Undermyfork, a Mobile App Success in Diabetes Management

Finding that sweet spot where your blood sugar isn’t too high or low is the golden ticket to excellent diabetes management. The reason it’s so tricky is that so many components affect control beyond insulin dosing. You must consider exercise, hormones, and stress—just to name a few.

As technology gets better, the task grows easier. With continuous glucose monitors and food logging apps like Undermyfork, finding the happy medium is not only possible—it’s much simpler.

Fortunately, researchers, scientists and innovators work daily to ease the burden. Type 1 Strong had the pleasure of conversing with Mike Ushakov, CEO and co-founder of Undermyfork, to discuss groundbreaking trends in diabetes management and the benefits of combining CGM data with food logging.

Type 1 Strong: Please tell us a little about yourself; how long have you been in the tech industry, and where do you live now?

Ushakov: I’m based in the Netherlands; I’ve worked in the tech industry for the last 20 years. Our team is in Europe and in the US. 

About Undermyfork – a Diabetes Food Diary Mobile App

The clinically validated app Undermyfork offers personal nutrition insights for better time in range by combining meal and insulin tracking with glucose data from CGM, FGM or BGM. The app connects to Dexcom CGM API, which allows users to stream data directly from their Dexcom cloud to the Undermyfork app. Best of all—it’s free.

Ushakov co-founded the popular app, which went live in 2018, with Eugene Molodkin and Nikita Shulaev. Ushakov previously partnered with Molodkin and Shulaev on a browser extension company called Metabar that helped shoppers find online deals. From there, the three developed Forksy, an AI-powered nutritionist, to help individuals log and track food. 

Type 1 Strong: You previously partnered with Molodkin and Shulaev in the consumer tech world, then moved to health tech. Was there a personal motivation to create Undermyfork, or did you simply see the need for users? 

Ushakov: We saw an unmet need for a simple app that helps people with diabetes understand the implications of what they eat on their blood glucose. We were very sure that if we do an app that will be easy enough to use for a non-tech-savvy person, it would lead to better clinical outcomes. With our first clinical data recently published, we proved to be right. 

Type 1 Strong: Can you elaborate on the motivation to make this app easy for users? You use a term called the 'grandmother test,' when a product can be easily accessed in several minutes by your 80-year-old grandmother. You applied this when researching diabetes food logging apps and found very few to be easy to navigate.

Ushakov: I personally believe that CGM tech would go far beyond several millions of users it has now. Eventually, it would substitute BGMs, though this will take time. We are talking about hundreds of millions of potential users for CGM devices. I think it is quite a paradox that there are not a lot of products in the diabetes space that are capable of serving an audience of this scale. That was one of the main reasons to build Undermyfork: create a CGM companion app that will be useful for any potential CGM user, no matter how proficient in tech they are. 

CGM & Time in Range

Undermyfork allows people with diabetes to track how specific meals affect their time in range. According to the Endocrine Society, time in range (TIR) means the percentage of time spent with your blood glucose level in the recommended target range. Figuring out your specific range is a job for you and your healthcare professional, as glucose goals vary for each person. 

Type 1 Strong: Undermyfork began with a team of engineers, developers, medical advisors, and legal counsel. How long did it take to find your team and get the app running? How many employees do you currently have?

Ushakov: We are a team of 10 people now. It took around nine months from the app idea to the first version, but it took three years more to get the first proof of improvements in clinical outcomes. 

Type 1 Strong: Undermyfork has received its CE Mark (Conformité Européene), representing its adherence to European safety, health and environmental protection standards. Was it hard to acquire the CE Mark? In the United States, apps don’t typically fall under the FDA’s jurisdiction. Did Undermyfork need to follow any additional guidelines or regulations for its U.S. launch?

Ushakov: It was quite a lot of work to acquire CE Mark, though we are a low-risk product. We have to put a quality management system in place, formalize some procedures, and train our team to comply with relevant requirements – steps that are quite unusual for an early-stage startup to take. As for the FDA, we are still considering our strategy in the regulatory space, stay tuned for the news. 

Type 1 Strong: With all the food logging apps on the market, what makes Undermyfork unique? You've called it ‘Google Analytics for blood sugar.’ Can you please expound on Undermyfork’s vision and mission?

Ushakov: We don’t see a lot of food-logging apps that use CGM data as a primary data stream and are clinically valid, so it is hard to draw comparisons. I see our mission in unlocking the full potential of CGM devices, adding more use-cases of CGMs, building the best-in-class CGM companion app in the world – and by doing so, helping tens/hundreds of millions of people with diabetes improve their clinical outcomes and live better lives.

