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A DIY diabetes kit

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Re: A DIY diabetes kit

#11

Post by brudgers »

jacalata wrote: post #9
srameshc wrote: post #6

Earlier quoted context omitted.

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.

My understanding is that Dana Lewis developed the pre-cursors to OpenAPS because she had to perform dosage calculations several times a day. Often this was in the middle of the night. And getting it wrong could be fatal.

Going further, the calculations are rule of thumb and generic and each person has to make adjustments based on intuitions about their metabolism, what they ate, what they plan to eat, what activity they anticipate, and when they last dosed. It's every day, for the rest of their life.

[Source]

Scott Hanselman interviews OpenAPS hacker Dana Lewis:

http://www.hanselminutes.com/514/the-open-artificial-pancrea...

Re: A DIY diabetes kit

#12

Post by kennywinker »

jacalata wrote: post #9
srameshc wrote: post #6

Earlier quoted context omitted.

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.

Birth control is a bad example, because as far as I can find it's prescription only for sex-negative cultural reasons, not for medical reasons.

It is exceedingly easy to overdose on tylenol, and yet it's available without any controls.

Re: A DIY diabetes kit

#13

Post by monkmartinez »

jawngee wrote: post #5

My son was just recently diagnosed type 1 about 4 months ago (exactly on his 1st birthday, shitty birthday). Unfortunately, we live in Vietnam where access to even basics like pumps, let alone CGM, is non-existant, or incredibly hard. We had to fly to Singapore to get a pump, and then fly back every three months to get new supplies. CGM is a pipe dream. One thing this article doesn't touch on, which is unfortunate, i…

To the point about using Glucagon in some kind of fashion...

We (EMS) give glucagon to hypoglycemic diabetic patients when we are unable to obtain IV access. I am not a doctor, but we almost always prefer to give them D50 via IV for diabetic emergencies in the field. Most of the time, they don't need to go into the ER after such intervention. As a last resort we give glucagon IM and wait, and wait... more often than not, using glucagon requires a trip to the ER. Bottom line, glucagon and the resulting liver release of glycogen doesn't seem like a healthy way to regulate blood/glucose levels long-term.

Again, I am not a doctor... But as I understand the process, your liver needs time to build up glycogen stores. If you start hammering on the liver to deliver, you may trigger other unintended consequences. It just doesn't seem like a good idea from my admittedly naive, and emergency medical point of view.

Re: A DIY diabetes kit

#14

Post by tdeschamps »

srameshc wrote: post #6
jawngee wrote: post #5

My son was just recently diagnosed type 1 about 4 months ago (exactly on his 1st birthday, shitty birthday). Unfortunately, we live in Vietnam where access to even basics like pumps, let alone CGM, is non-existant, or incredibly hard. We had to fly to Singapore to get a pump, and then fly back every three months to get new supplies. CGM is a pipe dream. One thing this article doesn't touch on, which is unfortunate, i…

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

Maybe it's because the production process (protein separation, purification) has not been improved for a long time and the market is controlled by two big drug makers.

Re: A DIY diabetes kit

#15

Post by aab0 »

maxerickson wrote: post #7
srameshc wrote: post #6

Earlier quoted context omitted.

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

Walmart sells older forms over the counter. http://www.npr.org/sections/health-shots/2015/12/14/45904732... Pricing info isn't super apparent, I guess it probably isn't a whole lot more than the $25 a vial suggested in various articles and comments about it.

It's not. I'm not diabetic, but there's some interesting research on intranasal insulin and cognition, so I thought I might try it out. At my local east coast Walmart, I bought on March 13th 2016 a 10ml vial of Novolin R insulin for $24.88. (No prescription required.)

Re: A DIY diabetes kit

#16

Post by oskarpearson »

Good to see this here. I'm one of the developers (though more on the radio comms side, rather than on the glucose control side. See http://github.com/oskarpearson/mmeowlink/wiki for info).

My wife's been on the software since last September, and it's made a huge difference to us.

