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Dan was a spectacular brain, and made contributions that still echo today.

He is one of two friends to have passed from DKA. Miss you, Zach. RIP.

Miss pwning with you.

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 ;)

Cheers to Dan.

None have been approved for hospital use as of yet, which is the next frontier.

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.

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.

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…

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

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.

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.

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.

There are 6 month implantable CGMs, they're just quite expensive.

You got me thinking about possible hollow spots INSIDE my leg to put a sensor :P

Internal as in swimming in the bloodstream?

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.

Well I'm a T1D and I'm not generally worried about DKA because I wear a CGM and keep my blood glucose below 140 mg/dL

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.

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.

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.

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.

I can all but guarantee you they are the same device. IDK if they are even binned differently. The software is the main difference.

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.

Nope that was two years ago.

https://www.fda.gov/news-events/press-announcements/fda-clea...

I don’t think amateur cyclists will have much to gain from this other than satisfying their curiosity.

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/

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.

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?

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!

More on metabolic flexibility: https://www.levels.com/blog/what-is-metabolic-flexibility-an...

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.

Theranos lady.

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.

I agree, but there are a lot of factors going on to contribute to that number.

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...

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.

DKA is what killed the legendary Dan Kaminsky.