Platforms and Services

To me, it's quite clear that a complete system focusing just on diabetes data management won't succeed in the modern world. Rather, any system should be a part of a greater ecosystem of all health services. It is equally clear that a generic healthcare data management system cannot meet all the needs of different patients. This blog post elaborates on these thoughts.

Do one thing, and do it well

The first thing to take into account is focus. A system built to enhance diabetes treatment should really concentrate just on diabetes treatment. No generic healthcare solution will ever be as effective and useful as a system specifically tailored for diabetes treatment and designed with the needs of people with diabetes and their healthcare professionals in mind.

Being able to concentrate on diabetes treatment means that someone else should take care of things that are generic to all of the services, such as data storage and sharing, sign-on mechanisms, authentications, and so on. And that someone else should concentrate on that task, implementing such a generic platform as well as possible, for all those services to use.

You're not alone

There will be several services for managing diabetes data. No service will be perfect for all people with diabetes. People have different challenges with their condition, and they should be able to select the tools that best fit their individual needs. There also needs to be competition between services. That drives development and pushes each of the services to become the best they can be. It should also be possible to move from one solution to another, as your life changes. 

We should also remember that it's never just about diabetes. All people with diabetes are individuals, and the properties that describe their diabetes are never adequate to portray a holistic picture of their life. They have other illnesses and conditions, and that information needs to be taken into account when making adjustments to their treatment. I really don't think offering a complete end-to-end system for just diabetes data management works.

Besides, why would one want to implement all that generic functionality like data storage all over for each service? And even more importantly, why would a doctor need to sign on to several applications when meeting a customer? Healthcare organizations are very well aware of these issues nowadays.

There really is a genuine need for those platforms that store and manage all that data for all those services. And all the services really need to be integrated and talk to each other.

You're either a platform or a service

In my view, one should really make a choice. Either you're implementing a platform with open interfaces really well, or you're providing well designed services on top of such a platform. It's really difficult to be making both, while still keeping the interfaces open for all possible services, in a way that's fair and accessible for everyone.

There are many companies out there working really hard to make life easier for people with diabetes. I hope none of them think they're able to be the only solution making that possible, and really encourage them all to evaluate first whether they're offering a platform or a service. In the case of a platform, they should ask how they can best allow all third party services to operate on them, and not just limiting to diabetes services. A big question is also whether they are really simplifying the current mix of existing platforms or just adding to the complexity. In the case of offering a service, the companies should see how they can really add value to the whole ecosystem.

Media visibility

After Slush, we have been lucky to get some visibility in different media.

Taltioni 2.0 was launched 12 November and we got to present Sensotrend in the event, since it is built on Taltioni platform. Naturally, we were mentioned in Taltioni's press release regarding the new services coming up during 2014.

At Slush, as you already know, we got to launch our product on stage at the Health Track on World Diabetes Day, 14 November. Sensotrend was also presented in Slush Blog, Fighting Diabetes at Slush.

On 19 November, Mikael was featured on TV, in YLE Prisma Studio's episode about Quantified Self (around the 20 minutes mark, he appears in two short parts).

The Finnish Innovation Fund Sitra wrote about their experiences at Slush and mentioned us in their post Slush 2013 – showcasing the best of Finnish start-ups.

Read about Finland's hot start-up property from this year's #Slush2013, attended by 5000 people in Helsinki http://t.co/5eHhcMkzy2
— Sitra (@SitraFund) November 25, 2013

Last but not least, on Friday we were interviewed and photographed for Focus on Finland magazine. They were making an article about New Factory and Finnish startup scene. The issue will be out in January 2014.

These are the appearances we are aware of. If you have seen Sensotrend mentioned somewhere else, please let us know!

Our first Slush

Last Wednesday and Thursday it was time for Slush, the huge startup conference in Helsinki. Slush is all about startups, investors and media getting together to make contacts and learn what's going on in Finland and globally. For a small and yet quite unknown startup like us, it is an important way to meet the investors and also make the people aware that we exist.

We got a demo booth at Health Demo Area on Thursday 14 November, World Diabetes Day. And yet, that was not all! We were also told - only a couple of days before Slush - that we would get to launch our product at Health Track, meaning a 5 minute pitch for the audience interested in health topics. Brilliant!

The launch went really good. Mikael's speech was touching and he got a lot of positive feedback and even hugs from strangers who had heard him talk (in the pic he's presenting not his abs but his insulin pump). Diabetes is such a common disease, almost everyone knows someone with diabetes, and the ways to keep the condition better in control are very welcome.

We were also privileged to have plenty of visitors at our booth. We showed them our first demo version and explained countless times what we do and why that is so important. We also met many potential partners - we believe in cooperation and combining our strengths.

One last thing Slush rewarded us with was that they wanted to write about us in their blog.

