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The Unreasonable Math of Type 1 Diabetes

maori.geek.nz

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Re: The Unreasonable Math of Type 1 Diabetes

#181

Post by m_kos »

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…

> gluconeogenesis

I am very curious about gluconeogenesis. I am well aware of this pathway but have read a few times that glucose generation from protein happens very rarely. Have you ever tried eating zero carb whey protein in a fasted state? If yes, have you noticed a spike in glucose? I am genuinely very interested in your experience with gluconeogenesis as a person with diabetes.

Re: The Unreasonable Math of Type 1 Diabetes

#183

Post by x0x0 »

go_blue_13 wrote: post #169

>A CGM can cost $400 a month What in the world? $5k a year? How on earth are those things so expensive? 2 fully spec'd macbook pros per year? Surely they aren't that complex. Am I missing something?

Consumables -- that go into your body, and hence are expensive to manufacture -- are a big chunk of that cost.

Re: The Unreasonable Math of Type 1 Diabetes

#184

Post by ineedasername »

Rule #1 if T1D is never be out of reach of food.

The author of this article is correct that too little insulin is bad, but the margin of error for acute distress in that direction is much more forgiving for high blood sugar than low blood sugar (at least in the short term dying-on-the-floor time frame)

Target level is around 90. A little too much insulin can easily push that down to 25/35, which gets you into passing out territory. Conversely, you can get up to 300-400 by not having enough insulin and simply feel very crappy. (Caveat: an 18MO's system may be much more sensitive to highs at that age)

So yes, the acute dangers skew more towards too much insulin & low blood sugar, which is quickly fixed by a high glycemic index food. A small tube of icing is a good emergency supply here, especially for a loved one to carry. If the person with T1D is unable to help themselves then you can gently smear the icing in their mouth and it will begin getting absorbed pretty quickly. Not quickly enough to avoid a terrifying experience, but it works.

We have small stashes of shelf-stable snacks and juice boxes all over our home, multiple layers of redundancy when outside the house... It probably seems strange from the outside, but after so long it just feels normal and there's no feeling of cognitive overhead thinking about it.

Re: The Unreasonable Math of Type 1 Diabetes

#185

Post by ineedasername »

alar44 wrote: post #151
klipt wrote: post #130

Earlier quoted context omitted.

> some nuisance like heartburn Unmanaged heartburn can lead to esophageal cancer, you shouldn't take it too lightly.

Quoted post unavailable.

It seems like a valid side note that, similar to diabetes, other ailments also have hidden complexities.

Re: The Unreasonable Math of Type 1 Diabetes

#186

Post by ineedasername »

Insulin pumps can significantly improve ease of managing this, and are even used with toddlers. They also offer much fiber control than the 0.5u delivery mechanism the author is using for manual injections.

My wife switched to a pump many years ago and it was, instantly, a life-changing experience, granting a level of freedom she had never had before. (Instant being roughly 2 weeks of adjusting to a different insulin delivery schedule)

Re: The Unreasonable Math of Type 1 Diabetes

#187

Post by R0b0t1 »

westoncb wrote: post #164
shadowtree wrote: post #141

Earlier quoted context omitted.

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.

I don't want to feed your pessimism too much but I think the general culture of being too reserved with funding and testing is going to do more harm than that.

Re: The Unreasonable Math of Type 1 Diabetes

#188

Post by Nition »

go_blue_13 wrote: post #169

>A CGM can cost $400 a month What in the world? $5k a year? How on earth are those things so expensive? 2 fully spec'd macbook pros per year? Surely they aren't that complex. Am I missing something?

I know this doesn't change your point, but note that it's $400NZD -> ~$270USD.

Re: The Unreasonable Math of Type 1 Diabetes

#189

Post by grahar64 »

go_blue_13 wrote: post #169

>A CGM can cost $400 a month What in the world? $5k a year? How on earth are those things so expensive? 2 fully spec'd macbook pros per year? Surely they aren't that complex. Am I missing something?

They are entirely disposable. The transmitter lasts 3 months and the sensors last 10 days. I read something about the FDA requiring the sensors be forced to not work after 10 days, because they were worried about infections.

Re: The Unreasonable Math of Type 1 Diabetes

#190

Post by smnrchrds »

tagh wrote: post #152
techsupporter wrote: post #124

Earlier quoted context omitted.

What's even more frustrating is the disparity in who can get them and how even if they are cleared for use in your country. The author here points out that New Zealand's medical system doesn't always pay for CGMs, while the Australian system does. In Ireland, the Dexcom G6 system is available but the FreeStyle Libre 2, an updated version of the FreeStyle Libre with more frequent reads and better alarms (Libre vs Libr…

>The author here points out that New Zealand's medical system doesn't always pay for CGMs, while the Australian system does. Only for under 21s, and only recently. Once you hit 21, the rug is pulled out from under you.

My province (Alberta) in Canada is just starting to cover CGM costa and only for under 18s.

https://www.cbc.ca/news/canada/edmonton/glucose-monitoring-d...

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