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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#131

Post by mrcwinn »

I love this post so much. I'm very grateful for the time the author spent writing it. Thank you!

My dad was Type 2 before he passed. My wife and father-in-law are both Type 1. They both use a Dexcom and an InPen to help regulate insulin.

What's striking about the chart "42 Factors that affect Blood Glucose": There are so many items influencing on this chart that my wife's Dexcom has no information on. Sunburn? Altitude? Hydration levels? The Dexcom is completely oblivious to these factors.

It seems like there is a better model that would do a better job of suggesting insulin levels, but if anything it's input-constrained right now.

Re: The Unreasonable Math of Type 1 Diabetes

#132

Post by UnpossibleJim »

richie5um wrote: post #103
Trasmatta wrote: post #81

Earlier quoted context omitted.

The good news is that for most diabetics, your body will automatically wake you up for a hypo. It's a survival mechanism. But some people suffer from hypoglycemic unawareness, and their body doesn't wake them up. Most diabetics have CGMs these days, though, and somebody like that should be setting hypo / hyper alarms so that either them or their partner wakes up. (The problem there becomes false alarms and the subseq…

“Most diabetics have CGMs these days” - not where I come from :-(

My doctor had to fight to get me one. I workout and was highly insulin sensitive (she made me workout less and gain some weight by doing less cardio - drives me nuts, I liked running). The insurance companies didn't want to fork over for the upfront cost, even though I had been to the hospital several times for low blood sugars. This included a stroke caused by a severe low blood sugar (yes, I lived alone at the time, pre CGM. Coworkers called a friend who had a key).

Granted this was 4 years ago, so I'm unsure how things have changed. The CGM is a game changer. I wish I had had it earlier. Would have kept me (hopefully) from a lot of issues and putting my friends and family through unnecessary pain.

Re: The Unreasonable Math of Type 1 Diabetes

#134

Post by MrFoof »

Trasmatta wrote: post #79
csnover wrote: post #63

Earlier quoted context omitted.

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…

Yeah, getting caught out somewhere without snacks and a looming hypo is one of my nightmares. I try to always, always, always have snacks on me (for a diabetic, this is even more important to have when you leave the house than your keys or wallet), but sometimes things happen, and you end up somewhere without anything. It's really scary, but the good news is that if there is anybody around, enough people understand a…

>The scary part is potentially getting caught out somewhere entirely alone and without an emergency snack.

First thing I do every morning is A) put on pants B) put my keys and a tube of glucose tablets in my front pants pocket.

You can probably guess the expensive way that became ritual.

Re: The Unreasonable Math of Type 1 Diabetes

#135

Post by KetoType1 »

com2kid wrote: post #119
KetoType1 wrote: post #34

Earlier quoted context omitted.

The secret to managing Type 1 Diabetes is a ketogenic diet. You will observe extreme stability of blood glucose (low variance) and because the brain uses ketones as fuel, occasional hypoglycemia will be an easily-managed non-event. You should get most of your calories from olive oil and nuts. Protein intake should be just as much as you need. Excess protein causes blood glucose instability. Carbohydrate intake should…

I'm vouching for this because there is indeed a community of type 1 and type 2 diabetics using keto for management. Obviously it isn't a one size fits all approach, and the above poster could have been a bit more diplomatic, but IMHO it is worth discussing treatments that have been demonstrated to work.

No post body was provided.

Re: The Unreasonable Math of Type 1 Diabetes

#136

Post by dsaavy »

sweston4 wrote: post #19

I'm a type 1 diabetic and data scientist. Estimating the causal effect of a unit of insulin or food on blood sugar is an absolute crap shoot. Consider that there's a +/-20% margin of error on the reported carbohydrates on nutrition facts. We might consider this irreducible error that just cannot be modelled (Maybe you could get a calorimeter, estimate the distribution of errors, and reduce that error somewhat). There…

This "variance reduction" strategy is also an approach by Dr. Richard Bernstein. Basically smaller doses means smaller mistakes. It's a great approach in my opinion. Obviously the key is sticking to a low-carb diet for that to work, along with tweaking your basal insulin dosage.

