Diabetics Doing Things FOUNDERS with Henrik Berggren CEO of Steady Health

[00:00:00] Rob Howe: Ladies and germs, it is Rob. I am back with another episode. We're talking T1D founders, baby. And this one, Henrik Berggren is calling from Silicon Valley, where he's been for the last few years, but he is from Sweden. So you're gonna hear a little bit of an accent throughout his interview, but a really awesome story. And he's currently the CEO of Steady Health, which I've seen a couple of my California type 1 diabetic accounts talking about recently. and it is a new technologically focused very modern approach to diabetes care it's care that's there when you need it steady talks about themselves as a digital medical practice that's on your phone so you can message their team set up a voice call have a conversation with an endocrinologist it can actually is a subscription based and it's california only at this point but really really modern really really cool i read a lot about the future of health care and some of it doesn't sound super exciting, but this is one of the things that's really cool. You can interact with your doctor over your phone. You don't have to leave your office. You can text. I hate calling. I hate going to appointments. This fixes that. So I'm really excited for Steady Health and the future of it. Be sure to check it out. And then listen to Henrik's story. Be sure to message him if you heard about Steady Health on this podcast. So Steady Health, Steady.Health. So it's not like a .com. It's steady.health, and that's the URL, so be sure to check it out and enjoy this interview with Henrik Berggren. low carb pizza, and enchiladas, which are delicious. But they've really outdone themselves this time with their new breakfast sandwiches. It's just like your typical breakfast sandwich, sausage, egg, and cheese, or bacon, egg, and cheese, except the biscuit is made out of cauliflower and the whole sandwich has only two net carbs. That's two net carbs. And if you pop it in the microwave, it's ready in seconds. I'm not a big breakfast guy, because I don't like having to deal with big blood sugar spikes for a high carb breakfast. But when I'm really craving a breakfast sandwich, I grab a Real Good Food sandwich out of the freezer and hit the road without having to worry about a big spike in my blood sugar. Check out realgoodfoods.com to find them in a store near you or use code ROBHOW, that's me, to get a discount when you order the sandwiches online. I'm a big fan of brands who continue to support creators with diabetes and there has been no bigger supporter of me and my friends in the diabetes community than Real Good Foods. If you haven't checked them out yet, give them a shot and let me know what you think. And now let's get back to the episode. great hello and welcome back to another episode of diabetics doing things we're telling the amazing stories of people with diabetes from all across the world and my very special guest who is currently in the united states but is from a place a little bit further away henrik bergren thank you for

[00:03:09] Henrik Berggren: thank you for joining the show my friend thank you for having me rob we're really excited about

[00:03:14] Rob Howe: this conversation today i am as well so this is part of our founders series and you are currently the CEO of Steady Health, which I really want to dig into and talk about later on down the line. But also one of the reasons that you're on this podcast is because you live with type 1 diabetes. So why don't you tell us a little bit about yourself, where you're from, and how you came

[00:03:35] Henrik Berggren: into this diabetes family? Sure, happy to. Yeah, I currently live in San Francisco, California. I've been here for about six years now, but I'm originally from Sweden, so quite far away from where I am today, and turning 40 in two weeks, I think. Oh, wow.

[00:04:01] Rob Howe: Congratulations.

[00:04:02] Henrik Berggren: Yeah, thank you. And been type 1 diabetic for 20 years this year. I was diagnosed when I was just about to turn 20 back in my home country of Sweden when I was doing military service. Back then, 20 years ago in Sweden, it was still mandatory to do military service before you kind of headed out and went about your ordinary career, so to say. And I was staffed in the Navy on one of the kind of big harbors on the East Coast in the south of Sweden. And my diagnosis story is pretty interesting. I had really been feeling pretty sick for a number of months. I thought I had some kind of extended cold or something like that. But all the signals are obviously really clear in retrospect. Going to the bathroom, I don't know, 10, 15 times a day, losing weight, pretty disoriented. But when I finally came to the Navy, and I'd actually be feeling that even before I went to the Navy, then when I was finally there things actually got a little bit better I think it was because we got you know regular exercise and structured meal times and and and all of those things but I mean I was still not doing great so I think after a couple of weeks you do kind of a routine health checkup to make sure that everybody's healthy going into the program and I imagine And they do one at the end of the program, too, to make sure that nothing has happened while you were there. And, yeah, it was pretty obvious. The doctor just pricked my finger. And I think my blood sugar levels were way above normal. And what happened from there was I don't remember much. I was pretty traumatic. I think they immediately kind of pulled me out of the program. and you're not allowed to be in the Navy when you have a chronic disease that requires medication that you can't be without. So they kind of, yeah, canceled everything right away and I got admitted to the hospital and got put on training for insulin and measuring blood sugar and things like that. And a few weeks later, I was back at my parents' house with no plan. I had this I had this, you know, I was going to be in the Navy for about, I think, 18 months or so, had that all planned out. So I had no kind of backup plan whatsoever. So I was just there kind of on my own, which is, yeah, I remember it was pretty traumatic to this day.