If you've any questions, ask here or grab me on twitter at @oskarpearson

Re: A DIY diabetes kit

#17

Post by et2o »

monkmartinez wrote: post #13
jawngee wrote: post #5

My son was just recently diagnosed type 1 about 4 months ago (exactly on his 1st birthday, shitty birthday). Unfortunately, we live in Vietnam where access to even basics like pumps, let alone CGM, is non-existant, or incredibly hard. We had to fly to Singapore to get a pump, and then fly back every three months to get new supplies. CGM is a pipe dream. One thing this article doesn't touch on, which is unfortunate, i…

To the point about using Glucagon in some kind of fashion... We (EMS) give glucagon to hypoglycemic diabetic patients when we are unable to obtain IV access. I am not a doctor, but we almost always prefer to give them D50 via IV for diabetic emergencies in the field. Most of the time, they don't need to go into the ER after such intervention. As a last resort we give glucagon IM and wait, and wait... more often than…

Also not an MD (yet) so grain of salt, but from my experience: Yeah, D50 is a more direct way to get glucose into the blood stream. It does take a lot more time to mobilize liver stores of glycogen.

But using glycogen stores isn't necessarily bad for you metabolically. Glucagon is used by your body everyday during periods of fasting between meals to maintain a minimum blood sugar. Your glycogen stores can supply enough glucose for several hours of fasting before you turn to other routes of metabolism, which would next preferentially be fatty acids. Glucagon IM injectors are given to lots of diabetics to prevent hypoglycemic emergency if drinking fruit juice or something isn't enough.

Re: A DIY diabetes kit

#18

Post by et2o »

et2o wrote: post #17
monkmartinez wrote: post #13

Earlier quoted context omitted.

To the point about using Glucagon in some kind of fashion... We (EMS) give glucagon to hypoglycemic diabetic patients when we are unable to obtain IV access. I am not a doctor, but we almost always prefer to give them D50 via IV for diabetic emergencies in the field. Most of the time, they don't need to go into the ER after such intervention. As a last resort we give glucagon IM and wait, and wait... more often than…

Also not an MD (yet) so grain of salt, but from my experience: Yeah, D50 is a more direct way to get glucose into the blood stream. It does take a lot more time to mobilize liver stores of glycogen. But using glycogen stores isn't necessarily bad for you metabolically. Glucagon is used by your body everyday during periods of fasting between meals to maintain a minimum blood sugar. Your glycogen stores can supply enou…

Another interesting thing is that your body has three signaling mechanisms to maintain a minimum blood glucose (can't live without it!). First glucagon, then cortisol, then epinephrine all function on a variety of pathways to generate glucose.

Re: A DIY diabetes kit

#19

Post by brudgers »

kennywinker wrote: post #12
jacalata wrote: post #9

Earlier quoted context omitted.

It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.

Birth control is a bad example, because as far as I can find it's prescription only for sex-negative cultural reasons, not for medical reasons. It is exceedingly easy to overdose on tylenol, and yet it's available without any controls.

Condoms aren't prescription only in many jurisdictions either.

Re: A DIY diabetes kit

#20

Post by monkmartinez »

et2o wrote: post #17
monkmartinez wrote: post #13

Earlier quoted context omitted.

To the point about using Glucagon in some kind of fashion... We (EMS) give glucagon to hypoglycemic diabetic patients when we are unable to obtain IV access. I am not a doctor, but we almost always prefer to give them D50 via IV for diabetic emergencies in the field. Most of the time, they don't need to go into the ER after such intervention. As a last resort we give glucagon IM and wait, and wait... more often than…

Also not an MD (yet) so grain of salt, but from my experience: Yeah, D50 is a more direct way to get glucose into the blood stream. It does take a lot more time to mobilize liver stores of glycogen. But using glycogen stores isn't necessarily bad for you metabolically. Glucagon is used by your body everyday during periods of fasting between meals to maintain a minimum blood sugar. Your glycogen stores can supply enou…

We agree on the metabolic reasoning! I freely admit that 98% of my experience with diabetes has been in the field dealing with hypo or hyperglycemic patients. Obviously, we are talking about diabetics that aren't the most compliant with their disease. However, even "good" diabetics have bad runs with questionable supplies, or any host of issues (sickness, environment, diet change, etc.)

I happen to live where a very, very large cluster of diabetics are studied. We do a lot of diabetic emergencies... I can count on my hands how many times we've used glucagon. Like I said, we can treat and release with D50. Not so with Glucagon.

If "they" figure out the delicate balance between all the systems in order to use glucagon the same way it is regulated in a non-diabetic; it stands to reason that "they" should have a way to repair/replace the islets of Langerhans as the first priority, don't you think?

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