Taking my diabetes treatment into my own hands • Hacker News Board

Re: Taking my diabetes treatment into my own hands

#51

Post by tornadofart » Wed, Jul 24, 2024, 9:25 AM UTC

I'm a T1D and I mostly agree with the author. I think this simulation is very interesting.

I disagree with the author however on the following point:

"injecting insulin ~15min before you start eating would do wonders for neutralizing the BG spike, the issue is, nobody does it, because what if you then get a smaller serving at the restaurant or it gets delayed?"

My doc told me the same, which I think is insane. "Here is a hack that solves 80% of your problems but nobody does it, so don't bother." WTF?

If you get a smaller serving, order some bread or eat some of your emergency snacks you should always have. If it gets delayed, do the same. You don't need to cover the whole insulin dose, just delay the hypo a little bit.

Relax. We live in an industrial world where glucose bombs are available always and everywhere. You'll be fine.

Injecting 15mins beforehand has made my life so much easier that I would not miss it for anything.

Feel free to ask me anything.

Re: Taking my diabetes treatment into my own hands

#52

Post by ddorian43 » Wed, Jul 24, 2024, 9:27 AM UTC

carlmr wrote: post #33

iamthejuan wrote: post #21

I would suggest to drink psyllium husk mixed with water, 15 minutes every meal. It would prevent glucose spikes which is the number cause for diabetis, lowers cholesterol level, regulates bowel movement and it is also an instant relief during hyperacidity.

Are there any studies on this? Not diabetic, but kind of want to prevent getting there, and although I always try to eat enough fibre I guess this could help add fibre anyway when I don't have enough.

Another alternative for not going there is to eat: low carb -> weight loss keto -> carnivore -> epilepsy keto -> epilepsy carnivore / KetoAF (the later being the strictest & highest efficiency).

Re: Taking my diabetes treatment into my own hands

#53

Post by croemer » Wed, Jul 24, 2024, 9:29 AM UTC

Fellow T1D here. Switched to a pump (tslim) 2 years ago, which is a stock/market semi-closed loop requiring no homebrew when paired with Dexcom.

Works pretty well in that it keeps things in range when not eating/exercising. Nights in particular now are chill, no more waking up in sweat.

Unfortunately the pump vibrates/alarms far too much, causing notification fatigue. I don't even look at them anymore. I wish there was more information in the vibration pattern: just morse code or something, so I can know what the pump is saying without having to do 3 taps to unlock and see whether it's just telling me something I know already. I wish the developers had to dog feed their product.

Re: Taking my diabetes treatment into my own hands

#54

Post by nerdponx » Wed, Jul 24, 2024, 9:29 AM UTC

mjaniczek wrote: post #19

Mathnerd314 wrote: post #3

> https://github.com/SmartCGMS/core/blob/dffdd89a274144d0e9ecb... > Especially, a diabetic patient is warned that unauthorized use of this software may result into severe injury, including death. I like the idea of the post - I have actually been thinking about including some biophysical models for medications in my app - but I do think that if you don't understand what a system of differential equations is, maybe tr…

Don't worry, I'm not using the app's suggestions blindly (or at all, currently). But yeah the SmartCGMS authors disclaimed as much - you're using it on your own risk. This is probably also why apps like LibreLink don't provide predictions but only show historical data - easier to not get sued if you don't give the user advice that could kill them? Re models, differential equations and finding minima: I do agree genet…

> Do you have some resources for optimizing a N_51 x N_51 x N_51 x N_51 -> R+ unknown black-box function?

Maybe Bayesian optimization? That's often how hyperparameter optimization is done in machine learning, but that has the additional constraint that each computation of the loss function is very expensive.

In general the term "black-box optimization" is the right search term, or "derivative-free optimization" which is what Wikipedia calls it.

Re: Taking my diabetes treatment into my own hands

#55

Post by croemer » Wed, Jul 24, 2024, 9:32 AM UTC

stranded22 wrote: post #11

Interesting read. My wife is T1D, moved to a closed loop last year. It has been life changing for her - this is not an understatement. Her mental health has massively improved because she isn't having up to 3-4 hypos a day. One thing not mentioned in the intro, hormones hugely affect T1D. She's started perimenopause and everything went out of the window. Closed loop has made this much more manageable.

Indeed, insulin sensitivity varies so based on amount of movement during day, stress, hormones, allergies, slight cold, etc that the rigid algorithmic approach they teach patients doesn't work in practice. I.e. you can follow what you're taught by diabetic nurse and you'll have bad control nonetheless.

What's the model she uses? My guess would be tslim+Dexcom? It does reduce stress a lot.

Re: Taking my diabetes treatment into my own hands

#56

Post by croemer » Wed, Jul 24, 2024, 9:34 AM UTC

gumby wrote: post #4

The fat thing mentioned in the post: fat seems to slow down absorption in my experience, though not to the extreme that some self-described “body hackers” (who don’t have DM) seem to think. I basically consider my malfunctioning pancreas to have been replaced/augmented by my brain, assisted by a cgm. My diet is rather boring but keeps me alive and keeps the BG in a pretty tight range. My biggest problems are hypo (us…

I've never had DKA in 12 years. How does it happen? I've been on CGM (Libre/Dexcom) and it's impossible to get high enough values unnoticed to end up with ketoacidosis for me. Even before with sticks, I just measured often enough.

Would be really curious to know more how DKA happens to you!

Re: Taking my diabetes treatment into my own hands

#57

Post by croemer » Wed, Jul 24, 2024, 9:37 AM UTC

wwilim wrote: post #28

gumby wrote: post #4

The fat thing mentioned in the post: fat seems to slow down absorption in my experience, though not to the extreme that some self-described “body hackers” (who don’t have DM) seem to think. I basically consider my malfunctioning pancreas to have been replaced/augmented by my brain, assisted by a cgm. My diet is rather boring but keeps me alive and keeps the BG in a pretty tight range. My biggest problems are hypo (us…

See, that's the thing. I've had T1D for 26 years now and I have stubbornly refused to accept that it's not a smart idea to eat anything I want. I am not going to give up hash browns until I lose a leg.

As long as you measure often and inject control amounts liberally eating pretty much everything is fine. I think the diet restrictions were very much necessary before frequent testing and fast acting insulins were available.

Re: Taking my diabetes treatment into my own hands

#58

Post by mjaniczek » Wed, Jul 24, 2024, 9:38 AM UTC

croemer wrote: post #53

Fellow T1D here. Switched to a pump (tslim) 2 years ago, which is a stock/market semi-closed loop requiring no homebrew when paired with Dexcom. Works pretty well in that it keeps things in range when not eating/exercising. Nights in particular now are chill, no more waking up in sweat. Unfortunately the pump vibrates/alarms far too much, causing notification fatigue. I don't even look at them anymore. I wish there w…

The LibreLink app allows me to use different alarm tones for lows and highs, and I'm _still_ getting alert fatigue. To the point that my wife needs to ask "is that your phone telling you you have a hyper?" for me to actually start doing something about it, sometimes.

Re: Taking my diabetes treatment into my own hands

#59

Post by interludead » Wed, Jul 24, 2024, 9:43 AM UTC

croemer wrote: post #53

Fellow T1D here. Switched to a pump (tslim) 2 years ago, which is a stock/market semi-closed loop requiring no homebrew when paired with Dexcom. Works pretty well in that it keeps things in range when not eating/exercising. Nights in particular now are chill, no more waking up in sweat. Unfortunately the pump vibrates/alarms far too much, causing notification fatigue. I don't even look at them anymore. I wish there w…

Your experience underscores the importance of user-centered design in medical devices

Re: Taking my diabetes treatment into my own hands

#60

Post by alex_duf » Wed, Jul 24, 2024, 9:43 AM UTC

jajko wrote: post #39

alex_duf wrote: post #38

Earlier quoted context omitted.

I also lived in two of the richest countries with a social medical system My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc. I'm talking about the situat…

My wife is a doctor (GP, before internal medicine in biggest hospitals), experience with France and Switzerland. What you say is true - they all start as naive optimists who get treated brutally by whole healthcare system first 7-10 years after school, everybody knows it, often illegal from hospitals but good luck suing your employer. Burned out, 60-70 hour work weeks with weekends is the standard, night shifts, a lo…

Doctors burning-out is probably the worse red-flag you could have for a health system. It's frightening to think the person diagnosing my parents and children might not be in full possession of their capacity or make rash decisions.

I'm seeing the same pattern for many crucial functions having been pushed over the line during the last two decades or so. Whether it's a doctor, a teacher, a nurse, a childminder, the police, etc. All the jobs that are essential for a developed society have crumbled down to the point I'd discourage any young person to pursue a career in that sector.