Data versus diabetes

My friend Dan Hon was diagnosed with Type 2 diabetes. The news shook him. He resolved to do something about it. Being a geek, he decided to measure and quantify the health factors (weight, body fat, activity, blood sugar) that contribute to diabetes. He's lost 30 lbs since the new year, and has gotten pretty far into reversing his diabetes. He's detailed his experience with various kinds of monitoring tools, and written a bit of a rant about what needs to be fixed in order to make this easy for anyone with a diabetes diagnosis to follow in his footsteps.

Incumbents rarely produce great experience design. They don’t have to, and they typically are dealing with historical monopolies on consumers or audiences. But there are also some first movers who don’t seem to have improved their experience over time. I’m looking at you, Withings. It’s a bit embarrassing that Weightbot has a much better mobile app than you do, and you’re selling the hardware.

In the blood glucose testing market, it looks like patents (as ever) are acting to stop newcomers to the market, particularly patents in the device and strips. It’s complicated: they have a very heavily integrated solution and, from what I can make out, rely on insurance providers in the US. The copay I’m charged for 100 blood sugar testing strips is $10. If I’m paying retail, it’s about $110. When I’m testing up to six times a day, that’s nearly 200 strips a month.

Now, if I were being overly cynical, I’d say that the interests of a company producing blood sugar meters and strips aren’t necessarily aligned with the interests of a patient who wants to stop having diabetes. From my absolutely scientific sample size of one (me), testing before and after every single meal, and testing a fasting blood sugar in the morning has been vital to me getting my blood sugar under control. It’s meant that I’ve learned what I can eat and how much, and crucially, that I can still have burgers. If I eat less burger. And more salad. But: I can still eat burgers.

What people with diabetes should have — especially people diagnosed with type 2 diabetes — is access to cheap blood testing monitors (oh, but they are cheap! The manufacturers give them away, and then charge you for the strips in a model you might be familiar with) that are easy to use and help you see trends over time, and, cheap blood testing strips that let you test at least before and after each meal every day. If you’re on, say, Medicaid, and you can afford one testing strip a day, I don’t think the success rate of people learning trends and altering their behaviour is going to be that high.

If I were still in the startup game, I have a pretty good idea of which industry I’d want to disrupt.

Myself, quantified


  1. Pharmaceutical companies and medical device makers *want* you to be on maintenance.  If you’re cured, you and your insurance company (or Medicare / Medicaid) are no longer a cash cow to them. 

    Clearly this is the case with many diseases and conditions.  Sure, many of those can’t be “cured” per se…or can they?  There’s no long-term incentive for Rx and device companies to spend their R&D dollars on permanent solutions.

    1. Diabetes – including type 2, can not be reversed or cured (some people can control their sugars enough to go off medication, but that is not the same as it being reversed – you still have to test, and you are still diet/exercise controlled, and eventually, you will have to go back on medication).   Some would like to say that gastic bypass can cure it, but there isn’t any long term data on it.  There has been much more $ dumped into the R&D of trying to *cure* type 2, since at least at that point your body is still producing and using some insulin rather then type 1, which would involving figuring out how to make it anyway – which is much harder.   (All this said, i have been type 2 for 10 years, and much to the utter frustration of my endo, I don’t test.  After 4 years of testing, I was not able to find any patterns in my daily testing that made sense with what I ate, or in any way related back to my A1C readings, which are much more accurate idea of how I am doing)

  2. “What people with diabetes should have — especially people diagnosed with type 2 diabetes — is access to cheap blood testing monitors…”

    I’m a type 1 Diabetic, have been since I was 5 (I’m now 36) and blood glucose montioring is extremely important for type 1’s, as much or more so than type 2s, who may retain some pancreratic function… type 2 is a largely self-caused epidemic, everyone always focuses on them, and how we can help them… I have zero chance of being cured. Test strips are 70 dollars for a box of 100, are not covered by healthcare and I need to test myself 3-4 times a day. I’ve had invasive surgery on both eyes and have kidney  disease thanks to diabetes. It’s frustrating to see people who have eaten themselves into this disease with their lifestyles of excess being given preferential treatment and attention when I did nothing to earn this disease but inherit it.   

