The Unreasonable Math of Type 1 Diabetes • Hacker News Board

Re: The Unreasonable Math of Type 1 Diabetes

#141

Post by shadowtree » Thu, Feb 17, 2022, 11:28 PM UTC

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…

Non-zero chance you might see a cure for type-1 in your lifetime.

https://www.clinicaltrialsarena.com/analysis/vertex-stem-cel...

It's a stem cell therapy, in human trials (not the usual "in mice" crap).

A single patient already had their diabetes disappear: https://www.fiercebiotech.com/biotech/vertex-diabetes-cell-t...

The downside of stemcell therapy is that it is essentially an organ transplant, aka requires immunosuppressants, for life.

Re: The Unreasonable Math of Type 1 Diabetes

#142

Post by sah24 » Thu, Feb 17, 2022, 11:33 PM UTC

UnpossibleJim wrote: post #132

richie5um wrote: post #103

Earlier quoted context omitted.

“Most diabetics have CGMs these days” - not where I come from :-(

My doctor had to fight to get me one. I workout and was highly insulin sensitive (she made me workout less and gain some weight by doing less cardio - drives me nuts, I liked running). The insurance companies didn't want to fork over for the upfront cost, even though I had been to the hospital several times for low blood sugars. This included a stroke caused by a severe low blood sugar (yes, I lived alone at the time…

P.S. feel free to email me at t1dresearchproject@gmail.com -- thanks

Re: The Unreasonable Math of Type 1 Diabetes

#143

Post by Trasmatta » Thu, Feb 17, 2022, 11:35 PM UTC

KetoType1 wrote: post #34

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…

The secret to managing Type 1 Diabetes is a ketogenic diet. You will observe extreme stability of blood glucose (low variance) and because the brain uses ketones as fuel, occasional hypoglycemia will be an easily-managed non-event. You should get most of your calories from olive oil and nuts. Protein intake should be just as much as you need. Excess protein causes blood glucose instability. Carbohydrate intake should…

I do want to try keto at some point, as I've heard a number of success stories for keto / low carb and T1D. It's hard to gather the motivation to start it.

One important thing to point out is that you can't reverse T1D with keto, like some people are able to with T2D. It can greatly reduce your insulin requirements, but not to zero. Your pancreas will not return to normal function.

Re: The Unreasonable Math of Type 1 Diabetes

#144

Post by paulcole » Thu, Feb 17, 2022, 11:36 PM UTC

irrational wrote: post #140

Trasmatta wrote: post #79

Earlier quoted context omitted.

Yeah, getting caught out somewhere without snacks and a looming hypo is one of my nightmares. I try to always, always, always have snacks on me (for a diabetic, this is even more important to have when you leave the house than your keys or wallet), but sometimes things happen, and you end up somewhere without anything. It's really scary, but the good news is that if there is anybody around, enough people understand a…

I never thought about how being diabetic takes emergency preparedness to a new level. We saw people unexpectedly stuck for a couple of days in traffic because of snow recently. What if there is an earthquake and you can't get to somewhere with snacks? There are so many situations that could unexpectedly arise that could cut you off from food. If I'm cut off from food, I'll be fine for a few days. Not so much a diabet…

> What if there is an earthquake and you can't get to somewhere with snacks?

I’m a Type 1 diabetic (diagnosed in my 30s) and have been living with it for about a decade now. This really isn’t a “what if” situation. I know what will happen. I will die or hopefully just become incredibly ill.

It’s not really scary at all.

It’s just something I live with and prepare for as best I can. The one thing that I’ve learned from living with Type 1 is that all you can do is make the best decision you can in any given moment. My favorite doctor told me that diabetes is a disease that is all about making decisions. So is life, I guess.

Re: The Unreasonable Math of Type 1 Diabetes

#145

Post by GiorgioG » Thu, Feb 17, 2022, 11:38 PM UTC

spaethnl wrote: post #52

I think this article does a great job covering many of the difficulties of T1D. One component I think was under-emphasized is the fact that correction insulin doses are not based on what your current blood glucose(BG) levels are, but on where you predict they will be when the dose really starts taking effect. Take for example a current best case scenario of having a Loop system via a continuous glucose monitor (CGM)…

Yep - my 10 year old son has a x2 pump and a Dexcom G6. Hopefully the software starts to improve at a faster pace with smartphones becoming more tightly integrated:

https://www.tandemdiabetes.com/landing-pages/remote-bolus

Re: The Unreasonable Math of Type 1 Diabetes

#146

Post by paulcole » Thu, Feb 17, 2022, 11:38 PM UTC

noodleman wrote: post #120

gowld wrote: post #66

Earlier quoted context omitted.