Undermyfork completed a pilot study in 2022 and presented its results at the scientific sessions of the Diabetes Technology Meeting, proving the app improved users’ TIR. The team had recently published a research article through the European Society of Medicine on the “Effect of Mobile-Based Application Usage on Time in Range and Time above Range in Patients with Diabetes Mellitus: A Pilot Cohort Retrospective Study.” The study concluded that an application assisting in self-management through CGM monitoring may help reduce glycemic variability and help people with diabetes reach glucose targets. The app’s meal photo collection and postprandial CGM data monitoring positively impact blood glucose stability. After a 14-day application, users demonstrated significant improvements for time in range and time above range.   

Type 1 Strong: This research paper is an exciting contribution to the diabetes world and to you and your team personally. How has it legitimized the app? 

Ushakov: This is a crucial step for us on our way for building not just a B2C app but a real digital health product. But it is also just a first step: it is a first pilot study, and our plan for the upcoming years is to collect more reliable data to get more support of our clinical validity. 

How Undermyfork Works

After downloading the app, users are asked which type of diabetes they have and how they track their blood glucose, with a list of CGMs and blood glucose meters for possible pairing options. Next, it asks for the users’ target blood sugar unit range, followed by the request to auto-sync your blood glucose data from your iPhone Health or Android. 

Users then log meals by snapping a quick reminder photo and assigning tags (breakfast, lunch, dinner or snack.) You can also add a description of the carbohydrate count and your blood glucose.

Undermyfork allows users to watch the correlation between their food and blood glucose data. If you’re wondering how that slice of pepperoni pizza affected your blood sugar or what happened after your last late-night snack, simply pull up the data. The photo-based food logging might appeal to Snapchatters and TikTok users, who already take pics of their dishes for Instagram.

Type 1 Strong: Uploading photos saves time for sure. How did you connect the idea of food logging with snapping pictures? And how does that visual help users?

Ushakov: As people tend not to use complicated products, we wanted to make the barrier to entry as low as possible, so meal photos as a data source just naturally came up. Didn’t you ever take a pic of your lunch salad for your Instagram? 

Adding Additional Insight

The app also allows users to add data like pre-meal glucose levels or how much insulin they dose with certain foods. The app’s Insights mark meals by colors (green, amber or red). The color relates to the percentage of time your blood sugar is kept in its target range after eating. Later, when you sit to analyze how your food affected your diabetes management, you can sort your entries by color and see which ones gave you good TIR scores and which didn’t. With the app, one can quickly determine what foods trigger high blood sugar levels or, in some cases, which foods require less insulin than expected.

Type 1 Strong: How does the color-coding help users eliminate bad food choices? Should all red meals be avoided?

Ushakov: Not really! Color-coding helps to visually classify your meals by postprandial time in range, but then you make your own choices about what to avoid - based on all meal context (as you see, in Undermyfork, you can also add bolus insulin data, physical activity data, even manually enter carbs – all this information layers help you later make informed choices on your meals.

Undermyfork Care

Users can also invite a doctor or another caregiver to access their data from Undermyfork on the Undermyfork Care portal. Doctors and healthcare teams will see trends and dashboards helping them quickly grasp what affected patients’ glucose management in the weeks and months between appointments and address the challenges.

Type 1 Strong: How soon after the app’s creation did you improve it with the Undermyfork Care aspect? Has the feedback been well received?

Ushakov: We always intended to have an interface for HCPs, but it took a year since launching the app to build Undermyfork Care. 

Type 1 Strong: On the app, it says, “Your data will be used to improve your experience and the performance of the app,” How does it improve the app’s performance? 

Ushakov: We are a tech startup, and if you put a new technology on the market, you basically launch a newly built rocket in open space. Sometimes, you can predict what would happen to your rocket in open space, but sometimes, it might go in an unexpected direction, and you have to have enough input to fix your rocket while it is still moving toward the stars :-). And with some users having thousands of meals logged in Undermyfork, we face new challenges that require new tech steps from us: this is a never-ending work. 

Type 1 Strong: It must feel rewarding to hear how users enjoy the app and how it’s helped.

Ushakov: It is indeed really rewarding. Every several days, we receive a user’s email with gratitude that warms the hearts of all our team members. I never experienced something like that in my twenty-year career in the tech industry. 

Type 1 Diabetes and Food Logging: Why It’s So Important

Watching trends and monitoring your levels may seem like an onerous step to glucose management you can skip. However, tracking blood glucose is essential to good diabetes care. It allows doctors insight into patterns throughout the day and night, where your blood sugar rises and falls. Using food logging apps will actually save you time and benefit your health in the long run.

Type 1 Strong appreciates those who devote their time, resources, and ingenuity to help T1Ds lead productive, rewarding lives—bringing us one step closer to finding a cure.