CGM Data: Around the World and Back Again – to my Pebble Watch

After attending the DiabetesMine Innovation Summit last November and being inspired by the Nightscout crew (and pretty much everyone else there as well!), I finally decided to take the time to set up a Nightscout website. I’ve had it up and running since Dec 2014. Being an adult with Type 1, I monitor my own blood glucose levels. I don’t have anyone that would be interested in following my data on a daily (much less hourly) basis, so I wasn’t sure if the functionality of Nightscout would be worth it for me. After 8 months, I can say with certainty that it has been…and then some!!!

I don’t actually use my NightPebbleWatchscout website or phone app very much but I LOVE wearing my real-time data on my Pebble watch. I’m probably 1000 times more likely to glance at my watch to check on my blood sugar than I am to dig in my purse (through all the snacks and toddler/kid gear) and haul out my Dex receiver or my phone. The setup to get my data to my watch was somewhat complicated but with the addition of the Dexcom G4 receiver in May, my data is almost 100% constant without much involvement from me other than occasionally restarting a few apps on my iPhone.

Last week, however, it suddenly quit working and I got emails written in what may as well have been a foreign language, saying things like “your Heroku app on free dynos needs to recharge.” I’m pretty techno-savvy and am generally an early adopter of new technology but I’m not a programmer and certainly don’t fully understand all of the ins and outs for each step I followed in the pipeline to ultimately setup Nightscout. Going back through them to figure out which accounts I used in my setup needed changes and what else it might affect wasn’t quite like starting at the beginning for me…but it was close.

There are so many different ways to setup Nightscout, including what hardware you’re using, what service providers you chose, what account parameters you chose with some of those service providers, etc., that it’s not an easy task for me to filter through the Nightscout setup guides and Facebook group looking for clues related to updating each piece of the specific pipeline that I selected to use. So, after I finished getting my data stream to my Pebble working again (took me about 3 hours), I decided to make a little diagram to help me understand how all the pieces I’m using fit together. Disclaimer: I’m pretty sure I have my pipeline figured out correctly but wouldn’t bet my house on it : )


My hope is that next time I need to make a change, I’ll be able to get it corrected more quickly…and with a little less terror! My current pipeline configuration prior to last week was free and now, with the required changes, looks like it will cost me $14/month, but it works for me and I wouldn’t trade it for the world.

MeandKidsI can no longer imagine not having my data on my Pebble. I feel so much safer. EVERY time I’m with my kids at the park, or the market, or driving in the car, and I glance at my Pebble, I’m thankful. Quite simply: I want to be the best mom I can be; I want to stick around to watch my kids grow up…and Nightscout helps me do that.

Big Diabetes Data Requires Big Analyses

If you’re anything like me, you’re currently clocking data on your CGM, your insulin pump, your BG meter, and any other number of devices including mobile apps for diabetes, fitness, or menstrual cycle, and wearable fitness devices like Fitbit.

It’s easy to look at one post-meal high and make a judgment call.  But it’s really hard to look at months worth of data and try to pull out patterns to really improve overall BGs and health.  Websites that integrate with my OmniPod and CGM (and are Mac compatible…don’t get me started on this…Gah!) only have the capability to really track BG and carb counts well.  But we all know it’s the type of carbs, not the number of carbs that really matters.  Also, was I especially active on a particular day?  Stressed from a big meeting at work?  Having PMS?  So many variables to consider!

big diabetes dataSince I already have all the BG and insulin data on my pump, meter, and CGM, (that I’ve laboriously collected!) I literally fantasize about just uploading those items to a single program online and then using apps of my choice to input details about my other “life variables,” such as food, exercise and activities, moods, monthly cycle, etc…..and finally (here’s the kicker) have the apps sync their data with the existing pump/meter/CGM data online in the same program!  Perfect!  Easy!  Right?  No way!

As you’re probably well aware, most of our diabetes meters, pumps, and CGMs have proprietary software and/or limited relationships with other diabetes-device companies.  So, based on who manufactured our devices, we’re all pretty much limited to one or two platforms for viewing the data…and those options sadly don’t integrate with apps we’re using to track our food, fitness, etc.

My current work-a-round solution for viewing OmniPod and CGM data (on a Mac) is Diasend, however even here you need a Clinic ID# (or to register as a non-US citizen) or your CGM tab will be grayed out.  I also use the mySugr app for logging (btw…I love mySugar), Google Cal for my monthly cycle and HRT, and just started tracking activity and sleep with a Fitbit Flex.  I make it work but it’s still me piecing together data from four different locations.

fitbit open apiFortunately (and just in the nick of time if you ask me) the US is at the beginning of a wave of personalized, data-centric healthcare, sometimes called the Quantified Self.  A lot of new data collection platforms designed for non-PWDs (like Fitbit and Lose It!) are using open APIs, which means they share and can integrate data.  After years of finding work-a-rounds and “making do” I feel like the current big data trend in healthcare is finally going to make my fantasy a realty…in the very near future.  So, everyone put down your proprietary diabetes devices for a second and raise your glass!  Here’s to hoping!

