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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#21

Post by Trasmatta »

coldpie wrote: post #14
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…

Same here. 100% dead accurate description. > what if I start to go low during this meeting? should I pop some carbs and run high for this interview, so I don't risk a hypo partway through? Love this part. Had to do it literally yesterday to prep for interviewing a job applicant. Imagine the stress of an upcoming meeting, but also your brain might stop functioning half an hour into it! Ha ha! Good times.

Perhaps the only good thing about T1D is the immediate camaraderie you feel with other T1Ds. When I spot somebody else in public with a CGM or a pump, it's just that instant feeling of "hey, we know nothing about each other, but we have a very intimate understanding of each other's suffering".

> Love this part. Had to do it literally yesterday to prep for interviewing a job applicant. Imagine the stress of an upcoming meeting, but also your brain might stop functioning half an hour into it! Ha ha! Good times.

Haha, yeah, this is one of those things that every T1D has had to do at some point, that non diabetics would probably be shocked by. There are just times when you can't risk going low. Going high ain't great, but it at least doesn't involve the immediate danger that a hypo at just the wrong moment does...

Re: The Unreasonable Math of Type 1 Diabetes

#22

Post by brainlessdev »

Trasmatta wrote: post #15
brainlessdev wrote: post #12

Earlier quoted context omitted.

Although I haven't experienced this first-hand, my partner has T1D and I can see her reflected in everything you say. I'm hoping for a near future where technology paliates some of the dread of living with T1D. Some lines of research, such as implantable insuling-producing islets [1] seem promising, at least to someone without the chops to judge what's going on. [1]: https://www.clinicaltrials.gov/ct2/show/NCT0351393…

Thanks for the kinds words. The primary problem with those types of treatments is you have to be on immunosuppressants, or the immune system just kills the cells again. That type of treatment is typically not recommended unless the patient is already on immunosuppressants, or has extreme hypoglycemia unawareness, or extreme needle phobia. Immunosuppressants are typically considered a worse outcome than properly treat…

I've been following the press about closed loop artificial pancreases closely, too. Currently, the open-source solutions there are require using insulin pumps that are pretty big and for some, that's not a choice they're ready to make. I too hope this tech continues to advance quickly.

Re: The Unreasonable Math of Type 1 Diabetes

#23

Post by Trasmatta »

jimmaswell wrote: post #17
brainlessdev wrote: post #12

Earlier quoted context omitted.

Although I haven't experienced this first-hand, my partner has T1D and I can see her reflected in everything you say. I'm hoping for a near future where technology paliates some of the dread of living with T1D. Some lines of research, such as implantable insuling-producing islets [1] seem promising, at least to someone without the chops to judge what's going on. [1]: https://www.clinicaltrials.gov/ct2/show/NCT0351393…

> a near future where technology paliates some of the dread of living with T1D I thought pump implants already did that, what's missing?

Pumps aren't implants, you replace them regularly. They are a massive improvement in care for many people, but they do not remove the daily toil of managing diabetes. Personally, I found a CGM to be even more helpful than a pump.

Closed loop artificial pancreases are the future, but they will still require a large amount of attention and management by the patient.

Re: The Unreasonable Math of Type 1 Diabetes

#24

Post by bleair »

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.…

There's also two "open source" systems - https://loopkit.github.io/loopdocs/ - https://openaps.org/

Tidepool is also trying to take the loop project and get a version of it FDA approved.

Both of the open source projects require you to do the work and actively take control of your setup (a cgm plus pump plus phone). They have really nice support communities. I would never go back to not using Loop.

Re: The Unreasonable Math of Type 1 Diabetes

#25

Post by berkes »

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…

> a survival instinct to EAT EVERYTHING that's extremely hard to control

T1 here too. The weird part about this, is that it happens while you are aware of it.

My brain: "hey, you're doing it again. stop it. You know it'll end bad". my hand: "nope. here's more cookies".

Re: The Unreasonable Math of Type 1 Diabetes

#26

Post by Trasmatta »

brainlessdev wrote: post #22
Trasmatta wrote: post #15

Earlier quoted context omitted.

Thanks for the kinds words. The primary problem with those types of treatments is you have to be on immunosuppressants, or the immune system just kills the cells again. That type of treatment is typically not recommended unless the patient is already on immunosuppressants, or has extreme hypoglycemia unawareness, or extreme needle phobia. Immunosuppressants are typically considered a worse outcome than properly treat…

I've been following the press about closed loop artificial pancreases closely, too. Currently, the open-source solutions there are require using insulin pumps that are pretty big and for some, that's not a choice they're ready to make. I too hope this tech continues to advance quickly.

The Omnipod 5 just received FDA approval, and looks really cool. I'm going to wait a bit and see reactions from other diabetics, though, before I jump onboard.

Re: The Unreasonable Math of Type 1 Diabetes

#27

Post by kahrl »

whatshisface wrote: post #20
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…

> Consider that there's a +/-20% margin of error on the reported carbohydrates on nutrition facts. Is this accounted for by product-to-product variation or package-to-package variation?

The toothless FDA allows for a 20% margin of error on nutrition facts labeling, so it could possibly be one or the other or both.

Some products may just have variation. Some foods will be maliciously mislabeled with 19% less calories/sugar/fat but may have little to no variation within the same product.

Re: The Unreasonable Math of Type 1 Diabetes

#29

Post by Trasmatta »

berkes wrote: post #25
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…

> a survival instinct to EAT EVERYTHING that's extremely hard to control T1 here too. The weird part about this, is that it happens while you are aware of it. My brain: "hey, you're doing it again. stop it. You know it'll end bad". my hand: "nope. here's more cookies".

100%. A minor low doesn't cause this reaction from me, but at a certain point the survival instinct kicks into gear so heavily there's almost nothing you can do until your BG starts to rise, even when you know you've overdone it.

It's the real life experience of this Frog and Toad meme: https://i.imgur.com/YdSSscE.png

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