Now imagine what it's like for someone with T1D to live alone, if you haven't yet been to a funeral for that. Every single time you go to sleep is a roll of the dice.

This is a bit melodramatic. I've lived alone with T1D for the better part of a decade without any problem. I went to uni, alone, without any problems. Frankly, I think depending on other people is a liability. I can't count on my hands how many times I've had to explain to people that you don't give an unconsious diabetic insulin, you call an ambulance and follow the instructions you're given. I just don't trust the…

Everybody’s T1D experience is different and it’s not that melodramatic. Before I had a CGM I went so low at night my partner had to call 911 in the morning.

Sure I bounced back and got a CGM, but only because I could afford one. I was terrified of going to sleep at night without a handful of alarms set to wake me.

Re: The Unreasonable Math of Type 1 Diabetes

#147

Post by GiorgioG » Thu, Feb 17, 2022, 11:41 PM UTC

zaroth wrote: post #95

mhb wrote: post #73

Is a CGM one of the only things that is cheaper in US healthcare? GoodRx has the Dexcom G6 for under $400. He says a CGM is NZ$400/month (~US$270).

CGMs are disposable, for example the Dexcom sensor that is replaced every 10 days. There’s a transmitter part which plugs into the sensor and has a Bluetooth radio and a battery which is cheaper and lasts three months. You pop it off an old sensor and click it into a new one every 10 days until it expires.

IIRC the Dexcom G7 will have the transmitter built-in (and thus will also be disposable.) I'm happy about this b/c transmitter expiration anxiety is real with insurance companies being so stingy - you're lucky to get your new transmitter only a few days before the old one expires.

Re: The Unreasonable Math of Type 1 Diabetes

#148

Post by [deleted] » Thu, Feb 17, 2022, 11:42 PM UTC

Trasmatta wrote: post #143

KetoType1 wrote: post #34

Earlier quoted context omitted.

The secret to managing Type 1 Diabetes is a ketogenic diet. You will observe extreme stability of blood glucose (low variance) and because the brain uses ketones as fuel, occasional hypoglycemia will be an easily-managed non-event. You should get most of your calories from olive oil and nuts. Protein intake should be just as much as you need. Excess protein causes blood glucose instability. Carbohydrate intake should…

I do want to try keto at some point, as I've heard a number of success stories for keto / low carb and T1D. It's hard to gather the motivation to start it. One important thing to point out is that you can't reverse T1D with keto, like some people are able to with T2D. It can greatly reduce your insulin requirements, but not to zero. Your pancreas will not return to normal function.

[deleted]

Re: The Unreasonable Math of Type 1 Diabetes

#149

Post by ksaun » Thu, Feb 17, 2022, 11:42 PM UTC

terrbeardotorg wrote: post #137

johnyzee wrote: post #126

Sorry to hear what you are going through. A couple of comments from someone with an interest in the topic, but obviously not your practical experience on the front line as it were: (1) You mentioned ISF (insulin sensitivity factor), but what you did not mention is that this is not a static factor. It is possible to significantly improve insulin sensitivity through diet and life style, and this is particularly useful…

"Ketones are high when availability of glucose is low" - it seems the body calculates this based on the amount of insulin available, which is why you can eat nothing (and have no basal) and have a BG spike.

Right -- because you have insufficient insulin available, cells cannot utilize the glucose. So your blood glucose rises. If BG is too high for too long, ketones build up, leading to diabetic ketoacidosis (bad), which is different than the ketosis (good) sought by a ketogenic dieter.

People with T1D are taught to check keytones if BG is very high (CDC says > 240 mg/dL; we were taught > 300) for an extended period of time, or also when sick.

https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.ht...

Re: The Unreasonable Math of Type 1 Diabetes

#150

Post by steveklabnik » Thu, Feb 17, 2022, 11:49 PM UTC

ksaun wrote: post #138

steveklabnik wrote: post #90

Earlier quoted context omitted.

> It's abit like monitoring traffic load and adding more servers as you go, except too many servers kill you. Not even just that, but with fairly primitive monitoring tools. The built-in stuff for Dexcom can only alert on highs or lows, not on things like the rate of change, which would be much more useful IMHO.

The Dexcom G6 is capable of alerts for rate of change, but it's about what the rate was, not what it will be. It still can be helpful. (When looking at the app, there are "trend arrows," also, but they unfortunately are misleading in some situations. Often looking at the data points can give you a sense of your situation, though.)

TIL that this must be in the main app somewhere, but not Follow. (and yeah, the arrows are all over the place, sometimes different between Follow and the main app... the data points is the best, for sure.)