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The Unreasonable Math of Type 1 Diabetes

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Re: The Unreasonable Math of Type 1 Diabetes

#71

Post by zippergz »

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)…

I mentioned it in another comment, but inhaled insulin does act much faster than injected insulin. Of course, one downside is that it requires manual dosing; it can't be managed by a pump. But it's extremely fast (and finishes quickly too), so you can get much closed to dosing based on current numbers (obviously you do need to anticipate a tiny bit, but it's drastically less).

Re: The Unreasonable Math of Type 1 Diabetes

#72

Post by [deleted] »

gowld wrote: post #66
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…

Now imagine what it's like for someone with T1D to live alone, if you haven't yet been to a funeral for that. Every single time you go to sleep is a roll of the dice.

[deleted]

Re: The Unreasonable Math of Type 1 Diabetes

#74

Post by Trasmatta »

arka2147483647 wrote: post #70
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 have had Type 1 for 30 years. To be honest, i don't do the math. I choose the amount of units to inject by feel. I mean, i know by eating a banana, i get something like 20g of carbohydrates, and i should take 3u. But if i feel, that the correct dose is 6 units, then i take that. I cant really explain it. But i kind of feel the state, where i am going, and can adjust instinctively. Works more often than not. I have…

I'm at 10 years, and this is basically how I do it as well. The math just doesn't work, because there are too many factors at play, most of which you don't even know about, and can't plug into a simple equation. You might have the exact same meal and the exact same insulin dosage on two different days, and go low on one and high on the other.

You eventually gain an instinct for it. Doesn't always work, but for me it works better than the formulas...

Re: The Unreasonable Math of Type 1 Diabetes

#75

Post by stonemetal12 »

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 20% seems to be how much you are allowed to lie by. You get another bit for variability of the test, and a third error term for variability of "good manufacturing practice".

Here is the actual rule from https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfr...

A food with a label declaration of calories, total sugars, added sugars (when the only source of sugars in the food is added sugars), total fat, saturated fat, trans fat, cholesterol, or sodium shall be deemed to be misbranded under section 403(a) of the act if the nutrient content of the composite is greater than 20 percent in excess of the value for that nutrient declared on the label. Provided, That no regulatory action will be based on a determination of a nutrient value that falls above this level by a factor less than the variability generally recognized for the analytical method used in that food at the level involved.

Reasonable excesses of vitamins, minerals, protein, total carbohydrate, dietary fiber, soluble fiber, insoluble fiber, sugar alcohols, polyunsaturated or monounsaturated fat over labeled amounts are acceptable within current good manufacturing practice.

Re: The Unreasonable Math of Type 1 Diabetes

#76

Post by alex_stoddard »

savant_penguin wrote: post #57

I find it really curious that evolution didn't get rid of such nasty condition. Too much sugar you die, too much insulin you die. And that affects you since birth. How is it possible that something so deadly (that I assume is genetic) still exists?

It's an auto-immune disease with complex causality. It doesn't necessarily manifest at birth, the time to develop the auto-immune response and for it to become severe varies. For some individuals perhaps it never develops.

The same propensity to develop a harmful (until my mother's generation invariably fatal) immune response attacking the body's own insulin producing cells might be an advantage to fighting off certain infections (possibly in a different genetic context or living with a different set of environmental exposures).

Re: The Unreasonable Math of Type 1 Diabetes

#77

Post by gruez »

gowld wrote: post #66
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…

Now imagine what it's like for someone with T1D to live alone, if you haven't yet been to a funeral for that. Every single time you go to sleep is a roll of the dice.

>Every single time you go to sleep is a roll of the dice.

Isn't that the case even if you have someone sleeping beside you? I suppose it mitigate some risk on the off chance that your partner wakes up and notices you're sweating or whatever, but what if they're sound asleep? Does someone who's high/low on blood sugar exhibit symptoms that are easily picked up by a sleeping person?

Re: The Unreasonable Math of Type 1 Diabetes

#78

Post by emj »

arka2147483647 wrote: post #70
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 have had Type 1 for 30 years. To be honest, i don't do the math. I choose the amount of units to inject by feel. I mean, i know by eating a banana, i get something like 20g of carbohydrates, and i should take 3u. But if i feel, that the correct dose is 6 units, then i take that. I cant really explain it. But i kind of feel the state, where i am going, and can adjust instinctively. Works more often than not. I have…

> 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 you react to changes in life works wonders, e.g. exercise, eating fat foods, sitting all day.

Re: The Unreasonable Math of Type 1 Diabetes

#79

Post by Trasmatta »

csnover wrote: post #63
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 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 at least enough about diabetes to give you something to eat if you start saying "I'm having a diabetic emergency, does anyone have anything with sugar?"

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

Re: The Unreasonable Math of Type 1 Diabetes

#80

Post by ray__ »

savant_penguin wrote: post #57

I find it really curious that evolution didn't get rid of such nasty condition. Too much sugar you die, too much insulin you die. And that affects you since birth. How is it possible that something so deadly (that I assume is genetic) still exists?

It isn't (entirely) genetic. There are some genes that are risk factors, but no one knows what causes T1D. It also doesn't affect you at birth–it's an autoimmune disease that usually manifests between the ages of 3 and 20 but can appear at any time in life (see the other commenter in this thread whose wife developed T1D in her 40s). In keeping with this, the risk factor genes are mostly related to the immune system. Even in populations with the highest risk haplotype, only ~5% develop T1D, and many people without this haplotype also develop T1D.

If it were purely genetic, evolution would have selected against these genes long ago since T1D was a terminal disease with a life expectancy of less than a year until the discovery and development of insulin-based therapies in the 1920s.

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