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I find it hard to believe that this patent was keeping Apple from adding blood glucose sensing. Yes, I know a patent on blood oxygen level sensing stopped Apple

by tzs 2y ago

I find it hard to believe that this patent was keeping Apple from adding blood glucose sensing. Yes, I know a patent on blood oxygen level sensing stopped Apple, but there is a huge difference between oxygen level sensing and glucose sensing. For oxygen sensing there are numerous readily available inexpensive stand-alone sensors available at any drug store or online. They are non-invasive and painless. Yes, a continuously wearable sensor would be better for some people but most people don't need that. Accordingly it is something that while nice wouldn't really sell a lot of watches, and so something that might not be worth licensing if it is under patent. Glucose sensing on the other hand is a literal pain to test and has ongoing costs due to consumables used for the testing. Non-invasive painless glucose sensing on a watch is a feature that would sell a lot of watches. I think demand would be high enough, even if they have to raise prices, that it would easily be worth it.

analog31 2y ago
I work in a related area. Non-invasive blood glucose has been a holy grail for analytical science, for decades, and remains a brutally difficult problem.
- crazygringo 2y ago
  Yup. But there's hope that computational techniques can extract the signal from the noise. If they can it'll be huge. Maybe even Ozempic-huge. There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level.
  - bubblethink 2y ago
    >There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level. That doesn't work, even if it were true. You can also manage your weight by never allowing the weight on the scale to go over a certain level.
    - jbaber 2y ago
      As a number nagging you to eat better, glucose is actually great because it's responsive in real time, not a lagging indicator like weight.
    - crazygringo 2y ago
      What do you mean it doesn't work? How do you know? And no -- your weight on the scale varies drastically with water levels and food in the gut. By up to five pounds. It is useless for figuring out if you can eat another bite of rice. While glucose levels are literally minute-by-minute. They're fine-grained enough to actually tell you when to eat more and when to not.
      - ac29 2y ago
        I think the point was that it is easier said than done. Losing weight is simple in theory, you can just eat less. In practice, eating less is very hard for some people. Having real time glucose information isn't going to help those people.
        prirun 2y ago
        Just as one data point, I have a diabetic friend on insulin and under a doctor's care who was put on a CGM and told by the doctor "if the meter reads 150 or higher, don't eat". Sometimes this meant not eating for a day. He lost 70 lbs in about a year and hugely reduce his insulin use.
        crazygringo 2y ago
        Actually, it may very well help those people. Losing weight is hard because it can be incredibly difficult to "just eat less" by the right amount. If you "eat less" too little, you won't lose weight. While if you "eat less" too much, your health suffers and willpower becomes too difficult. And counting calories doesn't work well if your calorie needs vary per-day, which nearly everyone's does -- how much did you walk, what temperature were the rooms you were in, etc. The idea is that real time glucose information will allow you to "eat just right" -- never eating so little that willpower becomes an issue, but never so much that you gain weight (or fail to lose weight). You shouldn't be so dismissive of the idea.
  - RandomUser4976 2y ago
    Nonsense. Tell this to humans that die when their blood glucose is insanely high (500mg/dl), go into DKA and they are SKINNY!!! You’re suggesting 20 calories can make you obese because it raises blood glucose lol! 3-5 grams (12-20 calories) of a mild-glycemic index carbohydrate can send your blood glucose well above 120mg/dl and you would not gain weight because of an extra 12-20 calories. Additionally, 1,200 calories from fat (133 grams of fat) will not spike your blood glucose until 5-12 hours later and you you can gain weight, but that signal is lost because the rise in blood glucose happens 1-3 meals, or even the next day after eating the high fat meal. Blood glucose is VERY important but not predictive of weight. Diet, (the amount and macro composition of calories) is predictive of weight and exercise is predictive of weight. The are other factors, but those are the main predictors.
    - crazygringo 2y ago
      > Tell this to humans that die when their blood glucose is insanely high (500mg/dl), go into DKA and they are SKINNY!!! We're not talking about people with underlying health conditions. Exceptions don't invalidate a general principle. > You’re suggesting 20 calories can make you obese because it raises blood glucose lol! Nothing "lol" about it. An extra 20 calories, 20 times a day, every day for months and years, above your caloric needs, is yes quite likely to make you obese. How else do you think most people get obese? > fat... will not spike your blood glucose until 5-12 hours later And you can become aware of those patterns. You will know, for example, not to eat anything else during that window. Or learn to eat fat in gradual amounts, rather than large amounts in a single sitting. > Blood glucose is VERY important but not predictive of weight. You seem quite confident about that. You're also quite possibly wrong. The underlying logic is pretty sound: we gain weight when our blood sugar goes up and therefore our insulin goes up to remove the sugar from the bloodstream and, eventually, store it as fat.
