[HN Gopher] Taking my diabetes treatment into my own hands
___________________________________________________________________
Taking my diabetes treatment into my own hands
Author : mjaniczek
Score : 362 points
Date : 2024-07-24 00:06 UTC (22 hours ago)
(HTM) web link (martin.janiczek.cz)
(TXT) w3m dump (martin.janiczek.cz)
| floam wrote:
| My dad had a strange case of Type-1 diabetes that manifested
| later in life, at the same time he also got hit with rheumatoid
| arthritis.
|
| > 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.
| lazyasciiart wrote:
| The two T1D people I know both started as fairly small
| children, so perhaps having parents managing them made it
| easier for them to always do the injection 15 minutes ahead.
|
| 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...
| mjaniczek wrote:
| I haven't, but I am now! Thank you for the suggestion
| cperciva wrote:
| Not that strange. Adult-onset T1D is just as common as
| Juvenile-onset; it just happens to often get misdiagnosed as
| T2D.
|
| 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.)
| floam wrote:
| I was aware of the autoimmune nexus but not that adult-onset
| type 1 is common or the likely mechanism that'd trigger them.
| Thanks
| e40 wrote:
| Apparently the flu can trigger it too.
| Mathnerd314 wrote:
| > https://github.com/SmartCGMS/core/blob/dffdd89a274144d0e9ecb...
|
| > 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.
| bigiain wrote:
| > 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.
|
| <looks at all the AI hype>
|
| Seems it's just you and me that think that way...
| mjaniczek wrote:
| Don't worry, I'm not using the app's suggestions blindly (or at
| all, currently). But yeah the SmartCGMS authors disclaimed as
| much - you're using it on your own risk.
|
| 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.
| nerdponx wrote:
| > Do you have some resources for optimizing a N_51 x N_51 x
| N_51 x N_51 -> R+ unknown black-box function?
|
| 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.
| Mathnerd314 wrote:
| So Metropolis-Hastings for example is a probabilistic
| algorithm. You don't need a probabilistic algorithm. (Well,
| you do when you want to estimate your physiological
| parameters, the Bayesian stuff and so on, but that is a whole
| separate can of worms). I didn't look too carefully at your
| objective function but it looked continuous - small
| perturbations in input mean small changes in the objective
| function. Like hypoglycemic readings, you can easily
| calculate "how hypoglyemic" rather than a yes/no. Naturally
| there are places where the objective function isn't
| continuous and that's where you have to do a discrete-style
| search, but when it's mostly continuous there are well-known
| numerical methods. Like check out
| https://docs.scipy.org/doc/scipy/reference/optimize.html, it
| isn't necessarily what you need but looking up the Wikipedia
| pages of the method names will be helpful. I've also found
| ChatGPT knows an insane amount of math, I wouldn't trust it
| to write a specific algorithm but it can give intelligent
| comparisons and list similar algorithms.
|
| 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.
| Mathnerd314 wrote:
| Oh and regarding probabilistic stuff, I have been playing
| with PyMC, it seems eminently usable. There is some
| slightly more specialized software like Stan, and it is
| certainly worth looking at some Stan tutorials if you don't
| know anything about probabilistic programming, but PyMC is
| hackable and modular in a way that Stan is not. There is
| also tensorflow-probability but I couldn't get it to work,
| it seems not as active as PyMC. Haven't read it but I found
| https://github.com/CamDavidsonPilon/Probabilistic-
| Programmin... and that's probably going to be my coffee
| table reading for the next few days.
| derlvative wrote:
| Don't worry, his doctor doesn't know what a differential
| equation is either so this is a large improvement.
| gumby wrote:
| The fat thing mentioned in the post: fat seems to slow down
| absorption in my experience, though not to the extreme that some
| self-described "body hackers" (who don't have DM) seem to think.
|
| 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).
| wwilim wrote:
| See, that's the thing. I've had T1D for 26 years now and I have
| stubbornly refused to accept that it's not a smart idea to eat
| anything I want. I am not going to give up hash browns until I
| lose a leg.
| croemer wrote:
| As long as you measure often and inject control amounts
| liberally eating pretty much everything is fine. I think the
| diet restrictions were very much necessary before frequent
| testing and fast acting insulins were available.
| mft_ wrote:
| Interesting; as a non-diabetic, there are lots of (nice)
| things I don't eat regularly (pretty rarely in reality) for
| general health reasons. Hash browns aren't a particular thing
| for me, but they'd definitely be on my 'not regularly' list
| (deep fried, comparatively simple carbs, lots of salt, etc.)
|
| 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.)
| mjaniczek wrote:
| A datapoint of one: T1D has definitely made me crave sweet
| stuff more. Perhaps due to being "forbidden fruit", etc.
| etc.
