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The Unreasonable Math of Type 1 Diabetes

maori.geek.nz

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Re: The Unreasonable Math of Type 1 Diabetes

#91

Post by pimeys »

Trasmatta wrote: post #13
kettleballroll wrote: post #11

Earlier quoted context omitted.

> I will say it turned me into a huge proponent of massive amounts of protein and fiber in my diet (but kinda turned me off Thai food :/ ) Why?

Protein is low carb. Fiber is a carb that doesn't impact your blood glucose, because your body doesn't break it down. Thai food is heavy on noodles and rice, which are both very high carb.

Protein does have an effect for your glucose level. Just comes after a few hours as a nice surprise. And fat makes the insulin work worse, combine the fat with protein and it is quite complex to understand why your glucose is going up 3 hours after eating.

Oh, add some carbs to your protein and fat. Like a steak with creamy sauce and french fries. All the insulin you think is good is not enough.

Re: The Unreasonable Math of Type 1 Diabetes

#92

Post by arka2147483647 »

emj wrote: post #78
arka2147483647 wrote: post #70

Earlier quoted context omitted.

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 yo…

Well, I have had the incredible luxury of being born in Finland, so state/municipality pays everything. Insulin, Glucose-test-supplies, Doctors. I truly fell sad when i hear what US based persons have to go through. Though, i suppose i pay it in taxes :)

About devices.. The first Glucose-test-device (what are they even called in english) took 5min to process the results. Current one is 5sec. A massive improvement in both speed and accuracy in these things.

I hope a good non-invasive device is developed, though i'm not sure it is essential, for me anyways.

Re: The Unreasonable Math of Type 1 Diabetes

#93

Post by zaroth »

jnsie wrote: post #42
zaroth wrote: post #6

Earlier quoted context omitted.

Bi-hormonal was always something I thought they should do but didn't know anyone was actually trying it! Thanks for the link. Although in theory you've screwed up if you need to bolus glucagon. Also, I can't imagine it feels all that great to be getting exogenous glucagon.... But from a safety perspective, having the device have a reserve tap of glucagon ready to deploy allows the algorithm to deploy full insulin dos…

> Although in theory you've screwed up if you need to bolus glucagon. Not at all. There are myriad reasons why one might go low despite doing everything right. For instance, unanticipated cardiovascular activity. T1D is a 24/7/365 PITA and one cannot anticipate everything, even with the best will in the world.

Oh I 100% agree. I have two kids with T1D.

I think the words “in theory” are probably doing too much lifting in my original sentence.

Re: The Unreasonable Math of Type 1 Diabetes

#94

Post by pimeys »

zaroth wrote: post #5
beached_whale wrote: post #2

The one that a lot of people seem to neglect is that the factors change. This can be slow or abrupt and often or rare. It happens and learning to recognize(the hard part) and then adapt can lead to better outcomes. Waiting for a MD/Nurse to suggest changes is often too long.

This is an excellent point. What makes this even harder is that some of the changes (like basal rates) the equipment is good about supporting multiple profiles and letting you switch between them. Where as the carb ratios and correction factors are set once and overwritten when you update them, and hard to generate reports on how they are changing over time... so not designed to really be adaptable. There are micro f…

The oref1 algorithm in AndroidAPS can detect unannounced meals and together with a very fast insulin such as Lyumjev can automate meal boluses for some people.

I know diabetics in 85% in range using this method. Doesn't work super well for me though.

Re: The Unreasonable Math of Type 1 Diabetes

#95

Post by zaroth »

mhb wrote: post #73

Is a CGM one of the only things that is cheaper in US healthcare? GoodRx has the Dexcom G6 for under $400. He says a CGM is NZ$400/month (~US$270).

CGMs are disposable, for example the Dexcom sensor that is replaced every 10 days.

There’s a transmitter part which plugs into the sensor and has a Bluetooth radio and a battery which is cheaper and lasts three months. You pop it off an old sensor and click it into a new one every 10 days until it expires.

Re: The Unreasonable Math of Type 1 Diabetes

#96

Post by shanselman »

I’ve been a type one diabetic for over 25 years, I’ve been looping with an artificial pancreas for over eight years, and never has an article so perfectly described the immense cognitive load that we have to deal with every waking hour (and a lot of non-waking hours) as this article. This is the canonical explanation now that I will send non-diabetics

Re: The Unreasonable Math of Type 1 Diabetes

#97

Post by [deleted] »

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.

[deleted]

Re: The Unreasonable Math of Type 1 Diabetes

#98

Post by sarusso »

ciceryadam wrote: post #84

Late blooming (LADA) T1D here. I think that CGMs are a great quality of life improvement. I have Abbott Freestyle Libre's prescribed by my diabetologist every 3 months, and they work well with Glimp[1] and any android phone with NFC - the app has nice statistics that really correlate with glycated haemoglobin (HbA1c - long term sugar level indicator) results from my checkups. You can (and should) calibrate the CGM re…

Beware of apps like Glimp as the Freestyle Libre gone trials with its own, proprietary algorithm. I saw studies reporting a difference between Glimp and the official Libre HW reader (or App) where it turned out to be off by quite a lot..

Moreover, as far as I know Glimp is a closed source App (even if free) and no one except the developers has a clue about how they treat data inside it.

Re: The Unreasonable Math of Type 1 Diabetes

#99

Post by Sharlin »

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".

And of course, those are both your brain. The self-aware rational parts just aren't always in charge (heck, I'm not sure if they're even in charge most of the time, no matter what they would like to think).

Re: The Unreasonable Math of Type 1 Diabetes

#100

Post by mikenew »

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 along those lines?

If the problem is that the pancreas can't produce insulin, I would have thought something like a ketogenic diet would make it easier since you would have less of a need for insulin, and therefore less guesswork trying to counteract the blood sugar spikes from a high carb meal. But it sounds like bringing blood sugar up is a big part of managing T1D, so I'm just wondering why that would be the case for a diabetic but not for a non-diabetic.

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