In general, for us Slush was a success. We met investors and made good contacts, launched our automated diabetes diary and got many people talk about us. Thank you Slush, thank you all who were there. With this experience it's good to continue our work.

Time to sign up!

November 14 is the World Diabetes Day. It is also the day that we get to launch our service in the Slush startup conference. To celebrate both events, we're giving full 6 months free use of our service for everyone who signs up on that day!

The address for signing up is signup.sensotrend.com

Sign up and let other people with diabetes know of this opportunity as well!

We will go live in Finland early next year and internationally later 2014. The free time will of course start when we go live in your home country. That will happen sooner if we get more signups from your area, so consider sharing the signup link with all the people with diabetes you know!

Presenting Sensotrend, the Automated Diabetes Diary

For our blog readers, this is a sneak preview on the product launch on November 14, the World Diabetes Day.

I'm Mikael from Sensotrend. We've launched an Automated Diabetes Diary.

I'm a Type 1 diabetic myself. My body no longer produces the insulin hormone, rather I must inject it myself using an external device. If my body does not get insulin, I'll be in a coma in 24 hours, and dead soon after that. So I make sure I'll always have insulin available.

Then I have the problem of knowing how much insulin to inject in any given situation. Hormones generally work together, and if you're only controlling one of them, it's really tricky. No two bodies are the same, no two life situations are the same. Diabetes treatment is highly individual, and all people with diabetes must constantly track themselves, and learn from the data they gather.

There are now over 370 million people with diabetes in the world, and the yearly treatment costs are almost half a trillion dollars. And the numbers are just growing (up-to-date information will be published on the World Diabetes Day).

Back to tracking and learning. Traditionally, all the tracking has been done with a logbook. Nowadays there are also smartphone applications available. I need to log my blood glucose measurements, estimated amount of carbohydrates in everything I eat and drink, physical activity or lack of it, and the insulin dosages I have used. The problem for me is the amount of work it requires to keep such a diary.

You know, most of that data already exists somewhere, or can be tracked really easily. The diabetes devices produce rich logs, a pedometer app on my smartphone tracks my activity automatically on the background. I can choose a meal logger app to just snap a picture of what I'm eating.

The point is that I want to use the best tools available for tracking all this information, and not transfer it from place to place manually.

That's how we manage tracking. How about learning?

What's been missing so far has been a way to get all this information together, in a way that's meaningful for people with diabetes and their healthcare professionals.

This is what we do.

There's an emerging market of Patient-Centric Health Information Exchanges like Taltioni and Microsoft HealthVault. They are systems parallel to the Electronic Health Records you find in hospitals. Patient-Centric Health Information Exchanges are focused on preventive care and after care, where patients perform the measurements and are more in charge of their own treatment.

We integrate data from all the apps and devices to these Health Information Exchanges.

Once we have all the data in these central locations, we visualize it to diabetics and their healthcare professionals. They can analyze how certain kind of activity or meal affects blood glucose levels or weight.

We want the healthcare organizations to learn from this data as well.

They can use it to rationalize use of resources. For instance, instead of a fixed quota of glucose test strips per patient, they can provide just the amount of strips that person is using. This eliminates waste. With more data they can also see which kind of treatment and support each individual diabetic requires.

In the future, we want to use Big Data Analytics to mine this data. If a group of people with diabetes are doing really well compared to another group with similar parameters, we can see what these well performing ones are doing right and what the others may learn from them.

We'll be presenting our automated diabetes diary on a stand in the Health Demo Area of the Slush conference.

There you can meet the team. We're currently two type 1 diabetics that know diabetes and software really well, and a PR and marketing person.

We're looking to add some financial expertise to our core team, by the way, so please spread the word. And we're also looking for financing.

The thing I want to leave the audience with on the World Diabetes Day, is that everyone signing up at signup.sensotrend.com on November 14 will get 6 months free use of our application when we launch in their market. That will be early next year in Finland, and internationally later next year.

And for you, our dear blog readers, the offer is valid starting from now! The web page is already live, so go for it. And if you know any people with diabetes who might be interested, please spread the word! Please also forward the message to all healthcare professionals, financial experts, and investors you think might be interested in cooperating with us.

Thanks for reading! And as always, feedback is warmly welcomed. It's now even easier to leave the comment below, no account or registration is required. We're looking forward to hearing from you.

Product Launch

We'll launch our service, the Sensotrend Diabetes Diary at Slush startup conference on the World Diabetes Day, November 14, 2013. That's a week from now!

Check out our main page at sensotrend.com that day. The early adopters registering that day will get access to the service free of charge! Stay tuned for more details, and please spread the word to all diabetics you know.

We're super excited to be able to launch the product big time in a big startup conference, and especially on that special day.

The Pitch

We have mentioned our pitch in a couple of posts. In this post we share a snapshot of our presentation. Let us know how you like it!

