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Don’t Be An Apphole.

Don't be an apphole, yo.“What diabetes apps do you use?”

I am asked this question all the time, especially now that entire conferences are being geared towards mobile health, honing in on the fact that more people have mobile phones than access to toilets.  (This is true, or at least according to the fact I saw on Time.  A phone but no toilet?)  “Mobile apps to manage diabetes – isn’t it exciting?  What are the ones that you’re using?”

Last month, I spoke at the Kairos Summit in NYC about mobile health and the app-frenzy in the healthcare sphere.  I felt kind of like a tool, though, because I don’t use any mobile apps to manage my diabetes.  There are a few that I use to track other health habits (like sleep and exercise – see this post for health applications I am using that aren’t specific to diabetes), but as far as ones aimed at my pancreas?  None.  

Why?  Because I haven’t found one yet that’s useful.  Applications to log my blood sugars?  I tried that … actually, I’ve tried that several times over.  Even the savviest mobile logbook still requires me to open the app, enter the blood sugar, and save it to their system.  It doesn’t sound like a big time-constraint, but for someone who uses a glucose meter that isn’t synced up with my phone, it’s a big extra step to make every time you test.  Personally, I’d rather plug my meter into my computer and suck the results off it that way.  

And as far as food management, as it pertains to diabetes, I don’t use a carb counting application or a food diary.  The food apps I use are more along the lines of Yelp, letting me know about ambiance or price, not the grams of carbs in the main entrees.  

I think I'm a mobile curmudgeon.  Most applications that are geared towards diabetes seem useless and cumbersome to me, and I just want them to get off my lawn. (And to turn the music down and to get their hair out of their eyes.)  Every diabetes app touts itself as the newest and shiniest way of paving the road towards an A1C of 6%, but I haven’t seen one that’s better than the consistent use of my glucose meter and CGM.

You know what I’d like?  I’d love an app that:
  • Automagically sucks the results from my meter and CGM and pump and stores them as one, single document that gives me all my numbers at a glance.  And it would require nothing more than Bluetooth (or, at the very, very least, one single cord that worked with all three devices.  A magical cord.  A uni-cord [mega-hat tip to Scott and George for "unicord."])
  • Counted carbs for me by way of simply snapping a photo of the food on my plate.  (CarboGRAM instead of Instagram?)
  • Synced up with my Dexcom and texted a loved one if my blood sugar dips into hypoglycemic range
  • Stored a list of my medications and kept track of interactions, keeping me safe from taking drugs that would interact dangerously with one another
  • How about one that rewarded me for good health habits, even when my numbers aren’t cooperating?  I want big, inflatable arms to come shooting out of my phone every time I admit that I tested my blood sugar, and the arms could give me a big hug.  Even if the number is shit, I’d still be given huggy props for testing, and for reacting to that number.   Or if big, inflatable arms aren’t an option, I’d settle for a .gif of cats drinking iced coffee.  (I did find a video, though.  Go, Cuddles!)  (And in a further aside, there are apps being developed along these "reward" lines, which I think is awesome.  Positive reinforcement is at a minimum in daily diabetes, and all efforts are appreciated.)

I'd just love something that contributes to an ease of diabetes management, not something that adds to this already-daunting to do list.  It can be done.  There can be a mobile solution to all of this data management.

If you’re creating a health app for a patient population to benefit from, actually talk to them and find out what might be useful and improve their health outcomes. App developers, don’t just make an app for the sake of having an app.  Make one that’s useful, that actually fills an unmet need for the patient with diabetes (not just the unmet need of your company needing to have an app for something).  For real.  Don’t be an apphole.


Hear, hear! I've tried them all, too.

My biggest complaint is that even the sleekest apps don't seem to take pumpers into account. How am I supposed to note a temp basal? An occlusion? A site change? Even Sanofi's cute little iBGstar app doesn't allow more than a single decimal place on your insulin dose, so it's rounding up and documenting incorrect dosages.