      - jrflowers 2y ago
        > The underlying logic is pretty sound: we gain weight when our blood sugar goes up and therefore our insulin goes up to remove the sugar from the bloodstream and, eventually, store it as fat. I like this post because it assumes that humans don’t use sugar for energy. It is all stored as fat because the human body is a closed system that does not burn calories. Also I like “I see you said 20, obviously you mean 20 times that”
  - analog31 2y ago
    Indeed, there's always a hope that more advanced computation will crack this nut in the future. That's been a constant for a quarter century too.
paulcole 2y ago
> Glucose sensing on the other hand is a literal pain to test I’d be hard-pressed to believe that someone trying the newest Dexcom G7 CGM would find it more discomforting than a mosquito bite. And for that literal pain you get 10 days of constant readings on your phone. > I think demand would be high enough, even if they have to raise prices, that it would easily be worth it. This is probably correct but I don’t think many non-diabetic people would see an actual benefit from CGM data. It’s the kind of thing people love to think is useful but in reality it’ll be just one more thing to ignore.
- JoshTko 2y ago
  The market is likely for folks that are unaware that they have some glucose issue.
  - paulcole 2y ago
    I agree with the idea that the market that this will be sold to is people who believe they will benefit from CGM data. My point is that CGM data is very very very unlikely to change behavior in the overwhelming majority of people.
    - genewitch 2y ago
      If apples app explains everything simply and factually, maybe users can set alerts if a meal spikes tbem more than a meal normally does. I don't know much about diabetes so flip that around if I said it backward. I would have probably quit drinking alcohol a lot earlier if I had seen the hell it plays with sugars in your blood iirc. Sometimes a notification that you did something unhealthy might be enough? Like my watch buzzes if it detects less than X steps in the last hour, tells me to get up. The app tells me I get to sleep too late most days. If it told me that food I just ate is something I'll have to be careful with...
- sgmoore 2y ago
  > you get 10 days Isn't that the key point and means Dexcom/Libre would cost you (or your insurance company) several thousands of dollars/pounds/euros/etc every single year. For many people they already have an iphone and just need an Apple watch which could last for several years.
ijustlovemath 2y ago
we're building an artificial pancreas for hospitals, so I know a good bit about CGMs. Noninvasive blood sugar sensing is horrifically difficult. Every few years, people come along and say "oh this is just some simple DSP on spectroscopic information, piece of cake" before inevitably running up against: - skin conductivity changes over time - the ways in which skin tone changes signal absorption (which itself changes over time) - the ways in which different levels of fitness affect blood flow, material density etc. You also can't use it in a hospital setting, due to how your skin and bloodflow changes during serious conditions like sepsis (though I'm guessing they're not thinking about that market). Really smart people have been trying to use Raman spectroscopy to solve this problem for decades at this point (early patents go to early 2000s). Apple is an extremely strong hardware vendor, and I wish them luck, but I would not hold my breath for this. Plus, I'm guessing they will not open the signal up for looping, which would really leave the T*DM community out to dry.
- cookingmyserver 2y ago
  Honestly, none of those sound like blockers for the use case I and many other diabetics would like - monitoring for general blood sugar responses (rough curve) after eating. Sure, you wouldn't be able to use the measurements to dose insulin or even measure your actual (numeric) glucose level, but measuring my A1C every three months is good enough to do that in mine and many other cases. I've had my blood sugar controlled through diet and metformin with it being in the range of 5.9 - 6.2. I could do so much better if I had a better understanding of how my body, specifically, reacts to certain foods, mealtimes, routines (exercise after eating), etc. It would be super helpful to know (relative to other foods) how my body reacts to claimed low-carb foods. Is there a large spike (don't need to know the number) or is it a much more flat curve? How long in general does it take for the line to return to pre-meal levels? What does that trend look like over many months? Heck, I could even run a rudimentary and simple test to do comparative insulin response to a known amount of carbs to see if my insulin response is improving over time (using the period of the curve). I would love to get an alert that hey, we think your glucose level shot up a lot (don't care how much) so that I can remediate it through exercise then and there and avoid that food or timing going forward. Really hoping the people in Medtech don't make perfect the enemy of good in this case. Although maybe what you listed would still be blockers for even getting general glucose curves. I've been planning on getting a CGM for at least a few months to achieve all of this, but it would be great to just have it in a watch or other simple wearable.

