Last April, ahead of the delayed Tokyo Olympic Games, the pharma giant Abbott issued a press release announcing that the world’s fastest marathon man, Eliud Kipchoge of Kenya, was using their Libre Sense glucose sport biosensor. This led to much curiosity about glucose monitors in the world of distance running, which is also the world’s largest mass participation sport for recreational athletes. Earlier this year, Indian cricketer Shreyas Iyer sported a black patch on his tricep, just above the elbow, visible every time he played. Millions of viewers on television and thousands in the stadium spotted it. And that’s how the continuous glucose monitor broke into the mainstream fitness conversation in India.
A continuous glucose monitor is a medical device with a small sensor that is inserted under the skin to continuously monitor blood glucose, says Dr Amrita Ghosh, consultant diabetologist at the Fortis C-Doc Hospital in New Delhi. “The sensor measures interstitial glucose level, which is the glucose found in the fluid between the cells, every few minutes. A transmitter wirelessly sends the information to a monitor that may be attached to an insulin pump or a separate device,” Ghosh says.
Dr Sunil Kumar Mishra, director of endocrinology and diabetology at Medanta Hospital in Gurgaon, adds that the continuous glucose monitor can help one stay on top of diabetes and is used especially for those with Type 1 and Type 2 diabetes who are on a complex insulin regime. “It helps in the management of diabetes as people can now see the variations happening with every meal and physical activity. It additionally helps in identifying and recording changes in your blood sugar levels,” he says.
We already have devices to track our sleep, heart rate, blood oxygen levels, temperature, steps, runs, cycle rides and swims, among other things. Now, wellness start-ups have repurposed the continuous glucose monitor as a health and fitness tracker that can track your metabolic health through blood glucose levels. “We track the spikes, drops and how long you stay in the target blood glucose levels in real-time to determine your metabolic health through the continuous glucose on your body and app on your smart phone,” says Manan Chandan, senior director for new initiatives, HealthifyMe, a health startup.
Ultrahuman and Sugar.fit are the two other major start-ups in India that offer this metabolic health tracker. Of the three, Ultrahuman is the most visible brand because of its aggressive social media campaigns and multiple collaborations with hand-picked celebrities, influencers and athletes, including the cricketer Iyer. Shivtosh Kumar, co-founder and product head of Sugar.fit says that the real-time data collected by glucose monitors can help increase our understanding of the impact of different foods, fitness, sleep and other metabolic activities in general. “Based on this data, we can create a precise nutrition plan for ourselves which helps us understand the timing of when energy is required for a fitness activity and also understand our quality of sleep. Hence, when you plan to go to the gym, you can check your glucose levels and see if you are optimally fuelled for a workout, and if you are not, you can consume a pre-workout snack which gives you the desired spike in glucose levels,” says Kumar.
Glucose monitors measure your blood glucose levels, and the app you’re using collates other health data like steps, heart rate and exercise from other health apps on your phone. Behind the scenes, an algorithm processes this data and gives you a metabolic score. The longer you stay in the target blood glucose level scores and the fewer spikes and drops you have, the higher your metabolic score, explains Chandan. The higher your score, the better your metabolic health, he adds. “Tracking our metabolic health helps us keep a measure of how our metabolism performs under different circumstances. This data will help us improve and conduct the desired changes we need for a healthier life, as you can't improve on what you can’t measure,” says Kumar.
While Dr Ghosh feels the continuous glucose monitor is a useful tracker for pre-diabetic and diabetic fitness enthusiasts, she sees no particular benefit for those with normoglycemia (normal concentration of sugar in the blood) unless the collected data is used for research or experimental studies. “Now, it is becoming a new technology thing backed by social media that otherwise metabolically healthy persons, especially fitness enthusiasts, are wearing continuous glucose monitors to measure their blood glucose variation to time their nutrition according to the effect on their blood glucose,” she says.
It would seem that most people who’re using glucose monitors are doing it out of curiosity. That’s what drove Raunak Jain, a Bengaluru-based executive, 30, to use an Ultrahuman monitor for two weeks (the typical life span of these devices). “I wanted to check how it could actually help me achieve my fitness goals,” says Jain, who leads an active life and is lean and fit. He adds he was able to figure out what foods caused the glucose spikes and what foods helped maintain the levels within target range.
Mumbai-based actor-director Shray Rai Tiwari, 34, was roped in as a partner by Ultrahuman because he wanted to find out what blood glucose levels meant and how to monitor the fluctuations. Tiwari says that he could identify the nocturnal hypoglycemia (drop in blood glucose levels) that he was experiencing because of the monitor. “The app suggested a change in my diet and that arrested the crashes in my glucose levels,” he says. HealthifyMe’s Chandan also arrested his nocturnal spikes in glucose levels by changing his meal time and making small adjustments to the foods he ate.
“Unless we understand our unique metabolism, we will not be able to make precise changes in our diet, exercise and sleep patterns. And, a damaged metabolism is the root cause of many lifestyle diseases,” says Kumar. One of the biggest hurdles for continuous glucose monitors is the high cost of the device. An annual supply of Ultrahuman monitors costs ₹1,04,999, and a 12-week supply is pegged at ₹24,999.
There is also the fact that the device needs to be changed every 8 to 14 days and has a needle attached to it. Users, even those who have collaborated with brands, have complained of feeling the needle prick and slight discomfort for the first couple of days after installing the device and are concerned about the invasive nature of the sensor. Chandan himself feels it might be wise not to play any contact sport with the device on. Normal workouts, strength training, running and cycling, though, would be just fine.
Most users would require a fair bit of knowledge about these monitors, as well as plenty of interpretation from coaches and nutritionists, to make sense of metabolic scores, glucose spikes and drops. Keeping all this in mind, Tiwari wants to get another continuous glucose monitor and track his metabolic health and glucose levels again, but Jain refuses to spend any more money.
The leadership teams and founders of these wellness start-ups are aware of the prohibitive cost of the hardware. Kumar believes that one way of making them more affordable would be to increase the life of the sensor. HealthifyMe is working to create an AI-powered virtual glucose monitor that can predict spikes and drops based on the information collected from the sensor being used. Tushar Vashisht, co-founder and CEO of HealthifyMe, says, “Once the virtual sensors are ready, users would have to use a physical sensor just once every 12 weeks to re-calibrate to their changes. This is how this technology can become affordable and available to all.”
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.