Levels: glucose monitoring, wearable injectors and product testing

In this episode David Flinner, co-founder at Levels joins Mary Borysova on the Health Tech Matters podcast to discuss how Levels is expanding access to continuous glucose monitoring and helping people find their optimal diet and improve their metabolic health.

How David discovered Levels

While working at Google David started to search for insights into his own brain fog and low energy before a well timed meeting with Sam Corcos and an introduction to Levels.

there’s so much untapped need in human health and Google’s really well position with their massive scale to crunch the numbers and gain insights through big data and whatnot. At the same time in my personal life, I was feeling a lot more brain fog, lower energy. I didn’t really know what was going on and I didn’t know much about metabolism, but I’d heard that maybe my metabolism is slowing down, whatever that means. Somehow I heard about glucose monitoring and I was doing a Google search for it. Maybe I can monitor my glucose to see if my metabolism is slowing down. I quickly hit some roadblocks, in the United States, continuous glucose monitors they require prescription. Historically you can only get prescribed them if you’re actively managing Type 1 or Type 2 diabetes. I just stopped there, but it turned out that 12 hours later, my friend Sam Corcos was coming to visit San Francisco and he had asked to stay in our guest room. I hadn’t seen him for a long time. I didn’t know what he was up to. It was just literally this coincidence where he arrived, we caught up and what he was starting with Josh was exactly this company that was meeting the need that I had hit on my own in my research for glucose monitoring.

The value of an unusually high number of co-founders

Most startups might have one or two co-founders, Levels has 5 but they all bring specific expertise to help complete the puzzle.

I think the founding team has been super helpful for Levels in particular. It’s a little odd to have… not odd. Maybe it is not standard to have five co-founders but I think the things that I really find useful about it are a deep trust in each of them and their personal character and their integrity and their competency. We’ve been able to split out into domains that we each can own really well and just completely run with. I trust them all completely and they trust me and it’s been really good for us….Josh and Sam initially were the very first two and then I quickly followed on. Josh had the original idea, he’s the founder. He’d been working on this for a couple years and in the background, but hadn’t really kicked it into full gear. Then Sam comes on board, he’s a serial startup guy who has a lot of experience with that world. Then looking to bring in a lot of the product development shops, hold in myself and Andrew Conner our head of engineering from Google. Andrew actually has a huge startup background as well. His last company was acquired by Google so he’s in there done that. Then Dr. Casey Means, our chief medical officer and co-founder was just the final missing part.

The value of an aligned network of supporters

Building a startup is hard, building a successful startup in a vacuum is next to impossible. The Levels team and in particular CEO Sam Corcos have built a tight network to get rapid feedback and learn quickly.

one of the things he’s been really helpful for Levels has been relying on… for Sam in particular, I think has been building a good network of people who are aligned and are there to help. We like to reach out to our investor network, to our friends network with all sorts of ask, product feedback. Our beta members participate in all the internal builds. Essentially, we push all the builds out and then the feature’s not done yet or it’s done enough, but not really done. We get fast feedback on it, just like a bias towards transparency and openness with people has been really helpful.

Levels is solving for a huge problem

I’m probably working more now than I was at Google, but I feel a huge sense of purpose. A big part of the reason why we started Levels was for the mission. You can say that cheesily, but we really believe it. Our mission is to solve the metabolic crisis. It’s this unspoken issue that’s affecting so many people out there in the United States. I’m not sure about the whole world, but in the United States, only 12% of the population it’s considered metabolically healthy. Everyone else is on a spectrum of some unhealth. It’s just a huge opportunity to affect people’s lives, both in the near term things and the long term health consequences.

How Levels launch in beta

Levels combines a hardware monitor with interactive software to uncover landmines in metabolic health and create a baseline for metabolic awareness.

We have a beta program right now. We haven’t fully launched, we’re still building the product, but what you get when you sign up, it’s a product that is positioned as a 28 day metabolic awareness program. In the United States, these sensors, they’re regulated prescription only. First we facilitate a telehealth consultation with a licensed physician in your state who can evaluate whether this is a good fit for you or not. If it’s deemed to be a right fit for you, then Levels will ship you a kit that contains two continuous glucose monitors. That’s one month supply of glucose monitors and sensor covers help protect the sensor and feature the Levels brand. Then the Levels app and the Levels app is the main part where you can track and see how things are going. You’ll be guided through that four week period on a journey that starts with just trying to baseline, see where you’re at, see if there’s any hidden landmines in your diet, things that are going well, things that are not. Then try to branch out and explore and see if there’s anything that you want to do to test different areas that are open to you, and then finally optimize towards taking steps towards your health goals.

Why Levels outsources monitoring hardware

Outsourcing a seemingly core part of a companies product may seem risky but for Levels this is a comfortable bet

we are also partnering with a third party hardware manufacturers for this. It’s an interesting decision making your own hardware is something that is possible, but it takes many years and it requires going through a lot of… It’s a lot more steps. Our core competency is really good software. We want to build the data and analysis layer on top of that and that’s where we focus. There are about 30 different hardware manufacturers as well, that we’re tracking that are coming to market over the next couple years.

