Continuous glucose monitoring for non-diabetic yet carbohydrate-conscious biohacker types is gaining significant momentum, and for great reasons!
Those on the Paleo/low-carb/keto dietary wagons recognize the importance of keeping insulin and glucose levels low.
Most will also recognize that every individual will respond uniquely to the ingestion of various foods and drinks.
If your goal is to stabilize glucose and/or keep it below a specific threshold, then a continuous glucose monitor is the most effective tool one can have to monitor individual responses to dietary and lifestyle influences on glucose release.
For a refresher on this topic, I like to refer back to a previous blog post on this topic: Why 24/7 Blood Glucose Monitoring Gives Your Health A Tremendous Edge. That blog post discussed the general idea of glucose monitoring.
In the blog post you're reading now, I’ll dive deeper into the concept of continuous glucose monitoring. With continuous blood glucose monitoring, a sensor applied to the arm takes glucose readings on a constant basis.
The continuous blood glocose sensor subsequently creates a visual of glucose dynamics across the time because you read the results on an app.
The approach is really useful for tracking the dose/response curves associated with eating and other activities impacting glucose.
For instance, your body might not respond really well to white potatoes, but might respond really well to wheat. Only by testing will you find that outcome.
Alternatively, you might do very well with fruits, or, do very poorly eating them! I hope you can imagine why this process can be a game-changer for your health!
Having established that continuous glucose monitoring (CGM) is a useful tool for the low/no carb lifestyle, and even if you commonly consume more carbs, let’s move on to the focus of this blog post.
With the blooming popularity of CGM’s, innovative health technology companies have aspired to develop apps that help you interpret your CGM data as well as keep you motivated to achieve various milestones related to blood sugar management.
I will have a look at two different CGM apps: Levels and Veri. I've compared those two apps and reviewed them using the “FreeStyle Libre” CGM device. To my knowledge, it is the only device supported by these two apps.
You can view that FreeStyle Libre device below:
The white device is directly placed on your arm, and then measures your blood glucose levels 24/7.
I give the nod to Levels for a superior service, as I feel theirs was a bit more refined, more features, and the “challenges” aspect kept me engaged. Props to the gamification in this app.
For now, I was unable to compare platform costs, as each of these were in beta trial phase.
For baseline reference, I'm Joe, I'm a 43-year-old male who simply wants to live the longest, healthiest life I can while still enjoying some indulgences along the way.
My diet & exercise program is geared towards health optimization and longevity with a few exceptions here and there. I’ve got a wife, 4 young kids, and a full-time job. Life is stressful and busy but I try to squeeze in beneficial lifestyle choices.
I run 3-4 days per week, with most sessions being 4-mile jogs @ 7:30/mile pace. One session per week is high intensity sprinting. Diet is low carb, minimal sugar with periodic 24-36hr fasts. My program is not quite keto, as total carbohydrate intake is usually 50 grams per day. Although, for the purpose of measuring blood glucose responses to various foods, exceptions to the diet were made while performing this review.
Despite a long-standing addiction to gummy bears (Sidenote: Smart Sweets makes a very low sugar, allulose-sweetened option for fellow gummy addicts!), I recognize the negative impact excessive sugar/carbohydrate consumption has on the populace.
These apps are built to help diabetics get more out of glucose management. The apps are also great options for non-diabetics who want to explore the impact of diet and exercise on glucose output.
Again, the focus of this review is comparing two third-party apps that complement the Freestyle Libre CGM system.
Before we jump into these apps, I have to say that the Libre app is itself a good standalone option.
The aoo does not have the bells and whistles of the Levels and Veri apps that you’ll read about below. But if all you are looking for are straight-goods blood glucose data, the Freestyle LibreLink app meets the expectation.
Here's a view of that original app:
The main screen features percent of time in target range, last scan data, average, an 18-hour graph, and a ticker-tape showing you how much life is left on the 14-day sensor. With this app you get all the basic data you'll want, but not anything spectacular.
Upon arrival, it is obvious the Levels team has a solid marketing team. The black box is attractive, and upon opening the package, you are greeted with an empathic message: “We’re here to help you pursue true health.”
Trained as a skeptical scientist, I typically frown upon a marketing department’s attempts to establish empathic connections right out of the gate. Typically, I’m like “cut the 'crap', show me the goods”.
In this case, however, I was left with the impression that these folks do want you to have a positive experience with their product. So kudos to the team here, they roped me into their ecosystem with what appears to be genuinely interested in your personal success.
The box contains two Freestyle Libre continuous glucose monitors as well as instructions on how to download the Levels app and get into the tool.
Here, in turn, is where my one hang-up with the service manifested. Because I was "lucky" enough to be a beta trial user, the installation of the app was a bit of a rigamarole. I’ll spare you the gory details, as it is not relevant to the performance of the final product.
Suffice it to say, that my experience installing the Levels app was a horror show!
The good news?
Once inside the app, the world of continuous glucose monitoring is at your fingertips. And wow, Levels sure makes it exciting!
The process of linking the app to your glucose monitor is relatively easy and the app walks you through the necessary steps. After the synchronization process is complete, you hold your phone up to the glucose monitor on your arm and scan for data.
The monitor sends glucose data to the Freestyle Libre app, which is tethered to the Levels app. And here’s where the fun begins.
As a newbie to glucose monitoring, I was motivated to consume all manner of food combinations to determine what types of glucose spikes I'd experience. The Levels app was designed to cater wonderfully to this purpose.
Levels app dashboard
The “Dashboard” screen within the app is where most of your time is spent.
An ~18-hour snapshot of your glucose history is displayed in graphical format, along with bars for a target glucose range you can modify to fit your personal glucose range guardrails.
The Dashboard screen also includes a “metabolic score” banner, reported in a percentage, that benchmarks your daily glucose performance against your historical average.