[00:07:15] Rob Howe: Yeah, it seems like that's a pretty big life shift that happened relatively quickly, right? So, you know, you have these plans, you, you know, have a certain amount of time that you're going to apply to something. And I feel like, you know, you give yourself that time to sort of figure it out. So what do you remember about those first few months, even years, living with diabetes and the adjustment that it had on your life? Do you feel like you were set up pretty well for success based on from diagnosis and from the doctors and some of the training and education that you got? Or was it a little bit of a struggle?

[00:07:50] Henrik Berggren: I think it's probably a little bit of both. On the good side, I come from a country where we have a very good and well-run healthcare system that is free for everybody that is born and living in Sweden. So, you know, everything from being in the hospital to getting put on insulin and supplies and things like that were all free, which is, you know, I know not the case for many, many patients around the world. So not, you know, just having that puts me in a category of very, very fortunate people. But I would say it was also very challenging. I found just understanding my own body, understanding the disease and how it affected me to be very difficult. You know, kind of understand it's, I mean, as most people know, it's a disease that is, it requires so much analytical thinking and math. And I think I was just not at a place where I could actually take that in and kind of understand it at a deep level for many, many, many years after. And I think it's also very lonely. You know, I didn't have any friends with diabetes. There were no history in my family. The prevalence of type 2 diabetes in Sweden is not very large. So the kind of understanding and depth of understanding of the disease in general was very limited, not only for me, but also for the people around me, which made things challenging. And I do think that, you know, the healthcare system provided a lot of value when it comes to education and, yeah, just education and so on around it. But, yeah, it was definitely very challenging.

[00:09:58] Rob Howe: And yeah, I mean, I think it's interesting the differences in awareness and community, you know, from two countries that are obviously a long way away, but in some ways, very similar, and in other ways, extremely different. um you know obviously in in the united states type 2 diabetes is much more prevalent which from an awareness standpoint means that most people have heard of diabetes did you find that it was difficult to explain uh yourself to to people or people were asking invasive questions or it was um you know just difficult to adjust to a normal life with diabetes in sweden yeah for sure

[00:10:36] Henrik Berggren: I think most people had a very cursory understanding of what the disease meant. I actually remember one of the horror stories where, you know, I was 20 years old and was looking forward to a life where I could spend time with friends and go out on the weekends and have a few drinks and so on. And I remember one of the nurses from, I think it was the hospital where I was first diagnosed, close to the naval base. She said, well, you can forget about alcohol for the rest of your life or something like that. And I remember it just like kind of completely broke me down. I was like, oh, wow, like it's my life now. It's going to be extremely, you know, boring. and just like do I have to kind of just stay at home and not do anything that kind of my friends are doing? And it would be hard to spend time with them. So I think the overall educational level or kind of understanding the disease for people that didn't have it was extremely low. And I think that can be partly explained by, you know, the low prevalence in the Nordic countries, definitely in type 2 diabetes. annually. It's a small country to start with. So regardless how you cut the numbers, there's just not going to be as many people that have it, right? You know, it's funny that actually,

[00:12:01] Rob Howe: my doctors told me the exact same thing when I was diagnosed at 16. They were like, well, you know, if you drink alcohol or you do any kind of recreational drugs, you'll die. And I remember, you know, my friends still tease me about that today because like I told them that because that's what the doctor told me. And obviously, you know, when you're 20 years old or 16 years old, those things are much more important than they end up being later on in life. But they just seem like such big moments, you know, at that time. Yeah, it's kind of like one part of like painting

[00:12:32] Henrik Berggren: a picture of what your life is going to be. Right. And, and you, you, you end up anchoring on this kind of like very, very kind of dramatic truths that, that, and these people probably didn't think a lot about it when they said it, right? They were just like, oh, like, you should probably stay away from this. But yeah, it ends up being having a very, a very large effect on, on, on, on the person who is newly diagnosed. So yeah, and that's, I, I, that was very painful.