| KittenInABox wrote:
| It's just a response to the constant frustration of feeling
| limited, especially by something arbitrary. If I got told
| randomly that now every single family gathering, social
| event, date, drink with the boys, exercise routine, and
| road trip must circle around a chronic health condition
| that I must make conscious decisions around every day all
| day for the rest of my life, it makes total sense for me to
| occasionally go "fuck it".
| mft_ wrote:
| I understand (as much as I can) that it must be very
| frustrating, as you outline. However, the post I was
| asking the question of sounded a step or two beyond
| occasionally saying "fuck it" (which we all do, I
| suspect, whatever out motivation for health conscious
| behavior):
|
| > I have stubbornly refused to accept that it's not a
| smart idea _to eat anything I want_. I am not going to
| give up hash browns until I lose a leg.
|
| Maybe I'm over-interpreting a single line of text on an
| internet forum, but this sounds like more of a policy
| than an occasional lapse.
| croemer wrote:
| I've never had DKA in 12 years. How does it happen? I've been
| on CGM (Libre/Dexcom) and it's impossible to get high enough
| values unnoticed to end up with ketoacidosis for me. Even
| before with sticks, I just measured often enough.
|
| Would be really curious to know more how DKA happens to you!
| gumby wrote:
| Just living my life in an urban setting it's never been a
| problem.
|
| 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.
| kelseyfrog wrote:
| The author can simply use the adjoint method to estimate their
| personal parameters, no?
| rpgwaiter wrote:
| Hey fellow T1D, this is good stuff. As a tip, I'd recommend
| taking your daily insulin dose, splitting it in half and doing
| twice daily. It helped me quite a bit in dealing with the
| inconsistency of it all. I personally inject around midnight and
| noon if I can remember.
|
| 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!
|
| [0] - https://github.com/j-kaltes/Juggluco
| ollysb wrote:
| This sounds interesting, which basal insulin do you use?
| rpgwaiter wrote:
| Lantus, I started doing this when my insurance stopped
| covering Tresciba for some reason. Probably less needed on
| good basal insulin but I imagine it would still help some.
| ollysb wrote:
| I'm using Toujeo which I believe is more consistent over 24
| hours but I'm going to try your suggestion and see how it
| goes.
| arcb wrote:
| Incredibly motivating to read.
| oezi wrote:
| My uncle died after getting into a hypoglycemic coma at night. I
| think it is a real shame that technology hasn't been able to
| solve what looks like a medium-complexity feedback loop system.
| friendzis wrote:
| There ARE licenced closed loop systems for blood
| glucose/insulin management out there. As always - $EURPS
| manmal wrote:
| The down correction is pretty much solved (injecting insulin
| automatically). But the body is unpredictable, so the up
| correction is needed to prevent hypos. The one thing we
| currently have is automated glucagon delivery, but this has
| severe downsides:
|
| - 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.
| stranded22 wrote:
| Interesting read.
|
| 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.
| mjaniczek wrote:
| Out of curiosity, is your wife's closed loop solution official,
| or homebrew? (If official, which country do you live in, if I
| may ask?)
| stranded22 wrote:
| It's official - UK (England).
| jevogel wrote:
| In the US, the official Omnipod 5 with Dexcom G6 closed
| loop solution is also available, starting early this year I
| think. My wife prefers her DIY AndroidAPS setup with
| Omnipod Dash and Dexcom G7, though, because the G7 allows
| you to warm up a new sensor when the old one is still
| active, so she doesn't have any gaps in her data.
| croemer wrote:
| Indeed, insulin sensitivity varies so based on amount of
| movement during day, stress, hormones, allergies, slight cold,
| etc that the rigid algorithmic approach they teach patients
| doesn't work in practice. I.e. you can follow what you're
| taught by diabetic nurse and you'll have bad control
| nonetheless.
|
| What's the model she uses? My guess would be tslim+Dexcom? It
| does reduce stress a lot.
| stranded22 wrote:
| She's using omnipod + dexcom g6.
|
| 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'.
| interludead wrote:
| The mental and physical benefits of improved glucose management
| cannot be overstated
| stranded22 wrote:
| Definitely - but it is also that she doesn't need to keep
| such a management on it, freeing her mentally. That and not
| yoyoing in sugars (and feeling like a failure).
|
| Her description: what else can you do for 30 years and still
| feel like a failure as it isn't working like it should?
| wwilim wrote:
| One thing you would really benefit from that you don't need a
| doctor for is getting your BG displayed on a smartwatch.
|
| 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.
| trimethylpurine wrote:
| Did you have good luck with these?
|
| 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.
| tgaj wrote:
| He is talking aobut connecting the monitor like yours to the
| smartwatch so you can see you glucose level without pulling
| our your smartphone. There is no smartwatch on the market
| that is able to read glucose level using some kind of
| infrared blood sensor. All the ads are lying.
| trimethylpurine wrote:
| Thanks for clarifying. I can see that's what he meant now.
| DoreenMichele wrote:
| The pdf here:
|
| 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.