    1. Thanks for your compassion, Brad Pocatello. I guess the fact that people whose parents/grandparents were diabetic being an influence in my flipping over into Type 2 means I got what I deserved. I lived with type 1 diabetics for nearly 40 years as they paid little attention to diet other than their glucose numbers. While they drank cokes or ate candy bars to “raise their sugar” I was eating whole grains & legumes & avoiding caffeine, sugar, refined flours. Still got type 2, but thanks for caring.

      1. Yeah we sometimes have to “raise our sugar”…I usually use glucose tabs for them. Yes sometimes I eat poorly but I bet my long-term diagnosis is much less hopeful than those type 2s who eat poorly too…

    2. Hear hear. I’m type 1 also and whenever there’s a new “treatment” for diabetes it’s never specified whether it’s 1 or 2. There should be more info. Ultimately we won’t ever be cured because we use more test strips too. I’m on a pump and test at least 10 times a day.

    3. Sorry to hear of your health problems, but the author doesn’t seem like the type to dig at people with Type 1. He’s arguing for cheap, specialized monitors that can track blood sugar levels over a period of time, because we already have the technology, and because it could help keep a Type 2er off of insulin. He just structured the sentence awkwardly, maybe.

    4.  I appreciate your situation but the idea that people with type 2 diabetes have only themselves to blame is an unfair blanket statement.  To be sure, there are many diabetics who had the choice to eat better, but overwhelmingly type 2 diabetes is an affliction of the poor, and those in poverty often have no choice but to eat foods high in starch and corn syrup and low in nutritional value.  Not everyone can afford to eat lean meats and fresh vegetables.

      1. “Not everyone can afford to eat lean meats and fresh vegetables.”

        Well that might be a little true, but considering the average person really only needs 2000 or less calories a day it isn’t that difficult to obtain them form reasonably healthy minimally processed sources for probably the same thing they are spending their money on now.

        Bulk oats are certainly cheaper than Quaker instant.  And as an overweight person I feel pretty confident in saying that if someone isn’t really watching what they eat, consuming a “portion” of something is unlikely.  That bag of chips I just opened, yeah I’m not eating 1oz…it’ll be closer to 1/4 or 1/3 of the bag.  Those cookies that are two to a serving, I’m probably having 4 or 6.  Eight ounces of soda, but I just opened a 20oz bottle…

        It’s not just about access to reasonably priced food, it’s about the willpower and desire couple with the understand and knowledge of what you are eating to get a person to make better choices.

        1.  I agree.  I never said it was JUST about access to reasonably priced food.  I was simply stating that it was ALSO not JUST about willpower, as you seemed to be implying.  Furthermore, in addition to willpower and access, there are also cultural and media elements.  People are bombarded with hours upon hours of media enticing them to eat supersized meals at McDonalds, drink colored sugar water pedaled by surfers and supermodels,  and drink beer and smoke cigarettes because it will make them “cool.”  Advertising in the last 50 years has been largely about getting people to consume more than they need to, and if it didn’t work, corporations wouldn’t spend billions of dollars doing it.
          I don’t fall for it myself, and sure, I take a bit of pride in that.  But it doesn’t give me the right to think that the people that do fall for it are all to blame.  Much of the fault lies with the corporations that are brainwashing them.

    5. Type 2 Diabetes is a complicated disease with many complicated avenues of how to get to it. Every person’s situation is not going to always be as simple as the media, and news articles love to oversimplify it. They just showcase it this way because they want RATINGS, and they want to create a controversy. 

      36% of Americans are obese, but only 8.3% of Americans have diabetes (ALL types included, as well as the ‘undiagnosed.’) If diabetes were solely a self caused disease, ALL obese people, and some overweight, would have it. Furthermore, more and more news articles are coming out stating how obesity may plainly be a SIDE EFFECT of diabetes which had been making itself known in the body YEARS before overt signs, and diagnosis. Even the American Diabetes Association, these weekend, acknowledged that the #1 risk for becoming a Type 2 Diabetic was being pre-diabetic, and that anyone (no matter the weight), could be pre-diabetic. Genetics is a MUST to be a type 2 diabetic. You could be the fattest man in the world, like Manuel Uribe (1,120 lbs), and NEVER get diabetes, because you don’t have the genes for it. He sure doesn’t have it, no issues with insulin resistance, etc, either. 

