Meal Memory – Finally! A Useful, Low Hassle Diabetes App

By Adam Brown and Kelly Close

Twitter summary: Meal Memory – A terrific + simple Apple/Android app for tackling meals with #diabetes through pictures + paired blood glucose information

There are many diabetes apps available for smartphones, but many get deleted quickly or never used. Why?

• Diabetes apps ask us to do too much manual entry.

• Diabetes apps don’t give us enough benefit relative to the costs of using them.

• Diabetes apps are not fun to use.

For once, we’ve been using a new diabetes app with regularity. It's called Meal Memory (free for Apple, Android devices), and it revolves around a super simple concept: take a picture of every meal and pair the associated pre/post-meal blood sugars to get a clear visualization of how specific meals impact blood sugars. Doug Kanter, the founder of Databetes and a fellow patient with diabetes, created Meal Memory, and we think he’s done a terrific job with a tremendously simple, useful design. This article shares our experience using Meal Memory regularly over the past couple weeks, including what we learned and what we hope to see from this app in the future.

What is Meal Memory? 

Meal Memory is an Apple and Android smartphone app that brings more diabetes awareness to meals through a very visual display. Pictures of meals appear in a news feed in the app's home screen. The app then adds color-coded dots to indicate in range (black) vs. out of range (blue, red) blood glucose values before and two hours after the meal. The dots are overlaid on the central news feed, allowing a quick visual glance of the meal history and associated blood glucose values. A major goal is to see the blood sugar impact of meals, but in a way that is less numbers focused: what did I eat (meal picture), and what was the blood glucose response (color-coded dots)?

The app experience is different depending on what glucose monitoring devices you are using:

• Meal Memory is currently optimized for those on the Dexcom Share receiver and iPhone, since the glucose data is automatically imported via Apple’s Health app – recording a meal simply requires taking a picture (5 seconds) and coming back to the app later to see what happened.

• Those using only a blood glucose meter, Medtronic CGM, Abbott’s FreeStyle Libre, or an Android device can still get great value out of the app, but they will need to manually enter a blood glucose value pre-meal and two hours post-meal.

Meal Memory for Dexcom Share Receiver users

Meal Memory integrates with Apple's Health app, which pulls data right from the Dexcom Share2 iPhone app (paired with a nearby Dexcom Share receiver). That means all the CGM data prior to and after the meal is imported into Meal Memory automatically. This cuts down the manual entry to zero – you only need to open the app and take a picture of the meal (10 seconds max) and return several hours later to see the CGM trace, glucose values (pre-meal, two-hour post meal), and color-coded dots automatically imported. [Dexcom posts to Apple Health with a three-hour delay, so the glucose data appears gradually and not immediately.]

We were very impressed by the ease of this setup and the magic of the CGM data imported automatically. While manual entry tends to exhaust Adam after a day or two of using other diabetes logging apps, using Meal Memory and Dexcom Share has made it easy to stay engaged with the app over the past couple of weeks.

Meal Memory for Glucose Meter, Medtronic CGM, FreeStyle Libre, and Android Users

Meal Memory is a bit harder to use for those not on the Dexcom Share receiver, but with a little more effort, it still offers great value. In addition to taking a picture of the meal, you must manually enter the blood glucose value pre- and post-meal. It adds about 5-10 seconds to the recording process on each end.

The hardest part is the post-meal tag. The app has a reminder built-in to notify you two hours after the initial picture to return to the app and enter a blood glucose value. This is terrific, though to get the actual post-meal tag and color-coded dot, the glucose value must be entered within exactly two hours of the initial meal picture, plus or minus five minutes (so for a meal at 2pm, the post-meal value has to be entered between 1:55 and 2:05 pm). That means you have to be very responsive to the notification and have your phone on you; difficult, but certainly not impossible. Hopefully, this window will expand over time (or be customizable), giving the post-meal glucose tag for values entered within 15 minutes or 30 minutes of the two-hour mark.  

Why do Adam and Kelly like Meal Memory?

• Dead simple: You can just take a picture of the meal and come back to see how you did.

• Useful: In one glance, you can scroll through the home screen and see which meals you nailed (black dots post meal) and which you can improve on (blue or red dots post meal).

• Improves the feedback loop: Right now, we rarely download our diabetes data. Even when we do, the meal information is not detailed enough and too abstract (numbers focused). This app solves both problems – we review meal data far more consistently, and the meal information is richly detailed via photos. You can also get a much better sense on how you’re doing on carb counting.

