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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#11

Post by kettleballroll »

1auralynn wrote: post #3

My younger brother was diagnosed with Type I when he was 4 and I've always thought I had a pretty good handle on how tough having diabetes must be. I recently had gestational diabetes when I was pregnant and boy was I wrong. It's TOUGH. Particularly getting a handle on glycemic indices. I will say it turned me into a huge proponent of massive amounts of protein and fiber in my diet (but kinda turned me off Thai food…

> I will say it turned me into a huge proponent of massive amounts of protein and fiber in my diet (but kinda turned me off Thai food :/ )

Why?

Re: The Unreasonable Math of Type 1 Diabetes

#12

Post by brainlessdev »

Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

Although I haven't experienced this first-hand, my partner has T1D and I can see her reflected in everything you say. I'm hoping for a near future where technology paliates some of the dread of living with T1D. Some lines of research, such as implantable insuling-producing islets [1] seem promising, at least to someone without the chops to judge what's going on.

[1]: https://www.clinicaltrials.gov/ct2/show/NCT03513939

Re: The Unreasonable Math of Type 1 Diabetes

#13

Post by Trasmatta »

kettleballroll wrote: post #11
1auralynn wrote: post #3

My younger brother was diagnosed with Type I when he was 4 and I've always thought I had a pretty good handle on how tough having diabetes must be. I recently had gestational diabetes when I was pregnant and boy was I wrong. It's TOUGH. Particularly getting a handle on glycemic indices. I will say it turned me into a huge proponent of massive amounts of protein and fiber in my diet (but kinda turned me off Thai food…

> I will say it turned me into a huge proponent of massive amounts of protein and fiber in my diet (but kinda turned me off Thai food :/ ) Why?

Protein is low carb. Fiber is a carb that doesn't impact your blood glucose, because your body doesn't break it down. Thai food is heavy on noodles and rice, which are both very high carb.

Re: The Unreasonable Math of Type 1 Diabetes

#14

Post by coldpie »

Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

Same here. 100% dead accurate description.

> what if I start to go low during this meeting? should I pop some carbs and run high for this interview, so I don't risk a hypo partway through?

Love this part. Had to do it literally yesterday to prep for interviewing a job applicant. Imagine the stress of an upcoming meeting, but also your brain might stop functioning half an hour into it! Ha ha! Good times.

Re: The Unreasonable Math of Type 1 Diabetes

#15

Post by Trasmatta »

brainlessdev wrote: post #12
Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

Although I haven't experienced this first-hand, my partner has T1D and I can see her reflected in everything you say. I'm hoping for a near future where technology paliates some of the dread of living with T1D. Some lines of research, such as implantable insuling-producing islets [1] seem promising, at least to someone without the chops to judge what's going on. [1]: https://www.clinicaltrials.gov/ct2/show/NCT0351393…

Thanks for the kinds words.

The primary problem with those types of treatments is you have to be on immunosuppressants, or the immune system just kills the cells again. That type of treatment is typically not recommended unless the patient is already on immunosuppressants, or has extreme hypoglycemia unawareness, or extreme needle phobia. Immunosuppressants are typically considered a worse outcome than properly treating T1D with insulin + CGM.

For the same reason, sometimes T1D's will get a pancreas transplant if they are also getting another required transplant that will require immunosuppressants.

I think the best hope in the next 50-100 years or so is continued development and improvement of closed loop systems. Eventually we should get to a point where highly sophisticated closed loop artificial pancreases can automate much of the process away. This will improve treatment and long term health outcomes, but will still require a fairly significant level of maintenance and oversight on the part of the patient (or their parent). There's a lot of really promising work being done there.

Re: The Unreasonable Math of Type 1 Diabetes

#16

Post by FunnyLookinHat »

Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

I've been diagnosed with gastroparesis [1], and reading this gave me the exact same reaction! Almost all of my day is consumed with "what did I eat most recently? when should I eat next? How much? What am I short on for today? Protein? Carbs?" It's mentally exhausting. I'm thankful though that I only have to be concerned with "how much I can eat in a day" and there is no upper threshold. Lately I've been thinking about T1D and similar issues that have a high focus on managing food intake, and I completely empathize with you and everyone else who has to do this.

If anyone reading this struggles with gastroparesis I'd love to chat about diet choices that have worked for me. Contact info in my profile.

1) https://www.mayoclinic.org/diseases-conditions/gastroparesis....

Re: The Unreasonable Math of Type 1 Diabetes

#17

Post by jimmaswell »

brainlessdev wrote: post #12
Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

Although I haven't experienced this first-hand, my partner has T1D and I can see her reflected in everything you say. I'm hoping for a near future where technology paliates some of the dread of living with T1D. Some lines of research, such as implantable insuling-producing islets [1] seem promising, at least to someone without the chops to judge what's going on. [1]: https://www.clinicaltrials.gov/ct2/show/NCT0351393…

> a near future where technology paliates some of the dread of living with T1D

I thought pump implants already did that, what's missing?

Re: The Unreasonable Math of Type 1 Diabetes

#18

Post by peterb »

Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

This.

Re: The Unreasonable Math of Type 1 Diabetes

#19

Post by sweston4 »

I'm a type 1 diabetic and data scientist. Estimating the causal effect of a unit of insulin or food on blood sugar is an absolute crap shoot. Consider that there's a +/-20% margin of error on the reported carbohydrates on nutrition facts. We might consider this irreducible error that just cannot be modelled (Maybe you could get a calorimeter, estimate the distribution of errors, and reduce that error somewhat). Therefore, even if we created a model that explained all explainable variance, we still have a 20% margin of error. If a meal has enough carbohydrates, a 20% overestimate of insulin requirements would lead to an insulin overdose that would kill you if the resulting low blood sugar is not dealt with. In other words, the irreducible variance is so large that a "perfect" model would regularly suggest lethal insulin doses.

My "solution" is to eat low-carb/keto as a "variance reduction" strategy. Still, removing carbs also introduces gluconeogenesis (the production of glucose from protein) as a factor to consider. The synthesis of protein to glucose also occurs on a much time different time horizon than the consumption of carbs themselves which has implications for insulin dosing and insulin type.

I could go on! But long story short, modelling blood glucose is bloody hard.

Re: The Unreasonable Math of Type 1 Diabetes

#20

Post by whatshisface »

sweston4 wrote: post #19

I'm a type 1 diabetic and data scientist. Estimating the causal effect of a unit of insulin or food on blood sugar is an absolute crap shoot. Consider that there's a +/-20% margin of error on the reported carbohydrates on nutrition facts. We might consider this irreducible error that just cannot be modelled (Maybe you could get a calorimeter, estimate the distribution of errors, and reduce that error somewhat). There…

>Consider that there's a +/-20% margin of error on the reported carbohydrates on nutrition facts.

Is this accounted for by product-to-product variation or package-to-package variation?

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