[00:13:04] Rob Howe: That's one of the interesting things to me about diabetes care as well. And we can get into this a little bit more when we talk about steady health, but there's so much nuance in a, in care of a life with diabetes. There's so many, because there's so many factors and variables, it's very difficult to have like hard, fast systems where, you know, clear and clear lines where you do this or don't do this. There's often a lot of gray area. And obviously like drinking is one of those where, you know, it's technically safe to drink, but obviously need to be careful and, you know, consume in moderation. But for a doctor, maybe the easiest thing for them to do is say, hey, we don't have to worry about this if you don't do it.

[00:13:45] Henrik Berggren: Yeah, so much nuance. And I actually think what's fascinating about diabetes today is that for a long time, we haven't had the data to actually understand how nuanced some of these advice or food or exercise and medication that we're taking actually is for each and every individual. And I think we're actually in a very interesting position right now where over the next decade or five years to a decade, I think we're going to discover much more interesting facts about how different diabetes is affecting different types of people and individuals.

[00:14:30] Rob Howe: I totally agree. I often call this time that we live in as a diabetes renaissance, where we have technology, both on the care side with CGMs and insulin pumps and inhalable insulin and rapid acting insulins. And on the other side, we have social media technology and consumer technology, and the internet is connecting people in ways that it never has before. And so if you're diagnosed today, your experience is drastically different than someone who was diagnosed five years ago. And I think that will continue to, as we go through, I guess, Parkinson's law, right? Or is it Moore's law where, yeah, Moore's law where like computing power doubles every 18 months?

[00:15:14] Henrik Berggren: Yeah, Moore's law.

[00:15:15] Rob Howe: And so we're in that awesome stage, and that's applying to life with diabetes, which obviously is exciting for people like you and me. So let's talk a little bit. Let's shift. Let's go forward a little ways. You are a founder of companies. Where did your entrepreneurial spirit come from, and what do you credit that as you've started and exited companies over the years?

[00:15:43] Henrik Berggren: what do you think that that came from? Yeah, I mean, it's actually has a connection to my to my diagnosis story, because so I mean, maybe the backdrop is I've always been interested in computers. You know, I got my first computer when I was about 14, and just started to take it apart on a weekly basis. I think in the first six months of having having it, I think my parents had to get it in for repairs, I mean, three or four times where the guy in the store was just like, again, well, I have to like, you know, assemble it again because I had taken it completely apart. So I always been like a kind of a tinkerer and someone who likes to maybe not read manuals as much as try to do things on my own. um so after my stint in the navy was cut short and i was on my own at my parents house well what was i supposed to do well um this was in 1999 remember at the end of 1999 so for me it was like well i have my computer and there's this kind of revolution happening uh let me get into that and understand more about it. And I got really engaged in engineering and programming. And that's really how my career started. So in a way, I have my diabetes to thank for where I am today, in a way. So I really started kind of building web pages and websites for myself and for my friends and at that time. And I did so many of them so that there was kind of an agency company in Malmo, where I was living at the time, in the south of Sweden, who kind of found me online and offered me a job. And that was kind of my first foray into engineering kind of professionally, but also the kind of startup ecosystem. It was an agency, so it wasn't like a product company traditionally, but it was still kind of a part of the ecosystem. And I ended up working there for several years, kind of learning as I was going from some really good mentors that had degrees in computer science and so on. And I just was completely jumped in and was sort of, yeah, just completely dove into the whole kind of startup ecosystem that was very nascent in a small country of Sweden at that point in time. And I got so interested in it, so I set my sights on studying engineering on my own, which after I think a few years of working at a startup and another agency, I decided to move to Stockholm, which is the capital of Sweden, to attend the Royal Institute of Technology and study computer science. But yeah, so the diabetes kind of had kind of pushed me, pushed me definitely in, in, in that direction.

[00:19:20] Rob Howe: um isn't it crazy how sorry go ahead uh yeah i was just saying it's it's crazy and i and i can't wait to get to where we are today once we get through the you know the remainder of your story of how diabetes sort of set you on this path to you know and change your life and let you discover this you know passion that you may otherwise have not discovered as soon or maybe had to find a different way. And now you're in a position to, you know, apply, you know, your skills that you've acquired over the years and help people with diabetes. I'm really interested in touching on that. But later, we've obviously got some ground to cover before then. So you're in Stockholm. How did you, you know, what were the next number of years like and how did you end up, I guess, you know, a name that most people are familiar with? I know one of your companies was acquired by Dropbox. Talk a little bit about your transition maybe from there to the U.S.