by tzs 2y ago

analog31 2y ago

I work in a related area. Non-invasive blood glucose has been a holy grail for analytical science, for decades, and remains a brutally difficult problem.

crazygringo 2y ago
Yup. But there's hope that computational techniques can extract the signal from the noise. If they can it'll be huge. Maybe even Ozempic-huge. There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level.
- bubblethink 2y ago
  >There's a theory of weight loss that you can objectively manage your weight by never allowing your blood sugar to go over a certain level. That doesn't work, even if it were true. You can also manage your weight by never allowing the weight on the scale to go over a certain level.
  - jbaber 2y ago
    As a number nagging you to eat better, glucose is actually great because it's responsive in real time, not a lagging indicator like weight.
  - crazygringo 2y ago
    What do you mean it doesn't work? How do you know? And no -- your weight on the scale varies drastically with water levels and food in the gut. By up to five pounds. It is useless for figuring out if you can eat another bite of rice. While glucose levels are literally minute-by-minute. They're fine-grained enough to actually tell you when to eat more and when to not.
    - ac29 2y ago
      I think the point was that it is easier said than done. Losing weight is simple in theory, you can just eat less. In practice, eating less is very hard for some people. Having real time glucose information isn't going to help those people.
      - prirun 2y ago
        Just as one data point, I have a diabetic friend on insulin and under a doctor's care who was put on a CGM and told by the doctor "if the meter reads 150 or higher, don't eat". Sometimes this meant not eating for a day. He lost 70 lbs in about a year and hugely reduce his insulin use.
      - crazygringo 2y ago
        Actually, it may very well help those people. Losing weight is hard because it can be incredibly difficult to "just eat less" by the right amount. If you "eat less" too little, you won't lose weight. While if you "eat less" too much, your health suffers and willpower becomes too difficult. And counting calories doesn't work well if your calorie needs vary per-day, which nearly everyone's does -- how much did you walk, what temperature were the rooms you were in, etc. The idea is that real time glucose information will allow you to "eat just right" -- never eating so little that willpower becomes an issue, but never so much that you gain weight (or fail to lose weight). You shouldn't be so dismissive of the idea.
- RandomUser4976 2y ago
  Nonsense. Tell this to humans that die when their blood glucose is insanely high (500mg/dl), go into DKA and they are SKINNY!!! You’re suggesting 20 calories can make you obese because it raises blood glucose lol! 3-5 grams (12-20 calories) of a mild-glycemic index carbohydrate can send your blood glucose well above 120mg/dl and you would not gain weight because of an extra 12-20 calories. Additionally, 1,200 calories from fat (133 grams of fat) will not spike your blood glucose until 5-12 hours later and you you can gain weight, but that signal is lost because the rise in blood glucose happens 1-3 meals, or even the next day after eating the high fat meal. Blood glucose is VERY important but not predictive of weight. Diet, (the amount and macro composition of calories) is predictive of weight and exercise is predictive of weight. The are other factors, but those are the main predictors.
  - crazygringo 2y ago
    > Tell this to humans that die when their blood glucose is insanely high (500mg/dl), go into DKA and they are SKINNY!!! We're not talking about people with underlying health conditions. Exceptions don't invalidate a general principle. > You’re suggesting 20 calories can make you obese because it raises blood glucose lol! Nothing "lol" about it. An extra 20 calories, 20 times a day, every day for months and years, above your caloric needs, is yes quite likely to make you obese. How else do you think most people get obese? > fat... will not spike your blood glucose until 5-12 hours later And you can become aware of those patterns. You will know, for example, not to eat anything else during that window. Or learn to eat fat in gradual amounts, rather than large amounts in a single sitting. > Blood glucose is VERY important but not predictive of weight. You seem quite confident about that. You're also quite possibly wrong. The underlying logic is pretty sound: we gain weight when our blood sugar goes up and therefore our insulin goes up to remove the sugar from the bloodstream and, eventually, store it as fat.
    - jrflowers 2y ago
      > The underlying logic is pretty sound: we gain weight when our blood sugar goes up and therefore our insulin goes up to remove the sugar from the bloodstream and, eventually, store it as fat. I like this post because it assumes that humans don’t use sugar for energy. It is all stored as fat because the human body is a closed system that does not burn calories. Also I like “I see you said 20, obviously you mean 20 times that”
- analog31 2y ago
  Indeed, there's always a hope that more advanced computation will crack this nut in the future. That's been a constant for a quarter century too.