The very first version of Levels

The very first version of Levels included no proprietary software but provided direct access to early customers metabolic data.

The first challenge we had to solve when we started Levels was how to get access to continuous glucose monitors. The first thing we had to do was stand up this telehealth consultation network, which took quite a while, but in terms of a user facing product, once that was solved, we had the barest of MVPs that was possible. Our pharmacy partners for the first products shipped these continuous glucose monitors from the pharmacy in a cardboard box to our beta user’s house. The whole Levels app was we sent you an email that said hey… Actually it was a text, we just sent you a text and said, “Please text us questions you have and screenshots of what you see in the sensors manufacturer app.” The whole goal of this was proving the concept. We didn’t really know what people were going to resonate with at this point, this is a novel data stream, a new area.

Learning by staying close to the customer

By imagining early conversations as an app David was able to learn quickly and understand the problems customers were facing.

We wanted to say very close and very connected to our members and to our beta audience and just listen to them and get feedback and try to understand what problems they were facing, so that we could then build a product based on that. Very much something that was, do things that don’t scale. In the early days it was just me manning this text thread with… Starting out with one person and then dozens of people and seeing what they had. We called it the David bot because…I would take what they sent me on the screenshot and try to imagine if this were an app or what are they actually interested in getting out of this?

How Levels developed a product roadmap The roadmap has been driven by 2 variables – internal CGM usage and external customer feedback from the early community.

I think we came at this from two angles. One is we all had used CGMs at this point and we had a sense as to what might be an interesting experience, but we really wanted to say largely, primarily grounded on our user feedback. The bulk of our early stage was based on user feedback. That was through the early product approach through the SMS, like David bot and also through feedback calls. Every person, every beta customer who came on with us signed up knowing that they agreed to do an onboarding call, a midpoint call and a debrief call for feedback. We were very closely coupled to the members in pulling out insights and what they were hearing. That feedback largely drove the process in the early days.

Focusing on qualitative insight

As a pre-launch startup the Levels team focused on having conversations with their prospective customers to understand what made them take rather than looking at complex quantitative metrics.

We didn’t have product analytics or at scale users, you might at Google to run AB tests and things like that. What we focused on was the more like the qualitative data we had over 2000 phone calls with prospective customers. There was a period of time where Sam was on the phone pretty much back to back on 30 minute calls with prospective customers for two months or something. We had this wait list process where we didn’t have an open signup yet, but we still allowed people to get on the wait list. So we just started emailing people on the wait list saying, “Hey, can we get on the call.” And learn from you? Who are you? What makes you tick? What are you looking for in Levels. Just to try to gain this profile of who are the people that are interested in this? What are the things that they’re also interested in?

Mary Borysova: Welcome to Health Tech Matters, a podcast where we explore how great healthcare products are created. Today our guest is David Flinner, co-founder at Levels. Levels has expanded access to continuous glucose monitoring and making it mainstream, helping people find the optimal diet and improve their metabolic health. In late 2020 Levels raised 12 million seed round led by Andreessen Horowitz. Stay tuned. Let’s just start with your personal background.

David Flinner: Sure. Before Levels, I spent most of my working career at Google. I was there for eight years out of 10 years and I did a variety of roles. Started out in technical support, ended up in product management and worked in the online advertising industry a little bit at YouTube, and then got into international payment systems. Outside of Google, I quit in 2016, I had some side projects that were independently making some passive income. They were silly websites, but they were enough to float us in our life in San Francisco, but not enough to actually live well. At that point, my wife and I wanted to travel a bit. We set off to travel for a year around the world, thinking we’d do 12 countries one month each. We accidentally ended up building out this situation where we became mini travel influencers or something at the time.

David Flinner: We ended up going to 70 countries and staying at five-star hotels for free. This original plan was for me to take my side projects and make them into a real product. I started at Google, did that for a long time, took a little break, I quit and tried to do my first mini startup myself, but ended up helping my wife startup of her own while traveling around the world. When we got back to the United States, my old team heard I was back and so they asked me to come back and I didn’t know what I was going to do yet next so I rejoined Google. After a year I was thinking about transitioning into Google’s life sciences division. They were doing some really interesting things. I thought there’s so much untapped need in human health and Google’s really well position with their massive scale to crunch the numbers and gain insights through big data and whatnot.

David Flinner: At the same time in my personal life, I was feeling a lot more brain fog, lower energy. I didn’t really know what was going on and I didn’t know much about metabolism, but I’d heard that maybe my metabolism is slowing down, whatever that means. Somehow I heard about glucose monitoring and I was doing a Google search for it. Maybe I can monitor my glucose to see if my metabolism is slowing down. I quickly hit some roadblocks, in the United States, continuous glucose monitors they require prescription.

David Flinner: Historically you can only get prescribed them if you’re actively managing Type 1 or Type 2 diabetes. I just stopped there, but it turned out that 12 hours later, my friend Sam Corcos was coming to visit San Francisco and he had asked to stay in our guest room. I hadn’t seen him for a long time. I didn’t know what he was up to. It was just literally this coincidence where he arrived, we caught up and what he was starting with Josh was exactly this company that was meeting the need that I had hit on my own in my research for glucose monitoring. That’s where I-

Mary Borysova: Lucky coincidence.