For me, this approach worked when I switched from Novolog to Novolin R, which has a slower effect rate. I use shots so it helps match the blood sugar profile of eating higher protein and fat meals. If you use a pump, you can adjust your bolus to give a % upfront and a % over a period of 2-3 hours so that you can match the slower glucose production from protein. In Bernstein's book, he had some typical ratios for grams of protein to insulin that turned out to be pretty close for me.

It obviously doesn't solve everything but I certainly feel better when I'm at 60 and have 1.5 units on board compared to if I had 7. The Novolin R makes me feel even better because I also know my blood sugar can't drop too fast, where Novolog I could be dropping 6-7 mg/dl per minute. So I have time to react and let my body absorb some simple sugars before it's too late.

Just a personal anecdote, maybe someone will find this useful!

Re: The Unreasonable Math of Type 1 Diabetes

#137

Post by terrbeardotorg »

johnyzee wrote: post #126

Sorry to hear what you are going through. A couple of comments from someone with an interest in the topic, but obviously not your practical experience on the front line as it were: (1) You mentioned ISF (insulin sensitivity factor), but what you did not mention is that this is not a static factor. It is possible to significantly improve insulin sensitivity through diet and life style, and this is particularly useful…

"Ketones are high when availability of glucose is low" - it seems the body calculates this based on the amount of insulin available, which is why you can eat nothing (and have no basal) and have a BG spike.

Re: The Unreasonable Math of Type 1 Diabetes

#138

Post by ksaun »

steveklabnik wrote: post #90
emj wrote: post #78

Earlier quoted context omitted.

> 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…

> It's abit like monitoring traffic load and adding more servers as you go, except too many servers kill you. Not even just that, but with fairly primitive monitoring tools. The built-in stuff for Dexcom can only alert on highs or lows, not on things like the rate of change, which would be much more useful IMHO.

The Dexcom G6 is capable of alerts for rate of change, but it's about what the rate was, not what it will be. It still can be helpful.

(When looking at the app, there are "trend arrows," also, but they unfortunately are misleading in some situations. Often looking at the data points can give you a sense of your situation, though.)

Re: The Unreasonable Math of Type 1 Diabetes

#139

Post by sah24 »

UnpossibleJim wrote: post #132
richie5um wrote: post #103

Earlier quoted context omitted.

“Most diabetics have CGMs these days” - not where I come from :-(

My doctor had to fight to get me one. I workout and was highly insulin sensitive (she made me workout less and gain some weight by doing less cardio - drives me nuts, I liked running). The insurance companies didn't want to fork over for the upfront cost, even though I had been to the hospital several times for low blood sugars. This included a stroke caused by a severe low blood sugar (yes, I lived alone at the time…

Hi, do you live in the USA? I had a similar experience to you. I am considering doing a research project for grad school about patients in the USA who experienced insurance denials for CGMs.

Re: The Unreasonable Math of Type 1 Diabetes

#140

Post by irrational »

Trasmatta wrote: post #79
csnover wrote: post #63

Earlier quoted context omitted.

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…

Yeah, getting caught out somewhere without snacks and a looming hypo is one of my nightmares. I try to always, always, always have snacks on me (for a diabetic, this is even more important to have when you leave the house than your keys or wallet), but sometimes things happen, and you end up somewhere without anything. It's really scary, but the good news is that if there is anybody around, enough people understand a…

I never thought about how being diabetic takes emergency preparedness to a new level. We saw people unexpectedly stuck for a couple of days in traffic because of snow recently. What if there is an earthquake and you can't get to somewhere with snacks? There are so many situations that could unexpectedly arise that could cut you off from food. If I'm cut off from food, I'll be fine for a few days. Not so much a diabetic. That's scary.
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