- That your medical professionals are acting in your best interest
- That your insurance company is acting in your best interest
- That your medical professional knows what they are talking about
- That things that are legal to put in your body will not cause irreparable harm to you
- That the legal level of pollutants in the water, air, ground, walls, floors, etc are actually safe or even being measured properly
- That you aren't being subjected to something that later will be found to be unhealthy, even if it is currently known, until it is litigated in retrospect
- That you can afford the treatment that would be necessary to make yourself healthy
- That anyone in the industries that would normally protect you (healthcare, insurance, public health, government, etc) even care to do so
I understand that some people would look at that list and say I should have never expected some of those, but pardon me for being propagandized at a very young age that we lived in a country that was good and just. That's my bad.
So I am not surprised to see this, and expect to see more of it.
I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance. This is a fiction and has never existed.
The default state is for none of these services and protections to exist whatsoever. Everything beyond nothing is an imperfect and unstable solution held together with duct-tape.
I'm with you. One quick look at history shows nothing is set in stone and it can always get worse.
The system is for profit by choice, it is under our control as society to guarantee that list or not, and we have chosen not to.
Might be the right or wrong decision, that’s up to each of you, but denying it’s has been chosen it’s very naive
What a depressing worldview... :(
I think that children are generally raised to not believe there is "risk" associated with listening to experts. This means specialists like Doctors but also politicians and military officials.
The idea that there could be a grift set up to take advantage of people in the medical space, for instance, which is highly regulated and supposed to be for the benefit of people first and for generating capital second, is not intuitive to children.
In fact a wide array of industries and services in the United States, and the world (to not be political, as some commenter said) are set up to take advantage of children or naive young adults.
Secondary education and student loans is a glaring example of this.
> The default state is for none of these services and protections to exist whatsoever
In all of human history this is mostly untrue. Humans have always formed societies, and those societies have always provided services for their people. In fact, before capitalism, most of these services were provided in-kind as a right of being a part of the tribe.
This idea that every person is born as an individual and nothing is granted to them belongs to a certain political ideology that is designed to make sure people feel entitled to nothing, and keep things in the private industry, and keep government small. But I digress.
Of course someone has to provide the service, and collect the materials for the service. And that person deserves to be compensated for that work. But the idea that the default state of a human is to be alone with nature and subject to pure individualism is simply not true, and never has been the norm, until that idea was used to justify not providing people with anything.
> Everything beyond nothing is an imperfect and unstable solution held together with duct-tape
This idea is also untrue. We've had a lot of time to perfect these things. If we can build skyscrapers and infrastructure to maintain them, we can provide these services. You are conflating political ideology and economic motivation with literal ability. The ability is absolutely there, and was in the past as well. There is something different going on that causes these systems to be "held together with duct-tape" and it's actually other humans actively trying to destroy these systems, not that they are impossible.
Reasons why should be obvious, but listening to podcasts, or reading pop-science books, connecting the dots and thinking you’re qualified to give, again, life-threatening advice, does not mean you’re actually qualified or you have an idea of how deep the rabbit hole goes (as we are learning, nobody really does).
Unfortunately, in my experience I encounter a lot of people who haven’t opened up an intro to biology book since their teenager days let alone an undergraduate biochem book, but they listen to podcasts and think they have it figured out and have the audacity to speak with confidence. I’ve been in situations where the practitioners are wincing but are too polite to call people out - it’s easier to let them just yap out what the podcast said and then change the topic. Don’t be one of these people.
Isn't it suspicious to offer YMMV caveats in a situation that is obviously dripping with caveats?
If I were to summarize the thousands of hours of what the Phd/MD health podcaster space has promoted, the jist of it comes down to:
- Get about 1 cup of 5 colors a day. Usually a smoothie is the way to achieve this. I make them in batches and they are conveniently available as grab and go.
- Prioritize sleep
- Exercise to improve v02 max as high as possible
I think _most_ of the population on hackernews has the financial privilege to implement the above 3 in various ways. But those will provide such a quality of life improvement to anyone dealing with chronic illness that it reduces the need for medicine a ton. And much of the damage from the environment can be mitigated by providing the body with the nutrition necessary to detoxify and deal with the various stresses they bring.
The way to look at modern medicine is that, modern medicine is very good at fast death scenarios. Heart attacks, randomly acute conditions, but they are terrible when it comes to slow death conditions like diabetes and dementia.
We need to look to rely on modern medicine for quick death, while creating interventions on the slow-death side ourselves, unfortunately.
Or they're delusional and legitimately believe the nonsense they're up to (insert your personal childhood gripe here) is in your best interest.
I think that low baseline expectations is very important for mental health and general resilience.
After 5 years I decided that method was bullshit designed just to sell insulin. Went keto and was off insulin withn 2 months and haven’t had a drop of extraneous insulin since (7 years).
My doctors advised against me going keto because the ADA recommends their diet. When I explained I was going to try it anyway because it made sense that if my body was having trouble processing glucose, that eating a diet that minimized glucose would probably have a beneficial effect.
It was at that point that I realized that many doctors are simply following a treatment formula. Ultimately the ADA had to recognize that keto can be affective at managing diabetes. Yet, they still publish the pretty literature that advises type 2 diabetics to eat a diet that for them is significantly worse than a low carb diet.
I think the two main factors driving this outcome are:
1. Due to the complexity of the problems they face and the quick diagnosis expected from them, medical professionals are taught to think in an expert system-like if-then statements. Some of these are rules of thumb, some may no longer apply due to latest research, and some may not be applicable to you.
2. Metabolisms may differ in important ways. A new doctor is trying to make a decision in a highly complicated high dimensional space with the few data points that you provide. This is OK, but they get too confident with their diagnosis.
Point two, though, is just an example of how preventive medicine is forgone due to its cost. The system doctor's use to share data could also stand massive improvements.
In my case - just to get the facts on Blood pressure took quite a bit of digging - thanks to some independent doctors who went against the grain and had a conscience and courage to dissent. Cholesterol is an even murkier pool. Its amazing how muddled the picture is.
2) Large activated carbon air scrubbers. For air filtration you really need not just HEPA particulate filters, but robust VOC capture. The tiny bit of activated carbon in things like a Winix C535 or Coway Mega/AirMega really don't clean much. Instead, consider something like buying two 10"-12" carbon scrubbers from https://terra-bloom.com and get a matching size of their in-line "Silenced Ultra Quiet EC Fan". You can just stack these three items together and it forms a tall but not horribly ugly appliance that doesn't take up much floor space. You'd probably need to replace the filters once a year, and have quite a few around a normal-sized house, just like standalone HEPA filters (which you'd also probably still want as well).
