting insulin.
Cardiac surgery, burn units, ICU, neuro come to mind. All have been studied to show mortality and complications improvements with AGC, but unfortunately the commercial technology has not materialized yet.
Drug interference (with the sensor chemistry) and perfusion (which the sensor needs to function) are two major problems that a hospital presents that are not present in ambulatory (outside the hospital) use. Also the FDA has not approved any systems yet; the software is actually quite difficult to get right.
I’m willing to bet we can see longevity improvements from better blood sugar control. Not 100% certain but extremely likely, this would include potential heart attack and dementia reduction…
That's not a fair representation of what happened. That study was going for _aggressive_ control - beyond what any normal person would do. They were combining multiple drugs to force blood sugar down rapidly, including right after meals (when it _should_ be going up).
Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks.
From the AI
> The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.
I'll be showing my bias here, but you're probably referring to NICE-SUGAR, which I think suffered mainly from having a pretty uninspired control algorithm. We built and simulated it and several other clinical protocols and it had the widest spread of performance, but it lost a ton of points to hypoglycemia performance, which is where you get into increasing mortality. The NICE-SUGAR protocol [1] has no notion of weight based dosing, and even has some completely missed edge cases. There have been similar studies in Japan with a better algorithm and they showed the expected benefits.
No, you were deliberately disingenuous (I understood that) but I decided to answer the best possible interpretation of what you meant. I'd seriously reconsider this argument style, just because it's common doesn't mean any of us should think it's acceptable to pass of half truths as pithy commentary. You won't listen of course, nobody does anymore, they just want some ego points of being technically right in the narrowest of ways. Pointless point scoring.
IMO blood sugar is too simple and focused on because of ease of measurement. Someone can have rollercoaster blood sugar and be far more metabolically healthier than someone with low and steady blood sugar. Continious insulin and cortisol monitors are far more interesting IMO
Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe
They are specifically relevant to trying to enter a fasted state.
The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight).
Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
An 8oz serving of milk (236 ml) has 12 g of carbohydrate.
People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g.
That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.
Preventive medicine is a bit one. If your fitness watch could measure blood glucose, I think it would be a ton more impactful in terms of health outcomes.
Can you be specific about what your bloodwork results showed and what special insights your CGM gave you and what behavioural changes it led to?
My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary
Seeing just how much rice can impact your blood sugar is eye opening. Sticking to a "half the normal amount" of rice when eating Indian/Asian food can help a lot with blood sugar. And keeping blood sugar in check _seems_ to have a fair amount of researching backing up the idea that it's healthier and makes you feel better
For sure it's going to depend on the person, but I bet a lot of the hacker news crowd here appreciates observability and metrics.
In software we're wiring up stuff with prometheus and making grafana dashboards and changing code and configuration based on what we see happening. CGMs in a way give you insight into one aspect of your body and diet.
I've been trying Lingo, and it's been super-interesting to see in almost realtime how your body reacts to different foods. Sure you read all the time about "watch your carbs..." or "don't eat so much sugar", but it's hard to know how seriously to take that advice.
It's a whole different thing though when you eat one thing for a snack and see a big spike in a graph on your phone, and eat a different thing the next day and see hardly any change at all. It makes it much easier to rationalize your food choices.
My story is: I had a really bad crash after eating a chocolate, which never happened before. That prompted the bloodwork, which shown that A1c was not where it's supposed to be.
I bought CGM myself, without any doctor's input. Didn't know they exist before reading some selfhelp book which my wife found.
Echoing another poster, it's eye opening how some of the foods you'd never think of, are spiking glucose levels.
Overall, after both me and my wife adjusted diet, much better energy through the day, no crashes.
I know, logically, that if I eat a bunch of carbs or sugar my blood sugar will rise. I know if I go for a walk right after a meal it will help blunt the rise. Eating fiber at the start of a meal is also supposed to help avoid the spike.
However, I can’t quantify any of these things, so it feels too abstract. If I was able to see numbers and real-time impacts of my actions, it seems like it would do wonders for adherence to various protocols.
It seems like it could also provide a warning signal if levels are chronically elevated due to diet and lifestyle factors, which would eventually lead to insulin resistance and type 2 diabetes if left unchecked.
Diabetes (as with much else) is a continuum. Many people are prediabetic, or experience periods of high or low blood sugar.
There are also multiple types of diabetes, not just the generally-known Type I / II split, but gestational (affecting pregnant women), Type 5, malnutrition-related, and others. (See Wikipedia for a listing: <https://en.wikipedia.org/wiki/Diabetes#Types>.)
Other factors can also influence blood sugars, including infections, physical activity, and stress.
High blood glucose causes a host of bad health issues even in non-diabetic people: visceral fat, liver fat, inflammation, cardiac disease... You don't need to wait to be diabetic to embrace good dietary habits, and a glucose monitor would go a long way helping people make that transition.
Also rare genetic issues like GSDs and FAODs may benefit immensely from dual glucose and ketone metering. Next we need potassium and magnesium meters and that will benefit the people with rare renal wasting syndromes like Gitelman and Bartters
Metabolic psychiatry is rising, though very slowly. You do "epilepsy keto diet", and may work in bipolar/schizophrenia (need GKI 1-2, it's not keto for weight loss). But you don't need the continuous monitor, normal ketone monitor is fine, because the food list is very narrow.
