Dunno if the millennials,Gen Z,Gen A etc. know these sorts of things - well, there is an old lady by name Julia Roberts who was nominated for an Oscar (its like an award) for a movie about Type 1 Diabetes that I first saw in a theater (that's like a place where us Boomers go to watch stuff you would normally see on your iPhone). I don't know if you have the patience to sit through a long, quite funny and very talkative movie about a bunch of old ladies, one of who's a diabetic, talking about everything under the sun but diabetes, in a salon. Half the diabetic community believe the movie is over dramatized or what have you, but hey, the other half disagrees. Regardless, it remains one of my most favorite films. https://en.wikipedia.org/wiki/Steel_Magnolias
The Unreasonable Math of Type 1 Diabetes
201–210 of 315 posts
Re: The Unreasonable Math of Type 1 Diabetes
#202I'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?
This kind of exists, and here is one such system:
https://www.tandemdiabetes.com/products/t-slim-x2-insulin-pu...
The pump delivers insulin and gets blood glucose readings from a CGM (continuous glucose monitor) over bluetooth. Then the pump can make decisions such as stopping insulin delivery if you're going to go low, doing small correction boluses, and adjusting basal rate.
However it's far from perfect and still needs a lot of management. My wife has T1D and was recently pregnant, which really raises the bar on how tightly you need to control your diabetes. She ended up mostly micromanaging it all herself rather than trusting Control IQ to do the right thing.
The other issue is CGMs are not that accurate, so these systems are making decisions based on not great data.
Re: The Unreasonable Math of Type 1 Diabetes
#203Sugarmate is a fantastic app/service that will call a phone number with an automated message if your Dexcom CGM falls below a certain threshold. It’s allowed my wife and I to sleep a tiny bit better knowing if our son’s blood sugar goes low that we’ll be woken up. Not affiliated, just a happy user.
Re: The Unreasonable Math of Type 1 Diabetes
#204I'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.
Oh, I am very happy to answer this to the extent I can. Whey protein impacts my blood glucose in confusing ways! Most days, I'll have a whey protein shake that consists of one scoop whey protein, a little bit of coffee for taste, and some almond milk. This will typically be my first meal after ~12-16 hours without eating. The correct dose of insulin for this shake can vary from 2 units of insulin to 4.
First, I believe you're correct that gluconeogenesis happens rarely. More specifically, I believe it happens in the absence of carbohydrates in the food you consume. Since I eat a low carb diet, it would make sense that I experience gluconeogenesis.
Second, have I noticed a spike in glucose? Yes! I have to take some amount of insulin if I have a protein shake. The coffee has no effect, so any effect comes from the almond milk and whey. There's maybe half a cup of almond milk in my shakes which is close to negligible. We can probably assume that whey drives most of the glucose effects from my shake.
Third, why is there so much variance in my blood glucose response and insulin requirements? Here, I do not have a defined answer. One aspect may be that whey is quickly digested. The quick digestion may accelerate the effect of gluconeogenesis. Another factor may be the state of the glucose reserves in my liver before I consume the whey. If I'm in a state of ketosis, it may be that my body accelerates gluconeogenesis because it believes it's in a carbohydrate shortage. In this situation, the glucose spike may exceed what would otherwise be expected. There's a few other things such as exercise I'd include here, but I don't have a single definitive answer to this.
A final note: In some sense, I can feel/anticipate my insulin sensitivity during the day. I cannot explain this in writing in any coherent way, but I have decent intuition on what insulin dose between 2 and 4 units I should pick each day. Or, before bed, even if my blood sugar appears constant and in-range, I may anticipate that it'll go up and down as I sleep and eat/inject insulin accordingly. One part of this intuition is "knowing" rather a protein heavy meal will kick into gluconeogenesis while I sleep. Anyways, I can answer more, but as you can perhaps tell, most of my explanations are of the waves hands variety.
Re: The Unreasonable Math of Type 1 Diabetes
#205I am up reading this in bed. Also watching my 11 year old’s BGL slide down under 80. I’m about to go wake him and make him drink some milk.
Diabetes is a shit autoimmune disease. But the tech gives us some hope. And I treasure every day, no matter how hard, I get with my kid.
Hang in there. It gets easier to manage as they get older and more involved in their care.