3) Wash everything often - bedding, clothes, carpets, floors, walls, appliances, etc. Obviously, attempt to use a soap that won't add additional pollutants. Wash them twice, once with soap then again without soap.
4) Time. Assuming similar materials, something that is 5 years old should have already leeched out a lot of the chemicals which are going to off-gas/transfer/leech from it. So the polluting rate of something 5 years old that's been washed 50 times and already worn and broken in should be assumed to be lower than an identical, new, version of the same thing.
But for a simple pill solution, consume sulfur. For as important as it is, it's not widely front of mind in the health space. So much focus on Vit D, Magnesium, Omega 3s, etc, which are all absolutely necessary.
Some great sources of pill based sulfur are Taurine, NAC, and MSM (methylsulfonylmethionine). My preference to recommend blindly as a general pill is MSM. But sulfur is key for the liver's detoxification functions to work ideally.
There's quotes flying around that say something like: 80% of the population (US or world) is deficient in X.
Usually X is omega 3's, Magnesium, Vit D, and also to add to the list, Sulfur is a huge one. Outside of being in a culture like Koreans that consume cruciferous veggies 3x/day (via kimchi), most americans only get it from meat, garlic, onions and broccoli. If one has brittle nails or hair doesn't grow as quickly, that would be the sign that something like MSM in pill form would be helpful. Otherwise, folks are probably fine if they are consuming daily amounts of anything containing sulfur.
And I'm not going to feel stupid or naive for feeling like children are tricked into believing the opposite is true.
I want to also say, this state that everyone is acting in their self interest is not something we should promote, or be proud of, or assume is the natural state of things. It is a state that we are being forced into, and we are being convinced to accept.
People as individuals are actually very good. And if we were to get over a few little logical fallacies, we could extend that goodness onto our whole society. But there are many reasons why that is considered harmful by some in power, and then many more who are propagandized into agreeing with them.
It would be surprising if one's body were different. The general level of faith there seems inconsistent with reality
Managing the condition isn't too difficult after 30 years of it, but dealing with the politics of NHS diabetes care is astronomically more difficult than it was in any decade previously. In my experience, if you are not pregnant, or you aren't at risk of passing out in the next 15 minutes, they don't care. Whatever long term consequences you experience are another department's responsibility.
A trend I've seen is that younger diabetes nurses and doctors are extremely dependant on tech (CGMs, insulin pumps), but don't comprehend how they work or what the data means. They don't know what patterns to look for beyond a 24hr window and generally seem to think everything is a bolus ratio or basal problem, overlooking other settings such as correction factor, duration, etc.
Because they are tech illiterate, vendor lock-in is becoming an issue, as no health tech companies want you using another tool except the one they get paid for. So I find myself being swapped from platform to platform as they change my devices every year or so, each one being less workable than the last. Glooko only allows 6 months of historic data to be viewed, and only through their web UI. Abbot refused to let me download my data after I was forced off their platform to Glooko. I was happy on Tidepool, but it doesn't work with my current set of devices.
No, more funding will not fix this. Threats of criminal punishments for lazy medical professionals and unlimited fines for anti-competitive behaviour from diabetes tech manufacturers will.
https://news.sky.com/story/the-nhs-sold-out-its-staff-doctor...
https://www.telegraph.co.uk/news/2024/05/15/doctors-forced-t...
The starting salary for a first-year doctor is below the national median income, and for a nurse significantly below. Their inability to requisition funds & time for care is something there is repeated labor action about. The NHS budget is 5.9% of GDP versus the 17.3% of GDP that the US economy spends on healthcare or the 11.3% of GDP that the UK economy spends on healthcare overall.
Maybe more funding will fix it?
Is it really that low?
In the USA an entry level doctor will make around $130,000 and the 'Average doctor' makes $200-$350,000/year depending on what website you want to believe.
And we're running like 13% of the population having diabetes.
Here you are comparing a doctor at the start of their career with a population consisting mostly of workers with decades of experience.
The NHS is underfunded, but this isn't a problem of funding. The lack of a scientific approach to managing diabetes is strictly down to ineptitude.
Mind providing some sources for this? Rather tired of hearing this unfounded conspiracy theory from people
> Maybe more funding will fix it?
Where does the money come from?
I agree about Glooko, it's not as good as diasend was.
Expect to start having appointments cancelled and to go years without hearing from them once she is passed to the adult diabetes team.
So I've been using Abbot (LibreLink) since 2019 and if you log into LibreView (https://www.libreview.com/) there's a 'Download glucose data' link in the top right of the screen.
There's also a handy PDF report that I send to my diabetic nurse before my annual meeting, I think I'm the only one of her patients who knows how to do this because she's always thrilled and spends half the appointment going through it in amazement at the data/trends.
Abbot have been quite good overall despite the fact I reported a bug to them in their Android app in 2022 and they still haven't fixed it. If you add LibreLink to the whitelist of apps that can interrupt DND, then enabled DND, LibreLink alerts you saying "Alarms unavailable."
I was referred to a dedicated team with a specialist nurse who checks in with me regularly. Maybe I am fortunate not to live in a big city where most NHS facilities seem to have descended into third world standards?
Good luck with your programming, but the agenda you're pushing for it is remarkably short-sighted.
My lowish tech solution to delay (and hopefully prevent!) the onset of T2 is to use a glucose monitor every 2 hours, every day, and create a database of foods with my postprandial blood sugar reaponse at 1.5 and 2 hours. I also keep track of how exercise affects my blood sugar.
Over the last couple years, I have gotten great data on the foods which spike me and the foods which are neutral to my blood glucose.
A lot of foods doctors/the internet tout as "diabetic friendly" (like beans, lentils, corn in any form, brown rice, buckwheat groats, non-granny-smith apples) spike me like crazy. Other foods are totally fine (bananas, snap peas, nuts, steel cut oatmeal, fermented dairy, fish).
Having an autoimmune disorder on top of the prediabetes, I've learned that the only one who cares about my health and longevity is me. My doctors care about my inflammatory markers and nothing else.
Strict carnivore for me was steak, hamburger, stew meat fried in butter, mushrooms and onions in butter, bacon, and very sharp cheddar (only on burgers or raw). Eat every bit of gristle and fat. It is very hard to get enough fat.
Brain fog lasted for 10-11 days. Felt fantastic after that.
To keep your carnivore costs down I would recommend stew meat from Costco fried with onions and mushrooms when you can't stand steak or plain burgers.
This has worked for me for the last 6 months. I have no idea what it will be long term. Maybe someone will find something useful in it.