David Flinner: Yeah.

Mary Borysova: I only know few startups that were founded by only one person. Just two, three…

David Flinner: Yeah, I think the founding team has been super helpful for Levels in particular. It’s a little odd to have… not odd. Maybe it is not standard to have five co-founders but I think the things that I really find useful about it are a deep trust in each of them and their personal character and their integrity and their competency. We’ve been able to split out into domains that we each can own really well and just completely run with. I trust them all completely and they trust me and it’s been really good for us.

Mary Borysova: How did it happen so that there are five co-founders so…

David Flinner: Yeah, we all within a matter of months came together. Josh and Sam initially were the very first two and then I quickly followed on. Josh had the original idea, he’s the founder. He’d been working on this for a couple years and in the background, but hadn’t really kicked it into full gear. Then Sam comes on board, he’s a serial startup guy who has a lot of experience with that world. Then looking to bring in a lot of the product development shops, hold in myself and Andrew Conner our head of engineering from Google. Andrew actually has a huge startup background as well. His last company was acquired by Google so he’s in there done that. Then Dr. Casey Means, our chief medical officer and co-founder was just the final missing part.

David Flinner: She’s the one who has the medical expertise. All the rest of us have a technology and software background. She had been independently working on this idea too on her own, but from the other lens. She was working with patients, saw the suffering firsthand that all of your lifestyle choices can lead to down the line. She wanted to move upstream and into preventative health. After becoming a surgeon, she then switched into starting her own functional medical practice to help people make better choices upstream.

David Flinner: She realized that that thing doesn’t scale and so she wanted to help more people. She’s being very open with what she wanted to do, talking to her friends and family, trying to network and saying, “Hey, I want to have this idea where I take all these learnings and then come up with a company around it that helps at scale, bring people towards better health outcomes.” We got connected to her through friends or friends. I was just like, “Yep, this is exactly what we need.” Because we don’t have the medical side of this yet and let’s all go together.

Mary Borysova: I see and how did you meet the first three founders?

David Flinner: I met Sam also through friends of friends. One thing you’ll know about Sam is he’s probably one of the best networked guys in the whole world, he seems to know everyone. I got to know him well from the first time actually on my world trip. We stayed in touch casually, maybe once a quarter, once every half year. Then when the time was right, he was in San Francisco and things just happened. It’s also how I think how we found Andrew. Sam was plugged in with this group called On Deck. I don’t know if you’ve heard of them, they’re founders or something.

David Flinner: I think one of the things he’s been really helpful for Levels has been relying on… for Sam in particular, I think has been building a good network of people who are aligned and are there to help. We like to reach out to our investor network, to our friends network with all sorts of ask, product feedback. Our beta members participate in all the internal builds. Essentially, we push all the builds out and then the feature’s not done yet or it’s done enough, but not really done. We get fast feedback on it, just like a bias towards transparency and openness with people has been really helpful.

Mary Borysova: That’s very interesting because first of all, you have very rich background in what a different structure and you must feel a bit… I don’t know, maybe even stressed by transitioning to such a small company.

David Flinner: Honestly it was super refreshing and I’m probably working more now than I was at Google, but I feel a huge sense of purpose. A big part of the reason why we started Levels was for the mission. You can say that cheesily, but we really believe it. Our mission is to solve the metabolic crisis. It’s this unspoken issue that’s affecting so many people out there in the United States. I’m not sure about the whole world, but in the United States, only 12% of the population it’s considered metabolically healthy. Everyone else is on a spectrum of some unhealth.

David Flinner: It’s just a huge opportunity to affect people’s lives, both in the near term things and the long term health consequences. For myself, I was actually pretty stressed at Google, which is where I came from. I loved it there, I had a really good time, I learned a lot and with working with lots of really interesting people doing interesting projects. I had three hour commute each day back and forth. It was totally different culture, like big company and then jumping ship to get onto the startup world was… it’s more work, but it’s a huge breath of fresh air.

Mary Borysova: Let’s talk a bit about the product. How does it work and what it is?

David Flinner: Levels is a bio wearable device, which is the continuous glucose monitor paired with a software solution on top of it. That is a consumer software app that is the first app that we think exists that closes the loop on how your dietary choices and lifestyle activities affect your wellness. In the same way that you might wear a loop to figure out how your heart rate’s doing, or maybe try an Eight Sleep to get better sleep, there really hasn’t been any way to track your diet and see in a quantifiable way, a measurable way, how each individual dietary choice you make affects your wellness and Levels lets you do that. It’s like an x-ray for your diet and you can make data driven decisions based on what’s working for you or not.

David Flinner: The continuous glucose monitor is a sensor that… It’s like a small patch that you’ll wear on your body. It’s last for 10 or 14 days, they are temporary and what it does is it continuously measures the glucose in your body. The interstitial fluid. That readout gets sent to the Levels app and the Levels app then interprets it and makes it easy to understand, helps you connect the dots on your choices and how they’re affecting you. We all know theoretically that it’s bad for us to eat certain foods but when you experience it for yourself and you see the real time feedback and what’s happening, we’ve seen that it can lead to pretty lasting behavior change.

