Tidepool—A Comprehensive Platform for Diabetes Management
Editor’s Note: Tidepool has recently added a clinician portal to help patients upload and seamlessly share data with their care providers.
Meet Howard Look, founder and CEO of Tidepool, a secure, open-source platform for diabetes data and the apps that use that data. He’s been VP of software of Pixar, on the founder’s team that developed TiVo and ran a secret software project at Amazon, harnessing cloud services. He has a computer engineering degree from Carnegie Mellon University and a daughter who has type 1. Recently, he met with President Obama and spoke on the panel of the Precision Medicine Initiative Summit on February 25, 2016. Howard is an impressive and busy dude. We’ve also learned here, at Beyond Type 1, that he’s passionate about building technology that betters the lives of others and makes living with type 1 diabetes (T1D) just a little easier.
Tidepool, a grant recipient of Beyond Type 1, offers comprehensive feedback on blood sugar levels for better diabetes management by streaming data from all these different diabetes devices (such as an insulin pump and continuous glucose monitor (CGM) or meter) and consolidating that data on a single platform that can be shared with doctors and then analyzed with the added context of food and exercise. Not only will you see when you went low or high, but you’ll find the reasons as to why, so you can make more informed decisions in your management. What’s more—it’s free.
BT1: What do you need in order to use Tidepool (apart from your diabetes devices and a computer or phone)?
HL: It has to be on a Chrome web browser. We debate this all the time, but as a start up, we had to make a decision and simplify our focus. It’s the most popular browser and easy to download if you don’t have it. It also lets us offer the Tidepool Uploader from the Chrome Web Store, which is really easy to use.
HL: “The Basics” view of Blip is an at-a-glance look at how things are going. It shows your blood glucose distribution based on the data from your blood glucose meters or your CGM. (You have a meter versus manual option as well.) You can filter by “lows” or “highs;” you can see boluses. You can even see when there’s a site change. In clinic, this would be called a “compliance report” or “adherence report.” We hate those words. “Compliance” implies you aren’t trying or “complying,” so we decided to call it “the basics,” because it’s the bird’s eye view of the data that you need to know. Then, if you want to dive deeper, you can click on specific days to examine a daily or weekly trend.
BT1: What’s the difference between the “Daily and Weekly Trends” from “The Basics”?
HL: Trends is an overlay view, so I can say, “Show me one, two, or four weeks at a time” to see how data is trending. When we started showing this to parents, they asked us to add a feature to see how exercise on certain days might affect blood glucose levels (BGLs), and so we developed the interface so that we could select specific days (that your child exercised for example) and see how BGLs were affected.
We wanted to build software that is usable by real people. We wanted it to be easy to use. Other software out there has very complicated displays that make it difficult to analyze. If the data is difficult to read, it sends a very clear message to the person with type 1, that you aren’t supposed to be involved in your therapy. Data shouldn’t alienate you from your own care. We made the decision that we are only going to build software and user experiences that work for real people. If your doctor can’t sit with you and say, “Let’s look at this together,” it isn’t working.
BT1: What is the Nutshell app that’s a part of Tidepool?
HL: Nutshell is still in beta, but you can sign up to try it on our website. We tend to eat the same meals over and over again, so based on this knowledge, Nutshell was developed to help you better manage you BGLs when eating. You can record where you ate (like home or at a restaurant), the food you ate, when you ate it and how much insulin you gave yourself for it. You can even take a photo of the food for a visual marker to use for later.
BT1: What does it mean to “crack” a meal?
HL: It means the bolus I gave myself for the meal worked and brought my blood sugar level back down to a desired range. So the next time you eat the same thing, you have a reference and know what works for you individually in dosing. Without technology like this, “carb counting” is more like “carb guessing.” Software like Nutshell can remove that guesswork and give you consistency in your diabetes management.
BT1: You are using hashtags to give added context to data, and how important that is, it’s not just about the numbers but also causality. That seems to be an integral part of what you’re offering, so can you talk more to the value of that?
HL: Managing type 1 isn’t all about numbers and data; it’s also about the context within which that data occurred. We also offer a mobile app called Blip Notes that allows you to add context to your diabetes data. We want it to be simple. You use for example, #soccerpractice or #sitechange, (it remembers your most recently used hashtags and the most frequently used), so when you’re reviewing your data and your doctor wants to know what happened in certain areas, you have the context to tell him or her.
BT1: What’s next?
HL: We are working on integrating fitness data with meal data so you can hook up your Fitbit for example, and show it alongside your food data for a more comprehensive look at how the two activities inform each other. So you’ll have your bolus, food, activity and blood sugar level all in one place.
BT1: Essentially the team that makes up Tidepool is a powerhouse of software developers, engineers and designers, most of whom have a personal connection to type 1. How did you find each other? And what really was the spark for the idea of Tidepool?