So, we're automating the tedious task of keeping a diabetes diary.

We start by explaining diabetes briefly. Diabetics need to track blood glucose levels, carbohydrate intake, insulin dosages, physical activity, and changes in weight. To get along in everyday life, but also to be able to make improvements to their treatment.

It's nowadays really easy to track all that information. Diabetes devices produce rich logs, and we can choose from dozens of pedometer and sports tracking apps, activity tracker gadgets and meal loggers.

The problem is that there is no way to bring all that gathered data into a single user interface that presents it in a way suitable for diabetes treatment.

That's what we do. We collect data from multiple sources, build adapters where required, and store that data to emerging Health Information Exchanges. Taltioni is a Finnish initiative, Microsoft's HealthVault is an example of an international solution.

We visualize the data for diabetics and their healthcare professionals. Also healthcare organizations benefit from the gathered data. They can, for instance, rationalize the provision of glucose test strips based on actual consumption, and also use the data to categorize diabetics to be able to offer most suitable, personalized treatment. Those are just the immediate savings. Of course improved treatment reduces the additional cost of complications that occur if diabetics are not in control of their condition.

The size of diabetes treatment market is huge, almost half a trillion! If every tenth diabetic would use our service and we'd charge just one dollar per patient per month on average, our yearly revenue would be half a billion.

Finland is a good place to launch our service. Type 1 diabetes is more prevalent than anywhere in the world, and we already have a Health Information Exchange in operation. Once such platforms launch in other markets, we want to be ready to offer our service. We want to be a global company, helping all diabetics all over the world.

We're currently a team of three. We know diabetes, software, and marketing really well, but would appreciate some expertise in financials and business execution. Would you know a good candidate to join our team?

Talking of financials, we're looking for 500 000 € seed funding to finalize our product, get the first deals with healthcare organizations, and to prepare for an accelerator round in late 2014. During the accelerator phase, we plan to go through the medical software certification processes and get the first international customers. We're expecting the emerging Health Information Exchanges to become widely adopted from 2016 onward, and want to be a globally recognized company by that time.

Finally, some buzzwords related to the field we're working in. If anything of the above resonates with you, get in contact with us. You can schedule a meeting with us at the SLUSH conference through this page, connect with me in LinkedIn, or email me at mikael.rinnetmaki(at)gmail.com.

Second Performance

I wrote earlier about our first pitching competition. Yesterday was our second public presentation, this time to FIBAN, the Finnish Business Angels Network.

This time the competition was tougher. A lot tougher. 10 companies had been preselected from 25 applicants based on the slide deck, and we were really honored to be in that lot. There were plenty of experienced pitchers from companies in accelerator phase, such as Responsive Ads who have cool HTML5 tech and feature Mashable as their client, the award winning Runteq, and also established companies with patent portfolios like Tamturbo.

The selected companies each gave a 5 minute pitch, no questions were asked. Cramming all the relevant info to just 5 minutes was incredibly challenging for us, but in the presentation we reached the end just on time. In the end, the three best pitches were announced. We're really proud of our second place! Tamturbo won the competition, the third place went to Jalava Sensors.

Our record of the second place

Afterwards, there was some time for networking and closer discussions with interested angel investors. We got some good contacts and initiated some interesting discussions. We're hoping the discussions will result in us getting more help in putting the numbers in shape. Financial expertise is clearly our week spot at the moment.

Diabetes diaries

Last night I participated to the GB DOC tweetchat for the first time. GB DOC (@theGBDOC) is the Diabetes Online Community in Great Britain, and tweetchat is real time conversation on the internet, using Twitter. Similar online communities exist at least in Australia (@OzDiabetesOC), Canada (@theCANDOC), France (@Fr_DOC), Germany (deDOC), Italy (@ITDoc3), Nigeria (@theNGdoc), Spain (@es_doc), and the United States (@DiabetesSocMed). But not in Finland, at least yet.

I've been monitoring the GB DOC chat a few times. This time the topic was particularly interesting for me, so I decided to participate to the discussion. It was about diabetes diaries.

It turned out many of the participants shared my views and had the exact same wishes for a perfect diabetes diary.

Q4 I want all my data in one place: meter, CGM, pump, activity, food, moods etc. As automatically as possible! #isthattoomuchtoask? #gbdoc
— Andrea Limbourg (@AndreaLimbourg) October 2, 2013

Is getting that kind of a service really that hard? So far it has been. And there have been challenges. As one doctor I talked with put it: the electronic diabetes diary is a 25 year old idea, but now it finally seems feasible. Glucose meters, bolus calculators, and insulin pumps produce verbose logs, mobile phones have cameras to snap pics of meals, and pedometer apps to keep track of physical activity. Combining all that data to a single, coherent visualization seems really quite trivial.

