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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#171

Post by jacquesm »

KetoType1 wrote: post #34
Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

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…

This is a pretty dangerous comment, if you consider going the Keto route and are a diabetes type 1 patient please consult your doctor, there are some risks involved and it definitely does not work for everybody.

Re: The Unreasonable Math of Type 1 Diabetes

#172

Post by idealmedtech »

Hi, I'm an artificial pancreas developer! Our device has been approved for human trials which we're going to begin shortly, probably near the end of this quarter.

One thing that the article (which is very well researched, by the way, kudos!) does not quite get right is that the insulin sensitivity _changes_ hour to hour, day to day, month to month. It changes nonlinearly with exercise, stress, sleep, diet, and in a million other subtle ways that we're still trying to characterize. This dynamism is part of what makes management of blood sugar so hard, because the same dose that got you in range a couple days ago now sends you into a hypoglycemic episode, which can be really really dangerous!

The good news is that, while cures for diabetes have been Five Years Out (TM) since the 1980s, artificial pancreas technology (like Loop, OpenAPS, and recently approved Omnipof 5) is here _today_ and already giving people a real solution, not to mention peace of mind, but we still have a long way to go! Access issues, trust relating to years of anxiety induced trauma, cost etc are all barriers to making these solutions widely available, but I feel hopeful that in 20 years, a T1D diagnosis will be as manageable as an eczema one.

If anyone has any questions about APs, I'd be happy to field them!

Re: The Unreasonable Math of Type 1 Diabetes

#173

Post by idealmedtech »

go_blue_13 wrote: post #169

>A CGM can cost $400 a month What in the world? $5k a year? How on earth are those things so expensive? 2 fully spec'd macbook pros per year? Surely they aren't that complex. Am I missing something?

They're not enormously complex from a hardware perspective, but the sensing element is really hard to get right. Interference from a whole host of common drugs (including ibuprofen) can really mess up one's signal. Not to mention the regulatory moat; many medical device startups die on the vine working for regulatory approval, or looking for funding for expensive human trials (which quickly get into the millions or tens of millions for a Phase II/III trial)

Re: The Unreasonable Math of Type 1 Diabetes

#174

Post by KetoType1 »

jacquesm wrote: post #171
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…

This is a pretty dangerous comment, if you consider going the Keto route and are a diabetes type 1 patient please consult your doctor, there are some risks involved and it definitely does not work for everybody.

Thank you for your concern, friend!

Tell us, how long have you been diabetic?

Anecdotally, I have maintained a HbA1c below 5 for more than 20 years using small variations on the ketogenic diet described above. I need just 6 units of Humalog (short-acting) and 16 units of Lantus (long-acting) per day. It makes diabetes very, very easy to manage.

If anyone reading this is tired of struggling with diabetes, please consider adopting a ketogenic diet.

Consult with a physician!

Re: The Unreasonable Math of Type 1 Diabetes

#175

Post by idealmedtech »

mikenew wrote: post #100

Awesome write up, but one thing I still don't understand; why is hypoglycemia such a big part of the problem? If insulin is your body's way of moving glucose out of your bloodstream and T1D means that lever is broken, why do you so often end up with too little blood glucose? Is it just because of overestimating the insulin dose? Or is there some other factor; i.e. does glyconeogenesis not work properly or something a…

In short, severe hypoglycemia is an immediate risk to your life, and prolonged hypos Gluconeogenesis still happens, but an insulin overdose can tank your blood sugar much faster than your liver can keep up.

Re: The Unreasonable Math of Type 1 Diabetes

#176

Post by Mezzie »

Trasmatta wrote: post #8

I'm a type 1 diabetic, and this was a helpful post at showing non diabetics why it is so. hard. Non diabetics typically think the difficult thing must be the shots and the finger pricks, right? Not really. The majority of diabetics get used to those things quickly (of course there are some of course that deal with a major major needle phobia that can make it even harder). The hard part is that it never ends. Almost e…

> I'm literally crying while writing this post, because it's so exhausting and it never ends.

If it helps (?), I also broke down crying reading this, because I have MS and it is so true to my experience. I've never been able to communicate well how exhausting the constant mental load is, and I imagine it's even worse for people with T1 diabetes since blood glucose can get out of whack a lot more quickly than my immune system can make more holes in my nervous system.

You nailed it on the head exactly with the constant balancing.

"Okay, so I didn't sleep for crap last night due to symptoms. Do I have some caffeine and spend the rest of the day in pain due to the increased muscle spasticity? Maybe if I have 3 cups of coffee instead of 1 and also take some of my muscle spasticity medication, I'll be able to stay awake but not be in too much pain. Except if I dip into what are supposed to be nighttime pain meds too often, I might run out of Tizanidine. When will my insurance refill? How much will it cost out of pocket when I have a bad pain month?"

And then I get stressed out about the MS, and we're supposed to avoid stress, so then I stress about my stress. Fantastic.

And all until the day we die.

Re: The Unreasonable Math of Type 1 Diabetes

#177

Post by idealmedtech »

sarusso wrote: post #87

For anyone following this thread, is there any online community of diabetic type 1 techies? i.e. like all of you guys commenting on this?

I'd recommend getting onto the OpenAPS gitter community! I'm sure they have a Discord by now, too, but whenever I have a question about something obscure related to diabetes tech, they've been a good resource.

Re: The Unreasonable Math of Type 1 Diabetes

#178

Post by go_blue_13 »

cleancoder0 wrote: post #105
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…

I once took a 5 hour bike trip on an empty stomach. At some point I couldn’t even turn the pedals. I had to lay on the ground, not feeling better even after half hour. I can still remember the feeling of eating some sweets. Felt like I was reborn. Can’t imagine what it’s like for T1

well put. After swimming 10km on a empty stomach that first glass of chocolate milk and a banana were near psychedelic. Obviously not the same life threatening situation as a diabetic but I can imagine there'd be some similarity to the experiences

Re: The Unreasonable Math of Type 1 Diabetes

#179

Post by idealmedtech »

spaethnl wrote: post #52

I think this article does a great job covering many of the difficulties of T1D. One component I think was under-emphasized is the fact that correction insulin doses are not based on what your current blood glucose(BG) levels are, but on where you predict they will be when the dose really starts taking effect. Take for example a current best case scenario of having a Loop system via a continuous glucose monitor (CGM)…

Re: 3, such technology did exist and was commercialized in the early 2000s, and was well liked by those who got to use it (https://www.researchgate.net/publication/38063312_The_Implan..., but it had a host of issues that made it difficult to be widely viable, and ultimately it was discontinued.

Re: The Unreasonable Math of Type 1 Diabetes

#180

Post by [deleted] »

semenko wrote: post #4

Hey Graham -- great post! The Medtronic / Guardian sensor combo is generally disliked by patients, though (in the US) the Medtronic 770G is FDA approved for ages 2+. Most prefer the t:slim X2 with "Control-IQ" (their hybrid closed-loop: https://www.tandemdiabetes.com/products/t-slim-x2-insulin-pu... ), which is FDA approved for ages 6+, and works great. The bleeding edge is the Beta Bionics ( https://www.betabionics.…

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