[00:20:13] Henrik Berggren: Yeah, yeah. Definitely. So what kind of happened in studying engineering was that I had one other big interest, which was music. And so there was this one person I met in school while studying engineering that had exactly the two same interests, music and computers and engineering. This guy's name was Eric Wahlforss. And he's still one of my best friends today. But at that point, he had a crazy idea for starting a new music platform. And he was so sort of engaged in this idea, so he couldn't stop talking about it after we met for a coffee somewhere in Stockholm at that time. He was one year ahead of me in school, but convinced me to, without ever having to have visited Berlin, made me just pack up a bag a year later and move there to join his seven-person company, which was a company called SoundCloud, which is today one of the biggest music platforms in the world. um so i actually moved to berlin to become their first kind of product manager um to work with some of their um more technical sides and partners and integrations um and that was kind of my first real kind of startup job um uh and completely in in a new uh in a new environment that was that was very exciting. And this was around 2008, I think, around. So after working there for a number of years, I kind of decided, oh, well, you know, I've worked at a couple of startups now. And I, you know, I, I, I, this doesn't look that hard to do on your own. So I'm gonna, I'm gonna give it a shot. So from there, I actually stayed in Berlin and started my first own company, which was an e-book reading startup called Readmill, which was kind of same thesis as SoundCloud, but making kind of media more social. Instead of audio and music, we focused on e-books. And how do people kind of engage in e-books and discuss things that are in books, in the books themselves, kind of a public discourse in the margins, which we worked on for about three and a half years. It was a very difficult space, which I won't get into too many other details of. But one thing that was really interesting that happened is that we had developed some technology on mobile devices that caught the eye of a big American corporation called Dropbox. Dropbox was about 400 people at this time. This was in 2014. And we, after chatting with them for a while, we decided to fly over and meet some of their executive team. And they expressed interest of acquiring this little company that was now about 10 people. And it was definitely interesting kind of going through the entire process of finding them, getting to know them, but then also selling this small company that, you know, only had 10 people that most of the time didn't know what they were doing, myself included, and selling it to a kind of a larger American startup at the time and transitioning to the U.S. But we took a big bet to say, hey, this company seems good. We love the product. We love the people. So we decided to go for it. And the deal closed in just a few months. And all of a sudden, I woke up in San Francisco one kind of April morning in 2014. And all of a sudden, I was an American resident.

[00:24:35] Rob Howe: It's amazing how fast things can change. That seems like a consistent theme in your life.

[00:24:41] Henrik Berggren: Yeah, I think I've always been in my, in like a very comfortable zone when there's a lot of change around me. And I think just that, you know, having moved to Berlin, which is, you know, much closer to my home country than San Francisco is, obviously. But culturally, actually quite different. You know, they speak a different language and so on. So in some way, America was closer. But so I felt I had some training already in getting in being in a new city, meeting new people and getting accustomed to a new way to do things. Yeah. And it was super interesting. And I think that the following three and a half years where I was working as a product management leader at Dropbox was some of the most rewarding in my career this far. I think I just learned a lot, met a lot of great people and looked back at my experience with my first company, kind of understanding, oh, these are actually the things that we didn't do as well. And here are some of the things that we did really well. And that helped me kind of navigate and learn a lot from both experiences. So that was extremely fascinating and, yeah, tremendous experience that I'm thankful for the Dropbox team till this day.

[00:26:18] Rob Howe: So let's talk a little bit about after your time at Dropbox ended. I remember reading in another interview that you did earlier last year with Healthline, so in 2019 with Healthline. Um, you mentioned that you knew that you wanted to take a little time off and in that space that you created for yourself during that time, you took a deeper look at your diabetes management. So really over your first, uh, honestly, what, 18 years of diabetes, not much had changed about your day-to-day management and you discovered CGM. So talk a little bit about what that journey was like for you and what light bulbs that maybe came on allowed to turn on for you in your diabetes treatment? Yeah, I think 2017 was a

