This week I am talking to Phil Curtis (@philtalks), Director at First–Thirty (@1stThirty) who is merging his knowledge and experience in the space industry together with personal experiences in healthcare to help ideas become solutions and businesses.
Phil developed Type 1 Diabetes early in life following a bout of Measles that left his insulin production system in the Islets of Langerhans no longer working. His early experiences managing the disease were challenging with data that was delayed and lacking in detail. This was compounded by some of the dire predictions he was exposed to of the impact on his health and wellness of the glucose flowing around his body.
Thanks to his focus and personal hacking of the problem over the years Phil finds himself in great health working as a sports coach and in good shape without any of the anticipated sequelae. He shares his personal experience of being prevented at the last minute from competing in the world championship rally racing because the organizers decided that his Diabetes was a safety issue. He was interviewed in Grandstand (the weekend presentation of sports in the UK on TV and if like me you were racking your brain to remember the catchy theme tune – here it is) and Top Gear about being sidelined at the last minute. The ability to drive in the UK with Diabetes is limited and requires additional medical oversight (this is also true for pilots)
His incremental insights came from the increased availability of data and the importance of immediacy to allow for real-time responses that prevented hypoglycemia and hyperglycemia from ever happening. He is grateful for the progress in technology that has improved the needles used to inject the insulin and the more recent innovation of the Continuous Glucose Monitor (CGM) which provides near real-time data on his blood glucose level.
Listen in to hear Phil’s exploration of this data, informed by his earlier competitive driving experiences and the significance of having that data provided to you while you are driving. For those of us with working insulin systems knowing the level while driving seems like an unimportant value but for the many diabetics (Over 1.5 Million in the US and almost half a million in the UK) it is highly significant – you can read all about Phil’s Diabetes Driving Hack here that cobbles together a host of wearable technology and add on devices to create a drivers alert system. He hopes to help individuals and companies who develop concepts like these to successfully navigate the process of going from ideas to companies and products to successful economic companies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
And today, I’m delighted to be joined by an old friend and colleague Phil Curtis. He is the director at first 30. Phil, thanks for joining me today.
Phil Curtis
Now, it’s a pleasure, Nick, lovely to be with you.
Nick van Terheyden
So, you and I have a long history. We’ve worked together in the past, we’ve actually traveled the world a little bit. But for the benefit of the listeners, help them out. Tell them a little bit about your journey to where you are. As the founder and director of first 30.
Phil Curtis
Yeah, sure thing. The journey actually comes there’s two pathways to it first being the Business Route, which, you know, I, I was originally a mechanical engineer, and he was a manager at the rover plant, the vehicle assembly plant at Kalyan, Oxford. And from there, I realized I wasn’t particularly good as an engineer and was a bit better at running companies than, than building cars. So I got myself into a consulting role with the big four big five big six firm, depending on the period, you’re in KPMG, which, of course, is where you and I first first came into contact. I was really fortunate, they had a very, very good international placement program. And as you’ll you’ll remember, from this, I got placed into Bahrain and took my took my young family out to Bahrain for three years, coincident with you being in Saudi Arabia. And so we had a very, very good crossover at that point. And since then, I’ve been back in the UK, building businesses and working in sort of publicly financed publicly funded companies. And last year, decided to with a slight milestone birthday, it was time for me to slow down a little bit, and possibly give something back to the next generation of entrepreneurs and business builders. And so I started first 30 as a way of helping technology companies, technology entrepreneurs, startup grow, and develop their develop their case. So I
Nick van Terheyden
So you’re right, Phil, we did, we both had the fortune of working in the Middle East, I was very grateful for that experience and the opportunity to both experience other countries and cultures, and also the opportunity to learn from others as a simple physician working in the consultancy world. But over the course of that time, one of the things that struck me, you know, in hindsight now was that I was, for the most part, unaware of a medical condition that you’d been living with for a long time. Tell us a little bit about that.