The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.
"management" is the key word. Early diagnosis might help a lot not just with T1 but also T2.
Early diagnosis would save a lot of pain and suffering... and money.
I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan.
Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis.
If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable.
Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario.
IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.
Metabolism, and the endocrine system in general, is very responsive to physical activity. Even in athletes, glucose can have significant ups and downs when it gets intense.
It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.
Automated control of every major component of the circulatory system should be coming up in the future of medicine if society doesn't implode first. Stabbed through the heart and lung? Plumb in an artificial blood pump and gas exchange unit until they can be surgically treated. There's no reason we can't duplicate the functionality of the heart, lungs, liver, or kidneys. It could save tons of lives if we get there.
We have functional machines that replace heart and lungs (for a while). Unfortunately they also mess up your blood cells and there is of course a risk of sepsis.
A device like this only really changes outcomes if people can actually afford to wear one continuously, not just during periods when they're already at higher risk
Invasive CGMs (Continuous Glucose Monitor) and minimally invasive CGMs exist. It's the non-invasive CGMs which are being worked on because managing an implant or having something always poking through you is a big annoyance+risk compared to wearing a watch, ring, or patch.
The problems for these non-invasive options so far is they either too easily fail to work, are bulky/expensive, give very ballpark accuracies, or some combination thereof.
The biggest problem is that they are racist. Optical blood sugar sensing devices were developed a decade ago. They were pretty accurate for pale white people, ballpark for most skin tones and don’t work at all for Black people. Good luck bringing that to market. Apple threw out the whole product and restarted with infrared.
My younger brother has been using the open-source system Loop for his diabetes T1 since he was six years old. It automates the bloodsugar monitoring and insulin delivery. All running on his iPhone. This technology has permitted him to live almost as if he did not have the condition. Truly revolutionary, and the project is being developed by an amazing community of volunteers (total heroes!).
I am a founder and researcher at https://replica.health and co-creator of https://metabo-net.org. This is super exciting and cant wait to see what we can learn once large datasets of overlapping ketones + glucose + insulin data become available.
One point I discussed with other researchers at ADA this year: in theory automated insulin delivery does not stand to benefit much from ketone sensors, since diabetic ketoacidosis will almost always be preceded by high blood glucose, which we already measure using the cgm. It will be interesting to see what this ketone data is actually used for.
Ketoacidosis can also happen with stable blood sugars if you don't get enough insulin. There were people rationing insulin due to cost and some of them died of DKA even if their blood glucose was perfectly stable.
Another possibility of DKA with good blood sugars is when you are sick.
I think this data would be helpful.
Ketones are only going to be present if you are exceptionally bad (very high carb diet) or exceptionally good (very low carb diet) at managing your blood sugar. It's not going to be terribly useful for your average diabetic who has fairly good control over their blood sugars.
This is not correct. When someone with type 1 has an illness they can develop ketones while their glucose appears stable within range. This is can lead to death.
About once a year, when my son is sick, we need to monitor his ketones with finger pokes. When he has a stomach bug and can't eat, we have had to go to the hospital for a drip to allow us to give insulin and lower his ketone level. Having ketones on the CGM with glucose would have been very helpful.
A measure which acts as a high and a low pass filter on a band of less risk which can be monitored by other means, or subject to improvements on measurements and narrow the central zone?
> your average diabetic who has fairly good control over their blood sugars
I think it's huge for diabetics. It's a mental toll for them. They hate having to constantly prick themselves to take readings. It's awkward, inconvenient and you have to do it multiple times to be sure you got a good reading. And worse of all, it's possible to forget to take a reading when you need to.
I don't understand. All of the diabetics I know personally (one type 1 and two type 2 diabetics) use continuous glucose monitors and have for some time, so they rarely need to prick their fingers anymore. Ketone levels can be checked with a urine test.
There's some difference in the readings of a CGM due to sampling different things (blood with finger sticks vs intercelluar fluid for a CGM) and taking a bunch of vitamin C (pills or in food) can throw the readings off. But I think one or two sticks a day to calibrate the CGM and in situations where readings seem off should be sufficient.
Which makes me think the market for these is diet-focused folk. Get the FDA to clear it on medical grounds for a specific usecase then sell it more broadly.
This already happens with CGMs. The bulk of the sales is with people who want them for lifestyle monitoring even though they're only medically cleared for diabetes use.
It would be beyond stupid for a healthy "diet focused" person to want to use this. They're not at risk for ketoacidosis, and there is zero evidence that continually measuring ketones would be useful in any sense. That's different from the purported use of CGMs, which is to monitor for glucose spikes in response to specific foods (and even then, the evidence that monitoring glucose spikes in healthy people has any benefits is really thin).
If someone really wanted to measure their ketone levels there are simple urine tests that do it - there is no need to measure it continuously for healthy people. And if they want to see if they're in ketosis it's pretty easy to determine - if they're on an ultra low carb diet and their breath smells like shit, it's a good sign they're in ketosis.
