The app tries to predict blood glucose in the future (drawing on CGM, food intake, lots of parameters and other data) and based on that either automatically injects insulin, or asks the user to confirm.
People need to compile the app themselves because the liability in the case of adverse effects is insanely high.
It’s a highly driven community. I’ve seldom seen such a useful and well supported application of modern tech.
Source: I worked for a company in the diabetes app space.
Heh -- Apple Watch + Loop (https://github.com/LoopKit/Loop) handles all my insulin dosing, so technically definitely a killer app that I can't live w/out.
I've turned off all other features/notifications on my Apple Watch, it just does this, and it's the most valuable product I use (since I no longer have to pull out an insulin pump in a meeting, look at some other screen to see glucose values, etc etc etc).
Using an iPhone still feels like a clumsy solution. I think the real application will use some ASIC in your insulin pump to do the processing, and immediately adjust the dosage.
As a Type 1 diabetic I've been watching these hackers with interest. There's clearly some great opportunities for linking continuous glucose monitoring and insulin pumps, particularly for young children.
Compared to old-school closed medical devices it looks like we might get much more data and much more control over what's going on.
But it's easy to see why the commercial companies haven't produced this yet. If a bug in this means you get too much insulin then you'll end up passing out and it could kill you within a really short length of time.
I spoke to one of my doctors about it and he seemed slightly scared at what these people are trying. There have been doctors researching this for years in carefully controlled trials, and now there are hundreds of people just plugging together phones and trying it out for themselves.
I'd feel more comfortable with my software running the pump than someone else's, especially given the UI of most insulin pumps I've seen. They make it easy it get it wrong.
There's a huge community of people actively doing this. Type 1 diabetics were tired of waiting for a "closed loop" (aka artificial pancreas) insulin delivery system so they developed their own. One open source project is called Loop https://loopkit.github.io/loopdocs/ It's very mature and I know a few people who have been using it for years.
Camdiab (https://camdiab.com/faq) is available in some places (UK) to provide automated blood sugar level management.
I have dived into this a bit, and the thing that I grokked is the challenge of proving that the algorithm/device loops really work and are really safe. There has been a lot of painstaking work to develop and certify a thing like Camdiab. Unfortunately it also means that it's important to buy the right smartphone to make sure that the right libraries are available and being used by the app... Has been a bit expensive.
They have also walked the road of testing and proving the devices/algorithm for use in small children and teenagers. Bear in mind that this is all very complicated and there are a lot of differences in the behaviour of different hormone systems in different cohorts.
Modern medical technology relies heavily on computers and software. Take an infusion pump for example. Controlled by a microcontroller and using software. Or insulin pumps; and some vendors are actually considering to add Bluetooth to insulin pumps, so that patients using such a pump can check its status on their smartphone (or on the upcomming smart watches). Also you can adjust the infusion rate of an insulin pump to accommodate for ingested sugar. Overdosing on insulin can send a person into shock and kill.
I view this is interesting research about medicine that has nearly zero usefulness for actually treating diabetes in humans.
Since this is a technical audience, if you're diabetic I can't speak highly enough of the opensource efforts combining a cgms (like a dexcom) with a pump and then software running on android or iphon or raspberry pi to create a "feedback loop" to slowly but usefully bring blood sugar back to desired range.
For more see:
For an overview
https://diyps.org/2017/08/09/what-you-should-know-about-clos...
iPhone version call Loop
https://loopkit.github.io/loopdocs/
raspberry pi
https://openaps.org/
Loop, an artificial pancreas system for diabetics, has a long history in terms of its development, but for a brief summary which might be of interest to the HN audience: It began as a home-brew system, built by diabetics who reverse-engineered insulin pump firmware and control software in order to gain control of the devices which keep them alive. If you've heard of OpenAPS or the Nightscout projects, this was born out of the same community. Insulin pumps, until several years ago, could only be configured statically to adjust the insulin dosing amount which keeps a patient's blood sugar values in range. But when paired with a continuous glucose monitor, a "closed-loop" system can be created to attempt to keep sugars in range algorithmically. A group of engineers launched Tidepool, a non-profit, in an attempt to get full regulatory approval for the software which thousands were running on their devices to expand it to a wider audience, and along they way they have been able to get buy-in from insulin pump manufacturers to develop an open and interoperable ecosystem. Now, 4 or so years later, the system has received FDA clearance -- the first of its kind, not created by one specific insulin pump manufacturer or corporation but instead by a group of developers with backing from this non-profit.
I'm curious what the build-your-own-pancreas people have to say about Tidepool's plan to build an iOS app to do the control logic, and at the same time developing standard interfaces to insulin pumps and glucose monitors. Any comments?
I'm a programmer and I've had a type 1 diabetes for the last 21 years. It is one of the most complex things in my life to take care of
when all of the insulin therapies don't really work that well and I don't wake up to the nightly hypos. Luckily I'm in the German insurance system and getting an insulin pump first and later a CGM. Already I'm using an NFC chip in my arm giving results to my phone and from there to InfluxDB and Grafana. Later with a proper CGM I also get automatic alarms which wake me and my partner if the sugar gets to low.
There are great open source systems for us technical people, but the tech is very expensive without an insurance and requires you to solder an extra device to get the values to your phone. At least with an NFC device you can wrap a smartwatch over it to get the readings automatically to your phone, rooted of course.