The discussion, and hearing so many other diabetics still haven't found a good diabetes diary, encouraged me to continue developing Sensotrend towards that goal.

To top it all up, I ended up winning the #bgbingo, with a perfect match. Lucky times... :)

Any thoughts about diabetes diaries you'd like in comments? I'm listening.

Market research

Another quick piece of news. We recently published a user survey, asking our potential end users how they feel about some aspects of their treatment.

So if you are a diabetic, or a parent of a child with diabetes, please take some time to share your views. If you know any diabetics, please share the address with them.

The survey can be found at http://www.surveymonkey.com/s/MJZWYFT (only in Finnish at the moment).

Pitching

No updates for a while, sorry about that.

We have been working on our pitch. A pitch is a tool most startup companies need to use. It's a presentation that sells the company to an investor, so that the company gets financial funding for growth. Pitches come in many flavors, from a one minute elevator speech (you need to explain the main idea of the company fast if you get to the same elevator with an investor) to a longer presentation describing details of the product, the markets, the team, and the business plan.

Our first public pitch was in a pitching competition organized by Protomo, our incubator. There were several teams both from within and outside the incubator, working through the day, presenting the idea and continuously improving the presentation. In the end, we managed to win the competition! Our price is some one-on-one time with an accelerator fund. We get to hone our pitch even further, and discuss all aspects regarding financials, markets, and funding options.

There is a bigger local pitching competition next week, and we're hoping to get to present there as well. Our main goal is in the big, international startup conference Slush, taking place in mid-November. We'll try to get a version of the presentation online as well before that, so you can all participate in the development.

For a diabetic, every step counts

Medtronic, the market leading insulin pump vendor, just published a blog entry in their blog, the Loop. Some text there makes me cautiously optimistic:

Since blood glucose is affected by so many things, we need to take a broader view of the technologies which are on the horizon. Never has it been easier to collect physiological data – perspiration, movement, heartrate, location. These aren’t diabetes devices per se, but they collect critical contextual data which these athletes are already using to improve their performance and glycemic outcomes. We’ve gone from a drought to a deluge of data.

There are four main factors affecting the treatment of a diabetic:

1. Blood glucose measurements
2. Carbohydrate intake
3. Medication
4. Physical activity

There are other factors as well, such as amount and quality of sleep, stress, other hormones, etc. But the four main factors listed above are the most important ones, and it is essential to understand the effects of each of those to the particular patient. They all affect each other.

So far physical activity has had a minor role in Medtronic's CareLink system, as well as in every other similar system. For many systems, a diabetic can enter any exercise explicitly. I'd do this for each game of football I play or for a session at the gym. But not necessarily when I'm just walking from a place to another. I may not realize it on that day, but on some days I end up being really active, and on other days really inactive. My step count from the pedometer app in my phone for the last week is 2891, 8903, 5814, 4994, 15 909, 8 804, and 3 265. It really makes a big difference whether I walk 16 000 or 3 000 steps per day. And it also affects my glucose levels the next day.

All that data is difficult to enter manually, but really effortlessly collected by an app on my phone. I hope pump system vendors would find a way to include data from various activity monitors into their reports, or allowing the data from their devices to be easily included in reports where all that activity data can be included.

Secrets

I ended one of my earlier posts about competition with a note that I should meet with Mendor, another Finnish startup working to improve the lives of diabetics. So on Friday we had a meeting.

The main goal for the meeting was, at least for me, to find out how we could cooperate instead of competing. I've waited a long time for a chance to work with something I find fulfilling and meaningful, and want to use this opportunity in the best possible way. If someone else is already doing what I'm about to do, I'd rather let them do it and concentrate on something else instead. I've got many, many ideas on how to improve the life of a diabetic. I just need to select the one I think will create the most value, and work on that.

Of course, to find out whether Mendor are planning to do what I'm planning to do, we need to be able to share our plans. But if I have a great idea for a company or for a product, is it wise to share it?

First of all, I would hate to base all my work on just an idea, and the assumption that nobody else has had the same idea. I'll much rather think that our team is exceptionally capable of executing the plan, and will come up with the best implementation of the idea. But the first goal must be to share the work between everyone interested in working in this field, and to collaborate.

Second, you need to think about what a company secret actually is. During the summer, I read Blake Masters' essay versions of his class notes from CS183: Startup, a computer science course in Stanford University, lectured by Paypal founder Peter Thiel. Peter's definition of Secret is that it's the answer to the question What important truth do very few people agree with you on?

So, to find out what Mendor agree and disagree with me on, I think it's best for me at this phase to just tell them what I think and what I'm about to do, as openly as I possibly can. I was very happy to learn that they also discussed their plans quite openly. It must be harder for them in the sense that they already have so much implemented. They are not able to ditch their main idea right away and select something else instead. However, having been around longer and having built something already also gives them an edge, they are not so afraid of competition from some fresh startup.