I think that to be relevant app and for that matter advances in meters or what ever need to do more with the same number of steps or deduce the number of steps needed to do the same diabetes management tasks. I know this may came as a shock to those who know me but I have even shared that with the device manufacturers. (I know as shocking as Kerri having coffee.)

In part the issue is that to be relevant an app will be a class III medical device and last I saw (http://mobihealthnews.com/21202/five-things-we-learned-from-the-fdas-medical-app-testimony/) no class III medical apps have been approved. That is a big economic step for the average app maker to take.

I'd totally buy that app. :-)

2 years ago, I exercised my curmudgeon rights and went retro by going pump and CGMS free. Results: same A1c, less aggravation. When I visit the Endo, he asks what I think my A1c will be and I look at the 30 day average on my meter. Spot on. His tip, "micro managing diabetes with technology does not make you healthier - the 10+ hours a week of exercise you get will more than make up for a 1% higher A1c."

Yes, I want that last one!

I love how there's so much excitement among developers, when the reality is most of the apps they're developing IMHO do nothing much to help people with type 1 diabetes and all they end up doing is becoming bloatware which clogs up our phones.

The only one I use that is specifically for my diabetes is RapidCalc. It's actually like a Bolus Wizard for folks who are on MDIs, so not only does it do the math of my bolus for me, but it automatically logs everything I do too. When I was on the pump though, I couldn't be bothered, because I always had the pump history at the ready. Now that I don't have anything else recording, that my main method.

I also use MyFitnessPal to calculate carbohydrates, which is awesome and I feel like I'm more spot on with carb counting. On top of that, it also records my calories so I'm able to lose weight too.

Besides those two, I also have Runkeeper, but that's more for general health, not really diabetes (although it doesn't hurt). I honestly can't imagine most people on pumps going out of their way to log stuff in yet another location, when the glucose meter and pump already do it. Like you said, we really just need a better unicord!

As a user experience designer (which means that I talk to users and then design physical experiences/products, software and apps that meet user needs) AND a T1D, I can tell you that these conversations ARE going on. Maybe not with every app designer and maybe not with the things you want but they are happening.

Here's some things that it might help to know:

1) When being interviewed, people often (read: almost always) lie about health related questions. Its not their fault, they want to seem responsible and they also want to believe they are the best version of themselves. So sometimes, what they end up describing are their intentions around their health, not what they actually do.

Unfortunately, what happens on my end is that, a lot of the time, we end up with data that doesn't really paint the true picture of what people need/want. Some of this effect can be lessened by observing people instead of questioning them, but that process is long and expensive and not always available on every project.

So next time you talk to a researcher please try to really reflect on the things you do and don't do - not what you wish you did. Also, don't think that I am singling out diabetics or the unhealthy here, people do it when interviewed about their finances and money too.

2) Many apps are developed by a single person in isolation. Most apps are NOT made by big companies or agencies. So what you end up with is an app that solves one person's problem, usually the person making it. My attitude towards that is "whatever". They had the ability to build it and maybe someone else will get some use out of it (fact: 400,000 apps in the app store have never been downloaded) but these apps shouldn't be confused with a company making something for YOU.

3) Apphole is awesome. I'm going to try to use it in a client meeting.

I agree, these would be awesome to have. My mental wanderings usually stop somewhere along these lines, so if someone could come up with some counterpoints, I would be most appreciateive;
1) Auto-syncing everything a) FDA issues - your pump isn't yet linked up to the CGMS, I suspect they would want at lot of trials done before hooking it up to the phone. b) Safety - even though communication may look like a one-way street (pump->phone) there still is the possibility of the phone taking control of the pump, which could be dangerous (continuous bolusing?). While the target demographic is small, there could still be circumstances to warrant the creation of something that would do this, and it would be bad (to say the least) if it got out in the wild.
2) Photo-carb-counting - I think the problem here is with scale - plate sizes vary and it could be tremendously difficult to calibrate sizes (eg. a fudrucker's 1lb-er burger vs a mac'd's 1/4lb-er burger). Although image processing techniques are getting much better, I'm not sure they're quite up to handling this task. Although a network-style algorithm with LOTS of previous data may do a pretty good job.

