If you want an idea of what’s coming next, look to see what the nerds do on the weekend and the rich do to live longer. Right now what is popular are GLP-1’s, cold plunges, and saunas. I currently do two of those things.

Let me tell you about something cooler. Continuous glucose monitors (CGMs), and I’ve been rocking one of those for a while now. Man, it’s changed my life.

CGMs were first designed for people with Type 1 Diabetes (T1D) to help manage their glucose levels, taking the guessing out of having to guess what their glucose was all the time, and the burden of pricking their fingers every time they wanted to know.

I, (un)fortunately (depending on how you look at it) was one of those people. I was diagnosed with T1D when I was 15 years old, entering my junior year of high school. I had no freaking clue to how to manage this, but I had to essentially figure it out on my own.

I played a high level of soccer, lacrosse, took on weight training, and don’t forget learning about puberty… those were just some of the variables that fed the output of what my glucose was at that time, and what that meant for the rest of the day. The body is a beautiful and complex system.

I was a high schooler, about to get to college, feeling like I just had to deal with this wild game of glucose yo-yo and the tools I had at my disposal were an insulin pump and finger sticks. Being in the position I was in, I started to become obsessed with how things work… and data. I wanted to make sure that I wasn’t just a person with diabetes, but Jared Seidel, someone who just also had diabetes. This was not going to control how I lived my life and dictate what I could and could not do. I accepted this was just going to be something I had to deal with for the rest of my life, until the day I croak, so I may as well get really good at handling it.

I Never Wanted to Use These Things

So there’s a joke that circulates among my friends that I gave my girlfriend (at the time) diabetes…

I was diagnosed with T1D at 15 years old, I was a young teenage male who cared about the way he looked. Like most teenagers, I was extremely self conscious about it. After being on an insulin pump for over 5 years, I went through college starting to weight train, with the intention of wanting to look good with my shirt off, as most guys do. I was poking my fingers over 10 times a day because I want to be so on top of my glucose management. My doctor kept asking me if I was interested in trying a CGM considering how much I checked my glucose levels. As the stubborn and self-conscious person I was, I didn’t want another thing “attached to me.”

Fast forward a year after my doctor started asking me if I was interested in trying out a CGM. The girl I was dating at the time was actually diagnosed with T1D. So now I live life with my friends telling me I gave her type 1. Honestly, I think its funny, so I don’t care. When she was diagnosed, her doctor put her right on a Dexcom CGM. I saw her wearing it, and I immediately thought, ok that’s pretty nice to have all that information right there, every 5 minutes. Instead of pricking your fingers every time you wanted to know, now you just needed to look at your phone if you wanted to now what your glucose level was, where your glucose was trending, and how your levels have been retrospectively.

As an engineer focused on medical device design, the Dexcom G6 applicator design caught my attention as ergonomic, and incredibly easy to deploy. You had my interest, now you have my attention.

Now, two years after my previous doctor recommended I try out a CGM and I shot her down, I was seeing a new nurse practitioner. She was a chiller, she knew how hard managing T1D was, and I told her about how my girlfriend just started on a CGM and how I was now interested. Here’s the closer. I told her my concerns about why I never really opted into wearing one, and that I didn’t want it on my stomach. That’s when she told me about how you could really wear it wherever you want, its just FDA approved for wear on the stomach, but so many people with diabetes wear it “off label” on their arm, leg, or butt.

That’s when the lightbulb went off. I decided I would try it on the side of my butt. Hidden in plain sight. That worked for me, for the way I dressed.

One thing to add, the one level deeper I would soon find out later was that since the companies can only submit to the FDA-specific wear locations, their algorithms lower in the software/firmware stack, were tuned to those “approved locations.” If they went for multiple wear locations, clinical trials start getting expensive. Fast. So while I “could” be compromising on a slightly lower level of accuracy, I was still able to make the decision to get on a CGM and level up my glycemic control.

Two weeks later I got one on me, I put it on. And if the lightbulb moment was me thinking this might work when I talked to my doctor, this was a freaking tesla headlight shining right into my eyes. I could now see all my data, make better decisions, and take the guessing out of my diabetes care.

How a CGM works. Cliff Notes Version

Aright, quick rundown on how these bad boys work.