Phil Curtis
Now, Thanks, Nick. That’s the that’s the second leg of the how I got to your story, really. I’m a type one diabetic, and I was diagnosed very young at the age of five. And diabetes in that form is one of those things, which, if you manage it carefully and closely, doesn’t have to be that obvious, it can be very intrusive, if it goes wrong, it can be so intrusive, and so so damaging. But if you manage it smartly, and well, nobody needs to know, outside of your very close family and your very close friends. And so I was I was diagnosed at five bad measles case, and very, very high temperature that that provoked an autoimmune reaction and killed the pancreas. So from then on, I’ve been working through using as much of the advancing processes, the advancing technologies that are available to me, I’ve always had this engineering curiosity about it. And so it advances in insulin delivery. But more importantly, in the early days was advanced as in testing. So how does one know the body condition? How does one know the blood sugar levels and when I first started, it was wading into a part and having to use a test you with a with a tablet, which would go either blue, which was good, sort of orangey, which wasn’t good, sorry, yellow, which wasn’t so good. And a very dark orange color, which meant you know, you’ve overloaded this the sugars. And since then, of course, we’ve gone through the finger pricks. And we’ve gone now into into sub scan sensors have always been involved. I’ve, from the very early days, I was lucky enough to be at looked after by the Oxford University Hospital, when I was here with the car factory. And they were one of the most advanced researchers, developers of treatment techniques and technologies. So I’ve always, I’ve always had that connection. And, you know, I’m 60 years old now, 55 years in, that’s a pretty good dose of experience. And learning every day, new stuff comes up every day. And there’s all there’s always new stuff
Nick van Terheyden
to do. You know, it’s interesting, you bring up some history that’s important to understand. And, you know, I, I couldn’t have reconciled the tablets in a test tube. But you know, the next innovation of that was dipsticks. And you know, I think people would have been potentially more familiar with that, although maybe that well, actually, I imagine that’s probably more familiarity, because we saw that with finger sticks, that was still the same process. Yeah, but the thing about the urine testing is that that’s delayed, you’re essentially looking at something that is delayed, and we moved up the chain to finger stick and measure the blood glucose that was, I guess, an innovation and started to allow for better control. You’ve been hacking this and living with it for the majority of your life. Tell us a little bit about the experiences and you know, maybe some of the learning points, the highs and lows in there.
Phil Curtis
Oh, and they’ve been many because the there’s a curiosity that the targets now that we are aiming to achieve. So we sit here now looking for a we set a range of blood sugar, blood glucose at the moment. So in and again, in the UK, we use different different scales. So 3.3 point nine millimole per DL, is the threshold for low blood glucose. 10 is the threshold for high blood glucose and you’re aiming to stay within that boundary. And currently the target this target sets around about 70% of your time you should be within that range. That sort of range was absolutely impossible to achieve, probably 510 years ago. And so if you think when I was a kid growing up and going through puberty, the idea of staying within the bounds of a good target range was almost impossible. So you did what you could. And, you know, the days of hyperglycemia is where you, you, you know, the low blood sugar events where, you know, it gets a bit messy, you get really sweaty, and you, you feel rubbish for a couple of hours. Similarly, the hyperglycemia were a much slower onset, and it’s a much I found it a much actually more pervasive, this smell of of the smelling your nose, that really won’t go away. Because the insulin takes two hours, or pretty much always has done to take an effect. So you can as a, as an engineer with an idea of control systems. If I feel bad, now, I’ve got to take a corrective measure that isn’t really going to work completely for the next two hours. So the question mark of have I done enough? And should I do more, the only now through the, through the ability to measure and monitor more closely? Can you eliminate that that roller coaster ride, that when I was a kid, you just had to suck it up and live with it. So the the effect on kidneys, the effect on feet, the effect on eyes, the predictions when I was a child, were for all the conditions that I would suffer. When I got into my 40s were were quite unpleasant. Now, thankfully, good control, good discipline, I’ve managed to I’ve managed to avoid most of those. But, you know, there are, there are implications on on the real world. So, you know, just recently, I’ve had to replace my driving license my driving license in the UK, last for three years, and has to be renewed on a on a medical review every three years. It’s a form filling exercise, but they still have this medical review that says are you still fit to drive? Sadly, the the idea of what fit to drive is, is in the dark ages, because they’re not really up to speed with how we monitor and how we measure. And I guess, you know, I may be unusual that I’m at one end of the spectrum on on being able to monitor this stuff. But you know, your questionnaire talks about are you aware of hyperglycemia? Do you understand the signs of hyperglycemia? Which, for me, I’ve got a I’ve got a set of testing gear that tells me every five minutes what my blood glucose is. So quite frankly, am I aware of hyperglycemia is a nice question. And I am. But I’ve got a digital readout in front of me that tells me what it actually is. So, you know, we’ve come a long way. Sadly, the authorities are struggling to catch up to keep up partly because they’ve got to deal with a mass population that isn’t as as joined up or connected as I might be. And, you know, this goes back. You know, I don’t know if you remember the, in the old days i i used to be into motorsport. I’m a kind of sports coach and I do a lot of activity stuff. I used to be into Motor Sports and and in my 20s We got together a rally team for for the world championship. And it was a bit of a novelty because one of the the blood sugar, the finger prick testing companies were sponsoring the team. So it was a great advertisement for them. We got through all the qualifying rounds did the the European championship round in Wales got to the Lombard, our AC rally, and the night before the FIA and the organizers decided they didn’t like the idea of a diabetic competing. Because there there was a possibility I would have to drive the car at some stage even though I was the Navigator. And as a consequence, they banned me. So you know, fortunately, we have another qualified co driver with the right licensing in the team. We sort of thought this might happen. So we were prepared for it. But yeah, you sort of hit a few brick walls along the way.