Their experience touches on 3 factors:
>Exercise volume (which, according to newer research, should be spread out over the course of the day)
>Diet (which should be focused not just on maintaining steady, low blood sugar levels, but on dietary factors that encourage subcutaneous rather than visceral fat deposition)
>Sleep quality
The last, I think, is extremely undervalued. My father developed T2 in his 30s, and it progressed consistently until he was diagnosed with sleep apnea and received treatment. Around the same time, his work schedule finally became more reasonable after a career of early mornings and late nights. This is someone who had to pass annual physical fitness exams for his job, cooked and ate relatively healthily, etc. I'm convinced it was the years of poor sleep that set him up for insulin resistance.
This publication is a good starting point to his approach. Early time-restricted eating of low sugar and low starch meals is the key: https://nutrition.bmj.com/content/bmjnph/early/2023/01/02/bm...
It sucks, and I wind up cheating 2-3x a week (I live with people that eat different than I do).
- compliance is straightforward
- on average, will tick all the boxes for nutritional needs. (ie. vegans eating only oreos would not be very healthy, while vegans eating 5 colors a day would be far better off)
Eat less, exercise more, and you may delay T2D. Reduce or avoid fast carbohydrates. Reduce carbohydrates.
Also the FDA cleared at least one brand of CGM to be sold without a prescription, starting "summer 2024": https://www.dexcom.com/stelo
You should expect to pay $80 - $200 per device, and they last one 14 days, but the insight they give is really worth it.
- Exercise: 'Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. ' - Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- Intermittent fasting: there's great evidence that IF (intermittent fasting) can put it in remission: https://www.endocrine.org/news-and-advocacy/news-room/2022/i...
- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup and mostly stick to low-glycemic index minimally processed foods. 'Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.' - Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1
They care about your payments, more likely...
Anything outside the check list leaves them scratching their head. They’re terrible debuggers.
I had early high blood pressure since high school. Four blood pressure medications, one being a diuretic. Signs of edema.
It’s not like my condition required any complicated diagnostics. I met the checklist.
5 cardiologists 2 nephrologists in my lifetime. Nothing but more pills for treatment. Over two decades.
I had to be the one to research and then ask to see an endocrinologist because I thought it might be hyperaldosteronism. They were dismissive when I asked but reluctantly made the referral.
Yes, it was unilateral hyperaldosteronism. Had my left adrenal gland removed because of it.
And now my BP is much more stable. I still take a couple of BP drugs, but in smaller doses. And my BP is much more normal and stable.
No more wild, 3am ER visits where my BP was 200/120. And I lost about 15 lbs of water weight.
If have long lived resistant hypertension, please ask to see an endocrinologist to get screened for hyperaldosteronism.
I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.
A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars.
[edit] Reading more of the comments this seems par for the course in many "wealthy" countries.
If you want to have the best shot at preventing disease and living a long, healthy life, it’s not complicated: eat a healthy diet, exercise, get a good night’s sleep, avoid drugs and alcohol, and have fulfilling relationships with other people. Beyond that, you’re spending a lot of money on things that are going to have a negligible or even negative impact on your health and quality of life.
Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it?
Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time.
Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)
This isn't my experience. Every time I've gone in for an annual check, the doctor has either suggested that I get or asked if I would like a blood panel. Maybe you should try another doctor.
Do you really need VO2 max test to tell you that you get out breath climbing a set of stairs? What genetic tests are you even talking about( brca ? ).
Is there any actual proof that "catching cancer early" has any long term impact on survival ? ppl can go waste their money if they really want for entertainment but I don't suggest burdening public healthcare with voodoo science.
> Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.
What do we want them to do. They are not going to come to your my home and switch out your burger and fries with a salad.
I don't get where this notion that you need to go to doctor to keep yourself healthy even comes from. Its not a secret how to be healthy.
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 situation in France and the UK, not sure where you are, my point is that I agree about the system failing us, there's a lot to be said about what could be done but that's outside my area of expertise. I'm just being a little nicer to the doctors, as there's only so much they can do given the means they're given.
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 medical industry is too incompetent to figure out what it is and that there are people who have worse problems, even though he has no idea what is actually wrong.
Then afterwards they are put into position where they have 30 minutes for patients (in France its ridiculous 15 mins, saving money = worse diagnosis/treatment, no way around it). Don't expect miracles if they see 20 folks like you daily, ideally with very vague problems like chest pain which can be anything from sprained muscle due to bad sleeping position last night to heart attack, while having 10 other comorbidities and taking various medication.
Doctors behave as whole system forces them to behave.
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? Then what? Do we die? Or is there some form of diet that we could live on??
I was diagnosed as pre-diabetic/T2. I started wearing a cgm and watching how various foods affected my blood sugar. I eliminated foods that caused spikes, and started cooking my own meals so I could control what went into them. I wound up with a very low carb diet of meat and vegetables, and a very stable blood sugar with NO spikes ever. According to my blood work and checkups I cured my NAFLD, cured my hypertension (including getting off drugs for that), and "cured" my pre-diabetes. I lost a lot of weight, but still have a lot more to lose.
I put cured in quotes because I don't think this diet can cure you once you're bad enough to need treatment. I think it can only put your disease into remission so that you don't suffer any health effects from it. Some of us just can't overeat carbs or we develop this disease, and the only effective treatment is to stop eating the carbs.
Doing so with mild T2 diabetes could lead to complete remission (as long as the diet is kept).
In more advanced T2 diabetes it could lead to significant improvement, and reduction of required medication.
People with T1 diabetes simply don't produce enough insulin. External insulin is required.
Management of T1 diabetes is also way more complicated and mistakes are immediately life threatening.
Are you familiar with Dr. Richard K. Bernstein's approach? It is a very low carb diet (he doesn't call it Keto as Ketosis is not the aim) combined with a lifetime of experience managing it.
See his book The Diabetes Solution, his Youtube channel, and the Type1Grit facebook group. There are a lot of type 1s running <5% HbA1C on his program.
He's definitely very contreversial, but I always found his reasoning extremley presvasive. Not to mention that he's a 90 year old with T1 from childhood, still practicing medicine and seeing patients (or at least he's been practicing up to a few months ago).
https://www.diabetes-book.com/
https://www.youtube.com/@DrRichardKBernstein/videos
https://www.facebook.com/Type1Grit/
There's also the great Gary Tabues and his books, especially Rethinking Diabets
For T1Ds I'm afraid even a keto diet still contains too much carbs to live healthily without insulin. Unfortunately if your body has fully stopped producing insulin and you don't take any artificial insulin your life expectancy is not looking good regardless of how you live.
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.
While the scantly researched health risks associated with a ketogenic diet remain, the diet is very effective to keep blood sugar stable. A low-carb diet protects most people from T2, and people with T1 profit from simplified insulin management.