      Type 2 diabetes is a disease in which our crappy immune systems (yes, our immune systems are pretty crappy, too…) have become incredibly sensitive to some unhealthful triggers — including drinking, smoking, obesity — but also some lesser known ones, like other illnesses (PCOS, for example), and other medications like steroids, bipolar medications, anti-depressants, etc.  We think “Oh, that’s just the minority…” but that’s not true. Anti-depressant prescriptions have risen by more than 400%.  In America, 10% of women or more, will have PCOS… (It doesn’t seem like much, but that illness is growing exponentially. I got it as a child, when I was underweight… just 7 years old. Made me put on 80 lbs, despite living on a BMX bike, and having NO video games in my home, in that era.) In China, the rising tide of diabetics are diabetics exposed to pollution — the mass amounts of pollution, etc, and they are thin! Pollution and pesticides are being considered as a far greater risk factor to developing diabetes than we ever thought obesity could be. 

      Now, this man in his rant is speaking from his experience — telling the experience of what a Type 2 needs… (And while we may get media attention, we get SORELY ignored by our doctors). All diabetics deserve better care, better access to testing tools, and insulin, pumps and CGMs, etc, without being made to feel ridiculous for it. Yes, some folks may get their diabetes “well controlled,” but that’s it — there is NO CURE.  “Reversing” diabetes simply means you’ve reversed the overt symptoms, and some of the complications, but it’s always there. You will ALWAYS spike if you go have a slice of cake, or one slice of pizza too many (and for some people, that’s just one slice!) It is a common, and huge misconception that Type 2 can be cured, and don’t even get me started on the gastric bypass fad (Only 41% see any improvement, from this surgery). Type 2 diabetes is a PROGRESSIVE disease, and eventually, if we live long enough… we WILL need meds, and even insulin. By the time the average type 2 is diagnosed, he already has 50-80% beta cell FAILURE. 

      Type 1 Diabetes is a challenging disease, for sure, and has it’s own unique elements aside from Type 2, but we need to take on an attitude that were we are NO ONE’S victim. You can’t go around feeling “woe is me, and screw those Type 2s who gave it to themselves.” That is not a healthy attitude for yourself, nor for anyone. It creates more persecution, and more hurt. It is NOT type 2’s fault that you were mistreated by ignorant idiots, or ignorant media, or ignorant doctors, and health professionals… 

      Our complications, and how well or badly we do with diabetes over time, depend MORE on our genetics, than on our type.  Yes, some folks with type 1 live carelessly for YEARS, and never get any complications; some live pretty well controlled lives, and will get many.  My dad, a type 2, was well controlled, and didn’t need any medications or insulin until his last few years of life. He was also THIN.  He died in 2003, of the effects of many, many complications that just got him as he aged, and the disease progressed.  He fought HARD for good management.

      ANY person, regardless of how they came upon getting ANY disease, deserves proper medical care, and deserves compassion, and NO ABUSE. You would NEVER treat someone with AIDS, or cancer, disrespectfully, or with contempt, regardless of how they lived.  The same should be true for diabetics.

      NO ONE is the judge and jury of how anyone lives (only that person and perhaps their doctor) — and certainly NOT you. I’m sure you’ve had your burnouts, and periods of ‘screw it,’ and it would be unfair of anyone to say you were just a ‘bad diabetic.’ 


      Lizmari M. Collazo
      “The Angry Type 2 Diabetic” 

      1.  and, lest we forget, there is a model for this ‘let’s him and you fight’ might of inter-disease antagonism: AIDS.

        It took ACT UP to do the heavy lifting in terms of getting a meaningful research response, but public sentiment didn’t galvanize until “innocent” sufferers were promoted as the face of the disease — and, of course, they suffered due to the ‘evil’ deviants who exposed them, directly or indirectly, to HIV.