Super interested in the Quantified-Self movement like me?  Here are a few really cool recent articles:

Will An App A Day Keep The Doctor Away? The Coming Health Revolution (Forbes)

Solving America’s Big Health Care Challenges With Big Data (Huffington Post)

How Patient Generated Data Changes Healthcare (Information Week Healthcare)

mySugr Diabetes Logging App: Awesomesauce!

How on earth could a diabetes logging app earn the term “awesomesauce”?  I mean, come on, we all know logging is lame.  Well, read on!  mySugr is easy to use, modern looking (seriously, no medical clunkiness here!), and extremely rewarding.  It’s fun to play, keeps my information stored and accessible in a bunch of useful ways…and it’s pretty too!

When you first create your account with the app, you get to name your “Diabetes Monster.”  This little guy sits on your home screen and chides you with silly faces and “na nanny booboos” until you earn 50 points in a day and then he gets a zipper placed over his mouth (literally) and you’ve “tamed the monster” for the day.  Here, mine is named “Yo Cyborg Yo” and I currently have 38 points, (which is tracked with a blue progress bar in the top portion of the screen).

mySugr home screen

mySugr logbook blank entry

Logging entries is quick and easy.  The time  and location are auto-set.  Most of the fields use your phone number keypad (as opposed to scroll wheels with limited options).  There are three screens of fun little icons for quickly adding information that you’d have to type into a notes field in other apps, like “alcohol” or “menstruation” (don’t worry, there is still a manual-type notes field for when you want it).

mySugr icons

One of my favorite features of this app is the ability to take pictures of what food I’m logging (right from the log entry), because it’s not about the number of carbs but the type of carbs, right?  They really hit the nail on the head here.  No more laborious, typed descriptions of what kind of food I’m eating…just snap-and-go!

There is a colored BG graph at the top of the logbook and as you scroll back through your entries, the graph moves too and shows the BG data occurring in the 24- hour period surrounding the logbook entries currently showing on your screen.  I love how dynamic this is!

mySugr-logbook      mySugr photo entry

You can also look up past entries by searching for any term you typed in (such as descriptions or notes), location name, or chose a picture from the photo library and then see the same 24-hour graph displayed for any search results entry you chose.  Great for checking to see what happened to your BG the last time you tried you a pint of stout from that new place down the street :)

mySugr challengesTo get the Pro version (which includes the keyword search, unlimited photos, and various personalization options), all you have to do is “play” the challenges.  Yes, there are enough challenges to let you win and keep Pro without paying for it…if you keep playing and completing them.  Two of the challenges involve logging a certain number of BG entries and two of them involve logging a certain amount of activity  (bonus: one of these earns community points towards JDRF donations!).  All challenges are available once a week.

Even though there isn’t a corresponding website where you can access your data and reports, your data is stored on a server and you can access it on multiple devices (iPhone and iPad) at the same time after entering your account info into the app.  This is key for me so if my iPhone gets lost/stolen I won’t lose all my past data forever.

In a perfect world, what would I add if I could?

  • I’d love if it had a way to enter information for an extended bolus.  When I eat something that I use a bolus extension for, I like to try to look back at similar entries and see if past extensions worked or need modification.  i.e. Did I extend 50% for 2 hours or 30% for 3?
  • I’d also like to be able to save “activity descriptions” I’ve entered in some kind of dropdown, so I didn’t have to type the same ones over and over.
  • And I’d like to be able to reorganize the order of the tag icons, so I could put the ones I use the most on the first screen and not have to flip through several screens to get to them.

A word on customer service:

I had a syncing error when the app was updated and lost enough data to make me loose a couple of challenges.  Sad face.  I contacted customer support (turned out to be Scott Johnson) and he promptly sent me a coupon code to redeem several days of Pro (plus some for my trouble).  When there was a glitch in the system to cache in those days on my account, I contacted him again.   It took quite a few trial solutions for them to figure out what was going wrong and fix it but they really stuck with it until a solution was reached….for one little piddly customer.  I was impressed.

mySugr Made with loveAs a final note, I really appreciate when I scroll down on the home screen and see a little “Made with love ♥” tag.  My husband, who is a designer, uses this saying a lot.  When we go out to eat he uses it to describe a plate of food that he thinks someone gave a lot of cooking time and attention to, as opposed to slapping it on the plate.  So, if mySugr were a plate of food I ordered in a restaurant, it would certainly earn the term Made with love!

A Few Blogger Reviews: