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Taking my diabetes treatment into my own hands

martin.janiczek.cz

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Re: Taking my diabetes treatment into my own hands

#121

Post by IggleSniggle »

flanked-evergl wrote: post #99
gbuk2013 wrote: post #97

Earlier quoted context omitted.

> Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. YMMV but as a software developer I am certainly not going to start throwing stones in a glass house. :) Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.

> Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession. I'm not sure why the educational requirements are so extreme for all doctors. Certainly for some, like surgeons, I get it, but for my GP I think it's a total farce. I don't make the rules though, I just can see a broken system when it's right…

Not sure how it is outside the US, but subscribing nurse-practitioners (requires just 2 additional years after a nursing degree) have been quickly replacing GP docs in the US for this reason. They'll send you to a specialist just like a GP would. It's all the same problems in terms of the underlying model, but the financial and time costs to the system are lower.

I'm not totally sold on what I'm selling though. My spouse has been a nurse practitioner for over 10 years; she had the option of becoming an MD but picked that route because she saw the grueling 80+ hr work weeks of older doctor friends and decided it wasn't for her. Unfortunately, she's still stuck with only 20 minutes for sometimes extremely complex patients that require a great deal of research and follow-through outside of work hours, and the extra slack in the system that is provided by her lower wages has just gone to hiring additional administrative middlemen that are seldom capable of actually filling in the gap, whether for reasons of liability, knowledge, skill, or motivation. These positions exist to try and ease the pressure on docs just like NPs exist to ease the pressure on docs, but it doesn't work because at the end of the day you need someone who can hold the liability (both legal and moral) and the knowledge (the correct diagnosis and the correct plan of action) within the same person.

Just like in software, where throwing more developers at a problem doesn't guarantee your problem gets solved more efficiently, for much the same reason. You need somebody who understands the domain, understands the tools, understands the business framework, and is ready to take responsibility for solving the problem. Each additional person introduces information overhead that makes each one of those tasks more complicated.

Re: Taking my diabetes treatment into my own hands

#123

Post by jhoho »

telgareith wrote: post #110
jhoho wrote: post #96

Not sure how widely known this is, but recent studies have shown great, sustained results for type 2 through dietary interventions using wholegrain oat (as it contains beta-glucan): https://www.thieme-connect.com/products/ejournals/html/10.10... https://www.sciencedirect.com/science/article/pii/S221479931...

Looked at the first paper. I have significant concerns that, frankly, I didn't finish reading. 1. Small sample size, 4. Cont. Because people rarely intentionally make themselves feel like crap- which you will with uncontrolled type II. The hospital stay, its exposure to allegedly* diabetic friendly foods, and subsequent time for the subjects to realize "I feel better, I like this!" Basically invalidates the entire pa…

There are several more studies and dietary recommendations regarding oat, just search Google Scholar and similar.

Re: Taking my diabetes treatment into my own hands

#124

Post by fortran77 »

DougWebb wrote: post #86
janandonly wrote: post #76

Very dumb question here, but I don’t dare ask it to ChatGPT. What would happen to T1 or T2 diabetics if we would stop eating all sources of sugars and carbs? So no fruit, no rice, no potatoes and so on? Would it be possible to survive and live comfortably in a state of Ketosis? Or is a 100% ketogenic diet simply not possible on diabetes? I’m asking because my true question is: what if insulin becomes too expensive? T…

T1 and T2 are completely different diseases. T2 should not be called diabetes. It should be called insulin resistance or chronic carbohydrate overdose. I was diagnosed as pre-diabetic/T2. I started wearing a cgm and watching how various foods affected my blood sugar. I eliminated foods that caused spikes, and started cooking my own meals so I could control what went into them. I wound up with a very low carb diet of…

There are some people with T2D—a minority of them—who are not overweight. I think T2D with overweight or obesity should be called something else.

Re: Taking my diabetes treatment into my own hands

#125

Post by CRConrad »

Engineering-MD wrote: post #107
gitfan86 wrote: post #103

Earlier quoted context omitted.

Type 2 has had a high correlation with obesity and high carb diets.

But interestingly also a very high genetic factor with 90% of identical twins both having T2DM (which is greater than that of type 1 which if I remember correctly is 40%)

> very high genetic factor with 90% of identical twins both having T2DM

Or both not having it, I hope?

Re: Taking my diabetes treatment into my own hands

#126

Post by Swizec »

carimura wrote: post #119
flanked-evergl wrote: post #36

Not a diabetic and I live in one of the richest countries with a social medical system, but the medical industry is an abject failure. My experience with most Doctors who are not surgeons has mostly been that are overpaid for doing essentially nothing and think all their patients are hypochondriacs.

In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick. I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fort…

> But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.

Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it?

Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time.

Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)

Re: Taking my diabetes treatment into my own hands

#127

Post by MajimasEyepatch »

carimura wrote: post #119
flanked-evergl wrote: post #36

Not a diabetic and I live in one of the richest countries with a social medical system, but the medical industry is an abject failure. My experience with most Doctors who are not surgeons has mostly been that are overpaid for doing essentially nothing and think all their patients are hypochondriacs.

In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick. I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fort…

None of those things are necessary most of the time, and they’re usually just going to make you paranoid. It’s why doctors don’t generally like to do full-body scans on healthy people: they’re rarely going to find anything clinically significant, but they’re often going to find something that causes a scare and some unnecessary tests. (And if the scan is a CT scan, on average, the radiation may cause more cancers than it catches if you’re scanning healthy people for no reason.)

If you want to have the best shot at preventing disease and living a long, healthy life, it’s not complicated: eat a healthy diet, exercise, get a good night’s sleep, avoid drugs and alcohol, and have fulfilling relationships with other people. Beyond that, you’re spending a lot of money on things that are going to have a negligible or even negative impact on your health and quality of life.

Re: Taking my diabetes treatment into my own hands

#128

Post by Palomides »

Swizec wrote: post #126
carimura wrote: post #119

Earlier quoted context omitted.

In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick. I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fort…

> But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick. Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it? Well it turns out you only have a 3% (…

the test isn't the problem, it's that doctors and patients aren't used to making decisions based on probability (patients demand something must be done, while doctors run on vibes and cover your ass)

(context: spent some time working in a prostate cancer research lab and have doctors in the family)

Re: Taking my diabetes treatment into my own hands

#129

Post by SystemOut »

lolc wrote: post #113
janandonly wrote: post #76

Very dumb question here, but I don’t dare ask it to ChatGPT. What would happen to T1 or T2 diabetics if we would stop eating all sources of sugars and carbs? So no fruit, no rice, no potatoes and so on? Would it be possible to survive and live comfortably in a state of Ketosis? Or is a 100% ketogenic diet simply not possible on diabetes? I’m asking because my true question is: what if insulin becomes too expensive? T…

I've lived low-carb as a T1 and my blood sugar was very stable. I would still take sugar to stabilize levels when dipping low. A completely ketogenic diet would be very hard for a T1 and not a sensible goal. Insulin management was simpler, but still required. On many days I would just do the one injection of long-lasting insulin. While the scantly researched health risks associated with a ketogenic diet remain, the d…

This may be a terminology thing but as a T2 I will always carry that diagnosis. However, mine is in remission because I manage it through medication/diet.

My doctor and I have talked about trying to see if I can drop the medications and still stay in remission but I'll still be a T2 patient.

Also, not all T2s can manage just through a ketogenic diet.

Re: Taking my diabetes treatment into my own hands

#130

Post by JackMorgan »

voidUpdate wrote: post #29

>Aside: what do you .NET folks use nowadays? Winforms lol, it just works and I don't have to spend most of my time trying to work out xaml stuff. Just add the components to the window, set up some event handlers, done

Unironically I use React or htmx with Typescript if I need a UI in front of dotnet. Having spent far too long dealing with all the dotnet thrash, all to build a GUI that only works on Windows desktops, I said enough is enough and learned how to build a web front end.

Best decision ever. I know plenty of dotnet folks who would rather eat a shoe than learn how to build a web front end, but frankly it's still better than what I would get with Winforms. There's so many great free libraries, tutorials, and resources for webdev.

And best of all, now I have something I can host on a free GitHub site and share with people, instead of figuring out how to build an installer.

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