        Can’t we avoid this phase of fighting, and unite against the real problems out there?

        1. Indeed. However for that to happen Pharma’s profit for pills agenda needs to die.

      2. One of the things I just love (seriously) about becoming a diabetic was that it gave me information to shove in the faces of those “It’s all your fault because you’re fat” idiots. There are plenty of fat people out there who consume less calories and get more exercise than thin folks. The body is just way too complicated to think of it as a physics experiment where calorie intake minus calorie expenditure equals fat storage.

        That info I mentioned? I was diagnosed because despite eating ravenously (even by my standards), I had lost a bunch of weight. Everyone was complimenting me and I felt great but I knew something wasn’t right. The initial blood glucose reading at the doctors office was 399. I asked if I got a prize if I could break 400; they weren’t amused.

        I attacked the problem with information gathering. I documented every bite, every calorie, and tested 8 times a day – morning, before and after meals, and at bedtime. I took the pills prescribed. I exercised like crazy, far more than I had done in decades.

        In 90 days my A1c went from 12.9 to 6.1. I had achieved control. I had also cut my daily caloric intake by more than half and done extensive exercise. I had it all on spreadsheets and bar charts in a nice folder to show the doc at the 90 day followup.

        Oh, and one more thing. I had put on 60 pounds.

        I did some more reading and found that weight gain was a side effect of the drugs I was prescribed. Less calories went in. I did more physical work. And I gained massive amounts of weight.

        The doc was happy with the A1c number because it showed that the medications had brought my disease under control. If they made me fatter, he flat out told me that was my problem. He had helped me get the disease under control and it was up to me to lose the weight, something he stressed was absolutely necessary if I was going to ever get off the meds.

        “How can I lose weight if the drugs you prescribe cause me to gain weight, no matter how hard I work?”

        “That’s something you’ll have to work out for yourself.”

        That was years ago and while I was able to maintain control for a while, I eventually gave up. I went out of control for years before a personal crisis forced me to rearrange my life. Many things have changed for the better in the last little while and I’m rapidly getting better.

        Still, the problems with treatment remain for most patients and I despair of ever seeing this change. There’s too much business potential in keeping you just sick enough to need profitable management supplies.

        One addendum – Thank you, Lizmari, for pointing out that obesity is often and apparently a side effect of diabetes, not THE cause. When I first started reading about that, it cleared up a lot of mysteries about my own body.

        1. > The body is just way too complicated to think of it
          > as a physics experiment

          The last time I saw a diagram of glucose metabolism it showed a couple hundred different actors and pathways.  And those were only ones inside the body.  Not simple.

          1. True, yet how many health professionals understand that?  I remember seeing a TV interview with Dr. DeBakey (yes, that one) where he did nothing to to conceal his absolute disgust at the mere sight of fat people.  He actually said, with complete exasperation in his voice, “All they have to do is push away from the table!”

            Here’s one of the most famous doctors of all time yet his knowledge was severely limited to that of a typical mechanic who saw things in a purely mechanical fashion.  Obviously, this happened a long time ago but even back then I knew enough to want to reach through the TV and strangle the guy.

            Sadly, even today there are doctors who seem to have the same attitudes about obesity and, by extension, diabetes.

        2. Great job on getting your act together and getting your numbers under control. It’s a similar story for me. I gained a LOT of unexplained weight, quite suddenly…  And then, I lost 30 lbs without trying, and it came to be that I had an A1C of 10.5% at diagnosis. I worked hard with a lower carb diet (not Atkins low, or Bernstein low, mind you… just moderately low) to get my numbers in range in 2-3 months, down to a 5.3% A1C. I also kept a lot of data, and spread sheets, too. I really was afraid of the meds, though, and I avoided all meds right away, in the beginning… just for a chance to try it on my own, at least for a while. Though I am still doing great without them, I’m considering starting Metformin because of the many benefits I could get for additional treatment of my PCOS, which isn’t improving much, despite an 80 lb weight loss. :/ Apparently, the extended release kind is a lot kinder on the GI system. Best of luck with everything, and you have a fellow Type 2 friend in me.