It turned out we shared many sentiments about diabetics, but are targeting different user groups. They believe their approach with pair measurements is the winning one, and have their hands full of work to implement Mendor Balance around that idea. I agree that pair measurements are an important first step for a majority of diabetics, but know for a fact that for a diabetic like myself that information alone is not sufficient to get the treatment to the level I want to get it.

We agreed with Mendor to keep in touch, and also already tentatively discussed the technical and commercial aspects of my solution connecting to theirs in some point in the future. It's feasible, but first I need to show there is actual demand and use case for my approach.

For me, the simplified version of the important truth very few people agree with me on is that

1. there is a significant group of diabetics that will benefit from seeing the data of all the aspects affecting their blood glucose levels in a single user interface, and that
2. collecting all that data can be made easy enough so that these people will actually do it.

One step closer to being a company

Today, we started as a team in Protomo, a local startup incubator. Four teams were selected from dozens of applicants, so we consider this to be a great achievement in itself.

We're now a team of three. Mikael Rinnetmäki and Timo Koukkari are both type 1 diabetics and contributing mainly to the technical implementation of the service. Assi Rinnetmäki will handle most of the communications and marketing, as well as managing all the administrative tasks related to actually turning the project into a company.

Creating a logo

After deciding the name (or at least the project name) of our product the next step was logo design. Since I'm studying publication graphics and web communications, it was natural that I'd be the one in charge of the visual expression. It's also part of my school curriculum to create a logo, in addition to a web site and a printable brochure.

Mikael had some plans for the logo already, and I started sketching some ideas based on them, first on paper, then with Adobe Illustrator.

A logo should be as simple as possible, easily recognizable and not with too many colors, since it's a lot easier (and cheaper!) to print it with less colors. In addition, we did not want it to be too colorful in a childish way but to show we are seriously and determinedly doing what we do.

At the beginning we decided the o in the word "Sensotrend" should be round and blue, referring to the universal symbol for diabetes. The natural color companion to that would be black, so we chose it to be the other color used in our logo. This combination works on white canvas as well as on other colors.

Now we had a round o as a starting point, and we wanted to find a font that would match perfectly with it. It should have circular rather than elliptical forms, and the lines should have an even stroke width. Also the line caps of the letters should be rounded rather than sharp, to create a nice and soft appearance.

I went through loads of fonts found on Adobe Illustrator but could not find the perfect one. So I started going through some fonts on the web, and finally found a good candidate. It's called Station and it's designed by French designer Anthony Bossard. It is rounded and even, and perfectly matches our purposes.

When the font was found, I wrote the text and started curving it. The idea is that the curvy path of the text symbolizes the blood glucose levels of a diabetic that tend to go up and down, creating curvy graphs. The curve was sharper at first, but it looked better being softer and rounder, and that's how it stayed. Finally, the d in the end of the word seemed to ascend too high, and I had to shorten it a little. After that the logo seemed ready enough to share here with you.

So, here it is, how do you like it?

Back to School

I just finished Statistics in Medicine, a Massive Open Online Course (MOOC) from the Stanford University.

I've been reading quite a bit about information visualization lately, and it seems a huge part of it is tightly connected with statistics. For my application especially, I need to know why the graphs presented in existing reports are visualized the way they are. I also wanted to know that I'll be using the correct terms in any documentation, and reports I'll be creating.

I did take a course in statistics already in my own college studies, but that was some time ago already, so this course was a good refresher. With this course, I also learned a lot about the medical context. I don't think I'll ever read an article popularizing scientific results without remembering some of the key messages from the course.

There was yet another thing I wanted to learn. Would I go back to school? My current financial income would actually be quite a bit better, had I chosen that route to take time off from work and enrolled into a university (yes, that's like it works in Finland). At least based on this course I think I made the right choice, though. General studies always include stuff that's good to know but not exactly what I need to know just now. I believe being a startup entrepreneur rather than a post grad student or a researcher better allows me to focus all my efforts into what I want to accomplish.

Nevertheless, I absolutely love that I can still get high quality education of my choosing when I think I need it.

To compete, or to collaborate?

When you're doing something worth doing, you inevitably run into someone else doing something similar.

Back in late spring this year, when I had just decided I'd take some time off from work to work in eHealth instead and started to plan the product, I learned that Mendor Balance was being installed to the clinic I visit for my diabetes treatment. My first reaction was "Oh crap, the clinic won't get another system any time soon, now that they just invested in one." After the initial shock I came into the conclusion that the clinic adopting new software and new practices is actually a very good thing, and ended up helping Mendor to support my glucose meter as well.

Even if they operate in the same market and license a software product, they are not directly competitors. They concentrate on different things and have different goals. And they do contribute well to building better tools for diabetics. I'm really quite happy they exist.