David Flinner: We’re using the sensor technology that has been around and approved for decades. It’s this safe bio wearable technology that’s been around traditionally for the management and treatment of diabetes, but we’re taking that data set and turning it into something that is easy to understand and very actionable for a wide audience, pretty much anyone who’s interested in optimizing their health. That’s where we’re at.

Mary Borysova: Basically there are two pieces of the product. One is physical product, so the patch thing that you have with your logo box and application.

David Flinner: Yeah, maybe I should just explain a little bit on that. We have a beta program right now. We haven’t fully launched, we’re still building the product, but what you get when you sign up, it’s a product that is positioned as a 28 day metabolic awareness program. In the United States, these sensors, they’re regulated prescription only. First we facilitate a telehealth consultation with a licensed physician in your state who can evaluate whether this is a good fit for you or not. If it’s deemed to be a right fit for you, then Levels will ship you a kit that contains two continuous glucose monitors. That’s one month supply of glucose monitors and sensor covers help protect the sensor and feature the Levels brand. Then the Levels app and the Levels app is the main part where you can track and see how things are going.

David Flinner: You’ll be guided through that four week period on a journey that starts with just trying to baseline, see where you’re at, see if there’s any hidden landmines in your diet, things that are going well, things that are not. Then try to branch out and explore and see if there’s anything that you want to do to test different areas that are open to you, and then finally optimize towards taking steps towards your health goals. That’s what the product is like. Then you get all sorts of interactivity in the app and then daily and weekly reports and a final monthly report that closes that off and that’s the current product.

Mary Borysova: Okay, I see. You were working also on the physical product because most of the startups are outsourcing this part and they’re using somebody’s product.

David Flinner: Yeah, actually we are also partnering with a third party hardware manufacturers for this. It’s an interesting decision making your own hardware is something that is possible, but it takes many years and it requires going through a lot of… It’s a lot more steps. Our core competency is really good software. We want to build the data and analysis layer on top of that and that’s where we focus. There are about 30 different hardware manufacturers as well, that we’re tracking that are coming to market over the next couple years. We think it’ll be something that’s like heart rate monitors. Back in the 90s or early 2000s, you would have a more expensive heart rate monitor experience, maybe one that strapped to your chest, like the Polar strap.

David Flinner: Then over time they got small. Now you can have one in O-ring, of course O-ring is not necessarily the cheapest thing but you can also buy very inexpensive heart rate monitors that are much smaller. Our mission is to solve the metabolic crisis. We need to make this as accessible as possible and so we’re trying to get the cost down. We see a future where the sensors, the price comes down quite a bit. We need to find ourselves on the where’s the value on top and coming up with this really simple, easy to understand consumer experience that helps people understand where they’re at and what they need to do to improve in their health goal.

Mary Borysova: What is the price for Levels products?

David Flinner: For this intro beta period, it’s $399 for that. That includes the telehealth consultation, the one month kit. We’ve done a lot of research, like market testing and there seems to be a lot of… we’re seeing a lot of demand at that price point for the beta program, but in terms of a long term ongoing subscription product that we also want to build. We’ve seen a lot of interest at that at $99 a month, going forward.

Mary Borysova: Sounds good.

David Flinner: We think within a couple years, we can realistically get there by way of analogy with test… we’re in the test of road surveys, we’re building out the initial version, hoping to use those funds to drive down the cost and build the versions that will be much more accessible.

Mary Borysova: Yeah, that makes sense. When you joined Levels, what was the first version of the product?

David Flinner: This one I really love. The first challenge we had to solve when we started Levels was how to get access to continuous glucose monitors. The first thing we had to do was stand up this telehealth consultation network, which took quite a while, but in terms of a user facing product, once that was solved, we had the barest of MVPs that was possible. Our pharmacy partners for the first products shipped these continuous glucose monitors from the pharmacy in a cardboard box to our beta user’s house. The whole Levels app was we sent you an email that said hey… Actually it was a text, we just sent you a text and said, “Please text us questions you have and screenshots of what you see in the sensors manufacturer app.” The whole goal of this was proving the concept. We didn’t really know what people were going to resonate with at this point, this is a novel data stream, a new area.

David Flinner: We weren’t sure what the clear answers were going to be. We wanted to say very close and very connected to our members and to our beta audience and just listen to them and get feedback and try to understand what problems they were facing, so that we could then build a product based on that. Very much something that was, do things that don’t scale. In the early days it was just me manning this text thread with… Starting out with one person and then dozens of people and seeing what they had. We called it the David bot because I would frame it as, so I would take what they sent me on the screenshot and try to imagine if this were an app or what are they actually interested in getting out of this?

David Flinner: I would send them back some analysis, or sometimes I would experiment with saying, “Okay, this time I’m going to tell you, maybe based on that meal you just sent me, here’s what you can do to improve.” Or another time I might give them encouragement or things like that and just see how people react and… Are people interested in motivation? Are they interested in learning more about how their food is affecting them? Are they nervous about what they’re seeing? Do they need to be helped through that? That was our very first product and we learned so much from it.