[00:27:05] Henrik Berggren: year where diabetes really kind of re-entered my life in a big way. And I was actually in for a change that I did not know was humanly possible. If you look at my diabetes over my first 17 years, You know, I've been managing it pretty well. I'm a pretty active person. I am somewhat OCD, so I'm very good about taking my medication and making sure that I stick to a fairly healthy diet and all of those things. So I've been doing, I would say, okay for the first 17 years. I think my A1C was always hovering around seven. So it was every time I was at my endocrinologist, they said, you know, you're doing fine. You can always do a little bit better, but you're okay. So I was never really motivated to do that much better. And to be honest, I actually didn't check my blood sugar very often. I always found finger-picking to be the worst part of diabetes because it wasn't so much that it was just painful to do. It was also that when you got the results, I didn't get smarter about what was happening. I actually just got more confused. I could not understand the cause of effect and the the the the the sort of connection between cause and effect for food exercise or medication or anything like that I found it extremely hard to to actually iterate and learn from from my own behaviors so in 2017 I had a bunch of friends are telling me oh you have to try this thing cgm uh the FreeStyle Libre was not available in the U.S. but they were all in europe and they were sending it to me and saying hey we we're using this and it's really it's really amazing you should really try it so when i was visiting family in stockholm i i i decided to just go to the pharmacy and and buy a few um you actually donate a prescription in europe for this uh you can just buy them over the counter so i thought But yeah, I'll just do that. And what happened after that was just insane. You know, as a product manager, the thing that we typically do is we look at a feedback loop and we try to learn from it. We say, hey, we run an experiment. We look at some data. And then we say, okay, did it go the way we wanted it to? Or did something else happen? What can we learn from that? And then we change our test a little bit and we try again. And that was exactly what happened to me with the CGM. All of a sudden, I had this feedback loop in front of me that I could use as a tool to learn from my own behaviors. So the next five months was a whirlwind of learning. And I realized that there were so many things about my own diabetes and myself that I just didn't understand. Things like food or things like exercise that I was doing. I'll give you one example that I think paints the picture pretty clearly. Sure. I play basketball every Monday. And for years, my doctor had been telling me, when you play basketball, make sure to go down in insulin before you play so that you don't end up low. Because when you exercise, your body is going to be more responsive to the insulin. but when I looked at the data every Monday after practice I saw my blood sugar go straight up not down like she said it would so I was confused by that and I said what's going on here so I went back to my normal dose and and and stopped kind of taking the dose down but it still went up and I I was just like how is this even possible like what's going on so I started kind of googling and trying to understand and my hypothesis quickly became that you know i'm so bad at basketball i am a not very tall skinny uh swedish guy uh that plays with uh you know uh some american uh guys that that played in college so all of the stress from being really bad at something i think just caused my insulin resistance to be bigger. So I started actually increasing my dose playing basketball instead of taking it down. And that actually helped me completely eradicate the highs that I was getting from the game. So today I can play basketball almost without getting any type of elevated sugar levels. And that was just so different from everything that I have learned over the past, you know, five years or so. So I started questioning everything that endocrinologists and doctors and even things that I've been reading, you know, online and so on. That was just one example, but there was like four or five of those things that I think I just learned was completely different for me as an individual.

[00:32:37] Rob Howe: and that's a really interesting story i think you know for me as an athlete like playing basketball is has always generated a lot of stress and a lot of cortisol and adrenaline even even when i play not in a serious level so that story is exactly the same for me like every time i go play basketball my blood sugar spikes a little bit so i got to increase uh my basal or give myself a little bit of a bolus before. And now I always wondered when I played, cause I would take off my pump and I didn't wear a CGM before 2017. And I would always wonder what happened to my sugars during the game. Like I knew they were high after, but I didn't really know what was going on. So being able to see that chart and be able to see the adjustments that were being made, you know, by my pump, now that I'm able to wear a CGM and my pump at the same time, and they are connected via the hybrid closed loop so my body my pump can make the adjustments for me while i'm playing depending on how high i'm going uh and now my results are so much better and i'm able to look at you know historical data and make inferences based on that whereas in the past i was just guessing or getting

[00:33:43] Henrik Berggren: frustrated by lack of information yeah i mean i that that that's that's exactly the kind of frame of thinking that i had as well like how do i use the the the the kind of learnings from from um from previous times when i've done the same activity or eating the same food and how do i use that to get smarter about next time that i'm doing it and what i realized is you know we a lot of us are creatures of habit not only talking about people living with diabetes but actually humans in general so there's a lot of things that are recurring in our lives so if you can't really learn how to um how to handle those recurring events i think that the amount of time that you have to spend thinking about your diabetes goes down as well as uh the times when uh when when those events drive your blood sugar extremely high or extremely low so there's like benefit there's almost like double benefit to really kind of understand those recurring events in your life.

