Levels has done something truly transformative: the company made continuous glucose monitors (CGMs) accessible to the general population and every day consumer.
In many circles, it seems the trend of bringing healthcare to the home and directly to the patient is continuing, but understanding metabolism and lifestyle habits through this new tech trend of smart, wearable devices adds another important component to enjoying improved health and well-being.
If you imagine your body as a well-oiled machine that needs to be maintained, the sources of fuel and nutrition that you provide it are paramount for its efficiency and optimization. The first step to achieving this is understanding how your body processes different types of foods – each person is different and there is no “one-size-fits-all” when it comes to health and nutrition.
However, getting a handle on the biochemical processes behind how food is broken down and used within the body can seem a daunting task for many, and even for those who understand it, it’s not always possible to monitor with the aid of tech. This is where Levels has done an great job continuing to iterate on their app and device user experience, adding more metrics and useful pieces of information.
Why should you care about blood glucose?
Continuous glucose monitoring doesn’t only provide value to the usual population of diabetics. Many athletes have also used similar technologies to understand how to keep their bodies at peak performance.
Unlike for heart rate variability where a high variability is thought to be ideal, for good metabolic health you want to achieve low glycemic variability – in other words, “steady” glucose levels. For the healthy adult, glucose levels should remain somewhere between 70 mg/dL to 110 mg/dL at all times, and post-meal glucose should not rise over 30 mg/dL. However, according to the American Diabetes Association, anything below 140 mg/dL is considered normal.
What are the risks of high blood glucose? For one, potential insulin resistance. Insulin is the hormone that helps shuttle glucose to cells for energy, and resistance to insulin can ultimately result in prediabetes or type 2 diabetes. However, consistently high blood glucose levels can also lead to other types of potentially damaging physiological stress to the body in the form of oxidative stress, inflammation, and glycation — all of which contribute to chronic conditions, including cardiovascular disease, Alzheimer’s, and cancer.
In the short-term, big changes in sugar levels — that “sugar high” and “crash” people talk about — can result in feelings of anxiety, fatigue, irritability, inability to focus, and other common neurological feedback symptoms. And sustained response of any physiological stress over time can perpetuate symptoms and create even more problems.
What if you are healthy? Well, part of a “well-being plan” often involves a healthy diet and getting the right amount of nutrition. However, the impact of any type of diet varies widely from person to person, because every person’s body will metabolize foods in different ways. Having access to a CGM makes these insights accessible to everyone, and not just those that are prescribed a CGM only after a clinical diagnosis.
These are just some of the reasons it is so important to have an understanding of blood glucose and have a grasp on your own metabolic health.
What’s it like using Levels?
After testing out Levels app for over a month, I was able to have a much better understanding of how my body responds to different types of foods, stress, and even how quickly it metabolizes glucose during different types of workouts. I learned what types of foods cause a spike in my glucose levels and was also able to notice when high stress levels would result in markedly higher blood glucose levels under similar external conditions (foods, sleep, exercise, work schedule).
It’s definitely a product I would highly recommend to anyone wanting to have a better understanding of their diet and lifestyle — it quickly becomes a foundational part of your personalized health, especially if you’re into using health wearables to understand and optimize your own well-being.
One nice feature is an instant metabolic analysis a few hours after you’ve eaten, and insights daily and weekly to highlight the impact of diet and exercise. Some time spent doing reflection on these habits and diet can go a long way. Based on what I ate and did, I could also start to spot trends when juxtaposed with my sleep tracking data. As a result, I was able to make productive adjustments every week.
Part of the Levels experience includes an at-home metabolic health panel, where you set up an appointment at home and someone will come to take a blood sample to build out a metabolic panel. There are then options to consult professionals to further dial in your metabolism and health.
The Levels team has put out many excellent educational resources such as blog posts and articles, as well as a podcast that is fun to listen to during walks. There are many nuggets of information constantly shared via the app, such as the pro tip of taking a walk after a carb-heavy meal can help the body metabolize the meal, or food substitutions to optimize glucose stability.
There are four major blood glucose levers Levels constantly touches upon: diet, exercise, stress, and sleep. They have gamified metabolic metrics to include aspects of these levers in the tracking app, which helps make managing metabolic consistency more engaging.
Installation of the device itself is extremely fast and painless. The Dexcom CGM is a wearable biosensor that samples your blood sugar levels every five minutes and relays the information back to the app with a transmitter via Bluetooth. The transmitter itself lasts for at least 90 days. An applicator “injects” a tiny microfilament with the push of a button, and you don’t really feel a thing after that unless you explicitly push directly on the device where it is injected.
I tried wearing the CGM on my arm initially, but personally found that I was much more comfortable with it on my abdomen, even when sleeping and rolling around. After the second week, I stopped noticing it was there.
We had a chance to interview Dr. Lauren Kelley-Chew, Head of Clinical Product at Levels.
Alice Ferng, Medgadget: Tell us at a bit about yourself and your role at Levels.