Another shock came after I updated my LinkedIn profile, indicating what I'm planning to do. An old LinkedIn contact sent me a message telling he has a company and they have been implementing quite a similar solution for some time already. My initial reaction: "Oh crap, I've made my market analysis and couldn't find anything like this." Again, I needed to take a step back and look at it from a positive angle.

First of all, competition validates the business idea. Someone else also believes what I'm about to do is worth doing.

Second, my vision reaches much further than the features of the product I'm planning to build first, during a few months. That product will combine all data relevant to a diabetic's condition into a coherent package. It would actually be ideal if that product would already exist. Then I could enter directly to the next level, where I can analyze those data and develop algorithms that help interpreting them.

So I called the LinkedIn contact, and we had a meeting yesterday. They have been in stealth mode, developing their product, but are now coming out in the public with it. We found out we're after pretty much the same goals, but with some differences in our approaches. Their solution requires all the information to be entered via a mobile application, whereas I want the data to be available automatically from the devices that already have it. I would like to allow many different devices and applications to be able to contribute to the data set, whereas their solution is more closed and controlled. Finally, they don't have a diabetic on board in the company, rather only have a doctor specialized in diabetes as an advisor. They are also running a trial with diabetics, I hope they'll learn from it.

I loved some parts of their product, though, and would like to cooperate with them. I think it would certainly help me get to my goals faster. We did not decide anything yet, as they need some time to think things through. But we'll keep in touch. Interesting times ahead. And I should still meet with Mendor as well, to discuss possible cooperation with them.

Would I share my personal health data?

My previous post included some of my personal health data. The Word document produced by the Dexcom software even includes the word Confidential in the footer. As I'm creating a new health related product, I must pay special attention to data privacy. I also need to think about different feelings people may have towards sharing their data.

Some time back I learned that Mendor, a Finnish startup company focusing on diabetes treatment, were installing their software product, the Mendor Balance, to the diabetes clinic I visit. Unfortunately that software did not support my glucose meter. However, when I contacted Mendor about the matter they said they'd be happy to build the support if they just got some example data from an actual device. So I sent them the logs from my meter, including real measurement data over several months. I had no concern over what they might think of me as a diabetic or as a person, based on that data. They just wanted to get some sample data to implement a piece of software.

Whether I feel comfortable sharing my personal health information depends on how I believe that information is being used.

Of course, in direct contact with a person, sharing information is much easier. I've had almost no concern explaining everything about my life to the doctors and nurses who have helped me with my diabetes. The more information they have, and the more accurate that information is, the better they can guide me.

I think I've shared even more with the people in my peer support group. There it's all about finding the fun in living with diabetes, we all exaggerate our foolish behaviors and the mistakes we've made. Absolutely no fear of judgement or patronizing. I've shared more than just data, I've shared stories, big and small.

That's one thing in itself, isn't it? I feel much easier disclosing sensitive information when I can annotate it and share some additional background to it. I'd be reluctant to share just some cold piece of data, just describing a tiny tiny piece of myself, as I wouldn't like people (or computer algorithms for that matter) forming their opinion of me just based on that data.

I must admit, for the previous post, out of seven days of monitoring data I selected the day with the nicest graph. The graph for the whole week is much less stable. It's just that I don't know all of you and you don't know me well enough, for me to feel comfortable sharing the bad days. I'll probably get more comfortable with that as well, once I get enough background context out in this blog.

Whether I feel comfortable sharing my personal health information depends on

1. how I believe that information is being used
2. whether I believe that piece of information is both adequate and meaningful for that purpose.

Of course, there is also the whole issue of trust in general. I'll probably contemplate that in another post.

It Needs to Print Well

Yesterday I had the annual review with my doctor. Besides the standard protocol I got a chance to discuss my views and plans for possible enhancements to the technology we use. I got really valuable feedback, encouraging enthusiasm, and plenty of new ideas as well.

There is one thing I really need to pay attention to. While it is really useful to be able to explore the data interactively on a computer screen, the IT systems and also the practices are still based on handling stacks of paper. However nice and fancy a visualization is on the screen, it also needs to print well.

This time, we spent quite a bit of time with my doctor, writing down values from my pump and meter, with a pen, on paper. The Accu-Chek Spirit Combo system has a software system to download log data from the devices to a computer, not all information is accessible.

For instance, the basal rates are only presented as graphical presentations. The adjustments to treatment often involve fine tuning the rates, and it is important to know whether the basal rate is 0.70 or 0.75 units per hour. It's really hard to tell that distinction from the graphics currently available. Only the total amount of insulin per day is printed as a number, not the values for the individual steps.

It's hard to tell the exact levels of basal insulin from the graphic.

