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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#231

Post by consp »

arka2147483647 wrote: post #70
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 have had Type 1 for 30 years. To be honest, i don't do the math. I choose the amount of units to inject by feel. I mean, i know by eating a banana, i get something like 20g of carbohydrates, and i should take 3u. But if i feel, that the correct dose is 6 units, then i take that. I cant really explain it. But i kind of feel the state, where i am going, and can adjust instinctively. Works more often than not. I have…

> honest, i don't do the math

Also 30 years here. I have exactly the same thing as you describe though when I switch insulin I do start calculating again to be sure it matches with my assumptions. Blood glucose measuring is required though as you mention. I'm one of the lucky ones with very lineair and predictable response to every unit more or less of insulin. Not everyone is that lucky though.

Re: The Unreasonable Math of Type 1 Diabetes

#232

Post by consp »

arka2147483647 wrote: post #129
JimmyAustin wrote: post #106

Earlier quoted context omitted.

I'm not diabetic, but I tried a FreeStyle Libre 2 continuous glucose monitor to measure my blood sugar, and I think it's basically what you are asking for. Tap your phone on a patch on your arm to get a instant view of your blood sugar, plus see the previous 8 hours. It is pricey though.

My understanding is that all current devices like this use a thin sensor "fiber" that is inserted under the skin, which is then connected to the coms-unit, which is in the sticker which remains on top of the skin. So they are still somewhat invasive.

And also annoying if your body really doesn't like them since they clog up after at most a day with me... (I've used them a few time since they were the size of bread boxes with long wires and the results after about a day always become erradic and unpredictable)

Re: The Unreasonable Math of Type 1 Diabetes

#233

Post by consp »

btowngar wrote: post #227
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 further thing - the article doesn’t talk much about the physical response to wearing a CGM such as the extreme skin irritation some people get from the adhesive. Or the fact that the CGM reading could be way off the reading you get from a finger prick test - which can in turn vary significantly from a lab test result!

I did the test once with most meters I still had laying around: ballpark correct but according to them my blood sugar level was between 3.8 and about 7 mmol/l. I have one which is very finacky in the 4.0 and lower range which is annoying if you want to know if it really starting hypoglycemia or you are just tired.

Re: The Unreasonable Math of Type 1 Diabetes

#234

Post by kakoni »

bleair wrote: post #24
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.…

There's also two "open source" systems - https://loopkit.github.io/loopdocs/ - https://openaps.org/ Tidepool is also trying to take the loop project and get a version of it FDA approved. Both of the open source projects require you to do the work and actively take control of your setup (a cgm plus pump plus phone). They have really nice support communities. I would never go back to not using Loop.

+ the funny thing is that both openaps/androids + loopkit are more advanced than the commercial offerings that we are starting to see now.

Medtronic licensed their artificial pancreas system MD-Logic from Israeli company DreaMed in 2015. Dexcom bought TypeZero (who have system called inControl) back in 2018.

Re: The Unreasonable Math of Type 1 Diabetes

#235

Post by mleonhard »

City of Hope Medical Center is developing the PIpepTolDC "inverse vaccine" to treat Type 1 Diabetes and other auto-immune diseases [0]. They have had two successful trials in humans [1, 2]. The third trial is recruiting adults with T1D onset 1-4 years ago [3].

The PIpepTolDC treatment is expensive because it is labor intensive. A technician must take some of the patient's blood, isolate their immune cells, replicate the cells, desensitize them, and then inject them back into the patient. BioNTech is developing a new category of treatments for auto-immune diseases [4] which should be inexpensive injections. These should include a treatment for Type 1 Diabetes.

Frankly, this tech seems amazing and ready to cure many diseases. The pace of development seems slow. I wish there were some way to speed it up. About 80,000 children develop T1D every year.

[0] https://www.precisionvaccinations.com/type-1-diabetes-vaccin...

[1] https://doi.org/10.1126/scitranslmed.aaf7779

[2] https://doi.org/10.1016/S2213-8587(20)30104-2

[3] https://clinicaltrials.gov/ct2/show/NCT04590872

[4] https://investors.biontech.de/news-releases/news-release-det...

Re: The Unreasonable Math of Type 1 Diabetes

#236

Post by consp »

sweston4 wrote: post #204
m_kos wrote: post #181

Earlier quoted context omitted.

> 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 belie…

> have to take some amount of insulin

There are quite a few pathways for your muscles and liver to release "stored glocose". If you want to artificially do it, get a glucagon siringe and get the worst hyperglycaemia you ever had since your liver starts converting glycogen into glucose en-masse. Natural release of glucagon is also regulated by having a low carb diet.

Re: The Unreasonable Math of Type 1 Diabetes

#237

Post by consp »

not2b wrote: post #45

My wife developed type 1 diabetes as an adult (40s) from an autoimmune disease (it attacked her thyroid as well). At first her pancreas still had a bit of function left, which made things even harder because there would be unknown random extra insulin, so the only way for her to manage was to eat ultra-low carb and not very much, so she lost a ton of weight. She actually did better once her pancreas no longer produce…

> insurance company keeps making her switch formulations depending on whatever is cheapest this month

That's batshit insane... Around here generics are now available for short acting insulins but while they should be the same they are not (ballpark maybe) but insurance is allowed to force cheaper if equivalent (according to them). My physision is writing force prescriptions the insurance has to obey since switching will be bad for the patient with the only benefit going to the insurer.

Re: The Unreasonable Math of Type 1 Diabetes

#238

Post by imtringued »

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…

Type one diabetes is an auto immune disease whereas type two diabetes is a symptom of the food industry, those are hardly comparable.

Re: The Unreasonable Math of Type 1 Diabetes

#240

Post by archi42 »

emj wrote: post #78
arka2147483647 wrote: post #70

Earlier quoted context omitted.

I have had Type 1 for 30 years. To be honest, i don't do the math. I choose the amount of units to inject by feel. I mean, i know by eating a banana, i get something like 20g of carbohydrates, and i should take 3u. But if i feel, that the correct dose is 6 units, then i take that. I cant really explain it. But i kind of feel the state, where i am going, and can adjust instinctively. Works more often than not. I have…

> I measure blood sugar A LOT, though. That is the most important part, you can really live a good life if you have that. I hope we get more powerfull and cheap way to do that continously. At the momemnt it's at least 300 USD a month for a CGM device that can measure every five minutes. It's abit like monitoring traffic load and adding more servers as you go, except too many servers kill you. That with knowing how yo…

300 USD? That is incredibly expensive! In Germany, the general public can order a Libre 2/3 from their website for 60 EUR. That's 150 USD per month (assuming 26 devices per year). Though that's a purely theoretical price: As with insulin, the mandatory health insurance seems to pay for it anyway.

Even with import taxes/tariffs applied, I could imagine a vacation to Europe being massively subsidized by just bringing back one or two years of GCM supplies (obviously Vimes theory of socioeconomic unfairness[1] applies).

[1] https://www.goodreads.com/quotes/72745-the-reason-that-the-r...

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