Dr. Lauren Kelley-Chew (Head of Clinical Product, Levels): I am the Head of Clinical Product at Levels. Prior to Levels, I led Strategy & BizOps at Verily Life Sciences, driving product, commercial, and clinical strategy with a focus on wearables, digital biomarkers, and emerging products. Previous to that, I founded a Y Combinator-backed digital therapeutics startup for digestive diseases and worked as a private equity investor. I graduated from medical school at UPenn, where I was a Gamble Scholar. Throughout my career, I have been inspired to build products and businesses that solve system-level problems and make good health accessible to everyone.
Medgadget: Can you help describe the values we’re reading as the consumer? For example, how does a meal impact blood glucose? How can it be expected to impact glucose? (I notice there’s been additional tips from the app and the daily analysis getting iterated on too).
Dr. Kelley-Chew: First, some background on glucose: Because glucose is a primary fuel source for our cells, how efficiently our body uses and processes it is vital to several areas of our health, from short-term energy and mood to long-term risk of chronic disease. Even if your annual labs put you in the range conventionally considered “healthy”, frequent blood sugar spikes and crashes can cause changes in your body that are detrimental to health in the short and long run.
The primary way our body gets glucose is through the food we eat, especially from carbohydrates. As that glucose moves into our bloodstream, a cascade of actions happen in our bodies to make sure it gets into our cells for energy or stored away for later use; the body aims to maintain a stable level. The reading in the Levels app is telling you how much glucose is in your blood right now. The sharpness and degree of rise you see from a meal depends on a number of factors, including how many carbs were in that meal, what kind of carbs (refined grains or sugars get absorbed more quickly, thus causing a sharper rise), what other foods you’ve eaten, how you’ve slept and more.
Additionally, how our bodies respond to the levers that impact glucose—diet, exercise, sleep, stress—is highly individual. Foods that may cause a sudden spike for you may only cause a gentle rise for me. We don’t yet entirely know why this is the case—genetics, microbiome, and other confounding factors may all play a role—but it’s evident in research and our member data. That’s why simply reading a carb count on a label or looking up a food’s glycemic index, while helpful, doesn’t tell the whole story of how that food will affect your health.
For example, you may find that the mid-morning energy slump is just a blood-sugar crash following the spike caused by your morning bagel. Or that your afternoon anxiety results from very high glucose from lunch.
Levels can help visualize data readings in the context of target blood sugar range (for someone without diabetes) so you can immediately see if those changes in glucose are within an optimal range. It can also help you to see a full day’s glucose changes (as well as track overall trends over weeks and months) alongside meals, exercise and sleep so you can connect those changes to behavior. Additionally, you can save a catalog of foods and meals that work (or don’t work) for you and receive suggestions and guidance based on your data.
Medgadget: What sorts of updates to the app are ongoing to help folks understand their metabolism even more?
Dr. Kelley-Chew: We recently added a few features to our app to enhance the user experience:
- Notification and insights surfaced to members and tailored to help them optimize their metabolic fitness
- Implemented a new rewards system to keep members motivated and celebrate their progress towards goals
- We’ll continue to add more insights and education to the app over time, tied to your specific goals and journey.
- We also share deeply-reported, science-backed stories with members and non-members through our Metabolic Insights site and our bi-weekly newsletter and social channels.
Medgadget: Does where the sensor is placed impact the numbers (e.g., centrally vs peripherally, or arm vs stomach)?
Dr. Kelley-Chew: CGMs are typically applied to either the abdomen or back of the arm (the fleshy part, between the tricep and deltoid muscles-avoiding the muscle) per manufacturer guidance. For accurate, consistent readings, we recommend using a consistent location (if the back of the arm, use the same arm) when changing sensors. While a CGM is always reading glucose from your interstitial fluid, it’s possible to see variation from sensor to sensor.
Medgadget: What are some upcoming features we can look forward to?
Dr. Kelley-Chew: Nothing we can share just yet, but stay tuned for some very exciting updates this year aiming to make improved metabolic health more accessible and actionable.
Medgadget: What are some upcoming partnerships or developments you’d like to highlight for Levels?
Dr. Kelley-Chew: Though we launched it last year, we’re excited to continue to build on our observational research study, Glucose and Lifestyle Data Patterns in the General Population. The study, which our members can opt to join, explores the relationship between blood glucose and food, exercise, age, sex, and other lifestyle choices. In addition, it aims to characterize glucose patterns in people without diabetes. In 2022, more than 10,000 members signed up to participate, and more enroll each week. To our knowledge, this amounts to the largest ever study on this topic in people without diabetes and a huge citizen science effort.
Levels blog – a wealth of science-backed, reported articles about metabolic health, nutrition and physical fitness guidance
Levels podcast – A Whole New Level – conversations about metabolic health with leading researchers and scientists
Youtube Metabolic Menu playlist – metabolic-friendly, low spike recipes and cooking tutorials with co-founder and CMO, Dr. Casey Means