Another subject to modifications are the parameters used by the bolus calculator, an assistant program in the glucose meter that helps setting the correct bolus for a meal. These include target range for glucose level, carb ratio (amount of insulin required for a gram of carbohydrates) and sensitivity to insulin, and have different values depending on the time of day. These values are not included in any of the reports produced by the software. Instead, I must manually access them via the meter and tell each value to my doctor who then writes them down. This process alone easily ends up taking a few minutes. I'd much rather spend that time actually discussing the values and possible changes to them. Fortunately my doctor was not in a hurry.

I have had similar problems with a continuous glucose monitor in the past. There are two different models available, the Medtronic Guardian REAL-Time and the Dexcom Seven Plus. I've had the feeling that the nurses are a bit reluctant to give out the Dexcom one. I've used it once, and think I now know the reason.

The results of the continuous glucose monitoring need to be printed as well, as there is no suitable place for them in the electronic health records. And it is also easier to annotate the printed versions.

The problem is that the software used to visualize the data from the Dexcom device does not print the essential information of amounts of carbohydrates, insulin doses, or exercise. On screen you can access the information of each event by bringing the mouse cursor on top of a respective icon. But when you print the information, it's just a Word document containing the screen captures as such, and you just get the icons. So, having printed all the data we then spent many many minutes with the nurse going through each meal, insulin dose, and exercise for the whole week. I'd read the values from the program and she'd write them down on the prints, with a pen. We certainly did not feel productive at all.

On screen you can interactively explore each value independently.

So I'm just marking it down here as a design principle. Perhaps not the most important one, but clearly one that must not be forgotten. However fancy a visualization is on the screen, it also needs to print well.

What's in a name?

This blog is published under the name Sensotrend. This post explains how that name came to be, and also asks for your opinion.

First of all, I wasn't really selecting a name for a blog. The idea of writing a blog was not my original idea. The original idea was a software product for managing all the data relevant for the treatment of my diabetes. So I'm more searching the name for a product or a service.

First, I started to think of relevant words. Diabetes, data, graphical, visualization, ... Having written some of them down, I started playing with abbreviations, misspellings, connotations, and double meanings. Including 'viz' to the product name could, with the help of a suitable slogan, associate the name with visualization - and also wizardry.

I also thought a lot about whether the name should be Finnish, English, both, or neither. I played around with words ending with 'sto', for instance. In Finnish, many words for places where you store things end with sto (for instance, storage room is varasto, library is kirjasto, where kirja means book, and atlas is kartasto, where kartta means map). The syllable sto would also refer to storage for people preferring English. I like the idea. However, this product is not about storing the data. In fact, it is quite likely other solutions will be used for actual storage of the data, and this solution is used for presenting it and exploring it. Still, in case I need to build a solution for hosting the diabetes data online, the name for that solution is likely to end with sto.

One name I quite liked was diagraph. It would present my diabetes data in graphics. However, it being an actual word in several languages, it might not be identifiable enough. Even more importantly, the internet domain name was already selected for corporate use. Another major thing to consider when selecting a name. There are many more, I know. The name of the product should be easy to remember, easy to spell, short enough, and it should not get mixed up with any bad word in any language.

Anyway, one morning on my way to work, I thought of Sensotrend. It felt good enough, at least for now.

The trend part, for me, tells that the solution presents and helps to find trends from the data. The first part refers to the blood glucose sensor, but also to sense - the product helps making sense out of trends. This might not be obvious to other people, though. The name also teased me right away with ideas for a logo. The O in the middle allows me to indicate the product is about diabetes - at least for the diabetics, who recognize the diabetes symbol (I know I still need to negotiate about the use of the diabetes logo as part of a commercial logo). And the domain was available, and a quick google search found nothing relevant. Finally, it should be easy enough to pronounce and remember. (Update:  I just ran the Google search again, and this time found traces of a Sensotrend trademark, which seems to have been expired. This may require further investigation. I wonder why I did not notice those when considering the name for the first time...)

I still consider this a work name for the product. It might well change for the final version. However, I'm happy enough with it to get this blog published under that name.

How about improvements? Personally, I think it still feels quite technical. I believe the name for the product should perhaps have more emotion to it. How about a name that said "Hey, you're in full control of your diabetes, you have all the power to change it for the better, now let's do it together!" I don't think you can read all that from Sensotrend.

Any suggestions? Would you care to share how you feel about the selected name, and what connotations it invokes?

Making Sense of Trends (Part 2/2)

In part 1 of this post I told about my life when I got diagnosed with diabetes and how I reacted to it. And how I eventually stopped paying enough attention to it.

That was until the mid-life crisis hit me. This happened a few years back. I started to notice my life lacked meaning, and started asking myself what I really want out of life.