[00:34:51] Rob Howe: So talk a little bit about how you took those insights, which I think, you know, for many people, I think are super relatable. Because when we put a CGM on, we start to learn like how our body responds to things, we begin to look at things a little bit differently. Talk about how you took that experience and got us to where we are today, being the CEO of Steady Health. And And how does Steady Health use CGM and CGM data to help people with diabetes?

[00:35:19] Henrik Berggren: Yeah, yeah. So what happened over those five months was just incredible. I lowered my A1C. I think the first time I checked after a couple of months was 5.7. I was sleeping better. My mood was better. My energy was better. I had gone down in insulin dose with about 60%. So I was just like, wow, this is incredible. How can I get to these results? And how come nobody from the healthcare system has actually told me that this is even possible? So I went to my endocrinologist and I showed her all of my progress and here's what I've done and here are the results and here's what I've learned. But I also had a long list of questions, like the basketball one, for example, where I actually didn't really know what was going on. I needed it to be explained to me. And what happened, I think, is what I've learned now is a pretty standard occurrence where I laid it out all on the table for her. And she kind of just pushed her chair away and just said, whoa, I really can't help you with this. uh this is kind of complicated um i i i yeah i don't have access to this data somehow and i yeah it's it's it's like i don't have time to kind of go through this in this much detail and that was really one of those moments where i just felt hmm i don't think that this is the way it's supposed to be and bear in mind i'm in san francisco like the i mean one of the uh uh one i I mean, the tech city in the U.S., right? And one of the major metropolitan hubs in the country. So I just felt, okay, if I can't get this care, like what does it look like in the rest of the country? So I started making phone calls to patients, to CDEs, to doctors, trying to understand to what degree are providers actually using the data and how are they helping the patients actually get to better management with it. And what I realized was most of the work was done by patients themselves. There are some superstar doctors around the country for sure, and they're doing an amazing job, but the kind of average provider doesn't actually know that much about delivering this new data-driven and personalized care. And it's actually not so much their fault. I think there's several things at play here. And the three core problems that I discovered were the training for doctors is not really that up-to-date. Diabetes is a completely different disease today than when it was only 10 years ago, and the training hasn't actually adapted that much. I think the tooling that they have at their disposal is still pretty rudimentary. They usually look at blood glucose data, but not so much at food, exercise, and medication, which are key inputs to the function. Otherwise, you cannot give advice on what to change. And thirdly, I think because of how insurance is set up, we also have very little time as providers to spend with patients in the first place, which doesn't allow us to actually go to the deep insights in the way that we need to, to actually make progress. So with those three things, I was like, there needs to be a better way here. So I was on a sabbatical and was thinking about, like, what should my next company be? What should I do with my life? And all of a sudden, I had these kind of problems in front of me. So I was like, wow, okay, I should probably do something about this. And that's kind of how Steady Health got started. And the easiest way, I think, to describe Steady and where we are today is essentially to say that we are a typical endocrinology practice that gives people with diabetes help with everything they need in management of their disease, everything from prescriptions, labs, referrals, data analysis, all of those things. But we're focused on doing two things very differently. The first one, we're exclusively working with patients on CGM. We believe that to be a step function in the way we can understand the disease better. So that gives us a much better 360 view of the patient. We can give them much more precise advice and keep track of them and their outcomes in a much more detailed way than we can with traditional blood glucose meters. So that's one. And the second one, we do all of our work virtually or remotely. So we are a pure telemedicine-based clinic that are able to give patients this type of care over video and over chat to give access to high quality endocrinology services regardless of where you live. Those are kind of the two big differences in how we operate

[00:40:56] Rob Howe: as a practice. And that's incredible. I mean, I think, you know, as we look at the future of healthcare, like obviously, especially in the United States, the health system does not necessarily always allow for providers to spend the time necessary to help patients with diabetes, and they just may not have the resources, and it's largely determined by geographics and demographics. What is your, as you look at now being a little bit over a year, I think, based on or maybe two years of the company, like what kind of results are you guys seeing from patient populations and from customer feedback that you're able to maybe share with us?