• Fun factor: (i) the magic of the Dexcom CGM data appearing automatically is awesome; (ii) it's fun to see how you do after a certain meal and how you can improve next time – kind of like a game!; (iii) the pictures chronicle eating, which is a memorable and fun way to review your days.  

• Encourages healthier eating. It’s great to see a scrolling list of pictures of what you’re eating! We like the idea of the list looking healthy, and we think this app helps us choose better foods. We also are more likely to show it to others when our recent meals look healthy.

• We love the idea of being able to see which meals “worked” (black dot) and which didn’t.

• Super customer service! The Meal Memory team responded in excellent time to questions.

What have we learned from using Meal Memory?

• Simply taking pictures of meals and reviewing them brings much greater awareness to food choices and snacking.

• It’s hard to get the recommended number of vegetable and fruit servings per day (a combined 5 cups per day is what the government recommends).

• As easy as this app is, we still sometimes forget to take pictures of meals. This was more of a reminder of why apps with lots of manual entry are a tough sell for many people with diabetes. If it’s hard to remember to invest 10 seconds into taking a picture with this app, it’s even harder to ask patients to type in a bunch of stuff at every meal.

Our Meal Memory wish list

We think the first-gen version of Meal Memory is a terrific start, and there’s no question it will improve over time. Here’s what we hope to see:

• Integration with glucose meters and Medtronic CGM, so those not on Dexcom can get the glucose data imported automatically.

• An expanded time window to manually enter post-meal glucose values. Right now, a manually entered value only counts for “post-meal” if it’s within two hours plus/minus five minutes of the initial meal entry. It’s hard to hit that, even if your phone is by your side. We’d like to see a customizable window, or at least expand it to two hours plus/minus 15-30 minutes.

• Dexcom Share posts to Apple’s Health app with a three-hour delay, so the two-hour post-meal glucose value actually appears in Meal Memory five hours later. This delay will hopefully improve over time.

• An insulin entry screen. It would be highly valuable if the app allowed a dedicated insulin dose entry screen, which would then show the number of units on the central news food (alongside the color-coded BG dots). This would facilitate an even better feedback loop: “Oh, I took 4 units last time I ate this lunch, and I ended up high.” Right now, insulin data can be added in the notes section, but you must open up the individual meal to see it, and it takes too much time to enter.

• Or even better, automatic import of insulin data! Once insulin pumps and insulin pens start uploading dose history information to the phone (we hope!), we assume it will be possible for Meal Memory to pull this information in as well.

• The app would help us identify bright spots and land mines. We wish Meal Memory had more sorting abilities. For instance, a menu could ideally show only those meals we did not handle well (blue and red dots) or those we did handle well (black dot). That would facilitate even easier, better learning.

• Location context. Could the app note the location I took the picture at, and show me those locations that lead to out of range results? Be more like Instagram, Kelly asks! Both of us are pretty sure that meals out vs. meals in just don’t work as well diabetes-wise.

• Multiple pictures for one meal entry. If I eat a salad on one plate followed by a main course on another, that appears as two separate pictures. It would be great if these could be linked within the same home screen entry, similar to how Twitter now allows multiple pictures attached to each tweet. 

• Search feature: For those using the notes feature for each meal, it might be nice to search the app for the last time you ate “pizza” to see what you did. This would also require insulin data to be maximally useful. 

• Ability to export a report to send to a healthcare provider.

Towards a flourishing ecosystem of apps

From a diaTribe perspective, we think Meal Memory is just the start of a coming ecosystem of apps, particularly as glucose meter and CGM data move to the phone with products like LifeScan’s OneTouch VerioSync meter, Roche’s Accu-Chek Connect meter, Dexcom’s upcoming Gen 5 (expected by end of year), and Medtronic’s upcoming MiniMed Connect (expected this fall) and Abbott’s Freestyle Libre (coming to the US in the years ahead and already in the EU). Platform software like Apple’s Health, Diasend, Glooko, and Tidepool should enable diabetes device data to flow more freely, allowing developers to make specific, targeted apps like Meal Memory. Less manual entry and more actionable insights – that’s what we all want! Thanks Meal Memory for moving toward that and for being a great model for other apps – and thanks to all the others working on digital health for people with diabetes.

[Photo Credit: databetes.com]