Re: The Unreasonable Math of Type 1 Diabetes
#206Hi, I'm an artificial pancreas developer! Our device has been approved for human trials which we're going to begin shortly, probably near the end of this quarter. One thing that the article (which is very well researched, by the way, kudos!) does not quite get right is that the insulin sensitivity _changes_ hour to hour, day to day, month to month. It changes nonlinearly with exercise, stress, sleep, diet, and in a m…
Hey Jeremy, I was hoping to send you an email based on the email in your profile (jeremy@ideal.com) and received an "address not found". Would there be a better way to reach you?
Re: The Unreasonable Math of Type 1 Diabetes
#207Hi, I'm an artificial pancreas developer! Our device has been approved for human trials which we're going to begin shortly, probably near the end of this quarter. One thing that the article (which is very well researched, by the way, kudos!) does not quite get right is that the insulin sensitivity _changes_ hour to hour, day to day, month to month. It changes nonlinearly with exercise, stress, sleep, diet, and in a m…
I just looked at your profile and saw what your company is working on. Very interesting!
My wife and I were recently in a situation where I'd wondered why the hospital didn't have such a thing!
My wife has T1D and we just spent 3 days in the hospital for the birth of our daughter. The most scary and frustrating part of the whole process was my wife's diabetes management. She uses a Tandem T:Slim and a Dexcom G6, and generally has very tight control. But the hospital insisted on taking over during active labor, and we had a very tense conversation with a tactless perinatologist about it.
They wanted to put her on an (IIRC) intermediate acting insulin drip, and rely on finger pricks. We were very worried that they would basically be following a canned script and would end up yo-yoing her blood glucose during labor.
We ended up getting our OB to convince the completely tactless perinatologist that we'd define "active labor" as actually pushing. So we delayed getting her off her pump/CGM and self management for quite a while. And by then we'd also fortunately convinced our nurse who was responsible for the insulin that we knew what we were doing. So she consulted with my wife (literally between contractions and pushing) on any insulin delivery. They adjusted the plan in real time based on what my wife said they should do. Had they just followed the script/protocol the hospital had, we probably would have seen them give my wife way too much insulin.
Then for the rest of our stay, the hospital insisted on checking her blood glucose with finger pricks, though she was self treating with her pump. It really felt like it was for their benefit and not hers.
It was really clear that literally every person we interacted with (except maybe the tactless perinatologist) knew less about T1D than we did. They are much more setup for poorly managed gestational diabetes.
Watching the hospital try to manage her T1D made us feel like we were jumping back in time a decade or two. And this was one of the big, nice, (and expensive) hospitals in San Francisco.
If she would have had a c-section or some other situation where she wasn't able to help direct her diabetes management, I'm kind of afraid of what could have happened.
It really made me wonder why there wasn't an artificial pancreas type system for hospitals.
Now I see that someone is actually working on that!
Re: The Unreasonable Math of Type 1 Diabetes
#208Hi, I'm an artificial pancreas developer! Our device has been approved for human trials which we're going to begin shortly, probably near the end of this quarter. One thing that the article (which is very well researched, by the way, kudos!) does not quite get right is that the insulin sensitivity _changes_ hour to hour, day to day, month to month. It changes nonlinearly with exercise, stress, sleep, diet, and in a m…
How does one go about getting on the list for trials?
Re: The Unreasonable Math of Type 1 Diabetes
#209Hey 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.
Our T1D kid has been pumping since 18 months. He was diagnosed at 12 months old. He's six now and has been pumping nearly the entire time.
We're in Vietnam but we do all his endo related medical stuff in Singapore.
Counting carbs in kids is a nearly pointless endeavor. Picky eating habits, nutrition mis-labeling (good luck finding accurate nutrition information in Vietnam), etc. And you'll also need to consider that their bodies are moving targets with hormones, growth spurts, etc. It's going to be really hard to manage just by math alone.
Being five years into it now, because the math seems to be changing daily, we are doing it almost by feeling backed by CGM evidence. In our case, the only CGM available here is the Freestyle Libre which is mildly inaccurate except for informing us on the general direction his blood sugar is taking. It's enough info that we've gotten his hb1ac into near normal range and the miaomiao3 turns into a full fledged CGM that we can use with nightscout and xdrip4ios for realtime monitoring.
I'd also advise you to think about joining a group of parents of T1Ds because there's a lot of things to learn and I've personally found it helpful when working through edge case scenarios that will eventually happen.
Re: The Unreasonable Math of Type 1 Diabetes
#210Now if only these companies could be encouraged to avoid creating products destined for the landfill needing people to reverse engineer them just to recharge them.
https://github.com/jakebenz/cgm is also related