I would love a mobile dr. app lol. One that I can plug in my basals and all of my info and have it tell me over time what adjustments I should make (ex. "try lowering your basal by.2 from 12pm-2pm to avoid late afternoon lows). All the apps that I have tried have been too time consuming and don't really help me make any effective changes.

Nice one Kerri. I always enjoy your blog but this one hits home. I'm a tech guy (Samsung Galaxy Note II instead of IPhone) and would really like to consolidate all my devices into my cell phone. Why can't it control my Dexcom, OmniPOD, etc? I personally think it's just a matter of liability in our society. Too bad it has to hold back real progress like this...

Keep up the good work! You are essential in keeping me going when I lose interest in my T1D.

The unicord, or better yet some sort of unicloud to collect all the data would be awesome. My daughter has her pump, her meter-remote, another meter in the nurse's office at school and yet another which travels with her through the school day and to afterschool activities. It would be awesome if all of these could somehow get together and send me a comprehensive report!

Great post. I don't have a phone that has apps. I am still old school with a razor phone. But if you can find an app that you described, I would be happy to get a smart phone.
Love, love, love the hugs idea.

One day we'll get that magic app that calculates the carbs just by taking a photo. One day!

The last few appointments I've had with my consultant he's been super keen for me to get an iPhone & get some apps on the go. I'm starting to suspect he has ulterior motives...

Ok seriously, you NEED to patent that app - it sounds super fantastic!!!

Ps. I too am not using any apps to help with my diabetes for similar reasons mentioned...which is why you TOTALLY need to get on that app :)

That first point is what I have been saying for some time too. Just give me all my data in one place with some intelligent and useful ways of displaying it and analysing it. Thank you for saying it better and louder that I ever could!

I agree with you - I have yet to find an app that lasts more than five minutes on my phone, but I really dont have a need for one either. My pump and Carelink take care of logging better than any third-party app can.

If there were one app that I'd find useful, it would be one that knows which restaurant I'm at (based on GPS) and gave me carb counts of the menu items as soon as I open the app, with no awkward searching or browsing.

I have resorted to developing my own apps, strictly non-commercial, for the specific use case you present: "Synced up with my Dexcom and texted a loved one if my blood sugar dips into hypoglycemic range"

Basically, my app is picking up the Dexcom data, near real-time, while my son is at daycare and pumping the data to my iPhone. It has been wonderful, and alerts can be configured with a lot more versatility than the receiver's standard set (e.g. send text and/or send emails if BG is less than 110 and the trend is double arrows down) .

I can see an app that syncs with other things like your computer and tablet along with your phone so once the information is entered it would be on all of your devices. I know there is glooko device that works for some meters but it would be nice if the data would automatically be synced without having to do anything or at least much of anything.

App hole! Unicords! Kittens'n'coffee! Oh my!

I am on MDI and I use two apps both by Friday Forward on my old iPhone. One is an insulin calculator which is super handy. Between the two apps I get a lot of "insulin pump functionality" (minus actual insulin delivery of course!) but it's helped me lower my HbA1c by 2%.

I would be lost without them. And now entering EVERY test, carb, and unit is second nature to me. Could always do with more kittens though :P

You get the best comments!

I have yet to find an app that is useful either and I've tried them all because it felt like that's what I was supposed to be doing.

I was TOTALLY thinking of an app that you can take a picture and your carbs are calculated! I even went so far to think that you would have to have a token, coin or something to put beside it to help with perspective and size. :) But then, I eat such weird food, it STILL probably wouldn't work. But - I WOULD love it.

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