For a T2, eating ketogenic could be healthier than eating carbohydrates. Depending on progression, they would recover quickly and not be a T2 anymore.
My doctor and I have talked about trying to see if I can drop the medications and still stay in remission but I'll still be a T2 patient.
Also, not all T2s can manage just through a ketogenic diet.
I can reduce sugar but not carbohydrates as a whole.
I thought this was a neat discussion: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062586/
A transcript of a speech Joslin gave https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1827782/pdf/can...
Insulin is cheap to make, now, it is expensive because of commercial considerations like monopolization or investment. In reality any national system worth its salt could produce enough insulin at a very low cost for all diabetics in the world. But, this won't happen because of trade rules and so on.
Some people are trying to build the infrastructure for local/homebrew insulin production, but it's proving to be challenging. See this site for more: https://openinsulin.org/2023-recap/
Winforms lol, it just works and I don't have to spend most of my time trying to work out xaml stuff. Just add the components to the window, set up some event handlers, done
Best decision ever. I know plenty of dotnet folks who would rather eat a shoe than learn how to build a web front end, but frankly it's still better than what I would get with Winforms. There's so many great free libraries, tutorials, and resources for webdev.
And best of all, now I have something I can host on a free GitHub site and share with people, instead of figuring out how to build an installer.
It is interesting that the author chose to use Elm to describe C# code. If it is their preference, they could have gotten all that with writing the "core" of the project with F#, without having to change examples neither in the actual implementation nor in the blog post (the author does mention F# but not whether they looked into using it).
I wonder how the mobile support is.
Of course it's often a little less performant and requires Learning New Things. But generally the trade-off is worth it for the significant benefits if you want to share it with the most people.
My wife is T1D, moved to a closed loop last year. It has been life changing for her - this is not an understatement. Her mental health has massively improved because she isn't having up to 3-4 hypos a day.
One thing not mentioned in the intro, hormones hugely affect T1D. She's started perimenopause and everything went out of the window.
Closed loop has made this much more manageable.
What's the model she uses? My guess would be tslim+Dexcom? It does reduce stress a lot.
The omnipod was a good change for her as there was one fewer places to fail (being airbubbles in the piping).
And now with the closed loop, it's stepped up again.
One thing she has found though - her hypo awareness has dropped. They 'feel different'.
Her description: what else can you do for 30 years and still feel like a failure as it isn't working like it should?
I disagree with the author however on the following point:
"injecting insulin ~15min before you start eating would do wonders for neutralizing the BG spike, the issue is, nobody does it, because what if you then get a smaller serving at the restaurant or it gets delayed?"
My doc told me the same, which I think is insane. "Here is a hack that solves 80% of your problems but nobody does it, so don't bother." WTF?
If you get a smaller serving, order some bread or eat some of your emergency snacks you should always have. If it gets delayed, do the same. You don't need to cover the whole insulin dose, just delay the hypo a little bit.
Relax. We live in an industrial world where glucose bombs are available always and everywhere. You'll be fine.
Injecting 15mins beforehand has made my life so much easier that I would not miss it for anything.
Feel free to ask me anything.
1) You can do an extended pre-bolus before you eat. This gives you a chance the cancel the remaining insulin dose if you learn your meal will change for any reason n-minutes before or during your meal. Maybe the meal unexpectedly tastes bad, you can cancel the remaining insulin. Maybe the restaurant tells you they are out of the dish you order n-minutes ago. This is called different names in various insulin pumps; Extended bolus, temp basal, etc.
2) Pre-bolus and eat AFTER you see your blood glucose decrease for 3-4 readings. Pre-bolusing for static time like 15 minutes before eating does not work consistently because there are lots of variables at play before you eat that directly affect (a) insulin sensitivity and (b) blood glucose. (Environmental temperature, insulin temperature, injection site, adrenaline, stress, pain, previous meals, lipid levels, exercise, medications, illness, to name a few).
Eating after I see my BG decrease for at least three consecutive readings has helped me stay in range (70-140) for 95-100% of the time and maintain a healthy A1C (less than 5).
Cheers!
I basically consider my malfunctioning pancreas to have been replaced/augmented by my brain, assisted by a cgm. My diet is rather boring but keeps me alive and keeps the BG in a pretty tight range.
My biggest problems are hypo (usually due to being in “flow” for long periods…bliss) and DKA (when I’m backpacking or on long bike rides, which my doctor recommends I not do, but I do anyway).
Would be really curious to know more how DKA happens to you!
Had a serious episode about a month ago (ketones at 9 mmol/L). I was on a short backpacking trip with some friends: four 15 mile days. I don’t carry a lot of carbs. My pen became hot despite my best efforts.
Had another episode earlier in the year in a similar trip backpacking in the snow — shorter distance, harder work; my meter froze and stopped working so I don’t know BG level. On the second day my pen got “slushy” even though I carried it next to my body/in sleeping bag.
My understanding is that in these cases your liver starts out dumping glycogen into the bloodstream but reserves are exhausted and so you start going into ketosis. I don’t understand the mechanism under which my glucose then hikes — some stress reaction?
This is generally scary for my companions but not for me as I am a bit confused, falling over etc. The only feasible way out was to hike. Fortunately on the first trip we had adequate water access so I drank (and pissed out) about a litre a mile.
Genuine question, not trying to 'gotcha': do you think your stubbornness in this regard was somehow accentuated by having T1D? Is this perhaps a recognised phenomenon amongst diabetics? (An old friend with T1D was similarly [maybe even more extremely] stubborn, being perhaps the most badly-behaved and impulsive of our friend group at that time.)
> Especially, a diabetic patient is warned that unauthorized use of this software may result into severe injury, including death.
I like the idea of the post - I have actually been thinking about including some biophysical models for medications in my app - but I do think that if you don't understand what a system of differential equations is, maybe trying to use a software library as a black box is a bad idea. For example... genetic algorithms... really? Like use a shooting method or bisection or something. If you have 3 doses you have 3 variables and it is all continuous so searching the space of inputs should be much easier than examining 51^4 discrete possibilities.
This is probably also why apps like LibreLink don't provide predictions but only show historical data - easier to not get sued if you don't give the user advice that could kill them?
Re models, differential equations and finding minima: I do agree genetic algo is a bit wonky, and the greedy random walk at the bottom was able to get similar results. Do you have some resources for optimizing a N_51 x N_51 x N_51 x N_51 -> R+ unknown black-box function? My googling led me to eg. Metropolis-Hastings algorithm, but I don't currently get it (the translation to the probability domain escapes me). You're mentioning shooting method and bisection, I'll take a look at those.