The leading technology for CGMs essentially utilizes a subcutaneous sensor that is ~0.5mm in diameter and inserted ~0.5 inches below the skin (Dexcom, Abbott, Medtronic). Subcutaneous means below skin, and not directly reading your blood glucose. The interstitial fluid below your skin (that’s subcutaneous) does reflect your blood glucose, but it is a 15-minute delay behind what your blood glucose is.

The sensor is quickly inserted using an applicator. With a needle (you barely feel it) it’s really fast. Typically you can’t even feel it there. It’s left behind right under the skin, and then the magic happens. There’s an enzyme-layered coating, at the tip of the sensor, where its under the skin. That enzymatic reaction will result in an electrical current being sent up the wire where each system has been fine-tuned to estimate your glucose value. That is then sent to some device where you can read the values; i.e. an insulin pump, receiver, or a compatible smartphone.

There you go, you just got over 20 years of CGM technology development explained to you in two paragraphs.

Lessons from the Trenches

So now that we got the black magic out of the way. What have I learned after being on a CGM? Now remember, I have T1D, I can’t make insulin, so my body reacts slightly differently to foods than a “normal” person would, the deviations from “baseline” could be greater, but the first principles as to why and how it happens, remain generally consistent across general human physiology.

1. Different types of foods can cause different types of glycemic spikes varying in intensity and length

2. Glycemic spikes and variations are not bad, but there are levels to how high your glucose spikes, how long it remains high, and how fast it comes back down to normal. That implies different things.

3. Everyone’s body reacts differently to different types of food and that shows in the glycemic spikes.

4. Certain activities and the timing of those activities can result in elevated glucose values… Or the reduction in spikes

5. After nutrition, physical activity is the most powerful tool I have to help limit glycemic spikes. (Weight lifting and running have two completely different effects on my glycemic control)

6. There are certain hacks you do to minimize glycemic spikes

Snowball Effect

I began reading books about health, sports performance, and nutrition. They all kept revisiting a similar topic: glucose spikes. These were books written by leading doctors (Peter Attiah), biohackers (Jessie Inchauspé), and clinical experts (Robert Lustig) that made me rethink the role of food and how our bodies respond to what we put into them today, vs a handful of years ago.

That’s what set off the lightbulb in my head. There are so many things that influence glucose levels and how they trend.

CGMs Are About to Blow Up

It’s becoming more and more common to see someone wearing a CGM, and it’s about to get WAY bigger. I’m seeing it everywhere. 5 Years ago we saw a massive adoption of fitness trackers, now it’s sleep monitors. CGM is probably next.

I’ve seen first hand how these products can track glycemic variations to help someone better understand how their body reacts to foods and activities. A lot of companies are being spun up around this thesis as well: Signos, Levels, Veri, January, Supersapiens, there’s a bunch.

There’s a real opportunity here for each of these companies to provide real insights into how certain behaviors affect your glucose… and downstream health. The 2 big questions that will make or break these businesses are:

1. Are the users gaining actionable insights with the glucose information they’re getting?

2. Do these customers keep coming back to use this product, or do they use it once and it’s good enough (i.e whats the LTV)?

Why do these companies need to get this right? They basically make the analytics software that is built on top of sensing hardware. They don’t make the physical product, but they control the experience and potential outcomes a user gains from measuring their glucose levels.

If a company can provide actionable insights to their target users there is definitely something there. Each of these companies are leveraging a different play, from my perspective.

Levels is targeting the user who is willing to pay to improve their health and maybe even lose weight. Signos is targeting obesity and diabetes prevention (Type 2 diabetes). January is leveraging CGM to provide AI coaching. Supersapiens is for high-paying, high-performing athletes (or washed-up ones like me), who want to monitor their glucose to over-optimize their performance.

The ones that are the most interesting (to me) are Levels, Signos, and Supersapiens. But I haven’t seen their financials to know if they’re good businesses.

It’ll be fun to watch this play out, each metabolic health company are targeting different sub-niches. It’s a good winning strategy.

It’s about to get even more interesting now that the two major manufacturers (Dexcom and Abbott) are planning to launch over-the-counter CGM products in the next 1-2 years (2024/5). They want a piece of this massive market that is metabolic health in the United States. It’s estimated to be a $22 billion industry by 2032.

The question I hear over and over again is “what do you do with that info”

Whichever company cracks that, is going to make millions of dollars, probably billions. Or get acquired… and continue to make billions.