[00:41:38] Henrik Berggren: Yeah. Yeah, it's actually been fascinating just how badly, like, this new type of care is needed. I mean, some of the feedback that we're seeing has been extremely, extremely positive. I've actually been surprised by how kind of like sought after something like this has been. I think diabetes today is a disease that can really be helped by technology, but it requires the providers to really understand that technology and how to use it and kind of be able to explain how it can be used in the best way possible and kind of guide the patients through the relationship with the technology so that on the spectrum of, you know, oh, I've just connected this technology. It's going to do everything for me up until like, oh, it's just a tool that can be used to improve management to kind of strike the balance between the two. You know, we've had people come in and we take people through this kind of tracking period where for one week they, you know, they share things around food, exercise and medication with us alongside with their blood glucose. And we provide them with a glycemic report that gives them some highlights and lowlights around, you know, here are some things that are driving you high or low. And here are some of the some of the meals that are really working well for you when it comes to your regimen. and some of the quotes that we've heard from that it's just like I learned more in this one-hour appointment that I've done as a 30 than I've done in my 30 year 30 years as living with diabetes or somebody somebody said oh it's like diabetes utopia which is pretty pretty strong pretty strong feedback but I think the the thing that most people are missing actually is that if you look at endocrinology care across the U.S. today, it's actually pretty surprising how spotty the coverage is. So I think only 25 percent of counties across the U.S. actually has an endocrinologist in them. And this represents, which means that 70 percent of the, 75 percent of the counties actually doesn't have an endocrinologist at all. And that represents about 22% of the US population. So think about it, 22% of people living with diabetes in the country doesn't have access to an endocrinologist where they live. They have to drive maybe an hour, maybe sometimes two, three hours to get access to great care. And that leads to, you know, them having to go to a primary care physician or some other type of doctor that maybe isn't as well trained in software, in medications, in types of technology that's being used. And that can really lead to suboptimal outcomes for those people. So that's kind of one of the problems that we're trying to solve here. Wow. I mean, that's one of the things

[00:45:02] Rob Howe: I think that keeps me up at night when I look at the diabetes online community. I mean, this is strictly from a social media and sort of marketing perspective. But JDRF reports that there's 1.25 million people in the U.S. with type 1 diabetes. I would guess that that number is closer to 1.5 million based on the data that we're, or the year that data set came from. But when I look at the amount of people who are involved in events and social media and just the general conversation, it's much lower than that. I would say probably only about 10%, maybe about 125 to 150,000 people. And so I wonder where are those 90%, like that silent majority and how can we reach them? And so that insight you were saying about only 25% of the counties in the U.S. have an endocrinologist, wow, just really rings true and hits home for me because that just means that there's 75% of the population, like you said, 22% of the U.S. population with diabetes that don't have access to an endocrinologist, which is just incredible.

[00:46:04] Henrik Berggren: Yeah, and I think that was actually shocking to me when we saw those statistics in the first place. So I do think that the kind of big innovation here is actually not ours. It's the ability to deliver medical care over telemedicine. or using technology. And I think that's going to serve people with diabetes extremely well in the

[00:46:34] Rob Howe: next, you know, five to 10 years. Definitely. So the big question I've got to ask now is for people who are listening, like, wow, this sounds great. Do you guys take insurance? How does the pay, the patient pay your pay relationship work? And, you know, also would steady health be able to

[00:46:55] Henrik Berggren: function as a full-time endocrinologist? Yeah, good questions. Yeah, so we function as a very similar to a primary care provider that exists mostly in California. They're called One Medical. And if you haven't heard about them, I'll explain to you basically there are kind of two parts to our practice. The first one is a membership fee, which currently is $60 a month, which is completely out of pocket. So not covered by insurance at all. But then all of our visits with our endocrinologist that we recommend you do around three to four times a year, so very similar to what most people with diabetes are probably doing today, are covered by insurance. So you only co-pay for those visits that are done all over video. But for the membership fee, you pay completely out of pocket. So it's definitely more expensive than what diabetes care looks like, the type of care that you get today at your local hospital. But obviously, this is just a starting point for us. Our goal is to make Steady available to as many people as possible. And to do that, we obviously know that the price has to go down over time. So one of the big initiatives that we're working on is working together with insurance companies to try and move as many dollars as possible from this out-of-pocket monthly subscription fee to their insurance. Now, this is going to be one of the kind of long polls that we're doing. And it's going to take us some time to, you know, get coverage all over the U.S. and so on. But it is something that we, you know, it's top of mind for us and we're definitely working on. And when it comes to being your kind of primary endocrinologist, we have kind of an interesting model, I would say. Now, you know, since we're a completely virtual practice, we obviously can't see you in person. So and it's very important for every person that lives with this disease to get a physical every year. And we recognize that. We think that's still as important as as it's always been. So we partner with primary care providers to do this specific part of the care. And we have developed some kind of software and also some educational material to partner with primary care physicians in a really good way. And we actually believe that primary care is probably very well positioned to do this type of work. They have lots more clinics, lots more physicians. you can probably get an appointment with them way quicker than you can with your endocrinologist. So hopefully that should actually be much easier for the patient and much faster and maybe even cheaper as well. And we provide them with, yeah, as I said, educational material and so on to really make sure that that's good. Absolutely. And I mean, obviously,