paulcole 2y ago

> Glucose sensing on the other hand is a literal pain to test I’d be hard-pressed to believe that someone trying the newest Dexcom G7 CGM would find it more discomforting than a mosquito bite. And for that literal pain you get 10 days of constant readings on your phone. > I think demand would be high enough, even if they have to raise prices, that it would easily be worth it. This is probably correct but I don’t think many non-diabetic people would see an actual benefit from CGM data. It’s the kind of thing people love to think is useful but in reality it’ll be just one more thing to ignore.

JoshTko 2y ago
The market is likely for folks that are unaware that they have some glucose issue.
- paulcole 2y ago
  I agree with the idea that the market that this will be sold to is people who believe they will benefit from CGM data. My point is that CGM data is very very very unlikely to change behavior in the overwhelming majority of people.
  - genewitch 2y ago
    If apples app explains everything simply and factually, maybe users can set alerts if a meal spikes tbem more than a meal normally does. I don't know much about diabetes so flip that around if I said it backward. I would have probably quit drinking alcohol a lot earlier if I had seen the hell it plays with sugars in your blood iirc. Sometimes a notification that you did something unhealthy might be enough? Like my watch buzzes if it detects less than X steps in the last hour, tells me to get up. The app tells me I get to sleep too late most days. If it told me that food I just ate is something I'll have to be careful with...
sgmoore 2y ago
> you get 10 days Isn't that the key point and means Dexcom/Libre would cost you (or your insurance company) several thousands of dollars/pounds/euros/etc every single year. For many people they already have an iphone and just need an Apple watch which could last for several years.

ijustlovemath 2y ago

we're building an artificial pancreas for hospitals, so I know a good bit about CGMs. Noninvasive blood sugar sensing is horrifically difficult. Every few years, people come along and say "oh this is just some simple DSP on spectroscopic information, piece of cake" before inevitably running up against: - skin conductivity changes over time - the ways in which skin tone changes signal absorption (which itself changes over time) - the ways in which different levels of fitness affect blood flow, material density etc. You also can't use it in a hospital setting, due to how your skin and bloodflow changes during serious conditions like sepsis (though I'm guessing they're not thinking about that market). Really smart people have been trying to use Raman spectroscopy to solve this problem for decades at this point (early patents go to early 2000s). Apple is an extremely strong hardware vendor, and I wish them luck, but I would not hold my breath for this. Plus, I'm guessing they will not open the signal up for looping, which would really leave the T*DM community out to dry.

cookingmyserver 2y ago
Honestly, none of those sound like blockers for the use case I and many other diabetics would like - monitoring for general blood sugar responses (rough curve) after eating. Sure, you wouldn't be able to use the measurements to dose insulin or even measure your actual (numeric) glucose level, but measuring my A1C every three months is good enough to do that in mine and many other cases. I've had my blood sugar controlled through diet and metformin with it being in the range of 5.9 - 6.2. I could do so much better if I had a better understanding of how my body, specifically, reacts to certain foods, mealtimes, routines (exercise after eating), etc. It would be super helpful to know (relative to other foods) how my body reacts to claimed low-carb foods. Is there a large spike (don't need to know the number) or is it a much more flat curve? How long in general does it take for the line to return to pre-meal levels? What does that trend look like over many months? Heck, I could even run a rudimentary and simple test to do comparative insulin response to a known amount of carbs to see if my insulin response is improving over time (using the period of the curve). I would love to get an alert that hey, we think your glucose level shot up a lot (don't care how much) so that I can remediate it through exercise then and there and avoid that food or timing going forward. Really hoping the people in Medtech don't make perfect the enemy of good in this case. Although maybe what you listed would still be blockers for even getting general glucose curves. I've been planning on getting a CGM for at least a few months to achieve all of this, but it would be great to just have it in a watch or other simple wearable.