Mary Borysova: How did you move forward? What were the processes how you were developing the roadmap because there are so many things you can do.

David Flinner: Yeah, totally. I think we came at this from two angles. One is we all had used CGMs at this point and we had a sense as to what might be an interesting experience, but we really wanted to say largely, primarily grounded on our user feedback. The bulk of our early stage was based on user feedback. That was through the early product approach through the SMS, like David bot and also through feedback calls. Every person, every beta customer who came on with us signed up knowing that they agreed to do an onboarding call, a midpoint call and a debrief call for feedback. We were very closely coupled to the members in pulling out insights and what they were hearing. That feedback largely drove the process in the early days.

David Flinner: For example, once we finally had our own Levels app, the only thing it could do was log food. We knew that you might want to see glucose data it in it, but we didn’t do that right away. We waited for people to complain and say, “Hey, I want to see glucose data in the Levels app.” One of the things we’re really big at here is going into something with a hypothesis, but making sure that we have data to back it up and letting the users tell us they want something. We built the early product based on user feedback that was emerging from those simple interactions. The first thing we did was have to just get the data. First it was food logs and then glucose information. I mentioned before but one of the features almost that people have come to like is the very fast iteration cycles that we have.

David Flinner: We’re pushing out builds, mostly weekly to our members so they can test out the latest features. In the early days, when we first had glucose in the app, plus food logs, all of the food logs… you can see your activities paired on the glucose line so that you can visually see, “Hey, this food was associated with a very sharp glucose spike.” That visual has been very powerful but in the first days when we did that, every single activity on the graph was hard, coded. It’s called pork tacos, some soup and the app would just tell you it’s pork tacos. Being comfortable with in progress work, but the learning we get from that is are people even interacting with the graph? Are they drawn towards tapping an activity icon on the graph to see what that happens?

David Flinner: We learned that that was really powerful for people. We kept iterating on it and drawing it out. Zooming back out a little bit, once we had some of the foundation of our own app, the very skeleton of it, we asked ourselves who were the people that we were serving with this initial data. A lot of that was… this initial audience was a bio hacker crowd. These were the people who already knew about glucose monitors. They really wanted them and one of the big values that we had at the time was now for the first time you could get access to one through Levels. The problems that were presenting to us were frustrations with the manufacturer’s sensor app, which is pretty limited. You can’t interact with the data you can’t pinch and zoom and drill in on things.

David Flinner: The presenting problem was to make a better version in the Levels app of what you were seeing in the manufacturer’s app. That’s what we started there. As we expanded, we started going out into this audience that we’ve been calling more of the health seekers, which is someone who strives to do the right thing, strives to eat organic or make the right choices, goes out, exercises mostly but doesn’t overdo it. Isn’t tweaking their bodies with experimental things all the time. We learn that the glucose data alone, even pair with your activities, isn’t enough really to understand what it means and people were saying, I see the glucose data. I see it goes up and down but I don’t understand what it means. Then we focused on seeing if it was worth helping people contextualize their data through scores, both for an individual meal and for the day.

David Flinner: Can we help people determine whether their choices were good or bad for them given their health goals? Can we help people determine if their days effort was aligned with trajectory of a positive change, so we did that. I think the theme here is that we’ve been focused on listening closely to what the next presenting problem is for our members and then tackle that and then see what the next thing that comes up is. Another category of things is being early and nimble. We have this opportunity where we can explore the problem space too.

David Flinner: Not be locked into a single direction. We try to run experiments on topics that are not necessarily on the core Levels experience, but see if there’s something else out there that we might want to change. Right now Levels started out largely as a single person experience. You and the CGM and your data but do people want to that with community? Do they want to try it with a getting started cohort, things like that. We have parallel processes where we’ll test some of these things, get feedback on them and then try to fold them back into the main approach. I have other dimensions that I think about the product development on, but that was how it was in the early days.

Mary Borysova: You actually mentioned that you were trying to bake your decisions with date?

David Flinner: We didn’t have product analytics or at scale users, you might at Google to run AB tests and things like that. What we focused on was the more like the qualitative data we had over 2000 phone calls with prospective customers. There was a period of time where Sam was on the phone pretty much back to back on 30 minute calls with prospective customers for two months or something. We had this wait list process where we didn’t have an open signup yet, but we still allowed people to get on the wait list. So we just started emailing people on the wait list saying, “Hey, can we get on the call.” And learn from you? Who are you? What makes you tick? What are you looking for in Levels. Just to try to gain this profile of who are the people that are interested in this? What are the things that they’re also interested in?

David Flinner: One of the learnings we found was that basically if you’re also the type of person who already owns a Peloton, you’re almost assuredly going to purchase a Levels Beta Kit. So as one example. Once we actually onboarded people into the program, the immersive data that we got from the texting experience and the feedback calls were all really critical. It was more qualitative for sure, in the beginning than quantitative.

Mary Borysova: Just so many calls and huge wait list. How did you achieve it? Because sometimes it takes months just to get to initial cohort.