I am a type 1 diabetic and this is not true, and an incredible oversimplification. And categorizing "very low carb" as "good" and "very high carb" as "bad" is bizarre and untrue. You can go into DKA on a low carb diet.
And low carb vs high carb for T1D is NOT a "good vs bad" equation to start with.
In Europe there is ketone-only continuous meter SiBio that goes for 86 EUR for 2 weeks.
A healthmaxxer goes with CGM to the left arm; CKM to the right arm and gets his glucose and ketones data for roughly 200-300 EUR per month. I did consider running this out of curiosity.
Having 2-in-1 is much nicer. Esp if you are diabetic.
just got the https://www.stelo.com/ device. Doesn't hurt at all to install under your arm. The applicator just does this big SNAP! when you press the button and the filament goes under your skin but it's painless and no blood, it's not a needle at all.
The difference is that these only measure blood sugar, while the new system also measures ketones, of keto diet fame, which are leading indicators of a really dangerous situation called diabetic ketoacidosis. It's treatable with a hospitalized IV insulin drip, but can be avoided if you have some advance notice.
My mom had T1D onset in her 50s. (It's usually thought of as a children's disease.)
She figured it out because she recognized the symptoms of ketoacidosis. That sent her to the hospital, which has thankfully allowed her to outlive her pancreas.
Diabetic ketoacidosis only happens in T1D, or when you have something extremely wrong going on metabolically (like failing organs, etc).
Normally it should never happen. It happens at ketones like ~10+ mmol, and it's ~impossible to go more than ~6 for a healthy human even eating 100% fat and fasting for a week+ and doing marathons or whatever all at the same time.
The keto diet, can actually help in T1D, by keeping blood sugar more stable overall, but you still need insulin, just less.
It can happen in people with uncontrolled T2D as well. My cofounder is a pediatric ICU doctor who has treated hundreds of DKA patients.
Also there wasn't really a relationship of the keto diet to the rest of my post, just using it to contextualize a technical term with one that might be more familiar.
> It can happen in people with uncontrolled T2D as well. My cofounder is a pediatric ICU doctor who has treated hundreds of DKA patients.
Yes, but you have to work really hard for many years to achieve this!
While on T1D it happens by default if you don't inject insulin.
> while the new system also measures ketones, of keto diet fame, which are leading indicators of a really dangerous situation called diabetic ketoacidosis
It was being said like ketones are bad, because they are known for this scenario, but should be noted that it only happens in these few scenarios, like in uncontrolled diabetes or organ failure or smth.
In most other cases they should be good. But won't happen randomly unless you're explicitly doing keto.
Ketones don't come from nowhere, they come from your body breaking muscles down in a last ditch effort to control sugars after they are dangerously elevated for extended periods of time, I'm talking 500+ over weeks. It's sort of like adding a "your car has been completely out of gas for one week" monitor to your "gas tank level" monitor.
Um, no ? Ketones come from fat burning, not muscle.
In T1D with no insulin, muscle break down from gluconesis will increase blood sugar in the blood even more. The absence of insulin also makes ketone production unrestricted, so you end up in ketoacidosis.
Muscle is used when you don't have fat, or when you eat completely nothing (burn both fat & muscle).
Like I've gained ~10KG of muscle while on keto diet. Blood sugar at 70-100 depending on scenario. Usually on the lower end.
These are the same CGM technologies (Dexcom = Stelo and Lingo = Libre), just aimed at the over the counter "health and fitness" market.
This is not verified info, but I would assume these are either A) the exact same device, just with different marketing B) "binned" production runs that did not meet the accuracy threshold for clinical/prescribed use, but are otherwise "good enough" for someone looking to healthmaxx.
I think they are the same with some software differences. I believe that the sampling rates and tolerances are different. For example, dexcom displays 5 minute samples while the stelo shows 15 minute averages (it internally gets a new sample every 5 minutes like the dexcom). I think the official accuracy is a bit lower for the Stelo as well, although in practice it's probably close to the dexcom.
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Looked into the OTC ones and it does seem they’re binned versions. The failure rate appears to be higher too, which is more acceptable in a non life threatening device.
It also probably gives the companies really valuable data.
Continuous monitoring without manual calibration or finicky sensor syncing is the real UX win here. Clean APIs for bio-data could unlock huge healthtech potential.
What a remarkable legacy. I hope this technology helps prevent others from being lost to DKA. May Dan’s memory live on through the people he inspired and the communities he helped create.
Does anyone know if something like this is required to be approved by the FDA? Like if someone were to make one for the hobbyist/weight loss market, would that even be legal?
It depends on intended use. If it is to diagnose, cure, treat, or prevent a medical condition then it is a medical device that may need approval. If it's not intended for anything medical, it doesn't need FDA approval. For example, clinical thermometers are class II medical devices, lab thermometers aren't medical devices at all. If the device were genuinely only marketed for general wellness, it would be exempt.
Amateur cyclists already wear CGMs, and as a type 1 myself, they see mine and start asking all about CGMs. It must be so boring for them to worry about fluctuations between 85 and 120.
