New Apple Watch update brings improvements for diabetes

The Apple Watch first arrived to much fanfare exactly six months ago.  Despite some sensational headlines in mainstream press and Dexcom’s bold efforts to fully support the Apple Watch with the Share platform, the overall user experience for people with diabetes was tolerable at best, due to limitations in the aptly-title watchOS (the Apple Watch’s operating system).

In contrast to the lightning-fast, always-visible live CGM views on the Pebble Smartwatch (courtesy of the home-made modifications pioneered by #WeAreNotWaiting/NightScout crew), the Dexcom Share/Follow apps for Apple Watch were clunky, laggy, and not visible at first glance. The few diabetes logbook apps that did support Apple Watch were equally clunky, hindered by the watchOS’s stubborn dependence on the iPhone.

But this past Tuesday, Apple released watchOS 2, giving app creators new abilities such as accessing health sensor data from the watch (e.g. heart rate, activity), downloading data directly from the Cloud via WiFi, and displaying information directly on the watch face. How does this benefit Apple Watch owners with diabetes?

Display diabetes data directly on the watch face!diabetes-apple-watch-complications-smallOne of the Apple Watch’s best feature is the ability to display additional information the Watch Face. These small views are called “complications,” a term reverently taken from the watchmaking world. (Not to be confused with medical complications like neuropathy and blindness). On the original watchOS (pictured on the left), these complications were restricted to displaying data from official Apple apps (e.g. alarm, moon phase, sunset, activity, etc).

With watchOS2, third party developers now can do the same. As pictured above, the CNN app displays the latest headline, and the United Airlines app displays upcoming flight information.

For users of CGM (like the Dexcom Share and Medtronic MiniMed Connect platforms), imagine being able to view your sugar and trend arrow right on the home screen, as pictured in the bottom right in this mockup. In such a scenario, tapping on the icon would take you directly to the app for more detailed information.

For non-CGM users, logbook apps could display complications that show how many sugar checks that remain, as an example. The bottom left of the mockup shows how my app Sugar Streak could show that the user has completed one of the two glucose checks they are trying to complete each day.

So, the summary/zinger: finally, GOOD diabetes complications! =)

Go back in time! (kind of)

See information in the past/futureTime Travel is Apple’s cute name for a clever feature. On the primary watch face, users can wind the digital crown to scroll forward and backwards in time. If appropriate, the complications update to show information that pertains to the displayed time. For example, in the above example, scrolling forward in time shows future appointments and the appropriate hourly forecast.

Continuing the conversation from before, CGM wearers could quickly scroll through their prior CGM readings and trend arrows were throughout the past 12 or so hours. Ridiculously neat!

Speedier Watch Apps That Are Less Dependent on the iPhone


For a variety of reasons, the initial release of watchOS did not allow for apps to be run natively on the Apple Watch. (Don’t forget, the original iPhone did not allow users to install ANY apps). When you launched an app on the Apple Watch, you would see the dreaded loading screen (pictured) while it pinged its iPhone mothership to learn what to do next. As a result, every single Apple Watch app had to essentially function as a second screen, helpless without an iPhone nearby.

With watchOS 2, Apple Watch apps can finally run natively. For example, a Watch calculator app can now run without an iPhone nearby. (Before the update it would require an iPhone, sadly).

But what about Diabetes apps, where most of them rely on data from the Cloud? Natively-run diabetes apps will still load significantly faster because the app can still load graphics and the skeleton of the app  instantaneously. Any data will then be downloaded via nearby iPhone or Wifi. The experience is similar to the Facebook app for iPhone: the app launches instantly, but takes a few split seconds to display status updates/photos. Overall, the process still feels fairly snappy.

Furthermore, downloading from the Cloud no longer requires a nearby iPhone! If the Apple Watch is in range of a known WiFi network, the Watch can download data directly from the Cloud.

Now for the Bad News…

Unfortunately, all these nifty features need to be supported by the developer so these features won’t be available until the companies or app creators release software updates.

Adding new features are easier for well-funded startups and companies like Dexcom and Medtronic, but many diabetes apps are built by individuals or independent developers who might not have the bandwidth to readily roll out new features.

At the time of this article’s publishing, not a single top search result for “Apple Watch diabetes” in the Apple Watch app store supported any of these new watchOS 2 features.

What Can’t WatchOS 2 Do? What’s Left on the Wishlist?

Despite its many advances and upgrades, watchOS 2 represents just one more step in the pathway to Diabetes smartwatch nirvana.


The imminent release of the new Dexcom G5 signifies a HUGE step for CGM users by transmitting glucose data directly to the iPhone (and later, Android). The G5 eliminates the need to carry around the Dexcom receiver, a feature users were begging for from day one.

Unfortunately, the G5 CANNOT directly transmit glucose data directly to the iPhone, even with watchOS 2. Therefore, if you’re going on a run and want to view your CGM data on your wrist, you’ll have to bring along the iPhone as well. Similarly, wireless glucose meters also can’t directly connect to Apple Watches, and will require iPhones as the bridge for communication.

Along those lines, while watchOS 2 allows the Watch to download data over WiFi, we’re not always in range of a friendly WiFi network. Perhaps future version of the Apple Watch will be able to connect directly to cellular networks or bluetooth sensors.

And a final personal pet peeve of mine: the Apple Watch display still doesn’t always stay on. To activate the display, you either have to raise your wrist, tap the screen or press a button. I seem to be a rarity among my friends, but I don’t appreciate having to dramatically lift up my arm in order to check the time or my sugar.

Overall, Apple watchOS 2 introduces powerful new features that will change the way people manage their diabetes. Now it’s up to the developers to do their part.

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