11–20 of 24 posts
Almost $1 billion per day in the United States.
https://www.cdc.gov/diabetes/data/statistics-report/diagnose...
28.7 million people in the US have diagnosis of diabetes. ~2M are type I, with the remaining 27M being type II.
u can cure type 2 if u have it quite easy. i recomend books by jason fung, diabetes code and obesity code.
It is a horrible disease - my sister was born with Type 1, and was lucky enough to be offered a pancreas transplantation some 10 years ago. Unfortunately her body rejected it after a year or two, and she was on immune depressants ever since, while waiting for a new one. She works in fitness, and lives a very active and healthy lifestyle - but still the diabetes was progressing, slowly but surely. Those new automatic…
> and modern delivery systems. While I'd agree with most of what you say, I disagree with this. Using a syringe and manually taking insulin is perfectly workable. Personally, I have chosen to go with manual insulin injections over a pump. That being said, the invention of the CGM (continuous glucose monitor) is, in my opinion, the single best thing to happen for diabetics since the advent of synthetic insulin. Being…
However, CGM is a technology which may have serious, life-threatening side effects when its data is inaccurate and used in concert with a hybrid closed loop insulin pump. In patients like me, the frequency of bad data is daily.
"Being able to know what your blood sugar is with no effort at all, and being alerted when it's high or low... is just life changing".
That may be true as long as we include death and serious injury as the "life changing" events that they are.
CGM is useful technology but "life changing" is assuming a level of execution that does not exist in the current generations of CGM technology that I've used, which include Dexcom G6 and Freestyle Libre 2.
It is well understood in the research community of MD-PhD's that interstitial fluid in adipose tissue is a reasonable proxy for plasma blood glucose with the correct algorithmic approach, but it is not perfect.
Particularly in patients who have low adipose tissue, the data emitted from these sensor devices is frequently wrong at fasting times such as exercise and sleep.
I've worn an insulin pump for more than twenty years and used Medtronic, Dexcom, and Abbott for their CGM data in recent years.
The sensors have been replaced under warranty dozens of times, due to inaccurate readings, the last of which I submitted today, when the pump alarmed at 1:30 AM last night reporting that my CGM BG was 50, when my plasma BG reading was 112, the former of which is hypoglycemic while the latter of which is slightly hyperglycemic. I've seen much larger variations than that.
We'll leave the fact that my quality of sleep has been destroyed by these devices for another discussion. This is frequently nightly.
The problem is this: at night or during exercise, when fasting states are both reasonable and customary since it's difficult to eat and sleep or eat and exercise concurrently, innacurate CGM data can induce the pump to either increase insulin delivery, decrease insulin delivery, or stop delivery entirely.
In turn, those 3 conditions can result in hypoglycemia or hyperglycemia, either of which can result in injury or death.
So while diabetes is a difficult disease, it must be noted that exogenous insulin is like any other prescription medication - there are side effects.
Further, technological solutions such as hybrid closed loop insulin pump systems, when used in concert with CGM, may have deadly side effects that are not clearly communicated, nor are they pursued with vigor in the billion dollar companies who promote these products.
Given what I've seen, I've merely warned my doctor and the FDA of the need for oversight and regulation in these markets.
I'm hopeful that the products do eventually get fixed, but having worked in medical devices, I'm not optimistic given the history of the FDA's involvement in insulin pump security breaches in the last decade.
u can cure type 2 if u have it quite easy. i recomend books by jason fung, diabetes code and obesity code.
You can mitigate the effects of Type 2 diabetes. That's not the same thing as curing it. The effects will almost certainly re-occur if you stop the behavior you are using to mitigate it (which is generally low carbs, low calories, exercise, etc).
You can go for decades or even a lifetime without remission but the moment you take a bite out of that raw cookie do prepare yourself for a salmonella infection.
I wonder how many others are silently walking around, unaware of their prediabetes.
Earlier quoted context omitted.