There has been talk, but as one who hangs around those circles I've not heard of anyone actually doing it. But I'm sure someone is. At the same time, what I'm reading is that CGM won't give a non-diabetic any actionable information.
a regulated blood sugar level aids massively in cellular repair, inflammation reduction, and immune response. These are well studied and established. I could absolutely see a top athlete using AID in the future as part of a recovery routine, but I can also understand reluctance to adopt anything new or weird.
A few years back, there were a number of startups that essentially resold prescriptions of the ABT/DXCM CGM and provided personalized meal/exercise-response analytics on top. Seems like traction has been tough going, though. Dialing back from "anyone with potential metabolic issues" -- what's a realistic market? Something like high-level athletes and/or bio-hacker enthusiasts are the only folks who seem to care. On the low end, the OTC options are eating away as well.. they are less accurate, but probably solve the use case better for a pre-diabetic "once-a-year/occasional" wear use case.
Talking to ultramarathoners and cyclists, I think lactate is a biomarker that is tracked (POC blood samples) and would be more immediately useful for training/performance. AID might be construed as a form of doping, IMO.
Lactate actually comes for free with blood glucose when you measure it with a chemical sensor, it's just not something that's usually asked for. I definitely think it would be considered a form of doping to use it in competition, but I think recovery is where it would make more impact anyways. You also wouldn't want to use it before a race, as you'd run the risk of reduced pancreatic function.
AGC will find its main application in surgical and inpatient uses, eg in cardiac, neuro, burn, ICU, and people with diabetes in any hospital setting.
There doesn't seem to be a continuous lactate sensor on the market. Lactic acid production and/or clearance are definitely useful data w.r.t. exercise (many training regimens talk about lactate thresholds) and also useful in in-patient settings.
No disagreement about AGC in the hospital -- there is a lot of lab/titration work in current clinical workflows for monitoring patient glucose levels.
Lactate's available in the internal engineering data of these sensors, just not something that anyone has wanted to spend the time or money to qualify with the FDA. It essentially comes "for free" due to the chemical reaction the sensor uses.
I think you are misinformed: the electrochemical reaction used by continuous glucose sensors relies on a glucose-specific enzyme and it doesn't have anything to do with lactate. Lactic acid strips use a completely separate enzyme/reaction.
Hat tip to you and sibling comment about continouous lactate sensors (seem like they are microneedle/patch based?). Quick review shows minimal clinical evidence, but maybe that's sufficient for the consumer wearable market.
I've had the fortune to work with several CGM OEMs behind the scenes as part of our work developing an artificial pancreas, they all have a secret lactate signal!
There doesn't seem to be a continuous lactate sensor on the market.
They exist, a simple search will turn up a variety (how well they work is a different question). But see my sibling comment, they're banned from cycling competition.
I am aware of the "eating wins races" strategy for endurance sports.
Glucose and ketone monitoring seems a natural, more precise extension of that strategy. Isn't the point of carb-cramming to get more glucose into your blood stream, where your muscles can convert that into forward motion?
Yes. But you don't need to monitor glucose levels to do this. Because it's well known you can productively use as much as you could manage to consume (without vomiting). So all the device will ever tell you (if you're in the middle of significant endurance event) is that you need to raise your blood sugar. It'd be no more actionable than a writing 'your blood sugar is low' on your hand with a sharpie.
Monitoring glucose and ketones can help you develop metabolic flexibility and let you grok how easily your body cuts over to ketones. Knowing your personal realtime glucose and ketone levels helps you understand just how much carbs will kick you out of ketosis or keep you in it. Glucose monitoring will help you avoid large crashes that can lead to low energy. Among other things!
My understanding is that essentially all high-level endurance athletes are just maximizing their simple sugar intake at all times (during exercise) and knowing blood glucose/ketone levels wouldn't change anything about that intake, nor would it have any impact on crashes.
Not all. Some runners play around with doing fasted long runs to enhance fat burning adaptations. The jury is still out on if it is advisable to add to a training plan. Some utlra runners have taken to extremes.
I thought this was going to be a non-invasive sugar-level device, but it looks like in fact the innovation here is that a popular CGM line can now do ketones?
non-invasive continuous blood sugar measurement is mired in patents and technical challenges. Turns out it's really difficult to disambiguate the absorption lines of glucose from other similarly shaped molecules when you're also dealing with untangling skin conductivity, transmissivity, sweat, inflammation etc.
I also think there's no financial incentive from incumbents to develop something like this. Why would abbott develop something that works "forever" if they can milk people buying new sensors every 10~14 days.
There is a major IP holder in the space who is asserting their ownership, so even if they could solve the technical challenges, they might not be able to come to market.
As someone who has to deal with type 1 diabetes every day, this is marketing nonsense. No one needs ketones in the sensor - we need high-quality sensors, and Abbott's are only mediocre at best. They are not as bad as Dexcom, which is appalling, but they are still far from the superior quality of Medtronic/MiniMed which measure glucose exceptionally well.
Ketones are rare. They can kill you, but before that happens, your blood sugar usually rises enough for you to realise you may have ketones and start using test strips to measure them. Instead of this marketing gimmick, Abbott should have focused on improving the quality of their glucose sensors which is far more important.
I tend to agree that making the sugar measurements more robust is worth more than measuring the ketones at all. However, low sugar and high ketones can happen. And just getting notified when ketones pick up can be worth something too. The additional measurement is not useless seen from my perspective.