David Flinner: Right, yeah. That’s a good question. I think I have to think back, it’s been a little while now. I think a lot of the wait list growth has come from people who were excited about Levels, who heard about Levels through podcasts. A big strategy of ours has been content and the content strategy is that we want to be true thought leaders in the space of metabolism for the general populous. There really isn’t a lot of research or literature out there that’s on metabolism outside of diabetes management. There is data out there but it’s just not summarized and written into articles broader than just the Levels app experience. We truly do want to make, make a dent in the metabolic crisis. If we can start a movement outside of our app, with the broader world to make people care about metabolic health, that’s great.

David Flinner: We have a fantastic blog and that informed part of our podcast strategy too. We just wanted to get on podcasts, not necessarily talk about Levels, but talk about metabolic health. Of course, we’ll talk about Levels too you. We saw a lot of people get excited about that because there seems to be something real underlying the need. People were signing up in large part due to that. We didn’t do any real marketing. We ran just a very negligible amount of ad tests in the early days, just testing some messaging. Very much… almost zero ad budget at all for marketing and it’s just been through word of mouth and the podcast content strategy.

Mary Borysova: Yeah, I think organic is very powerful especially on the early stages. If you have this narrow group, because obviously it’s like 5% of people who are interested in the glucose monitor, so you need to target those and it’ll be super expensive so it’s…

David Flinner: One other thing I just remembered was another thing that we saw that was pretty powerful, that we weren’t expecting initially was we saw early users start organically sharing their experiences and stories that were meaningful to them on Twitter, especially. Whenever we had someone tweet on Twitter, we saw a huge follow on crowded people ask, “Oh, what is that? Where can I get it?” That drove a lot of the growth too.

Mary Borysova: YouTube as well, because I’ve seen many videos.

David Flinner: Yeah, so it spread. I think it started on Twitter and then it expanded out into YouTube and Instagram over time.

Mary Borysova: A person has an app and they can see, let’s say at 9:00 AM, the glucose monitoring level.

David Flinner: The glucose monitor is monitoring all the time. It’s continually monitoring your glucose. Depending on the sensor, they’ll be monitoring at different intervals. The primary device we use it’s every 15 minutes, you’ll get an automatic reading, but then you’ll get a spot reading anytime you want through scanning the sensor.

Mary Borysova: I see.

David Flinner: Yeah, but then future models are going to be… This one’s based on NFC, but future models pretty much everyone’s moving towards a continuous streaming via Bluetooth. All the data will be coming in at regular intervals that are also closer in time. Maybe every minute, every five minutes, things like that. There’s always a data readout and that’s the powerful thing that has been missing for people who have been trying to measure their glucose using finger prick glucometers.

Mary Borysova: Yes, it’s just crazy. It sounds like future is now.

David Flinner: Yeah, it’s fascinating. I think there’s so much more signal you can get when you’re monitoring it continuously. With the finger pricks, you’ll have generic advice to maybe try to see what your blood sugar is, try to finger prick 30 minutes, 45 minutes, an hour or something into your meal but you may totally miss the picture because you don’t know if that’s the peak or if you’re already falling. Seeing the entire wave of the glucose response is just much more powerful. Then also seeing how you pair that with things like activity, going for a walk.

David Flinner: You can see in real time that if you eat a meal that is causing you to have a glucose rise and you go for a walk right away, you can see that you will improve the response. When you can see the effects of your actions, you can see how your body’s changing to the levers you’re pulling in real time. If your goal is to lose weight, having this certain type of glucose spike. You may not know at first that that is leading to a corresponding, a state in your body where you may be blocking fat burn mode. If you want to lose weight, then we might suggest swap out this piece of your meal for this other piece that is still tasty, but on diet.

Mary Borysova: When from the early stages. How you are prioritizing features and the next steps once you get this minimum viable product with all necessary features and pretty much working.

David Flinner: Yeah, there’s different dimensions to this. I think it’s with the way a lot of different inputs into deciding what to do next, but we are trying to build towards a launch that we’re planning for early Q3 hopefully. We’re also in this unique stage in startup life where we can be very nimble and pivot and move around. We’re trying to allocate some of our time, maybe like 40% of the time towards continuing to explore and that’s exploring broadly and deeply. Within different problem spaces and then 60% of the time on the core golden path experience, making sure that we really nail… For instance helping people determine whether their choices are good or bad for them. We have a roadmap of many things within that frame and also trying to still explore the space as to where the value is here before we launch.

David Flinner: As I mentioned before, we tend to launch things that are very early and get feedback. For instance, on Monday we launched a new sharing feature. I emailed all of our members to ask what they thought and I got a lot of feedback and we’re launching a new version with different sharing functionality today. That’s like iterating on the product. You’ll always have some bug fixes and product quality and then scale. Setting the stage for people to take on more members.

Mary Borysova: As a designer, I couldn’t help noticing that branding is very nice. You decided to invest in design, even you are on quite an early stage.