      1.   … and don’t get me started on how the medical-industrial complex, from research fundraising to public policy advocacy, pit DM1 and DM2 patients against each other. What other illness gets the left-hand caress of just enough maintenance tools to keep one’s condition stagnant, and the right-hand slap of a multitude of diabetic junk food, cookbooks and quack nostrums?

        It’s just as insulting to be marketed as the innocent lil’ puppies of a disease (they called DM1 “Juvenile Diabetes” up until this century) as it is to be condemned as gluttonous sinners. Brad’s response proves that the marketing worked.

    6. I take medication for mental illness that (which along with the disease itself) massively increases my risk for diabetes. What did I do to deserve that?

      We live in a capricious universe, not an ordered one that somehow unfairly dealt you diabetes (or me insanity, for that matter). There are just as many type 2’s that never ‘deserved’ it as there are type 1’s that are eating, drinking and smoking up a storm as we speak. Your condition entitles you to judge no-one.

    7. I have to correct just one thing you said, Brad. Test strips are covered by some health insurance companies. I have Type 1, and my Blue Cross Blue Shield plan covers a large part of test strip costs.

      And I feel your pain, man. I was a thin kid who was fed a health-conscious diet, but with no family history of the disease. Came out of nowhere when I was 15. But going on the Omnipod (disposable, tubeless insulin pump) was the best thing I’ve ever done for controlling it. Between that, jogging a few times a week, and leaning *heavily* toward a low saturated fat paleo diet, management is a breeze now. I stay far away from breads and pastas. Never touch them if I can help it.

  3. I am not an apologist for big pharma nor am I in favor of strengthening patents. With that said, the cost of diabetes maintenance he mentions seems overstated.

    The average diabetic who has Type II under control through lifestyle factors is not testing their blood sugar before and after every single meal. Perhaps very early on they are testing at nearly that rate, but once they have it under control (and an internal sense of what their sugar levels feel like) they will test less often. Many who have it under control might only check a few times a week.
    A strip of 100 glucose testing strips can be found for under $50 in fewer than 5 seconds using Google.

    1. That’s precisely his point though. People who are diagnosed with Type II diabetes aren’t going to learn what they need t, to get off insulin and require less testing if they can’t afford diabetic strips in the first place.

      1. It may very well be true that some individuals requiring insulin cannot afford the maintenance supplies, but that isn’t what I was refuting. I am merely claiming that he is overstating the cost of those supplies. The price he mentions is greater than twice the market rate and the frequency he mentions is at least twice (probably many times more) the rate of the typical consumer.

  4. No one should make on a profit on the lives of others because when life faces profits, greed wins out.

    1. …so you want to shut down world wide research and development into health?  The company I work for is working on a sensor to improve certain types of imaging technology by making them far clearer and cheaper.  I can safely say we would drop the work tomorrow if we were told it was illegal to profit off of it and go back to making chips for your phone.  Is that what you really want?

      Your sound bite sounds cute, but it is incredibly foolish and naive.  The alternative to people chasing after profits in the health industry isn’t all of that money being dumped into some magical non-profit drug manufacture.  It is that money going to crap like your cell phone and nothing getting spent on improving health.

      1.  Why can’t we publicly fund research?   No more bloated advertising budgets, and we pay what the drugs cost.   How about we start with the creation of an agency that takes all those ‘non-profitable conditions’ which promising research points to possible cures to (but there is no money in) and starts working on those problems?   Give them 5 years of funding, and see if they can get results?    $50 million should be a good start.   1% of Microsoft’s tax bill?

        1. $50 million is tiny in terms of drug development, and 5 years is not long enough. The average time from initial discovery to launch is over 10 years, and it costs about $1 billion for a truly innovative drug (NCE). That’s not including marketing costs- though it does include clinical trials and the costs of developing the tens to thousands (depending on how you count) of failed ideas.

