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Taking my diabetes treatment into my own hands

martin.janiczek.cz

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Re: Taking my diabetes treatment into my own hands

#91

Post by vallassy »

mono812 wrote: post #78

Interesting stuff! I'm a late T1D and there is just so much that subtly influences your blood sugar levels. I adhere to quite a strict diet and adapt my insuline dosage based on not just the carb contents and glycemic load of the meal, but also the starting point / trends I see in my libre readings. If you can predictably consume carbs (and glycemic load) you can also inject early with confidence (or even post-meal i…

I still haven't found a tactful way to bring this up, but have you considered a low- or zero-carb diet?

As far as I underdstand it, if you don't eat carbohydrates, you don't require insulin to deal with the spikes, and apart from a few grams in the bloodstream, humans require extremely little to no exogenous carbs.

I'd love to hear your thoughts if you've looked into this already.

Re: Taking my diabetes treatment into my own hands

#92

Post by capnrefsmmat »

flanked-evergl wrote: post #82
alex_duf wrote: post #38

Earlier quoted context omitted.

I also lived in two of the richest countries with a social medical system My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc. I'm talking about the situat…

> My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medica…

The best sources I can find indicate that doctors work ~25% more hours than other workers, on average, though this has declined since the 70s.

https://www.ajpmonline.org/article/S0749-3797(23)00166-6/ful...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/

Re: Taking my diabetes treatment into my own hands

#93

Post by _qua »

janandonly wrote: post #76

Very dumb question here, but I don’t dare ask it to ChatGPT. What would happen to T1 or T2 diabetics if we would stop eating all sources of sugars and carbs? So no fruit, no rice, no potatoes and so on? Would it be possible to survive and live comfortably in a state of Ketosis? Or is a 100% ketogenic diet simply not possible on diabetes? I’m asking because my true question is: what if insulin becomes too expensive? T…

You require at least a low level of insulin to keep metabolic systems in balance. Whether they eat carbs or not, T1 diabetic patients need insulin or they will go into diabetic ketoacidosis and die. Because insulin necessarily lowers glucose in addition to suppressing ketoacidosis, T1 patients need carbs.

T2 patients are on a spectrum with some having enough insulin production and sensitivity left that they can do okay with no/very low carb intake and may even get better as they lose weight. Some T2 patients get a kind of burned out pancreas and severe insulin resistance which requires exogenous insulin to treat and behaves more like T1 but with the caveat that due to reduce insulin sensitivity, they usually need much higher doses in insulin than T1 patients.

Re: Taking my diabetes treatment into my own hands

#94

Post by mono812 »

vallassy wrote: post #91
mono812 wrote: post #78

Interesting stuff! I'm a late T1D and there is just so much that subtly influences your blood sugar levels. I adhere to quite a strict diet and adapt my insuline dosage based on not just the carb contents and glycemic load of the meal, but also the starting point / trends I see in my libre readings. If you can predictably consume carbs (and glycemic load) you can also inject early with confidence (or even post-meal i…

I still haven't found a tactful way to bring this up, but have you considered a low- or zero-carb diet? As far as I underdstand it, if you don't eat carbohydrates, you don't require insulin to deal with the spikes, and apart from a few grams in the bloodstream, humans require extremely little to no exogenous carbs. I'd love to hear your thoughts if you've looked into this already.

Imho you can't really do a zero carb diet that's healthy. Keep in mind that even leafy vegetables have a bit of carbs in them. Low carb is possible and does indeed generally keep your blood sugar levels more stable. But even a meal that's mostly low carb vegetables and some meat still requires insulin if your pancreas has stopped working entirely.

I'm obviously a patient and not a doctor, but from what I've read as a Type 1 diabetic with (next to) no insulin production you have a life expectancy in the order of weeks, no matter what your diet is.

Re: Taking my diabetes treatment into my own hands

#95

Post by e40 »

Scotrix wrote: post #42

I‘m T1D and using Freestyle Libre + Omnipod Dash and iAPS + Apple Watch. Apple Watch is for me primarily to automate physical exercise detection and target adjustments but also works great with iAPS to control bgs and inject insulin from your watch without taking your phone out of pocket. All built as a homebrew closed loop. While it was somewhat difficult initially to make it work I managed to get over the last year…

Please share more.

Re: Taking my diabetes treatment into my own hands

#96

Post by jhoho »

Not sure how widely known this is, but recent studies have shown great, sustained results for type 2 through dietary interventions using wholegrain oat (as it contains beta-glucan): https://www.thieme-connect.com/products/ejournals/html/10.10... https://www.sciencedirect.com/science/article/pii/S221479931...

Re: Taking my diabetes treatment into my own hands

#97

Post by gbuk2013 »

flanked-evergl wrote: post #82
alex_duf wrote: post #38

Earlier quoted context omitted.

I also lived in two of the richest countries with a social medical system My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc. I'm talking about the situat…

> My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medica…

> Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible.

YMMV but as a software developer I am certainly not going to start throwing stones in a glass house. :)

Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.

Re: Taking my diabetes treatment into my own hands

#98

Post by cpwright »

One thing that I would object to is this characterization from the article:

>There are people who take insulin pumps (which provide insulin in very small very frequent doses and are ~permanently injected into your body, but are otherwise dumb as a brick) and combine them with continuous glucose monitors, and make the glucose measurements inform and control the pump. This is called “closed loop” or “artificial pancreas”, and getting one officially is very hard or impossible: not FDA approved yet / you need to be part of an university study to get one / … It’s one of those things that “will be here in 5 years”, they say every year for the past 30 years.

I've had a Medtronic CGM and pump for 6 years now (680G, now 780G). It is an FDA approved system with feedback from the CGM to the pump. The only thing I needed to get insurance approval was a blood test showing that I was T1 and not T2.

The auto mode has been greatly improved in the 780G pump vs. the 680G pump. I only need to stick my finger a couple times a week, and my control has improved. Without the pump and MDI it was quite a bit higher. It's nowhere near as good as an actual pancreas, but it is definitely not vaporware by any stretch of the imagination.

The Medtronic support is (mostly good), and I have a pretty high degree of confidence that it will keep me alive. I do have Kwikpens as backup in case of malfunctions - which do happen. The biggest things for me are as simple as ripping your infusion set out while away from home, or the thing has an intractable Bluetooth communications problem or other kind of hardware error.

The author is pretty much 100% right about "vibes" though, even with a pump.

Re: Taking my diabetes treatment into my own hands

#99

Post by flanked-evergl »

gbuk2013 wrote: post #97
flanked-evergl wrote: post #82

Earlier quoted context omitted.

> My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medica…

> Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. YMMV but as a software developer I am certainly not going to start throwing stones in a glass house. :) Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.

> Also consider additional time and cost of a doctor completing their education while working up to a max of 80h per week, which would be illegal for any reasonable profession.

I'm not sure why the educational requirements are so extreme for all doctors. Certainly for some, like surgeons, I get it, but for my GP I think it's a total farce. I don't make the rules though, I just can see a broken system when it's right in front of me.

Re: Taking my diabetes treatment into my own hands

#100

Post by flanked-evergl »

capnrefsmmat wrote: post #92
flanked-evergl wrote: post #82

Earlier quoted context omitted.

> My experience is that GPs are over-worked, under paid (given their responsibilities Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible. > and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medica…

The best sources I can find indicate that doctors work ~25% more hours than other workers, on average, though this has declined since the 70s. https://www.ajpmonline.org/article/S0749-3797(23)00166-6/ful... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/

I don't live in the US so the stat is not really relevant.
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