What I was saying is I don't think N_51 is the right way to model a dose. I would model it as a real number in the interval [0,50]. I would still round whatever the model gave to what I could actually measure out decently, but within the model I would not use discrete numbers.
Maybe Bayesian optimization? That's often how hyperparameter optimization is done in machine learning, but that has the additional constraint that each computation of the loss function is very expensive.
In general the term "black-box optimization" is the right search term, or "derivative-free optimization" which is what Wikipedia calls it.
<looks at all the AI hype>
Seems it's just you and me that think that way...
>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.
The concern is the the G7 CGM seems to have times where it is so wildly off with readings that a closed loop system could kill her. This weekend the CGM was saying she was all the sudden at 40, but she was at about 115. I am scared to think what would happen in the night if the closed loop system thought it needed to raise her blood sugar... Logically I know it wouldnt raise it to a point that would cause medical harm, it would still put it higher than would be ideal for her health.
Maybe there are differences between the different brands, but the G7 from Dexcom's big selling point was "no more calibrations" and the FDA approval for that tagline, and we've been seeing a need to calibrate more than the G6, which is disappointing. Granted... sample size of n=1 so...
The FDA approved systems do have safeties in there that alarm persistent highs or on any lows. They also won't provide more basal than a multiple of the pre-configured setting you have.
The biggest thing for me was the 780G alarms less than 680G when there is nothing that I actually want to do to change it. Waking up all the damn time is no fun.
"In July 2014, Tandem announced that it had submitted a PMA for the t:slim G4 insulin pump, which integrated t:slim Pump technology with the Dexcom G4 Platinum CGM System. This device was approved by the FDA in September 2015."
https://en.wikipedia.org/wiki/Tandem_Diabetes_Care
We were still working on international support when I left last year. As you can imagine, there are quite a few regulatory hurdles esp. regarding patient data portability and access.
I manage to maintain roughly 99% TIR (4-10mmol/l) on my Libre with this, virtually no hypos and just the occassional bit of hyperglycemia when I just don't want to care. Although obviously this does require you to plan a lot of things in advance and requires effort and all of this is just based off of personal experience and experimentation and does not necessarily translate to anyone else.
I'm still really hoping for a more low-effort solution to T1D treatment (or even a cure), but I'm skeptical that we'll see that anytime soon.
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.
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.
To put it bluntly: You don’t understand it.
Type 1 is different from Type 2.
A Type 1 person without insulin will die.
> “I will see that in someone with 0 percent insulin production, they’ll begin to fall ill within 12 to 24 hours after their last insulin injection, depending on its duration of effect. Within 24 to 48 hours, they’ll be in DKA. Beyond that, mortal outcomes would likely occur within days to perhaps a week or two. But I could not see someone surviving much longer than that.”
https://www.healthline.com/diabetesmine/ask-dmine-lifespan-s...
1. Small sample size, <20 iirc. 2. No control group at all. (There should have been a group under the same requirements and same diet) 3. They picked 'uncontrolled', and from my own experience that term is synonymous with "unmanaged." Which, translates to "patient is not compliant with treatment." As such, feeding them exclusively a vague "diabetic diet" coupled with the 5 day hospital stay- well its enough to cloud the results enough that no conclusions can be made.
4. Cont. Because people rarely intentionally make themselves feel like crap- which you will with uncontrolled type II. The hospital stay, its exposure to allegedly* diabetic friendly foods, and subsequent time for the subjects to realize "I feel better, I like this!" Basically invalidates the entire paper.
* allegedly, because I just got out of a hospital with a fantastic cafeteria. But, the "diabetic menu" had way to many items with high glycemic indexes, and nothing to maintain a steady sugar level until the next meal.
Finally: ''HbA1c was lower four weeks after the oatmeal intervention.''
Two days of fasting won't change an A1c value.
My father has diabetes since he was 30, my grand father had it too in his 30s.
I am beginning my 30s, will I get it too ?
Is it guaranteed that I'll get it ?
Can I avoid getting it ?
Both my father and grandfather had heart attacks...
The luck part is that it seems that infections trigger the autoimmune reaction that kills the pancreas. The genetics bit is that you may or may not have got the gene from your father.
Most people die of heart attacks in the end. Factors like smoking, lifestyle and fighting in wars are probably more important than well managed type 1 nowadays. The big difference now is that the insulin is human insulin, made by genetically engineered microbes. In the past it was harvested from animals and it didn't work as well. Also constant blood monitoring means that highs and lows can be detected and fixed before damage is done. So - things have moved on, there isn't as much to be frightened of, I'm sorry your dad died young, but you will probably be ok.
Get blood test for all five Type 1 Diabetes Autoantibodies: (this can be done for free) GADA IA-2A IAA ZnT8A ICA
Get blood test for pancreatic C-peptide.
Get blood test for A1C.
Check out tzield if you test positive.
I can share sources if you’re interested. I’m. T1D.
- 5-10g of vitamin D daily (assuming you're talking about type 1 diabetes) - type 1 diabetes is an auto-immune disease, and vitamin D plays a huge role in regulating our immune systems. In fact, type 1 diabetes is more prevalent for those who move from warmer countries to colder ones where there's less sunlight that those who do the opposite.
- Exercise: probably the single best thing you can do for your brain and body, and does a wonder in regulating the immune system and helps out many with not just diabetes, but with a ton of other disorders and the higher intensity the exercise, the better. Exercise which increases your VO(2) max here is the best - both strength training and interval training are highly effective.
- Intermittent fasting (and staying lean): assuming that you're attempting to avoid type 2 diabetes, there's great evidence that IF (intermittent fasting) can put it in remission: https://www.endocrine.org/news-and-advocacy/news-room/2022/i...
- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup on the ingredients list. In fact, in my case, I try to avoid any foods with more than 5 ingredients and try to stick to mostly a plant based and keto diet (this definitely helps with type 2 diabetes). Also avoid high-glycemic index foods (high-glycemic here means ability to 'spike' sugar and you can find the glycemic index of most foods through a simple good search. More info on this index: https://en.wikipedia.org/wiki/Glycemic_index ).
- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1
Yeah, by losing weight. Unless the reason they got it is because of some autoimmune timebomb that's genetically programmed to go off in the 30s and destroy the pancreas.
You are on the right path here but I think you are missing the “big players” for lack of a better term. The prediction software available now (open source) is quite good and works with different types of CGMS and pumps. You are really going to want to look at Loop.
