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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#221

Post by pimeys »

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.

There are open source apps such as xdrip that can alert on a trend change, and androidaps that turns off insulin delivery way before you get to a hypo.

The official one from Dexcom is not very good.

Re: The Unreasonable Math of Type 1 Diabetes

#222

Post by grahar64 »

ineedasername wrote: post #184

Rule #1 if T1D is never be out of reach of food. The author of this article is correct that too little insulin is bad, but the margin of error for acute distress in that direction is much more forgiving for high blood sugar than low blood sugar (at least in the short term dying-on-the-floor time frame) Target level is around 90. A little too much insulin can easily push that down to 25/35, which gets you into passing…

We already had nappies, wipes and bags hidden everywhere as emergency supplies. We just added the hypo packs of juice and shelf stable baby treats to them :)

Re: The Unreasonable Math of Type 1 Diabetes

#223

Post by grahar64 »

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…

AFAIK Ketones go high when glucose is low in cells, not in blood. DKA is literally so many ketones in the blood that it becomes acidic, this happens in conjunction with high BGL. Sams breath when he was in DKA was literally sweet smelling as his body was trying to get rid of the excess glucose. There is plenty of glucose, just none of it is available.

Re: The Unreasonable Math of Type 1 Diabetes

#224

Post by ng12 »

irrational wrote: post #140
Trasmatta wrote: post #79

Earlier quoted context omitted.

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 diabet…

Yep, very much. Most insulin pumps only cary a few days worth of insulin at a time so it's not uncommon to be heading home after work with only half a day of insulin left. That can quickly become a life-or-death situation.

Re: The Unreasonable Math of Type 1 Diabetes

#225

Post by sah24 »

UnpossibleJim wrote: post #198
sah24 wrote: post #139

Earlier quoted context omitted.

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.

I do live in the US. Yes. And actually, my endo is probably a better person to chat with. Let me drop her an email and see if she A) is allowed and B) has the time

sweet, thanks!

Re: The Unreasonable Math of Type 1 Diabetes

#226

Post by btowngar »

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…

And there can be large errors in the CGM data as well!

Re: The Unreasonable Math of Type 1 Diabetes

#227

Post by btowngar »

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…

One further thing - the article doesn’t talk much about the physical response to wearing a CGM such as the extreme skin irritation some people get from the adhesive. Or the fact that the CGM reading could be way off the reading you get from a finger prick test - which can in turn vary significantly from a lab test result!

Re: The Unreasonable Math of Type 1 Diabetes

#228

Post by grahar64 »

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)…

Dexcom being able to send more frequent updates during a hypo would be nice, but not sure if it would offer anything other than noise. We just finger prick during hypos, because I want more immediate information.

Re: The Unreasonable Math of Type 1 Diabetes

#229

Post by consp »

sokoloff wrote: post #168
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 had a “drunk” parked in the inside lane of the four lane road in front of my house one evening. He was just stopped in traffic and got out stumbling around. I was annoyed (naturally) and he handed me his phone. Whatever, dude; I don’t want to talk to your friend right now. Somehow he insisted and his friend told me he was diabetic and to call an ambulance. I did, got him some OJ, and moved his car out of traffic. H…

I've had the "are you drunk" comments a few times while hypoglycemic.

I once walked home from work and apperantly didn't notice it, walked a few busy intersections and finally sat down somewhere where someone noticed me and called an ambulance who game me a glucose iv and everything was back to normal in a few minutes. So everything was still somewhat working and the "go home" signal was set but everything else was broken. Not everyone responds the same though and concerning cars I have at least some dextrose with me at all times and some in the car as well, as well as hidden at work and at home and in all my coats and backpacks and everywhere... OJ works quite well since it is readily available.

They did teach my parents one thing when handeling people with hypoglycemia: never try to stop them from consuming your entire fridge. Motor control is lacking and a young adult can easilly hurt you badly if you try to intervene.

Re: The Unreasonable Math of Type 1 Diabetes

#230

Post by consp »

Trasmatta wrote: post #118
cleancoder0 wrote: post #105

Earlier quoted context omitted.

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

The interesting thing is that your BG levels may have actually been fine. Physical exhaustion doesn't necessarily lead to hypoglycemia in a healthy person. Hypoglycemia feels significantly different than just being hungry, for example. A bizarre phenomenon: feeling stuffed because you ate a huge meal, but having a hypo anyway. You don't want to eat anything because you're not hungry, but feel an overwhelming urge to…

I worked in the university library and a few times a year we had girls studying for hours on empty stomachs (brains consuming glucose is a different process from normal). They usually felt dizzy, were bleak and confused and were sometimes sweating and usually came to ask for some OTC painkiller or something. Usually gave them some of my dextrose tablets and someone's lunch and almost always it was fine a few minutes later. I'm pretty sure they had hypoglycemia. Though for (us) diabetics hypoglycemia where we start feeling it isn a considerably lower blood glucose level than for most regular people so there is some difference in how far you are gone down the rabbit hole already.
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