As an example: I was on a study that gave T1D patients Dapagliflozin (Farxiga). During the study, while on a long hike, I was hovering at low sugar and consequently insulin supply was mostly cut off for an extended period. As I started to to feel unwell, I measured ketones. I was briefed as preparation for the study to measure ketones when something seems wrong. Otherwise I wouldn't have thought of measuring ketones. Might not even have carried the kit.
On that occasion, the ketones were way above 1 mmol/l: a very high value. Protocol would have required me to call the study doctor due to the high level. Since it was a Sunday, I spared her, shot some insulin, ate a sandwich, and continued my hike. I could do that because I was not alone on that hike. I knew that if my situation deteriorated, somebody would be around to call rescue.
At the study debriefing I mentioned the incident and they said that adding to the effect of the Dapa, I was probably dehydrated, which led to the rare situation of both low sugar and high ketones.
All in all I think that if the sensor makers exhaust possible improvements for the glucose, it can make sense to add the ketone measurement as a safeguard. Having high sugar can have many reasons, and it often takes me a while to get to measuring ketones. Getting the signal of rising ketones, I would react faster a few times a year in situations where my insulin supply is broken.
Yes, this is true. There were also news about some Americans rationing insulin due to cost. Their blood sugar levels were normal, but they had high ketones and unfortunately died of DKA.
When I got first diagnosed, we were given ketone urine strips and told to use them, with the advance of glucometers, we forgot about ketone testing.
There are and have been continuous glucose monitors available for some time, and you can even get one if you don't have diabetes - I'm wearing the Lingo one right now.
All this device adds is a simultaneous ketone check, which is really only relevant to diabetics and not as much of a benefit because ketone levels are often checked with a urine test.
Understanding why children's pancreases stop delivering insulin in the first place, which remains one of the big medical mysteries, would be a huge breakthrough for preventative medicine.
You should understand the difference between taking a single drop of blood and trying to run a battery of tests on it, and sticking a probe into your extra cellular matrix to continuously monitor changes. It’s small, but it’s having a constant shifting flow of fluid at all times so it’s getting far more than one drop.
Looked after my son who has T1D for now 5 years, checked keytones maybe 20 times.
Compared to blood glucose which we check look at every 5 minutes.
Maybe this is more for Type 2 or other diabetes, or for people prone to DKA.
Or it is for people with a working pancreas who think looking at their blood sugars (and now keytones) tells them something like soothsayers reading tea leaves
In diabetics, DKA is preceded by hyperglycemia. Meaning, a CGM would tell you earlier that you are at risk for DKA than a CKM, a CKM would only tell you after you got it. Hence grahar64 is absolutely correct that as far as we know now, this provides no benefit to people at risk of DKA that a CGM does not already provide. I'm sure there will be some benefits but its really not clear at this point.
A CGM that has ketone levels is quite literally pointless. If you have a CGM in the first place you would know if your sugars were high enough for long enough to get DKA.
Mate they won't understand. People generally are exceptionally ignorant about type 1 diabetes and also eager to fall for marketing gimmicks like this one. They have no idea what type 1 diabetes is.
For anyone who doesn't get it: glucose is checked every five minutes because it changes very often, jumping or falling dangerously. It's a nightmare. Checking glucose is 1000 times more important than ketones which are almost never a problem. If you get accurate glucose readings you are highly unlikely to ever experience ketoacidosis in the first place. Before ketones become a problem, glucose has to stay high for hours. Abbott is pulling this marketing trick instead of improving the quality of their sensors. Libre 2 is absolute crap. Libre 3 is somewhat okay and sometimes even mediocre - which is still a pretty bad situation. Bad glucose sensor is a nightmare and it can kill a person or a child much likely than ketoacidosis. It will actually lead to ketoacidosis by showing incorrect glucose readings. Now I wonder whether they added a ketone sensor as a failsafe for their low quality glucose sensors.
No one asked them to add a ketone sensor as an add-on to their glucose sensor, except maybe their marketing department. People want higher quality glucose sensors that fail less often and are more accurate. Glucose sensors, not ketones!
Grateful we're moving forward on so many fronts in the world.
We came up with the idea of having a place where nerds could come together to hang out and learn from each other and we decided to call the concept "Hacker Dojo". I had a sign laser engraved in 2002 at a state fair to memorialize the idea but we didn't actually get to open a Hacker Dojo until 2009.
There's a conference room in it called Kaminsky.
Dan was not a very good roommate but man, his brain worked in weird and wonderful ways, and it was inspiring how he could just rabbit-hole on stuff other people didn't find interesting until he MADE it interesting and found things nobody else had.
I miss him too. What a gift he was to the world.
He is one of two friends to have passed from DKA. Miss you, Zach. RIP.
Miss pwning with you.
Cheers to Dan.
Normally (even with pure type 2!) glucose-ketone levels move in opposition: to put it simply ketone production is activated by low insulin, which is activated by low glucose. Ketone bodies are then consumed instead of glucose or excreted and generally homeostasis ensures that ketone levels do not approach anywhere close to ketoacidosis levels.