David Flinner: I think the brand aesthetics and just the overall brand were super important to us and very intentional we wanted to… I think it’s very much targeted at how we want to help people. We wanted to position Levels as something that is aspirational yet attainable for everyone. Some of the calculus in the early days was what’s a brand that would be… I don’t know. Like Nike, something that everyone can relate to. The details matter and especially in a consumer app.

David Flinner: There are a lot of details that are rough in Levels. All the small things buttoned up because it conveys trust if you have things that are different font sizes and unexpected stuff. It just signals in some way that maybe Levels doesn’t care about your data, maybe Levels doesn’t really have it all together. I think to win in a consumer app, you need to have a really good brand. You need to have really buttoned up design that speaks to your core principles and makes it really simple to understand.

Mary Borysova: Yeah, I think it’s very important because you’re actually selling injector. It is very sensible matter.

David Flinner: It was an interesting product experience. The design for it, because it was straddling the physical world and the digital world. You’re applying this sensor is not fully part of the Levels app, following instructions on that. It’s a big moment for people. We hear many people, they’re initially nervous to apply the sensor. For people who might not know, it’s not like wearing an apple watch.

David Flinner: What happens is you have an applicator that uses a needle, which does not stay in you, but it threads a small filament just underneath your skin, into the interstitial fluid. You can’t feel it, it would stay there for the duration of the sensor. It is a scary experience for people who haven’t tried it before. The shocking thing though, is that you can’t feel it and it’s not painful at all in the vast majority of cases. Sometimes you’ll feel a little pinch but it is truly nothing-

Mary Borysova: It’s all in your head. It’s not that it’s painful, it’s scary.

David Flinner: It’s interesting too. I think what we’ve seen from people is that sometimes there’s this fear of the application itself, but then sometimes there’s fear of results. We hear that people don’t necessarily want to know the results. I think one of the liberating things is that people find that… Sure, there are some things that you probably want to cut out of your diet, but there’s also some things that you’ll be surprised that work for you. We have one specifically but this is like a theme for people who are on very strict keto diets. Ketogenic diets, where they eat very high fat, very restricted carbohydrates. A lot of people find that they can actually eat more good carbs than they could. They’ll try out salads or carrots or peppers or things like that. They don’t get knocked out of ketosis, their glucose remain stable and so it can be a very liberating tool to broaden your diet on things that you used to love that you’ve been restricting for a couple years.

Mary Borysova: Lets switch gears. Let’s talk a bit more about the team. How many of you?

David Flinner: There’s just about 20, I think there’s maybe 22 now or so. We’re focusing on hiring engineers right now.

Mary Borysova: Everybody’s working remotely.

David Flinner: Yes, that’s a good point. Levels is a fully remote company. We were actually remote before COVID as well. We’ve always been a remote company and it’s new. The whole world changed and is now remote as well alongside us. But we think it’s a really powerful tool.

Mary Borysova: I do think remote type work can be worldwide or it can be US based remote type?

David Flinner: Really good question. It’s something that we’ve talked about. I think it can work. Time zones are the big thing. You do have more friction when you have differences in time zones. I think we try to hire more of our team in similar time zones so far. We recently hired first European hire and it’s been working out really well. I think I could see it expanding. One of the things that really drives our remote culture is this idea of asynchronicity. We really strive to not have any expectations on immediate answers to anything.

David Flinner: Whether it’s an email or a Slack or anything, the expectation is always that the person won’t respond right away. You have to plan ahead making sure that you supply all the details that you might need when that person finally gets to it. I think that’s been a really big key to our remote culture is not relying on people to be there in real time and then coming up with tools that fit into that new framework. We’ll do video chats as well but oftentimes do a video recording. We’ll trade back and forth video recordings with Loom. We do have some synchronous meetings but it’s usually the exception rather than the rule.

Mary Borysova: What are tools of trade? How do you share knowledge and organize all this documents, I’d say?

David Flinner: Documentation is probably the biggest thing… it’s huge part of Levels. We document everything and essentially if you start to hear yourself getting asked the same question two, three times, put into a document and then send that document to people going forward. We’re very big on memos. For example, instead of getting a meeting with five people and hashing through an idea and then sending out meeting notes. Whoever had the idea will try to write a memo first and then send that memo out, which is just like a rough draft of the thoughts and then send that out for the team’s thoughts or whoever the stakeholders are. We’ll talk in the document, you see this living trail of everyone’s thoughts, which is great for the rest of the team. Everyone can get context on the thinking and how it evolved.

David Flinner: As we summarize things, we’ll bubble that up and edit the original top part of it. I think using memos has been a very important tool for us. We use notion for that. It’s been really helpful in the structured data to link things back and forth collaboration in it in ways that with Google docs, I think historically it’s very siloed. It’s hard to link to other things and create structure. Notion is big for us. We use Slack but we probably use Slack differently than a lot of teams. The expectation is definitely that. It’s for ephemeral things, you should expect that Slack will be deleted after 30 days. Don’t put things in Slack that you want to save. If you want to save it, it should be in Notion and it should be linked in the company directory.

David Flinner: Some of this is overhead, but it’s been very helpful for capturing the state of things. Then it really helps us scale. New employees come on and they can go through all the history, they can catch up to speed on everything. We’re working with a partner, we can add the partner to our documents and say, “Here’s everything.” Things like that.