Nick van Terheyden
You know, I appreciate you sharing all of that. For those of you just joining I’m Dr. Nick the incrementalist today I’m talking to Phil Curtis. He is the director of first 30 We were just talking about his experiences with diabetes and the challenges that you face throughout In fact, you know, as part of that rally team for those on different sides of the pond. You know, this was a Top Gear interview for you to be clear pre Jeremy Clarkson and Stig I think but on grandstand for those that know what grandstand is at The sports program for Saturday’s where we don’t watch American football or indeed college football to be clear, it’s, it’s soccer or football, as we would call it. And, you know, huge brick wall. But one of the things that really strikes me about this is, first of all, you know, all those dire predictions which you’ve managed to disprove. And you know, there’s some fortune in there. But I think some extreme hard work and what I would describe as human hacking, you’ve hacked this process throughout that period of time, managed to control because that’s the way that you do sort of reverse that, you’ve now got more data at your fingertips. And, you know, you talked a little bit about that the continuous glucose monitoring that is interstitial in nature, it’s devices that are sort of placed and continue to output and, you know, regulatory systems don’t catch up as quick. But you know, you’re ahead of the game. Tell us a little bit, as you look back, what you think about of the the inflection points and the learning experiences that have really played positively to that whole hacking experience. And what I would call, you know, for the most part, a positive outcome.
Phil Curtis
Yeah, it’s it’s very, it, there are the big, those little S curve moments where you get to a peak of a, of a trend, the first big one was, as you pointed out earlier, the blood the fingerprick strips to to monitor blood glucose, rather than having to do urine. You know, as you say, urine is anything, probably 40 minutes plus delayed from actual blood sugar, and possibly even more. So the idea of having that close coupled relationship between what’s going on in the body and what you know about it. That was a real, that was a real turning point. And this was, you know, this was back in the 80s. So this was, this was hence when we know the company that I was working with, on the rally team, were providers of blood sugar testing kit, I was a user of their kit. And I was I was interviewed on screen. In the rally car, doing a blood test, you know, we literally came into the service holds the mechanics jack the car up onto on, we’re doing things with wheels and tires, my drive was out Avenue, having a cup of coffee, and I’m sat there in my seat doing a blood test. Now, that would have been impossible. And so to be able to, to continue healthily through the night, in that sort of environment. So that’s a big, big step. Then the other step has been much more progressive, which is the improving quality of hypodermic needles, and the insulin delivery pens. Because I, I now have a delivery pen, which I can change the needle every day, you know that the argument is you should have a fresh needle for every every injection, it’s a pain in the backside to do that every single time. So I sort of run I run, I run a needle a day, which will do me sort of three or four insulin injections in the day. But those needles are now brilliantly produced brilliantly sharp. And so the the impact on the skin and the subcutaneous layers below are minimal. You know, and I’m, I’m taking probably 567 injections a day. And I’ve been, you know, probably not quite as many in the early days. But, you know, if you think that you add that up over the years, since the injections got better, say the last 20 years, that’s an awful lot of injections. Yet no, no hypertrophy on the on the skin. It’s that is every we’re saying you know, you’re going to end up with skin like leather. And it doesn’t quite work like that, because the technology has improved. The next inflection point naturally is the subcutaneous, the the sensors, so I run a an ad a freestyle Libra, which is brilliant. But of itself, it has limitations. And this is where the hacking This is where the current hacking comes in. Because I started to extend its capability habita catching up, so abita developing this anyway. But you know there are sort of little niche technology companies out there. So there’s a there’s a small sensor, sorry, a small transmitter that goes and sits on top of the labor, which is it transmitted to your phone. So I can now get on my mobile phone and you know we had to cut the interview a moment ago when my low blood sugar warning went off. I now Get a transmission to my mobile phone every five minutes of what my BG level is. And you can set alarms. And so I set an alarm if 3.9 is my is my low level, I set an alarm at 4.5. I just hit that a moment ago. So this is the pre emptive alarm that says your sugars are falling, you’re not in trouble yet. But if you don’t do something about it, you will be. So a couple of glucose tabs. And you know, all is good. And that runs every five minutes. So that takes it to my phone, which gives me that control loop the next bit. And the red this is the really smart bit is that if you using the phone app, and again, it’s another third party don’t phone app that puts a calendar item onto your onto my Apple Watch, which also can then be shared with the car. So running Apple CarPlay, I can get a calendar item every five minutes