> and modern delivery systems. While I'd agree with most of what you say, I disagree with this. Using a syringe and manually taking insulin is perfectly workable. Personally, I have chosen to go with manual insulin injections over a pump. That being said, the invention of the CGM (continuous glucose monitor) is, in my opinion, the single best thing to happen for diabetics since the advent of synthetic insulin. Being…
I can understand your perspective since I've lived with Type 1 diabetes for most of my life. However, CGM is a technology which may have serious, life-threatening side effects when its data is inaccurate and used in concert with a hybrid closed loop insulin pump. In patients like me, the frequency of bad data is daily. "Being able to know what your blood sugar is with no effort at all, and being alerted when it's hig…
A semi-closed loop pump will give you a basal rate that changes through the day, informed by the CGM. A long-acting insulin dose (eg, Lantus) will give you a basal rate that changes through the day, due to absorption rate, temperature, exercise, etc.
Now, neither Basal rate will match your bodies needs minute-by-minute. But even with the CGM & looped pump regularly getting it wrong (which it does), it’s still I think getting it much less wrong than inject-and-pray long-acting insulin treatment.
As for risks, I had to do two days of training to get my pump and another online course to turn in the hybrid-closed-loop. That’s more than when I was given a glucometer and insulin pen when I was diagnosed, and it’s pretty easy to kill yourself with those.
This updated cost estimate for U.S. diabetics is for 2017, not now. Insulin prices in the U.S. are up substantially since 2017. Another expensive change since then is the increasing availability of the (so-called) continuous glucose monitors, now costing around $100/week for each diabetic using one. My opinion (I use one) is that mine is well worth it, but that the monitors are unlikely to reduce the total medical co…
Earlier quoted context omitted.
You can mitigate the effects of Type 2 diabetes. That's not the same thing as curing it. The effects will almost certainly re-occur if you stop the behavior you are using to mitigate it (which is generally low carbs, low calories, exercise, etc).
You can mitigate the effects of a cookie dough induced salmonella infection. That is not the same as curing it. The effects will almost certainly re-occur if you stop the behaviour you are using to mitigate it (which is generally not eating raw cookie dough every single week). You can go for decades or even a lifetime without remission but the moment you take a bite out of that raw cookie do prepare yourself for a sa…
A better analogy would be a transplant. Just because you are on immunosuppressants to prevent your body from rejecting the new organ doesn't mean you've "cured" yourself of that rejection; you're just mitigating/preventing the impact of it.
Earlier quoted context omitted.
I can understand your perspective since I've lived with Type 1 diabetes for most of my life. However, CGM is a technology which may have serious, life-threatening side effects when its data is inaccurate and used in concert with a hybrid closed loop insulin pump. In patients like me, the frequency of bad data is daily. "Being able to know what your blood sugar is with no effort at all, and being alerted when it's hig…
I agree that they’re quite imperfect. However, as people with Type 1 we don’t have the option of perfect. The alternative to CGMs is finger- pricking. The alternative to pumps is long-acting insulin. A semi-closed loop pump will give you a basal rate that changes through the day, informed by the CGM. A long-acting insulin dose (eg, Lantus) will give you a basal rate that changes through the day, due to absorption rat…
Two days of training is incredibly short given the complexity.
Killing yourself at your own hand is well-understood culturally, clinically, and legally. The mechanisms of insulin-induced trauma have been well understood since insulin shock therapy:
https://en.wikipedia.org/wiki/Insulin_shock_therapy
and Klaus von Bulow:
https://en.wikipedia.org/wiki/Sunny_von_B%C3%BClow
Being killed by a machine, on the other hand, directly or indirectly may be understood culturally from the long list of science fiction films featuring killer robots, but less so clinically and legally, because we don't have agreement or consensus on accidental death and the role of technology in rising risks in a complex systems environment.
We need to take the implications of the design of medical device autonomy seriously as we approach these problems with those solutions, since they often fail a definition of complete autonomy, but may in fact be considered close enough to pass the same standard of risk and care as we'd give to autonomous robots in industrial settings or self-driving cars.
Just because the administration of drugs doesn't seem particularly robotic, when that administration is beyond a certain percentage of machine control, I'd argue that it is behaving autonomously even though the control mechanisms fall short of machine learning.
It's as if we took Therac 25 and strapped it to a patient's belt with the oncology planning encoded in the radiation device. It may seem as if the complexity is less, but we don't have consensus on that either:
https://www.scielo.br/j/rbepid/a/Mn7DTtCYQLL5gkJgBb8XP3q/?la...