The following post was published on July 29, 2015 by our friends at Twine Health.  It is the story told personally by our founder, Andy Palmer, about using Twine Health’s Collaborative Care Platform to confront successfully a diabetes diagnosis . 

By Andy Palmer

As a mission-driven entrepreneur and angel investor I am always trying to use the products of the companies I work with and their advice. I hadn’t anticipated getting diabetes when I first started working with John Moore and Frank Moss as they started Twine Health, but last Spring I had a unique opportunity to become a user of Twine and it literally saved my life.

Diabetes is a huge problem as we all know – there are an estimated 350 million people living with this condition globally and every 7 seconds one person dies as a result of it.

In mid-February of this year my son, Jonah, convinced me to stop drinking diet coke. I had a serious habit of drinking 2+ liters per day. The first week after Jonah and I stopped drinking diet coke I felt like I was losing weight. I started measuring my weight daily and was consistently losing about 1 lb every 2 – 3 days. Over the course of 8 weeks, I had lost 30 lbs and remarkably hadn’t changed my eating habits AT ALL. I was eating anything I wanted in any quantity I craved. I figured that the stars had aligned – similar to my friends with high metabolism, I could finally indulge my love for food without consequence. (I know, right?!)

In April, I was in DC visiting my buddies Peter Barris and Harry Weller at New Enterprise Associates and wasn’t feeling quite right. My wife, Amy, suggested my unease might be related to blood sugar and recommended I pick up a glucometer just to check my level. First reading: 430. OK, so what is normal? I started searching online and turns out normal is 100! Alright, so now I have my first indication that something is rotten. I make a quick call to my primary care physician (PCP) and she tells me I need to go to the Emergency Room (ER) immediately, so of course I got on a plane and flew back to Boston. 🙂 Amy insisted I go to the ER at Mt. Auburn Hospital. I was admitted and they did their usual blood work. A great nurse explained to me that taking my blood sugar was necessary but that the doctors would really be interested in seeing my A1c results. The A1c test is a blood test doctors use to determine how your blood sugar has been averaging over the past two to three months.


The next day I visit my PCP and turns out my A1c is 13.1. So, next question “is that bad?” Turns out the answer is a clear “yes” since normal is between 4-6. To make matters more interesting, A1c is not the kind of thing that changes overnight. It takes most people a year or more to get to normal.

I scramble around to figure out what it means to try to “fix” my diabetes. I call my daughter-in-law who has a PhD in nursing education focused on diabetes management and she runs through what I can and can’t eat.

I’m now a great potential user of Twine, so I give John a call and ask “can you get me set-up”?


First step – Karen, a health coach. She asks me what kinds of things I want to work on and puts a plan into Twine for me. Seems kind of basic to improve diet and exercising, almost superficial. But I figure that it is a cool interface to keep track of my blood sugar readings, so why not?

Karen starts messaging me few times a day. She is asking me what I’m eating and commenting on my reading. It was really weird but just knowing that someone was watching my readings gave me a powerful sense of obligation. Karen cared enough to ping me all the time and breaking my diet or not exercising became an act of letting her down, I didn’t want to do that. I also found that my wife, Amy, was always asking me about my Twine readings.

After a few weeks of controlling my diet, my blood sugar had gotten under 200. That was enough to stop feeling sorry for myself and hit the gym. Unbelievable what exercise can do – my blood sugar dropped under 100 for the first time in probably 4-5 months. Karen reminded me it was diet and exercise and ME, not rocket science. OK, I need to get to the gym more often – got it.


A month in, I go back to my PCP and my A1c is down to 10.1! Solid change and I’m psyched but I still have a long way to go.

Karen says that it is easier to get to the first change. It gets harder as you go along, so I set my expectations appropriately. She still messages me 2-3 times/day. It is really amazing that she cares so much and is so close to my daily readings (vs. my PCP who really just wants me to come back every month to check my A1c and tell me to diet and exercise).

June rolls along and I’m still working on it, now I’m in the low 100’s on a regular basis. My Board of Director at Tamr wants us to get life insurance, meaning a physical and blood work. My A1c is down to 8.0! Holy cow! Amazingly, the insurance company still wants to charge me an excessive amount for coverage because their rule is ridiculous premiums for anyone with an A1c greater than 6. This seems incredible given how much I am improving. I’m reminded of the commercials for auto insurance “someone like me is NOT me” – I’m going to kick my diabetes to the curb with Karen on my side.

Andy's Blood Sugar Chart


I double my efforts on diet as we head into July. My blood sugar readings are in the low 100s most of the time with occasional values below 100 and some popping up above 150.

I visit my PCP in July not expecting my A1c to be much different from the 8.0 last month. Results come back and I am at a 6.1! Incredible. It has been less than 4 months and I’ve gotten my A1c from 13.1 to normal! The doctor tells me that is in a third of the time that she expected, this was supposed to take a year if I did everything right. Yes, I am a type A personality. Yes, I did put a lot of effort in. More than anything, what worked was knowing that Karen was watching me. She kept me honest with myself every day. I can’t imagine having done this without Twine Health and specially, without Karen.

It is clear to me that my investment and commitment to help John and Frank build Twine was a good choice. On average, those diagnosed with diabetes have health care costs 2.3 times higher than those without diabetes. Care for people with diabetes accounts for more than 1 in 5 health care dollars. If even a small fraction of diabetics are able to do what I’ve been able to do with Twine, we would save billions.

Collaborative care works. Changing habits depends greatly on being held accountable every day for your behavior by a small number of people in your life that care about you – your coach, spouse, significant other, or child. At its core, Twine is a tool to facilitate accountability for your behavior. It worked for me and I know it can work for many others.

This entry was posted in Uncategorized. Bookmark the permalink.


  1. Pingback: Twine Health acquired by Fitbit |

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s