Loop basically collects the inputs in the app automatically for insulin if you use a pump. I’m on the Omnipod DASH and Loop works with a few, Omnipod being my favorite. You can also input injections. It can also collect CGMS data automatically from that system. It works with Dexcom and others (I think Libre). You manually input carbs, and you are still gonna do that based on VIBES. After that, you get these magic prediction lines that show you where you are headed. And with the pump, it can add or lower insulin amounts (closed loop mode) to keep you in range. Pretty common to be 75-90% in range!
Check it out:
While it was somewhat difficult initially to make it work I managed to get over the last year to 85% in range continuously over weeks with a (for me in comparison to before) very low amount of hypos (3 or 4 per week).
Happy to share more and the challenges I had if someone is interested...
Works pretty well in that it keeps things in range when not eating/exercising. Nights in particular now are chill, no more waking up in sweat.
Unfortunately the pump vibrates/alarms far too much, causing notification fatigue. I don't even look at them anymore. I wish there was more information in the vibration pattern: just morse code or something, so I can know what the pump is saying without having to do 3 taps to unlock and see whether it's just telling me something I know already. I wish the developers had to dog feed their product.
Which obviously “never” happens to non-diabetics, because the pancreas regulates this automatically, adjusting to circumstances as required.
IDK if hypoglycemias happen naturally in T1Ds in situations where they don't in healthy people. I assume that eg. when exercising too much etc., even a healthy person would get a hypoglycemia?
I think you are correct but you may be overstating the case when you say, "healthy people can stay active for weeks without food". Carbs, yes. But its worth noting that Zach Bitter, who holds records in ultra marathon emphasizes multi-modal fueling for lack of a better frame, i.e ketogenic leaning for fat burning and carbs when needed; not perfect ketogenic diet. As we like to say on HN, "dynamic at run-time".
Exogenous insulin is the root cause of most hypoglycemia in insulin-dependent diabetes. There are other causes but they are relatively minor. Exercise, alcohol. Most people do not exercise or drink in a focused enough way for those to be major causes of hypoglycemia in insulin populations.
Insulin is just another pill with dramatically worse side effects than an actual pill, except maybe macrodosing psychedelics instead of microdosing glucagon.
You are correct in your macro diet analysis, except that fasting and ketogenic approaches are far more complex in concert with exogenous insulin than most people realize. If you have an endocrinology or organic chemistry background, this may be worth a shot; but the biochem is complex.
The LSS of your last question is that you don't have discrete conscious control of gluconeogenesis or much else in metabolism because it is all driven by well-functioning hormonal changes in the autonomic nervous system.
Again, "dynamic at run-time". The dynamics of insulin, glucagon, exercise, and fasting are far too complex to make this a one and done, simple prescriptive approach.
It's unusual, but I've practiced these approaches for decades, much to the chagrin of my health care team. That team being highly educated and experienced know the statistical outcomes and they're not good.
There are numerous problems with these approaches in diabetic populations who may not have the genetic sensors which make these states survivable, i.e. not all humans can feel changes in glycemia so overdosing insulin is a daily challenge to survival.
CGMs are not a cure-all either since the veracity and failure rates are poor by medical device standards.
I should know. I've worn a continuous glucose monitor for more than five years including two CGMs concurrently the last few years. They work great for some people.
In my case, they're horribly inaccurate (off by hundreds of md/dl) and when I was wearing a closed loop insulin pump, they are root cause of both overdose and underdose states leading to damning hypo and hyper glycemia since the pump has no way of knowing it's being led astray. I'm sure this is covered in cybernetics, control theory 101, or the like. At least I hope so.
Some, like me, can feel the glycemic changes and this promotes survival. T1D without glycemic sense may be a death sentence because the path from consciousness to unconsciousness is quick and these states are frequently not survivable without immediate action or a world class ER trauma team.
There's a reason T1D is classified as a wicked problem, like COVID.
This is why nocturnal hypoglycemia is dangerous even for those who can feel glycemic changes. Trust me, after 50 years of playing this game nightly, I'm not kidding when I say it takes Goggins-levels of asceticism, compulsiveness, and self-care.
I believe it's worth R&D spending and a cohort like me who have the biomarkers for surviving these approaches, but n=1. There may be others but I've not interacted with them directly.
Here's a well-cited oldie but a goodie on the complexity of diabetes for the obsessively curious:
https://www.researchgate.net/profile/Philip-Cryer/publicatio...
Dr. Bernstein's book is a must read for every diabetic person. His YouTube channel: https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag
Also, if you have an android phone (I have a separate android exclusively for CGM use), there are open source apps that can connect to Libre 3 sensors and let you export data in several formats[0]. You can even connect it to home assistant if you’re into that. It would be really great to have these app readings integrated into your simulation.
Can’t wait to see where this project goes!
Assuming you have an Android phone and a compatible smartwatch (Galaxy Watch4 in my case): 1. You need to install G-Watch Wear App on your phone and watch 2. You need to replace the official Libre app with a 3rd party app supported by G-Watch like xDrip or Juggluco. There are a few of those, mostly not on the app store and you can even feed their data into eachother, I'm not going to go into detail here. 3. Set your watch face to one of the two available godawful ugly G-Watch Wear App watchfaces and enjoy a live glucose graph on your wrist
Depending on your datasource it updates every minute or every 5 minutes with some smoothing applied - again, lots of fiddling here.
There are some alternatives for iPhone and probably other watch apps for Android as well.
I've tried 6 of these on my mom, at every price point, and compared with a prescription monitor (back of the tricep, needle thing). I couldn't find anything even remotely accurate.
- Liquid glucagon can last only 24-48 hours at room temperature
- Once glycogen storage in the liver is depleted, glucagon does help promote blood sugar production, but the effect is way lessened and unpredictable.
- The liver‘s glycogen storage is for many T1Ds a life saver in case they have a severe hypo. Injecting glucagon can deplete glycogen so you lose this buffer when you really need it - meaning you won’t wake up again when otherwise you would have.
So ideally, one would inject glucose directly, but that’s a volume/convenience problem. It would be ca like carrying a colostomy bag.
We researched more and more and found cutting out carbs heavily helped more than anything else, but she still needed some insulin. When mounjaro started getting a lot of attention, she tried that along with metformin. With those two drugs combined, she was able to get completely off insulin. She lost the weight gain from the 2 years of insulin, which reduced her resistance. She started having hypoglycemia and was able to reduce the metformin by half to get back to normal levels.
Her A1C is now 5.5 and has been < 6 for over a year now. Although the metformin was recommended by her endocrinologist, both the carb change in diet and trying mounjaro was something she had to take upon herself, none of her docs told us about this.
It's an absolute shame, and it feels like you're meant to be kept sick if you go strictly by the guidance from the ADA and even the doctors.