Closed loop insulin delivery systems functionally “cure” t1 diabetics and are here today. Have implemented for a t1 friend. Has transformed his long term outlook.
Relies on currently quite expensive hardware (continuous glucose monitors / insulin pump / iPhone / Bluetooth to radio device) but that could all be combined into 2 cheap devices easily. Regulation and inertia just seems to be making that process very slow.
Type 1 diabetic here. Maybe I can offer some unique insight. Or maybe, also being a hacker, that makes me overly critical, so sorry if this is too harsh.
There are tons of tools like this out there (including software from Medtronic, the leading maker of insulin pumps, that they've clinically proven increases diabetes control, and integrate directly with glucose meters). I don't use them because:
* My meter stores that stuff for me and does charts and stats. If I want those charts on my computer, I can just upload the data with the software that comes with the meter.
* Having all the information graphed in one place on the web isn't more useful than looking at my meter.
* If I did want more than the meter does in one place, I would just use a spreadsheet.
* These tools don't add any major additional insight into what I can do to manage my diabetes better, at least compared to the work in using them.
Your pitch -- and the center of your development thought process -- needs to be "use this and you will live longer and have less stress in your life, for X, Y and Z reasons". Don't write another line of code until you have that, is my advice.
The most general problem is that there is no "stickiness" to the app -- no compelling reason to keep using it day after day. (Some ideas to get you going: make it get smarter the more I use it. Send me actionable info -- "you've only gone to the gym once this week -- on weeks when you go at least 2x, your avg. BG is 20 points lower". Make me want to show off when I'm doing well, and indirectly apply social pressure to do better when I'm not.)
And you don't even have some basic details right. You have nothing for exercise! That's huge! And the glycemic load, fat content, and amount of fiber in a food is as important as how much carbohydrate is in it. Knowing how many carbs are in a piece of pizza isn't that useful (and there are a million other tools to do that already --including ones built directly into insulin pumps and blood glucose meters, and mobile apps). If you don't know that you should take very different insulin amounts and patterns when eating a serving of Skittles, pizza or brown rice even though they have the same amount of CHO, you don't know enough to help.
There really isn't anything in the app that shows you've even read the wikipedia page about diabetes. Sorry if that sounds harsh but every part of the app reflects it, and so as a diabetic it's hard not to find the whole thing condescending. In addition to nothing on exercise, your app doesn't do anything with A1C/fructosamine, C-peptide tests, cholesterol, T4, etc., all of which are more useful to compare to blood glucose readings than BP, and as important to track over time. Have you even heard of A1C? They run commercials on TV reminding diabetics to get it checked regularly all the time.
Maybe my expectations are too high, or maybe yours are. If you're going for super-simple, it needs to be a lot more simple, a bit more useful, and a lot more memorable. If you're going for sophisticated, you've got a whole lot of work to do and probably need to get diabetes and/or a medical degree first. But you need to make a choice: are you going for power users, or casual users? Even if you got the medical details right, there's a basic market fit problem here, and a lack of stickyness, as mentioned above. There are way too many competitors not to have the market fit be solid and have some very unique twist.
In general, if you're selling a specialty product, you need to know more about the specialty than the average user. I've created some very successful software for the specialty $foo market. But I was a $foo-ographer for 10 years, everybody in the $foo world knows my name, I've been blogging about $foo for 5 years, etc.
As a white guy, would you start a line of hair-care products for black people? Open up a Thai restaurant even though you've never been to Thailand, don't even eat Thai food, and there are already 3 good Thai restaurants in the neighborhood -- but you heard that lemongrass is somehow involved? Probably not, so why do this? DON'T FAKE THE FUNK.
Oh, final pet peeve. For the love of Pete don't say stuff like "CareLogger makes it possible to share your logged information with your physician simply by printing off the desired records." No. Being able to print a web page is not a feature. I can just take my glucose meter to the doctor and they can pull my data directly from it into their computer! Don't mention stuff that makes you look bad, even to downplay it. If you can't compete on a feature, don't mention it. Sell the features you do have, preferably the ones competitors don't.
In short, real humans and these medical devices are inexact. The device must choose “How much insulin should be dosed?”. Lawsuits argue medical devices should be flawless, so no company will bring out a device that could be pointed out as causing an incorrect amount of drugs being delivered
The open source insulin pump and continuous-glucose-monitors as a feedback systems are just incredible BUT they require the user to be very aware of what is easy and reliable and what can be flaky (see all the details about pod screamers - e.g. the pod can’t continue, or drift in cgm data)
Some of those folks have even automated blood sugar detection and insulin management, creating basically an artificial pancreas. It's pretty cool (open source) software if people want to learn more, called Nightwatch.
Considering the prevalence of type 1 diabetes at 3 million Americans (1%), and how big an impact this disease has on people's lives, I'm surprised that there aren't more developers who are either afflicted or have a loved one who is that hacks on open source diabetes projects.
The app tries to predict blood glucose in the future (drawing on CGM, food intake, lots of parameters and other data) and based on that either automatically injects insulin, or asks the user to confirm.
People need to compile the app themselves because the liability in the case of adverse effects is insanely high.
It’s a highly driven community. I’ve seldom seen such a useful and well supported application of modern tech.
Source: I worked for a company in the diabetes app space.
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