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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#161

Post by sweston4 »

dsaavy wrote: post #136
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…

This "variance reduction" strategy is also an approach by Dr. Richard Bernstein. Basically smaller doses means smaller mistakes. It's a great approach in my opinion. Obviously the key is sticking to a low-carb diet for that to work, along with tweaking your basal insulin dosage. For me, this approach worked when I switched from Novolog to Novolin R, which has a slower effect rate. I use shots so it helps match the bl…

Thanks for this! Bernstein's book is the source of my "variance reduction" strategy too! The one thing I haven't adopted is the slower acting insulin. It's one of those things that I know I should try but just haven't gotten around to yet, so thanks for the extra incentive to try it.

Re: The Unreasonable Math of Type 1 Diabetes

#162

Post by jacquesm »

KetoType1 wrote: post #135
com2kid wrote: post #119

Earlier quoted context omitted.

I'm vouching for this because there is indeed a community of type 1 and type 2 diabetics using keto for management. Obviously it isn't a one size fits all approach, and the above poster could have been a bit more diplomatic, but IMHO it is worth discussing treatments that have been demonstrated to work.

Quoted post unavailable.

> It will solve all your diabetes problems.

This is an overstatement, to put it mildly, at best you can say that it works for you and for those for whom it also worked after they have put it to the test. But it does not work for everybody and you shouldn't make unqualified statements like that.

Here is a much better (and much better qualified) picture:

https://www.healthline.com/nutrition/keto-diet-diabetes-type...

Re: The Unreasonable Math of Type 1 Diabetes

#163

Post by lolc »

berkes wrote: post #25
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…

> a survival instinct to EAT EVERYTHING that's extremely hard to control T1 here too. The weird part about this, is that it happens while you are aware of it. My brain: "hey, you're doing it again. stop it. You know it'll end bad". my hand: "nope. here's more cookies".

Eh, don't feel bad about the inevitable. My conscious self knows well to just count the carbs when I'm too low to behave. At least then I'll know how much insulin to dose when the curve ticks upwards again.

Re: The Unreasonable Math of Type 1 Diabetes

#164

Post by westoncb »

shadowtree wrote: post #141
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 immu…

I wonder if there's any good reason to reduce my pessimism about it: I can't help but think there are such strong economic incentives against having a cure (vs ongoing treatment) that it's very unlikely to become available during my lifetime.

Re: The Unreasonable Math of Type 1 Diabetes

#165

Post by [deleted] »

prmph wrote: post #154
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…

Is it not possible to have a device always connected to the bloodstream, with a replenishable supply of glucose and insulin in different compartments, that periodically checks the blood sugar level, and injects what is appropriate to keep it normal?

[deleted]

Re: The Unreasonable Math of Type 1 Diabetes

#166

Post by sweston4 »

mellavora wrote: post #35
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…

> that would kill you if the resulting low blood sugar is not dealt with. My wife is type I, so I have a sense of what you live with. She bought a book, "The Insulin Murders", which looked at a number of cases where insulin was the weapon of choice. The good news is that it is actually really hard to die from low blood sugar, assuming good medical care is available. Coma to death is > 12 hours, more like 24 or 48. As…

I 100% agree with what you're saying.

Assume a 1:10 insulin to carb ratio (though I don't think insulin dosages have a strictly linear effect) and a meal of 100 carbs. If the meal, in reality, has 80 carbs, you've injected two extra units of insulin. We might expect a unit of insulin to reduce blood glucose by 30-50 mg/dl, so we've reduced our expected blood glucose by 60-80 mg/dl. If you target a blood glucose of 80 mg/dl, this would mean your expected future glucose is 0-20 mg/dl. In that case, you would die.

Now, the problem with this example is that I would 100% take action to avoid dying, so my actual risk of death is still minute despite having a lethal dose of insulin in my body at the time I inject myself. However, it's still a bit strange to know that, conditional on me taking no independent action, I'm hours away from death in certain situations.

Re: The Unreasonable Math of Type 1 Diabetes

#168

Post by sokoloff »

csnover wrote: post #63
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…

One of the scariest experiences of my life was going on a walk after lunch with someone who had T1D and miscalculated their insulin dose. They went from totally fine, to saying “I don’t feel well, we need to head back”, to sweaty and sheet white and barely conscious within just a few minutes. The terror I felt as we waited for the doors of the lift to open so he could get to his emergency food is burned into my brain…

I had a “drunk” parked in the inside lane of the four lane road in front of my house one evening. He was just stopped in traffic and got out stumbling around. I was annoyed (naturally) and he handed me his phone. Whatever, dude; I don’t want to talk to your friend right now. Somehow he insisted and his friend told me he was diabetic and to call an ambulance.

I did, got him some OJ, and moved his car out of traffic. He went from incoherent and “drunk” to “seemed pretty OK” in just a couple of minutes before the medics even arrived. (He still took the ride, but it was none of my business at that point.)

Re: The Unreasonable Math of Type 1 Diabetes

#170

Post by grahar64 »

semenko wrote: post #4

Hey Graham -- great post! The Medtronic / Guardian sensor combo is generally disliked by patients, though (in the US) the Medtronic 770G is FDA approved for ages 2+. Most prefer the t:slim X2 with "Control-IQ" (their hybrid closed-loop: https://www.tandemdiabetes.com/products/t-slim-x2-insulin-pu... ), which is FDA approved for ages 6+, and works great. The bleeding edge is the Beta Bionics ( https://www.betabionics.…

Yeah, the tslim X2 would be the preferred pump at the moment, but by the time he gets old enough for a pump I hope the technology will have improved a lot.
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