HL: My daughter was diagnosed with type 1 in 2011. I didn’t know anything about it at the time—didn’t know that there were different kinds of diabetes, what insulin was, let alone how to manage type 1 diabetes. At the time I was VP of software at Amazon’s consumer electronics group and Katie gets diagnosed out of the blue. Very quickly, I realized how hard it was for her to manage and the tools we were given were terrible. When you live in the heart of Silicon Valley and someone hands you these terrible, hard-to-use technology tools, you know that we can do better than this.
I’m not a bashful guy, so I would go and meet with her doctors at Stanford, and they introduced me to other people at UCSF and in the industry. I started asking questions: who writes the software for these devices and why don’t they talk to each other? Is there anyone thinking about this? At the time, I was working on open-source software and I thought, “That’s what we need to do for the diabetes world!” Somewhere mid 2012, I felt like I knew what to do—I had the skills and I knew the people we needed to make this happen.
One of the people I met was Steve McCanne—he has a teenage daughter with type 1 and is a successful entrepreneur in Silicon Valley. I told him I wanted to build some software and he had started doing that as well. He was working on other projects, too, but was able to generously fund us so we could get started. He also believed in it being a non-profit, open-source product with great design. I was in a fortunate position to get some of the best people in the world to make Tidepool, most of whom have a personal connection to type 1. In mid 2013, we formed the company.
BT1: We’ve heard you call yourself a “fake-abetic.” Can you tell us why?
HL: I wear a Dexcom so I can always demo the technology, and for a while I was also using an insulin pump and injecting myself with saline. The first time I did it though was to better understand what it really meant to manage type 1. I did it for nine months and did everything my daughter did (except of course, I never went low or high). She was 12 at the time, and she’d ask me, “Where are your low supplies, Dad?” And a lot of times I’d have to say, “I know, I blew it.” It really established this camaraderie between us. I’m still wearing the Dexcom, not the pump though. I actually eat better now. I eat a lot less bread and carbs.
BT1: Why is the aspect of Tidepool being “open source” so vital to your goals?
HL: When it comes to managing diabetes, there needs to be an open, non-proprietary system. One of the things that was happening was that all the different device makers were building their own software that talked only to their devices and that precludes this ecosystem of innovation from happening. By building an open-source project, you do a bunch of things. One is you create a platform that not only Tidepool can build an application on top of, but it allows other people to build applications.
For example, this research effort we are supporting for the Jaeb Center, which is the largest coordinating center for type 1 diabetes research in the country, is using our APIs for their research. Because our platform is open, others can contribute to it, which fosters innovation. It’s also free, so it helps the most people possible.
BT1: There’s this discussion of all this unused data—it is so valuable to have access to it for research. We’re curious how Tidepool plans to use that data (obviously with compliancy). How do you propose to get it into the hands of researchers?
HL: One, we will be asking all of our users if they want to donate their data to a large anonymized database. Only with consent. We don’t believe we own the data; you own your own data.
The other, we will ask if people want to participate in specific research opportunities. We will be asking if, for example, they want to donate to the T1D exchange, where you could tie your Tidepool account to your Myglu account. We’ll also keep collaborating with the Jaeb Center as well and other researchers as well.
BT1: How are Nightscout and Tidepool different?
HL: Our family has been long time users of Nightscout and I still love that community and still visit the CGM in the Cloud Facebook group every day. They are very similar efforts in that they are created by highly motivated people who decided to go do what they thought needed to be done. The Nightscout team decided that they were going to make a remote monitoring system, and it changed everything. We hadn’t had anything like this before. As soon as Lane [Desborough] helped me get Nightscout running, Katie had her first sleepover in three years since her diagnosis.
I think what the Nightscout community has turned into is an incredible group, (it’s roughly 16,000 people strong). It has become a community of support as well.
Tidepool is an open-source project also, but it’s less do-it-yourself. We wanted to have it used in clinic both by patients and doctors, as well as be used at home. Being used in clinic meant it needed to be FDA regulated. We took the approach of building software that not only worked as an open-source project but also has the documentation that clinics, device makers and the FDA would require. We engaged early and often with the FDA. The Nightscout movement and Tidepool have been complimentary; there’s a lot of overlap in what we are doing and what the community needs. I think that the community needs both.
BT1: Would you say that giving people better access to their data gives them more freedom from the burden of the disease?
HL: Our goal is to provide tools that make life just a little bit easier. Dealing with Type 1 is a really burdensome challenge. It can be over 300 decisions a day. Whether you are someone with type 1, the parent of someone with type 1, or a doctor for someone with type 1, or a type 1 researcher, we want to provide tools that make it easier to access data, easier to analyze that data and to get more out of your devices. But this is all just an interim step until there’s a cure, which will be the ultimate freedom from the disease.