        2. We already do publicly funded research.  Most basic R&D is publicly funded and/or done by non-profits.  Corporations do a little, but it is generally through non-profit universities.  Where profit motivated corporations step in is when we try and make the leap from “cool idea bro” to “lets make a billion of these at less than a dollar a pill”.  

          What my company doing is a great example of this.  They took some academic R&D to do with sensor technology, said “cool stuff”, and then started to put their nose to the grind stone to figure out a way to build a few million units as cheap as humanly possible.  It is hard ass work.    I am not saying that corporations are a magical fairy-tale land of awesome, but the alternative is far far worse.  To have drug production in the hands of non-profits and government agencies from conception to production is the kind of hilariousness that wouldn’t be tried in even the most ardently socialistic nations.  That idea died the death it deserved when the Soviet Union crumbled due to their utterly worthless and incompetent industrial practices.  Governments and non-profits suck at production.  They have a place for R&D, and the US (like most nations) makes liberal use of them for that purpose.  However, when it comes to faster, better, and cheaper, corporations beat the living piss out of government owned industries and non-profits.  Even in the most socialistic single payer systems, drug and medical tech is built and sold through private corporations for profit.

          If you take profit out of medicine, people simply won’t do medicine.

  5. As  Type I diabetic, my out-of-pocket cost for maintenance before insurance (strips, meter, insulin, etc). runs around $450/month.  Most of the cost is due to patents increasing the cost well beyond the cost of manufacture (as an example, when I was in Asia, the strips I used cost less than 20% of the US cost, as did the insulin)

    1. Some of it is just plain economics too. A single vial of type N or R insulin has nearly doubled in cost over the past 5 years. My assumption is that doctors don’t prescribe this stuff anymore and when you combine a lack of money coming from insurance companies plus a reduction in demand, these companies jack up the price to keep it profitable.

      It is significant, because it’s the only insulin you can buy without a prescription, which means people buying it are probably without insurance. 

  6. he needs to do what I did. Consume a Very Low Carb / High Fat diet (Paleo) I lost 70 lb and reversed what was probably diabetes of some sort. I didn’t bother  with doctors or drugs. I just fixed my problem with REAL FOODS. 

    1. I’ll try to find it later, but I have an article around here somewhere on the dozens of ways — everything from retinal scans to electrical resistance — that big pharma and little start-ups have tried to come up with a way of non-invasively measuring blood glucose.  There’s been several billion dollars in private money that’s chased that idea exactly because there’s only one technique to easily measure blood glucose at home.

  7. If he’s testing himself 6 times a day, why not get a dexcom? It monitors continuously and you can apparently leave it in for 7 days.

      1. They cost about a grand, and a months supply of sensors about $350.. But according to the comments here, paying for enough strips to test 6 times a day is going to be around $220/mo anyways. And if you are serious about reversing your diabetes the data would be invaluable..

  8. All arguments about the strips aside (I am type II by the way but rarely test myself) Did no one else notice he works for the ad agency that does work for the Nike+ device he plugs consistently? There is a little disclaimer at the end but a lot of it seems to be astro-turf to me.

  9. The funny thing is that the reader device is usually free – the pharmacist will give them away, or you can get a coupon from the company for a new one. But the strips…that’s where they make the money.

    What would be nice would be if test strips were standard – or if you could develop a monitor that could use any kind of test strip. Or a reusable test strip. Or something to take your strip that could be plugged into a computer. Or if a nonprofit company could start manufacturing low-cost – but reliable – monitors and strips together. A family member has type 1 diabetes – it started as type 2, but it began as an autoimmune thing that attacked the pancreas until it stopped working completely. The family member tests at least twice a day (often more – it’s important to do periodic random tests at different times to see how things are) and it’s astonishing to see how expensive the strips are. Even up here in Canada-land.

    We all benefit when diabetics are able to monitor their blood sugar regularly, and if it costs a dollar a pop, there are going to be people who decide to hold off and stretch those strips as far as they can. Good, tight control is really critical…and it’s hard to maintain that control without knowing what your numbers are.

    I don’t care to get into the blame game of who gets diabetes and why. It sucks for everybody who gets it. Every single one of them.

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