In cases where insulin production is broken (Type I diabetes, monogenic diabetes, mody) despite exogenous carbs raising blood glucose levels ketone body production is still active, however in most cases glucose is the preferred energy source, which leads to broken homeostasis of ketones, ketones accumulating and resulting diabetic ketoacidosis.
Type II family is characterized by high insulin. Some call it insufficient insulin, some call it insulin resistance, but the result is that insulin remains high and ketone production low. Regardless if the person is nominally healthy or has insulin resistance, the only way to trigger ketone production is to get insulin low for extended period, which is caused by lack of exogenous glucose. So either ketogenic diet or full-blown fasting.
Advanced and prolonged Type II diabetes (even if treated with insulin) can cause insulin production to drop along with insulin resistance, so the patient could develop Type I-like symptoms and risks, including DKA.
There is an ever-growing bodycount in the NIO-GM graveyard [0], but I too hope that one day, it'll get figured out. My old roommate and good friend was T1 and monitoring one's glucose and remembering not to eat too much/little is half your life.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC8655290/
Anyway, this problem, to measure blood glucose non-invasive, is solved now. A product should be on the market very soon. And while I am not involved anymore, I once submitted an SBIR grant application to the NIH with this technology. A specific item that this technology used would be a few hundreds bucks if produced in quantities. I also wrote this in the grant application. The examiner googled this thing, and a top-notch single item for lab measurements was 50 grand. Obviously, too expensive. So the thing I learned:
An idiot and Google are a very dangerous combination. Even at the NIH.
PS: Neither the start-up, nor their technology is mentioned in the paper. All the mentioned technologies have been tried and are bound to fail in my opinion. At least the examiner gave me a very high score on "innovative".
For a closed loop we need insulin and glucagon in conjunction to keep the bg stable without user intervention.
That number seemed too large to be true, and I think you might be conflating some numbers...
The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states:
>For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes.
So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself.
Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications.
Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related.
Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here.
[1] https://pubmed.ncbi.nlm.nih.gov/37909353/
[2] https://www.diabetes.org.uk/about-us/news-and-views/cost-com...
[3] https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytic...
What areas do you have in mind outside of diabetes management?
Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out.
Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.
if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail.
other signs of digestive problems in this area may include:
- a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like)
- feeling generally flushed and hot after eating food (more histamine!)
- waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine)
- often having an upset stomach, and lots of stomach acid
- increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge)
- generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters)
- serious nasal congestion contributing to sleep apnea, and extreme fatigue
now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them!
(and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)
Bodies are fun.
I assume that by this you mean figuring out some kind of dietary restriction?
I also struggle with a lot of those things (also ADHD) plus other inflammation-related issues (ezcema), and noticed a very specific pattern of fatigue during the day that improves at night. It's hard to tell what might be effective or not since keeping stability in my routine is a struggle, but I've mostly came up empty on explanations/solutions so far.
Wearing a glucose monitor for a while showed me that some veggies are worse than the usual suspects: 80g of rice with fish gave me a glucose spike higher than a Nutella sandwich. Other veggies, like beans, surprisingly low.
Try eating wholegrain rice.
Wholegrain won't do magic here. Glycemic index of wholegrain flours and wholegrain products (bread, cookies...), even sugar free, can be higher than foods made with regular grain. E.g. glycemic index of butter cookies is 60-70 (https://glycemic-index.net/cookies-pastries/ https://glycemic-index-database.com/foods/butter-cookies-flo...), for a wholegrain baguette is 75 (https://glycemic-index.net/baguette-whole-grain/).
It is common knowledge in the vegan world to pair lentils with rice, as they complement (rice is low lysine, high in methionine, lentils the other way). Lentils includes fiber that lowers the glycemic index of the overall meal, but also rice eases the otherwise heavy digestion of lentils. They both pair in other micronutrients (iron, zinc, selenium, magnesium, potassium).
I had really high carb tolerance but doing keto for many years has plummeted it and I'm very sensitive now (can still train it). Another example doing keto for many years you also have lower alcohol tolerance.
Having been diagnosed with bipolar since 1997, when I began mainlining insulin last year I immediately took notice of how calm and docile I became. I have anger issues and taking insulin turned me into a lamb. I also immediately began sleeping peacefully and restfully, which had been elusive for a decade.
I currently take a calcium channel blocker for hypertension, and Metformin for the glucose, and I monitor with Stelo. But I would give anything for that calming effect of fast-acting insulin.
Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks.
From the AI
> The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.
[1] - https://www.glycemiccontrol.net/NICE/StudyDesign/NiceALGORIT...
The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight).
Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state.
Now, if you're talking about a cup of flavoured milk, that's a different question...
People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g.
That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.
That device helped a lot to switch diet habits.
My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary
Yet the mind of most people is terrible at that, we love to overeat our body regulations.
In software we're wiring up stuff with prometheus and making grafana dashboards and changing code and configuration based on what we see happening. CGMs in a way give you insight into one aspect of your body and diet.
I've been trying Lingo, and it's been super-interesting to see in almost realtime how your body reacts to different foods. Sure you read all the time about "watch your carbs..." or "don't eat so much sugar", but it's hard to know how seriously to take that advice.