This metric is a great tool to hold yourself accountable to your historical average. I found it motivating to achieve or exceed this number throughout my experience.
The “catalog” screen allows you to create records of specific meals and/or exercise sessions as a way to reference back to.
Each time a catalog entry is made, it automatically captures the glucose metrics for two hours following consumption/performance of the activity. Here’s where self-experimentation with various foods becomes a real treat. In the photo listed below, you can see that the app gives each food/event a score on a “10” scale, where lower numbers correspond to higher glucose spikes and higher numbers correspond to the opposite.
In the example in the picture below, three lite beers consumed over an hour did not meaningfully spike glucose (woohoo!):
One of the most engaging features of the app is the “Challenges” feature. Tapping into this space of the app, you’ll find 17 unique tasks designed to teach you how your body responds to similar but slightly different scenarios.
The app also has a “learn” screen where a seemingly endless library of articles and videos can be accessed, covering everything from “getting started” to “metabolism”, “women’s health”, “Levels Stories” submitted by users.
Beyond the app experience, the Levels team also sent weekly summaries via email that analyzed and interpreted weekly glucose data on your behalf. The effort this organization has put into keeping you informed and involved is impressive.
All these nice little extras make the Levels app superior to the FreeStyle Libre app.
They also have a members-only Facebook group that is quite active. I found the questions and answers posted to be quite insightful and on the mark for a new user getting to speed on this app and CGM experience.
Final comment & conclusion on the Levels app:
My first attempt at applying the glucose monitor resulted in a failure of the device, essentially nullifying its utility. I promptly reached out to the Levels team via email and within a single exchange, they had a replacement Freestyle Libre in the mail to me without any questions or hesitation. This was an awesome customer service experience.
In summary, I was very impressed with the Levels experience. Because I was in the beta trial, I am not aware of what the cost of the service is/will be.
However, given the features of the app and the service behind it, they have clearly developed a product that is worth paying for, if only for identifying responses to the bulk of the diet one eats on a regular basis.
Moving on to the second option, the Veri:
Let’s switch gears and have a look at the Veri platform.
Similar to Levels, a box arrived containing two Freestyle Libre sensors along with an instruction card for getting started.
And while the marketing isn’t quite as fancy, the startup process was quite a bit easier: simply download the app from the app store, register, sync to the Libre, and I was up and running.
Given that I was trialing the Veri app after I had finished with Levels, I wondered if I could run both apps simultaneously. I quickly learned that Veri is a U.K.-based organization and the Freestyle Libre devices are slightly different than the U.S. versions that accompanied the Levels platform.
As such, my attempts to run the apps in tandem were unsuccessful due to a synchronization error. Perhaps there’s a way to overcome this technicality. You would expect there to be somewhat seamless cross-functionality given that the CGM device performs the same function regardless of geographic origin.
The Veri app has two basic view options, “Timeline” and “Dashboard”.
The Timeline view operates much like a social media feed, where you can scroll through time to view information relevant to your data.
You can manually enter food and exercise with time stamps, as seen here:
The feed is spackled with links to educational quick-hit articles. I was impressed by the variety and quality of topics.
One of the features of Veri I enjoyed the most was the haptic response of the glucose scan button. This may seem really inconsequential, but the act of scanning the CGM using this app was really satisfying. It felt like an IRL button push (anyone guilty of pushing every button on and elevator console can likely relate!)
Secondly, the Dashboard view of the app offers the standard graphical view of blood glucose history:
This screen is where you can visualize the ebb and flow of glucose over a 6-hour window.
An average of the last 6 hours is displayed in large font in the lower left and the percent of time spent in the range on the right. I liked these informational boxes. These boxes give you exactly the data you want without much distracting fanfare.
That's all good...
Now let's consider the bad:
Two features that didn’t sit well with me:
First, time is set on a 24-hour clock and there was not an option to set to a 12-hour clock. I’m not opposed to using military time and the hour conversion isn’t that big of a deal. However, the majority of folks are trained on 12-hour clocks so why not build in the option?
Secondly, the high and low range boundaries changed time and again, the user does not have an option to manually adjust those guardrails. This may be a good thing for those who are happy ceding control of the metrics to the app and/or health professionals. For biohacker types, however, you'd probably like to adjust parameters like ranges to push yourself and the systems you use.
The upper limit of the range ended at 113mg/dL, this the Veri app’s decision. I, for instance, wanted my upper limit to remain below 100mg/dL but I did not have the ability to customize the app to cater to my wishes.
On a brighter note, the Veri team is committed to creating an ever-improving product.
A representative from the company reached out proactively to schedule a 20 minute vid conference with a developer. During this time, I shared every detail of my experience with the developer, including the points described above. We had a great conversation and I left assured that they were committed to improvement.
Overall, Veri is a better app than the one commonly accompanying the FreeStyle Libre, but, not as good as levels.
So here's my conclusion:
I thoroughly enjoyed my experience with each of the app platforms.
The ability to “tag” meals and exercise and refer back to them are key differentiating features of third-party apps for continuous glucose monitoring.
In summary, I would recommend using a third-party app as a new user to the continuous glucose monitoring space. I will say though, that once you’ve identified your body's reactions to a personal catalog of food and exercise activities, the apps may lose some of their usefulness.
With regards to review, I'll I think the Levels app is slightly better than the alternatives, due to more gamification features, better service, and more featured.
Let's hope, that when both apps come out of their beta-testing phase, we'll learn more about additional features, costs, and more!
This is a post by Joe Ailts. Joe has completed degrees in biotechnology (BS) and nutrition (MS) and is a science writer for Alexfergus. He has 14 years of experience in the clinical laboratory arena as well as in the dietary supplement industry.
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