Insulin can "cause" weight gain because having diabetes means your cells stopped absorbing the sugar from your blood properly. "Fixing" the diabetes with insulin means your cells start absorbing the energy you eat like they are supposed to, which means gaining weight again if input > output energy. On the other hand metformin and tirzepatide are also effective as weight loss drugs + lowering carb intake prevented the root problem that was "causes" weight gain with insulin in the first place.
I'm hoping I can lower my metformin dosage this next checkup as well, fingers crossed.
How come the disease gets so little publicity??
Supposedly I laid down on a couch and passed out, which is when one of the kids at the workshop realized it's a similar symptom to what their grandpa had, and alerted a grown-up. I'm very glad there were people around me at that moment.
I woke up to a full bottle of cola and some bread rolls with Nutella being forced into me.
> 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.
These exist now. I've had one for a few years now. Medtronic 670G.
> My treatment is usually: keep the Freestyle Libre app on my phone open as much as possible and when I see my BG’s getting high, I inject a small amount of insulin. How much? No idea. IT’S ALL VIBES.
Your correction factor is
CF = 100 / (Total Daily Dose).
To make a correction you do
Additional insulin to administer = (current blood glucose - target blood glucose) / CF
Now, even after doing this you'll still have blood sugar spikes and dips but this should get you most of the way there when combined with diet and exercise with very little "vibes" involved.
do you have a citation? that lines up close enough with my factors but I’ve never seen the formula stated that way and would like to learn more.
https://www.mountsinai.on.ca/care/lscd/sweet-talk-1/what2019...
For the past few years, he is now on keto diet and eats 2-3 eggs per day, due to some missing aminoacyd (not entirely sure why). His blood sugar is normal and he doesn’t have to take insulin anymore.
If anyone needs some more info, contact and I can ask him for more details.
I'm confused. Is your a friend a diabetic whose doctor never told them that carbs increase their blood sugar level? Because this isn't exactly hidden knowledge for diabetics.
Source: I do keto for other reasons.
> injecting insulin ~15min before you start eating would do wonders for neutralizing the BG spike, the issue is, nobody does it,
My dad did. Yeah, it did cause a couple scares. He had very well-controlled numbers but it was all-consuming and I can’t imagine the average person being as thoughtful or on top of it. I’d probably become quite depressed.
I wonder if the author has looked at an insulin port: makes the injection aspect much simpler. https://www.diabetes.shop/i-port-advance/iport_6mm/i-port-ad...
Both T1D and RA are autoimmune, so it's not surprising they showed up around the same time. He was probably infected with a virus a few years earlier which caused the production of auto-antibodies; Epstein-Barr and CMV are famous for this, and it takes a few years for enough damage to take place that symptoms show up. (Symptomatic T1D starts at around 90% beta cell loss.)
I had this idea of using gel caps to get a better read on my internal state because you can feel them going down but they don't actually get stuck (and even if they do they dissolve pretty quickly and don't cause too much discomfort). The idea is to have them in a variety of sizes, and to start with small ones and get bigger until you can feel one. That gives you much more fine-grained data which you can then correlate with what you've eaten the day before. Trick is, I can't find a source of placebo gel caps in assorted sizes anywhere. I can't even find a manufacturer to make them for me. Every manufacturer I've approach about this insists on having some active ingredient, and they also want minimum orders in the thousands of units.
The irony is that I would have no problem getting these on the market as homeopathic remedies of some sort.
0: https://ibspot.com/products/capsuline-size-1-empty-capsules-...
It’s an off-label use, but swallowed fluticasone is also effective for many people. Also has no to minimal side effects. I did that for many years before dupixent was available.
Exciting that you figured out your trigger. I collected a lot of data and made a lot of graphs, but never found anything conclusive.
Great article. Taking control of your health via the tools we have as technical professionals is awesome.
It's crazy that we still can't replicate biological processes. Literally a peace of meat can do this stuff but we can't replicate it.
As a software dev, I feel like the industry has slowed to a crawl. Most of the jobs are about building gimmicky software as part of some weird corporate acquisition scheme. There are very few jobs available to build real useful stuff. Those jobs involve taking risks... But private equity firms don't see the point of taking on risks when they can just as easily get risk-free profits.
I find the risk-aversion of private equity firms very weird because at their scale, with their finances, you'd think they could make a large number of risky bets and get relatively predictable results but that's not what they're doing. The alternative approach I'm suggesting clearly works; just look at what happened when companies started investing in AI. The level of risk in that case was off the charts, yet clearly, even that bet paid off. The productivity gains of recent AI innovation are broad and obvious. Why isn't this approach the standard?
If incentives are the issue, we need to reform the socio-economic system to align incentives to prioritize useful innovation. Remove perverse incentives which reward useless schemes. Encourage broad bets, prioritize technical skill. Funding should be easily accessible to skilled tech people and shouldn't be based on social connections or arbitrary metrics of past financial success.
Technical success and financial success rarely align these days because technological alignment with financial schemes is the main determinant of financial success in the tech industry.
A lot of innovation is brushed under the rug. Useful innovations which could have provided a solid foundation to build upon are completely deprived of funding. Almost every useful innovation becomes a dead end.
https://en.wikipedia.org/wiki/Orders_of_magnitude_(length)#1...
Even though that chart lists semiconductor process nodes as down in the single-digit nanometers, the articles about the semiconductor fabrication say that these are marketing terms and don't refer to the size of actual features produced by the fabrication process, which are apparently an order of magnitude larger or so.
So you could say cells are still doing some incredibly small-scale (yet voluminous) manufacturing, in a wet environment, such that we couldn't directly manufacture devices like that even if we understood all the details of how they work!
15 minutes before eating is a must or else you’ll be on a wild chase.
We’re somewhat insulin-resistant in the morning. Plus some glucose is dumped into the bloodstream to wake us up. This requires some units of a fast acting insulin or else the BG will go up even if you don’t eat anything. This is also why carb heavy foods are the worst breakfast foods.
Also going for a walk after meal smooths the BG curve wonderfully.
a centurion? an officer of the roman army?
I do not understand the phrase, is the author fat or not?
Doctors and nurses suffer from Dunning-Kruger massively. They will quite often be confidently incorrect. I’ve seen this living in large cities in the US and Europe. Or you can read about how medics often make potentially murderous decisions on diabetes treatment — there are plenty of stories. Humility is the cure. I say this as someone who went to medschool myself and I have a lot of respect for medics.
The most infuriating thing is when they say that diabetics just die in surgeries, but forget to mention that often the reason is medical negligence. Anyone who has had their T1D loved ones go through general anesthesia surgery knows some of the things doctors tend to suggest, like going off the pump for a number of hours with no insulin replacement. Or demanding significant diet changes just before the anesthesia with no insulin adjustment.