Mary Borysova: Yeah.

David Flinner: Then Loom is another tool that we use, which is the asynchronous video recording. You can record your screen, record your face and that’s been really useful. I do think it needs to be very intentionally set. I think it also has to be rigorously defended. In my experience, it’s easy to fall back into just wanting to get a meeting and talk and maybe not actually get anything done. There’s this fear of… we try to have a fire under us all the time on, we have to constantly be innovating, constantly be shipping, biased towards getting things out. I think it’s easy sometimes to talk in a meeting and feel good but not actually produce anything. That’s why we try to keep it in the documents. We can solve it over email quickly, it doesn’t need a meeting that needs to be scheduled two days from now, if we can handle it right now over email.

Mary Borysova: Okay, my favorite question, if you could write anything on the billboard, your personal message, what would…

David Flinner: Anything on a billboard?

Mary Borysova: Yeah.

David Flinner: Interesting, jumped to my mind. One of my personal fascinations, it’s not a hobby but I like to read a lot about space and science fiction and things like that. What jumped to my mind was look up and maybe it would be like something at night. That’s bad if you’re driving a car, you might crash but pay attention to what’s beyond. This just reflects my own personal interests. I think there’s so much on wonder and in the heavens and the broader… think of the hundreds of millions of galaxies. I like to think a lot about that in my spare time. Not health tech related, but yeah.

Mary Borysova: In the past year, what do you believe or habit has most improved your life?

David Flinner: That is a good one. Outside of optimizing my diet for things… I think the thing that is consistently the biggest driver of productivity is not drinking any alcohol, was a big change. Last year, I did three months without any alcohol. It’s just amazing how much more productive I can be essentially. I’m just saying, not that I was a heavy drinker, but pretty much having no alcohol frees up a lot more hours in any day. I’m not fully off alcohol like I was in that three month period but I think that was definitely the biggest change in productivity.

Mary Borysova: That’s interesting.

David Flinner: Probably the biggest ones are around diet. I’ve made so many changes to diet. I don’t eat candy anymore although I do eat desserts. I just found desserts that are better for me and not the packaged sugary Swedish fish or something. I eat a lot more along the Mediterranean style diet. Healthy greens, vegetables, fish, responsibly, raise beef, things like that. It changes your whole sleep. I think sleep is one of the key things that is really important for productivity and everything. It’s so related to metabolism. If you get poor sleep, you have really bad metabolism, you have bad everything the next day and then vice versa. If you make poor dietary choices or alcohol, it’s going to disrupt your sleep, it’s all very much intertwined.

Mary Borysova: Yeah and how did the definition of success has changed during the past years?

David Flinner: From a Levels perspective?

Mary Borysova: From your personal, those are just for your personal.

David Flinner: How has it changed? I feel like I’ve been so focused this year on Levels. That has been my primary success metric, so I don’t know if it’s changed but one thing that comes to mind is that this is not necessarily a change in success, but just a reminder on maybe the non-work things too that matter. My grandfather had some health issues this past year. I think just a reminder that your work is not the only success in your life.

David Flinner: It’s important to foster the other spheres in your life that are really important to you. There’s your work, your family, your friends, community, all these things. My grandfather’s health issues just reminded me how important it is that you spend quality time together and how grateful I am for that. That’s what comes to mind. You have to do your own prioritization, not just for product development, but for what matters to you in life and how do you allocate your time on things?

Mary Borysova: What was… let’s say, I can’t say the most valuable feedback you got but probably something you wish you knew before you received this feedback.

David Flinner: From a Levels perspective, I think this emerging theme of community. What we’re seeing is that there’s an organic community forming with the Levels early adopters. I think it would’ve been really nice to start some of that develop… Like fostering that and developing it into a product experience earlier on. I wish I had experimented a bit more with that. Right now the feedback’s coming in that there is this really growing good community of people that love to engage with each other. One of the big themes that we have as you even just stated, it can be scary to start Levels, you don’t really know what you’re doing.

David Flinner: I wish we had experimented a bit more with getting started cohorts and community based instead of single player mode for Levels in the early days. It’s still early days for Levels. We’re experimenting with that now, but I think that would be one of the biggest things that I’m hearing feedback now. I wish we had maybe started a little bit earlier.

Mary Borysova: For you personally?

David Flinner: I feel like it related to my past response. I maybe have spent too much time thinking about the company and not enough time on other things that matter, like community involvement or things like that. It was tough to navigate too with COVID because everything changes in your life and just getting involved more with the community stuff that we used to be more involved in prior to COVID, prior to Levels was really important to us. It’s just been a slipped as we’re all remote, isolated and there wasn’t really a structure for that. The internal feedback I have is I need to get back towards allocating more time towards that stuff.

Mary Borysova: That’s nice answer.

David Flinner: I haven’t solved that yet, but hopefully things just open up soon and we can go back to the life as it was.

Mary Borysova: Yeah.

David Flinner: Or something new and better.

Mary Borysova: Yeah. Thank you.

David Flinner: All right, take care.

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