So I tried to get a grip. I cut down on traveling for work, and took more time for myself. I also got a doctor's appointment, and indicated I would now have more resources and interest to invest in managing my diabetes better. As my own meter readings failed to provide any useful information, my doctor proposed continuous glucose monitoring as the first step. That means wearing a blood glucose sensor attached to the body continuously for a week or so, with a monitoring device recording the value from that sensor every 5 minutes. For the first time, I was able to see how my blood glucose really behaved. No more shotgun charts. The resulting chart was rather a roller coaster, showing the glucose go up and down, sometimes fast, some times slower. Very far from the ideal curve, but providing so much more insight than the isolated dots of the meter.

I made other changes in my life as well. I got married, adopted a more static life style, started to eat regular meals at regular intervals again, traveled a lot less than before. I got an insulin pump, and with it a lot more information and education about diabetes. I'm making progress again! One of the important things I learned was that physical exercise only helps in managing diabetes when it is performed at least two times a week. Exercise taking place less often just causes the body to get confused, and stressed in a bad way. Still, what I have learned the most from, are the data from my continuous glucose monitoring sessions, of which there are now several, and all the information they have provided me with.

So that's where I'm coming from. Future updates to this blog will concentrate on my notions of what helps in getting most information out of that data, and, perhaps even more so, what prevents diabetics from getting the most benefits out of continuous glucose monitoring, insulin pump, or diabetes management in general. Specifically, I'll be planning a new software product for managing all the information relevant to treatment of diabetes, and keeping the internet posted on my progress on that.

Anything you'd like to comment on?

Making Sense of Trends (Part 1/2)

This blog entry provides some background information about myself as a diabetic, in two parts. This first part describes my life when I was first diagnosed as a diabetic.

So, I'm a type 1 diabetic, and have been for over 14 years now.

When I was first diagnosed, I welcomed the condition as a friend. I had been working too much, sleeping too little, and my eating habits had been really poor. I considered, and still consider, diabetes to be a distress call from my body, asking me to take better care of myself. That call forced me to put things in perspective. Diabetes gave me the reason to pause my work for a meal every once a while, and to think about what I eat and how I exercise, and to value myself more over the things I was working on.

My first years with diabetes were good. I actually felt my quality of life had increased. I now ate regularly, which, as I only recently have learned, is also a major factor in general happiness. I also played a lot of different sports. That I had always done, but all physical exercise now gave me even more satisfaction, when I knew it was good for my diabetes as well. I faced no problems injecting the insulin or calculating the carbohydrates in my meals. I have later learned that such a "honeymoon" period is common with type 1 diabetics in the initial phase of the condition, when the pancreas still produces some insulin. A major factor was also the fact that I kept learning new things about myself and about diabetes, and I found that interesting and satisfying.

However, eventually the novelty wore off. And gradually, without me even noticing it, things started to get worse.

The treatment of diabetes in general kept getting better and better, allowing for more flexibility in a diabetic's life. My original treatment plan forced me to eat fixed size meals at regular intervals, but the new fast insulin allowed me to eat whenever and how much ever, without even the obligatory post-meal snack two hours after the meal. So I ate less regularly, and enjoyed the new freedom (I did not yet know what effect regular eating times have on happiness). I still did some sports, but also that less regularly. I traveled a lot for work, and kept myself quite busy with it. At the same time, I started to pay less attention to my treatment, and visit the health care professionals less often.

When I occasionally did pay a visit to a health care professional, the lab results always said I was healthy apart from diabetes, my HbA1c values (a long term metric for diabetics) was not perfect but still good. What was discouraging, however, was the spread of the results of my own blood glucose meter. Blood glucose results, metered several times per day, together with notes of estimated carbohydrates per meals and of physical exercise, are the most essential tool in the adjustment of the treatment of any diabetic. They should show distinguishable trends, such as if you're injecting too much insulin for the night time, for instance, which causes the blood glucose levels to be too low in the morning. My results did not show such trends. In fact, they revealed no clear patterns. Rather, they were a shot gun chart, plenty of measurement points scattered almost evenly across the canvas. There was nothing to learn from them, except for the fact that they definitely should be more aligned to reveal any information that could be used to adjust my treatment. However, I never really reacted on this. I wasn't desperate to improve on that, as the lab results said I was OK anyway. I felt content with my life as it was.

Enough text for one post already, right? Read on to part 2 when you feel like it.

Hello, World!

Hello, World! is a concept from the programming world. For a programmer learning a new programming language, the first thing to do is to create a program that outputs this magical sentence. During the past 15 years, I've written my fair share of programs like that.

Today, I'll be starting a life in a new world. I agreed with my employer I'll be taking some time off after summer holidays, and will be putting my efforts into something really important for myself, personally. So hello, the world of entrepreneurship!

With this Hello World post I'm also greeting the blogosphere. I haven't really been around much so far. So please feel free to guide me, let me know the best practices, and show me around.