on my dashboard that tells me what my BG is. So this idea about are you aware what a hyperglycemia feels like, when they’re worried about me driving, not only am I aware, but I’ve got a constant feed of where my bit my blood sugar is. And this is where when driving previously, you sort of did some tests before you got in the car, you sort of projected how long you were going to be in the car for and you made an estimate of whether your sugar’s were going to rise or fall or whatever. And you know, that was pretty unreliable. And all you could go on was your own personal awareness of how you felt. Now, I know, every five minutes, if it’s inching down or inching up, I can do something about it. And this is what gives you that ability to stay in that green zone, stay in that level in that, that boundary of being in the good in a good place. And so from a therapeutic point of view, the impacts on eyes, kidneys, feet, circulation, and all those other bad secondary effects are diminished. If you get this right, it’s absolutely superb. And this, this comes now full circle back to my business intentions, which are, you know, to work with entrepreneurs, technologists, startups, anybody that’s got any smart ideas in this space? To get them over the business hurdles of starting a company and building a business, that’s actually got the potential to change people’s lives and make diabetes care more fully available. I’ve got five suppliers in my personal hack system. Wouldn’t it be great if there was one business that could tie that together?
Nick van Terheyden
So I think for the benefit of the listeners, as part of this podcast will be posting, the details of that will point you to Phil’s website so that you can read about it, he’s going to detail the steps. I think for most of us who don’t live with that experience, you know, there’s a part of us that go, Well, who needs my blood glucose for that, but you’re highlighting all of these essential and this is not for a rally driver. Although to be clear, I think an awful lot of people still drive on the roads that way. But for the regular driver, this is an essential piece of data, which, you know, by the time they’re getting all of the indicators that you feel personally, it’s not that it’s too late. But you know, you’ve missed that two hour window. And, you know, you got to spend time for recovery, and all of this sort of securely, I have that. So I think tremendously exciting. And it’s one of the great powers of the spread of data and knowledge. And what I heard in your sort of description of this is, you know, data is key, the immediacy of data is key. And then the sort of innovations and supporting that, in the closing section, just tell us what the future holds and what you’re excited about. Where do you see this going? And where are the opportunities?
Phil Curtis
Well, I think, you know, it’s the future is the one big step, which I think is is an interesting one is, you know, the use of the making smaller the insulin pumps. So, you have a closed loop system where the insulin pump reacts to the test and is able to then without doing the injections now, at the moment, the pumps are either sort of taped on or in your pocket with a cannula to feed them. That’s inconvenient. It’s not it’s not easy. It’s not it’s not the most it’s not the best physical solution. There are also some limitations because the one thing I do one thing I know as a as a sports coach, you know, I’m a cyclist and a canoeist. I know when I begin a bike ride, what I’m about to do, so therefore I know and I can preempt, I can prepare with insulin, or sugars, to manage my way through that, right? The insulin pumps can’t do that. So the insulin pumps at the moment are in reaction rather than production. So the ability to use artificial intelligence and some machine learning to be able to understand what’s going on and what’s about to happen. That’s where the true that’s where the true next stage value is. And that’s, that’s a really exciting prospect. Yeah, so
Nick van Terheyden
it’s, again, it’s data and immediacy, and I think immediacy of action that is more more closely aligned with the body’s mechanisms of achieving this, which is, you know, it’s a, their feedback loop is constant, constant, constant and reproducing that which, you know, I think people sort of talk about as the automated pancreas a little bit incorrectly, because it’s really the automated islets of Langerhans. But that’s a whole other thing. But, you know, I think tremendous opportunity, and that innovation, for me, is clearly accelerating. I think we’ve, we’ve, we’ve reached this inflection point of access to information and technology, and there is real potential to help solve these problems. That will make life easier for folks that don’t have the engineering skills. We’re not in those circumstances where you’ve managed to sort of explore it but I think in in gratitude to the folks that laid the pathway, you know, we work on the shoulders of individuals like you and I would imagine that even some of these large organizations will look at this and say, gosh, we must do that which you know, to me is the the highest form of flattery. So, the exciting times just delighted to sort of hear about it and also for you to share it so just remains for me to thank you for joining me on the show. Phil, thanks for for being here.
Phil Curtis
Now it’s been a pleasure, Nick and I say anything I can do to again to share the some of these experiences and to just open up some of the conversations is is is worth it and very happy to do so.