It's a whole different thing though when you eat one thing for a snack and see a big spike in a graph on your phone, and eat a different thing the next day and see hardly any change at all. It makes it much easier to rationalize your food choices.
I bought CGM myself, without any doctor's input. Didn't know they exist before reading some selfhelp book which my wife found.
Echoing another poster, it's eye opening how some of the foods you'd never think of, are spiking glucose levels.
Overall, after both me and my wife adjusted diet, much better energy through the day, no crashes.
However, I can’t quantify any of these things, so it feels too abstract. If I was able to see numbers and real-time impacts of my actions, it seems like it would do wonders for adherence to various protocols.
It seems like it could also provide a warning signal if levels are chronically elevated due to diet and lifestyle factors, which would eventually lead to insulin resistance and type 2 diabetes if left unchecked.
Even if it doesn’t increase steps on average, it will absolutely still work with someone who’s self-motivated and not just looking for a quick fix.
There are also multiple types of diabetes, not just the generally-known Type I / II split, but gestational (affecting pregnant women), Type 5, malnutrition-related, and others. (See Wikipedia for a listing: <https://en.wikipedia.org/wiki/Diabetes#Types>.)
Other factors can also influence blood sugars, including infections, physical activity, and stress.
The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.
Early diagnosis would save a lot of pain and suffering... and money.
I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan.
Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis.
If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable.
Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario.
IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.
It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.
The problems for these non-invasive options so far is they either too easily fail to work, are bulky/expensive, give very ballpark accuracies, or some combination thereof.
One point I discussed with other researchers at ADA this year: in theory automated insulin delivery does not stand to benefit much from ketone sensors, since diabetic ketoacidosis will almost always be preceded by high blood glucose, which we already measure using the cgm. It will be interesting to see what this ketone data is actually used for.
Sounds bloody useful to me.
I think it's huge for diabetics. It's a mental toll for them. They hate having to constantly prick themselves to take readings. It's awkward, inconvenient and you have to do it multiple times to be sure you got a good reading. And worse of all, it's possible to forget to take a reading when you need to.
This already happens with CGMs. The bulk of the sales is with people who want them for lifestyle monitoring even though they're only medically cleared for diabetes use.
If someone really wanted to measure their ketone levels there are simple urine tests that do it - there is no need to measure it continuously for healthy people. And if they want to see if they're in ketosis it's pretty easy to determine - if they're on an ultra low carb diet and their breath smells like shit, it's a good sign they're in ketosis.
And low carb vs high carb for T1D is NOT a "good vs bad" equation to start with.
A healthmaxxer goes with CGM to the left arm; CKM to the right arm and gets his glucose and ketones data for roughly 200-300 EUR per month. I did consider running this out of curiosity.
Having 2-in-1 is much nicer. Esp if you are diabetic.
[1] https://www.sibiosensor.com/products/sibio-ks3-ckm-continuou...
https://www.stelo.com
https://www.hellolingo.com
She figured it out because she recognized the symptoms of ketoacidosis. That sent her to the hospital, which has thankfully allowed her to outlive her pancreas.
Normally it should never happen. It happens at ketones like ~10+ mmol, and it's ~impossible to go more than ~6 for a healthy human even eating 100% fat and fasting for a week+ and doing marathons or whatever all at the same time.
The keto diet, can actually help in T1D, by keeping blood sugar more stable overall, but you still need insulin, just less.
Also there wasn't really a relationship of the keto diet to the rest of my post, just using it to contextualize a technical term with one that might be more familiar.
Yes, but you have to work really hard for many years to achieve this!
While on T1D it happens by default if you don't inject insulin.
> while the new system also measures ketones, of keto diet fame, which are leading indicators of a really dangerous situation called diabetic ketoacidosis
It was being said like ketones are bad, because they are known for this scenario, but should be noted that it only happens in these few scenarios, like in uncontrolled diabetes or organ failure or smth.
In most other cases they should be good. But won't happen randomly unless you're explicitly doing keto.
In T1D with no insulin, muscle break down from gluconesis will increase blood sugar in the blood even more. The absence of insulin also makes ketone production unrestricted, so you end up in ketoacidosis.
Muscle is used when you don't have fat, or when you eat completely nothing (burn both fat & muscle).
Like I've gained ~10KG of muscle while on keto diet. Blood sugar at 70-100 depending on scenario. Usually on the lower end.
This is not verified info, but I would assume these are either A) the exact same device, just with different marketing B) "binned" production runs that did not meet the accuracy threshold for clinical/prescribed use, but are otherwise "good enough" for someone looking to healthmaxx.
The "real" device gives you what it measures as your real highs and lows while the OTC devices won't report high highs or low lows.
I have a Stelo (I was curious and diabetes runs in my family) while my wife has the Dexcom.
It also probably gives the companies really valuable data.
https://navid200.github.io/xDrip/docs/Dexcom/G7.html
https://www.fda.gov/news-events/press-announcements/fda-clea...
Is this a different type of sensor?
Was analogs in the 2010s, Obama had to pass the analog act low… now it’s back with peptides and glp 1 which aren’t scheduled but..
Yeah I guess make enough money and then lobby for the benefit of your audience base or for future proscuation
Isn't the FDA run by a health care influencer, that would love to hype products they can get a cut from?