One doctor once told a patient I know their blood glucose is okay in the morning, so they don’t need to check before the general anesthesia surgery in the evening — the blood glucose only needs to be checked twice a day. I’m sure the care diagram in that hospital says that, but it’s with the assumption that the patient is conscious and actively managing blood glucose on their own.
Another way I agree with the author is about closed loops. Many T1Ds, I believe, cannot have adequate control with the “one basal pattern and set carb ratio boluses” approach. Much less with multiple daily injections. Their daily insulin needs just fluctuate too much for an appointment with the doctor or nurse once or twice a year for dose adjustment. If the patient has any sort of hormonal deregulation day-to-day (which many of us do), it will just not work. My closed-loop total daily dose of insulin fluctuates between 90 and 220 units with very good control. Any sort of “roughly one total daily dose every day” approach will fail spectacularly in this case. Such a patient cannot achieve good control with traditional treatment, in my opinion. Though they sure are shamed a lot by doctors who, once again, Dunning-Kruger their way into thinking that treatment absolutely should work.
All in all, closed-loop is leaving many medical teams dumbfounded, some are even afraid of it (and refuse funding or tell parents their treatment is good without closed loops), but it’s a life changer. And a patient with this disease always needs to take it into their own hands because the 30 minutes T1D of training in medschool that I got is absolutely nothing compared to years of first-hand experience patients like myself have. That’s why I don’t blame doctors for being misinformed, but I do blame them quite a bit for not realizing the shortcomings of an education that, once again, generally touches on the subject very little.
I find that a lot of medical research literature is like this. A couple of "X is associated with increased mortality" papers that make no attempt at a causal analysis is enough to get doctors to recommend against X.
As far as I can tell, the organizations that make these recommendations don't want to run the risk that maybe the relationship is causal, and moreover don't know all the mediating/moderating factors and so can't safely recommend something that is associated with harming people even if they realize it's not necessarily causal.
The inverse is true for positive outcomes. Y is associated with lower mortality, so we recommend Y, even though we don't understand if it's causal or not. But we do not recommend Z which is closely similar to Y and, if there is a causal connection would share a common causal pathway with the Y benefit, because we have only studied Y and not Z.
It's a weird kind of extreme causal reasoning that ironically leads to a kind of abandonment of causal reasoning.
Healthly lifestyle (exercise, diet, ...) can help T1D management, but T1D is an autoimmune disease: our bodies literally destroyed the cells in our pancreas that produce insulin.
Interesting range of comments.
I think that whatever you do to manage your diabetes, logging data (meds, food, glucose, weight and bp for me) makes it more effective.
I've found that managing my diabetes and weight is better when I log. Just a text file. It keeps me honest with myself, and keeps my management practices front-of-mind. It's encouraging when I'm doing well, even very slightly exciting. And since I've learned not to beat myself up, it's gently self-corrective.
Going off logging, I slide out of control.
Anyway, that works for me, so it should work for anyone. Right? :-)
I'm T2D, with a completely borked metabolism and gastroperesis (thanks trulicity/ozempic). If I can manage to stick to mostly meat and eggs, I hardly need any insulin and am very stable. Unfortunately, I live with people who don't eat that way, and I'm weak in terms of temptation.
I've found different types of exercise affects my insulin response differently. I have T1D, had it for a little over 20 years. I've noticed that high-intensity short-duration exercises (hill climbs on/off bikes, burpees) have me requiring noticeably lesser insulin (both basal and bolus) for the same carb/calorie intake. This effect lasts for a couple of days, before gradually reverting back. I'm fairly active and play a few sports every other day for about an hour or two at the most, but none of them (in isolation), except for soccer, have shown similar effects.
Another curious effect I've noticed is great sleep (>= 8 hours) and managing my stress levels (which goes hand in hand with sleep quality) helps increase insulin sensitivity even further, but not overly so if I haven't been active over the previous few days.
Have any other T1Ds noticed something similar?
Resources that helped me achieve excellent control of my type 1 diabetes. My TIR is 95-100% and lowered my A1C from 11.9 to 4.1 (not low carb, I’m high carb in fact):
Fat and protein in meals require insulin 1-2 hours after eating via extend bolus (aka temp basal). Learn how to post-bolus (give yourself insulin AFTER meals) “Fat-Protein Units” (FPU).
Fat x .09 x 8 ÷ I:C = units of insulin Protein x .04 x 8 ÷ I:C = units of insulin
Sum both. Then dose insulin as a temp basal (extended bolus) over n-hours per the Warsaw Method time schedule linked below.
And continue to pre-bolus for carbs like usual 15-30 minutes before you eat (data driven approach is pre-bolus and eat meal AFTER blood glucose values on CGM trend down for 3-4 consecutive readings)
https://waltzingthedragon.ca/diabetes/nutrition-excercise/re...
https://drlogy.com/calculator/warsaw-method
Starting point to determine your insulin-to-carbohydrate ratio: 300 ÷ Total Daily Insulin Dose = 1 unit insulin covers n-grams of carbohydrate
https://diabetesjournals.org/diabetes/article/68/Supplement_...
Two books: https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin...
https://www.amazon.com/gp/aw/d/0593542045/ref=tmm_pap_swatch...
One podcast: https://www.juiceboxpodcast.com/diabetesprotip
https://news.ycombinator.com/item?id=14667430
Suggests muscle protein impacts insulin resistance.
If you have glucose in interstitial fluid, physical activity may help.
See:
https://news.ycombinator.com/item?id=25427090
I did a paper on Functional Hypoglycemia a zillion years ago. I have a condition which puts me at high risk of diabetes. Some thoughts I'm not going to try to give citations for because it's based on decades of reading etc:
The liver stores sugars that the body calls upon when you are hypoglycemic. Liver support, such as milk thistle, may help. (Tldr: you need to provide the building blocks for glutathione, which the liver uses a lot of. It cannot be consumed directly and must be manufactured in house.)
Diabetes is associated with inflammation which may be caused by either infection or high acidity. You could get pH test strips to pee on and track your pH levels as another data stream and IF you see a correlation, treat that as well.
Functional Hypoglycemia was traditionally managed with diet. I managed mine that way for years. Avoiding sugars and having fatty, high protein foods late in the day helped prevent middle of the night severe hypoglycemic attacks.
Studies show aloe vera does good things for diabetes. Will it help T1? No idea.
But you could read up on that and firsthand experience suggests to me it may remedy other issues that are pertinent to diabetes but maybe not recognized as directly related because it's more like an underlying issue.