[00:50:24] Rob Howe: it's a journey and you guys are, you know, working and tackling one thing at a time. And I think it's pretty inspiring to see how, you know, really primary care can be a catalyst for better endocrinology care across the U.S. Obviously, there's a lot of, you know, in an election year, a lot of things up in the air about, you know, the future of the health system and what that looks like in the U.S. But very cool to see people with diabetes leading the charge on the tech side of getting access to better diabetes care to more people. I've got a question for you, and we chatted a little bit about this beforehand, but you've now been the leader of a number of companies, but this one obviously has a different focus. So how is being the CEO of a diabetes tech company different than some of your previous ventures?

[00:51:14] Henrik Berggren: Yeah, I actually had some... I actually thought about it pretty deeply before I did it. Because one of the things I was afraid of was that, you know, diabetes is already a very big part of my life. I mean, I think about it several times every single day. So I didn't actually, I wasn't 100% sure that I was ready to also devote my time in developing software and building a team and, you know, providing a service. And that was now also going to be around diabetes. So it was kind of like my entire life now kind of rotates around my own disease. But I decided that, you know, I'm also in a position where I know the disease better than most people since I've been living with it for 20 years. So that puts me in a position that is probably quite good for actually making a difference. So I did decide that it's probably worth it. But I also knew that there was some risk going in. But I think it's been incredibly rewarding. And I think just the fact that when people come to study as a practice and they realize that this is actually built by people that live with the disease themselves, that gives it a certain authenticity and trust that I hadn't actually envisioned being such a big deal. a lot of people we talk to say oh I went to the website and it looked really good it looked what I was looking for like it was it was it was going to be a good fit for me but the thing that pushed me over the the the edge was reading about your story and reading about I know the fact that you are living with the disease yourself and that made me understand that like you guys knows know what it's all about. So that's really been kind of an interesting and I think rewarding experience. Now, it can get overwhelming at times. Sometimes it's just like, oh, wow, like everything in my life is around this disease and we all need a break. And I think it's good to be open and transparent about those breaks and actually take them and not be sort of like, you know, feel guilty for needing those kinds of breaks. Um, so, so, um, that's, that is a, is a part of my life that I also have to be careful about protecting. I mean, the, the, the, the times when I do not have to think about it. Um, so there are definitely a lot of benefits, but also some

[00:54:16] Rob Howe: downsides. Definitely. I mean, that's something I really relate to, um, in my life as well, because I live with diabetes. You and I are on a podcast right now talking about diabetes and diabetes companies and patients. And then I have Diabetes Instagram, and there's just a lot of other, you know, my personal care comes into that. And so, you know, finding that balance and making sure that I, you know, whatever new projects I take on, I make sure to keep my own health and relationship with positive relationship with diabetes in the front of my mind with that. So always an interesting balance. And I think especially for founders, you know, when you're working to deliver a product for people with diabetes, but also manage your own diabetes and kind of be a difficult, you know, line to toe. So, Henrik, I really appreciate you taking the time to come on the show today. You are, this story is so interesting. I think like I've had to check myself from continuing to go down like a rabbit hole of amazing questions about your experience. For people who want to learn more about Steady Health, where would you direct them to go?

[00:55:26] Henrik Berggren: Yeah, best place is just to go to our website. It's just steady.health. So no.com or anything like that. It's just steady.health. You can find a lot more information about what we do, what it costs, and what's happening in the future with our service. So go check that out.

[00:55:49] Rob Howe: Well, we will definitely include a link to that in the show notes as well. And really looking forward to following you guys along your journey as well as you guys continue to innovate in the diabetes space. And I might have to give this a try. it's really appealing to me and obviously like managing the data is something that's been a big point of emphasis for me this year so looking forward to seeing how you guys continue to grow thanks again for listening please follow us on Instagram check out our sponsor Real Good Foods we're diabetics doing things on all the major platforms and we also are available on Spotify so if you prefer Spotify or your subscriber check it out I definitely have listened to more on Spotify in the recent years. They've got a lot of great podcasts and it's just super easy to shuffle from music to podcasts and back and forth. Leave us a review if you have a chance and tell a friend with diabetes about this podcast. That's the best endorsement and the best support that you can provide. Thanks so much and we'll see you next time.