(don't have a problem with that, but it's predictable)
too bad it's not "wearable" like a watch but that might be coming eventually too since Garmin has a patent on it
* https://the5krunner.com/2026/02/06/garmin-non-invasive-blood...
(btw Fenix 9 launched today but it's same hardware as Fenix 8 and no glucose feature)
Before buying one, just know that fit cyclists will appear glucose intolerant on a CGM. See Fig. 1 at https://pmc.ncbi.nlm.nih.gov/articles/PMC10933193/
Talking to ultramarathoners and cyclists, I think lactate is a biomarker that is tracked (POC blood samples) and would be more immediately useful for training/performance. AID might be construed as a form of doping, IMO.
AGC will find its main application in surgical and inpatient uses, eg in cardiac, neuro, burn, ICU, and people with diabetes in any hospital setting.
Already banned:
https://www.bikeradar.com/news/uci-bans-supersapiens
No disagreement about AGC in the hospital -- there is a lot of lab/titration work in current clinical workflows for monitoring patient glucose levels.
Hat tip to you and sibling comment about continouous lactate sensors (seem like they are microneedle/patch based?). Quick review shows minimal clinical evidence, but maybe that's sufficient for the consumer wearable market.
They exist, a simple search will turn up a variety (how well they work is a different question). But see my sibling comment, they're banned from cycling competition.
Glucose and ketone monitoring seems a natural, more precise extension of that strategy. Isn't the point of carb-cramming to get more glucose into your blood stream, where your muscles can convert that into forward motion?
How? Like, what is the mechanism where this is useful?
More on metabolic flexibility: https://www.levels.com/blog/what-is-metabolic-flexibility-an...
Diabetics would snap up a smart watch which does accurate glucose monitoring in a heartbeat.
Is it a secret? Why not name them?
I'd love to start monitoring my glucose level, but i'd like to have the data in my own database so that maybe i can correlate that with other things.
Wearables ain't going anywhere but up.
Ketones are rare. They can kill you, but before that happens, your blood sugar usually rises enough for you to realise you may have ketones and start using test strips to measure them. Instead of this marketing gimmick, Abbott should have focused on improving the quality of their glucose sensors which is far more important.
As an example: I was on a study that gave T1D patients Dapagliflozin (Farxiga). During the study, while on a long hike, I was hovering at low sugar and consequently insulin supply was mostly cut off for an extended period. As I started to to feel unwell, I measured ketones. I was briefed as preparation for the study to measure ketones when something seems wrong. Otherwise I wouldn't have thought of measuring ketones. Might not even have carried the kit.
On that occasion, the ketones were way above 1 mmol/l: a very high value. Protocol would have required me to call the study doctor due to the high level. Since it was a Sunday, I spared her, shot some insulin, ate a sandwich, and continued my hike. I could do that because I was not alone on that hike. I knew that if my situation deteriorated, somebody would be around to call rescue.
At the study debriefing I mentioned the incident and they said that adding to the effect of the Dapa, I was probably dehydrated, which led to the rare situation of both low sugar and high ketones.
All in all I think that if the sensor makers exhaust possible improvements for the glucose, it can make sense to add the ketone measurement as a safeguard. Having high sugar can have many reasons, and it often takes me a while to get to measuring ketones. Getting the signal of rising ketones, I would react faster a few times a year in situations where my insulin supply is broken.
All this device adds is a simultaneous ketone check, which is really only relevant to diabetics and not as much of a benefit because ketone levels are often checked with a urine test.
If root cause could be identified people wouldn't need insulin pumps and other complications anymore at all...
But this is what you get with modern midwits running around everywhere....
Maybe this is more for Type 2 or other diabetes, or for people prone to DKA. Or it is for people with a working pancreas who think looking at their blood sugars (and now keytones) tells them something like soothsayers reading tea leaves
[0] https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.htm...
For example, about 20% of that number is because someone is finding out for the first time they have T1D [1].
Insulin costs and monitoring costs are also going to be a pretty big contributing factor. CGMs and finger sticks aren't cheap.
IDK how often it happens that ketoacidosis happens when glucose appears to be fine, I assume it's pretty rare.
[1] https://www.sciencedirect.com/science/article/pii/S016882272...
For anyone who doesn't get it: glucose is checked every five minutes because it changes very often, jumping or falling dangerously. It's a nightmare. Checking glucose is 1000 times more important than ketones which are almost never a problem. If you get accurate glucose readings you are highly unlikely to ever experience ketoacidosis in the first place. Before ketones become a problem, glucose has to stay high for hours. Abbott is pulling this marketing trick instead of improving the quality of their sensors. Libre 2 is absolute crap. Libre 3 is somewhat okay and sometimes even mediocre - which is still a pretty bad situation. Bad glucose sensor is a nightmare and it can kill a person or a child much likely than ketoacidosis. It will actually lead to ketoacidosis by showing incorrect glucose readings. Now I wonder whether they added a ketone sensor as a failsafe for their low quality glucose sensors.
No one asked them to add a ketone sensor as an add-on to their glucose sensor, except maybe their marketing department. People want higher quality glucose sensors that fail less often and are more accurate. Glucose sensors, not ketones!