Wearables ain't going anywhere but up.
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
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!
[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...
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.
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.
(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)
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...
One great thing about the keto diet is that it is the only diet where you can be sure you follow it correctly ... by measuring your ketone levels.
And for glucose since different people will react very differently to various forms of carbohydrate (and associated foods) a CGM is always a must. (1)
Is this a different type of sensor?
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'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.
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?
For a closed loop we need insulin and glucagon in conjunction to keep the bg stable without user intervention.
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.
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".
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.
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.
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/
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...
Sounds bloody useful to me.
I presume you are referring to https://www.ncbi.nlm.nih.gov/books/NBK554570/
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.
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.
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.
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.
https://www.fda.gov/news-events/press-announcements/fda-clea...
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.
Treatment for DKA as far as I kmow is to give glucose insulin and potassium.
For example if you have a stomach bug and can't keep down anything you are at risk of developing DKA even if your BG is normal.
The thing is how do we know we are starving the body of fuel. Most diabetics (me included) are told not to exercise if bg is higher than 250mg/dl, but that is it. We hit over 250 mg/dl frequently and sometimes stay there for multiple hours (infusion set problems, fatty food etc.).
T1D athletes report that they eat a lot and take a lot insulin before/after training and they say they get tired very easily if they don't. They thought this as restoring the glucogen reserves in muscles but maybe it is about fueling the body.
I sometimes feel uneasy even my bg is okay and it had led me to panic attacks. Now when I think it could be raised ketones, or just anxiety.
Knowing the ketones would be helpful.
It also probably gives the companies really valuable data.
Also, I agree--glucagon would be a useful thing onboard for T1d, but not really for T2d, because (as you know) the essential problem there is highs, not lows.
And I definitely agree about CGM accuracy: most people don't know that there's a significant margin of error in all CGMs. It's 'close', but not precise.
I'm a parent of a T1d kid.
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.
You're more likely to get a reaction to the adhesive that holds the device on your skin than the sensor filament itself.
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...
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.
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...
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...
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.
No disagreement about AGC in the hospital -- there is a lot of lab/titration work in current clinical workflows for monitoring patient glucose levels.
Already banned:
Diabetics would snap up a smart watch which does accurate glucose monitoring in a heartbeat.
Is it a secret? Why not name them?
IDK that it's really possible to get accurate glucose measurements without at least a little bit of invasiveness. I don't even think the lifespan of the current CGMs are being artificially shortened. I do think they are overpriced. But my understanding of how they work (silver coating on the spike generates a voltage) it makes sense that they have a limited lifespan.
The telling part, to me, that they are overpriced is that finger stick glucose monitors come out to roughly the same cost per month because of test strips are really expensive. The fact the both manufacturers have identical pricing is also pretty suspicious.
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
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.
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.
Though for the more terminally American founders here: reception filling in intake forms and charging one-time admission and diagnostic fees for new patients may have better margin than doctors charging billable hours
I am not involved anymore in the project but in another project. But if it interests you, I can point you to the publications and company.
Email: a50q40ju@anonaddy.me
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.
Fasting and ketosis has nothing to do with tight blood sugar control. Your body manages blood sugar even if you're fasted or burning ketones.
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.
I never looked before today, but always thought it was the other way around.
> That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g
Also neat to know.
I only know the impact that a Dunks coffee (with cream) has on my blood sugar (and how much insulin I need to take to counteract it). So this has been a learning experience for me. Thanks
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.)
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.
Bodies are fun.
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.
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.
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.
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/).
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.
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.
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).