| rozman50 wrote:
| A friend of mine had to take insulin dose daily. Talking around
| with people, he found out that diet with carbon hydrates (bread,
| potato, rice...) increased blood sugar.
|
| 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.
| xboxnolifes wrote:
| > A friend of mine had to take insulin dose daily. Talking
| around with people, he found out that diet with carbon hydrates
| (bread, potato, rice...) increased blood sugar.
|
| 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.
| rozman50 wrote:
| They probably knew about it, but not about strict keto diet.
| ddorian43 wrote:
| There are very big misconceptions about keto (ketoacidosis,
| too much protein, high fat is bad, cholesterol bad, etc) and
| many doctors don't mention it at all.
|
| They tell patients to "navigate carefully on a world full of
| addictive carbs" which has disastrous results overall.
| ddorian43 wrote:
| Note that this is possible only for T2D. For T1D, keto
| supposedly still helps to maintain lower & more consistent
| blood glucose, thus needing less insulin, but you still need
| it.
|
| Source: I do keto for other reasons.
| gukov wrote:
| One of the first things I figured out on my own right away is my
| carb ratio.
|
| 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.
| protomolecule wrote:
| >15 minutes before eating is a must or else you'll be on a wild
| chase.
|
| Also going for a walk after meal smooths the BG curve
| wonderfully.
| iamthejuan wrote:
| I would suggest to drink psyllium husk mixed with water, 15
| minutes every meal. It would prevent glucose spikes which is the
| number cause for diabetis, lowers cholesterol level, regulates
| bowel movement and it is also an instant relief during
| hyperacidity.
| carlmr wrote:
| Are there any studies on this? Not diabetic, but kind of want
| to prevent getting there, and although I always try to eat
| enough fibre I guess this could help add fibre anyway when I
| don't have enough.
| ddorian43 wrote:
| Another alternative for not going there is to eat: low carb
| -> weight loss keto -> carnivore -> epilepsy keto -> epilepsy
| carnivore / KetoAF (the later being the strictest & highest
| efficiency).
| acron0 wrote:
| This is very cool. I am fortunate enough to have access to a pump
| and have been hacking closed loops for a few years now using
| software like Nightscout, AndroidAAPS and xDrip+. My
| understanding is that none of these are exclusive to pump users,
| they just work a little easier with them. Maybe there is some
| interplay with these tools that you can leverage?
| monero-xmr wrote:
| For those of you on the cusp of diabetes, immediately start
| working out intensely and reduce your sugar intake. There is
| still time! It's not inevitable
| mjaniczek wrote:
| You're talking about T2D (which is more about insulin
| resistance than not producing insulin at all) which can be
| somewhat mitigated with lifestyle.
|
| 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.
| voidUpdate wrote:
| >Aside: what do you .NET folks use nowadays?
|
| 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
| neonsunset wrote:
| AvaloniaUI is nice and a commonly recommended choice nowadays
| if you are targeting desktop.
|
| 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).
| mjaniczek wrote:
| Yeah, I do have some passing experience with both F# and C#,
| and since the example code provided by the university was in
| C#, I kept that code and built on it. But I would have felt
| better in F#.
| neonsunset wrote:
| That's fair, thanks!
|
| There's an Elmish FuncUI extension for Avalonia that lets
| you write applications in Elm style: https://github.com/fsp
| rojects/Avalonia.FuncUI/tree/master/sr...
|
| (a caveat applies that it is very niche compared to regular
| Avalonia let alone WinForms or WPF, so the options for
| idiomatic graphing ui controls might be scarce)
| oblio wrote:
| Interesting, last time I looked at it, it was early alpha or
| something, a few years ago.
|
| I wonder how the mobile support is.
| interludead wrote:
| A sensible decision indeed
| InDubioProRubio wrote:
| But have you tried the NET(X)BigTHING framework for GUI? Its a
| chain of hype-(r-links) forming a gui..
| JackMorgan wrote:
| ... and it works on every platform from BlackBerry, iPhone,
| MacOS, Windows, Linux, desktop, and mobile! Has lots of tools
| to handle different resolution sizes and alternate languages!
|
| 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.
| JackMorgan wrote:
| Unironically I use React or htmx with Typescript if I need a UI
| in front of dotnet. Having spent far too long dealing with all
| the dotnet thrash, all to build a GUI that only works on
| Windows desktops, I said enough is enough and learned how to
| build a web front end.
|
| 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.
| flanked-evergl wrote:
| Not a diabetic and I live in one of the richest countries with a
| social medical system, but the medical industry is an abject
| failure. My experience with most Doctors who are not surgeons has
| mostly been that are overpaid for doing essentially nothing and
| think all their patients are hypochondriacs.
| alex_duf wrote:
| 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 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.
| jajko wrote:
| My wife is a doctor (GP, before internal medicine in biggest
| hospitals), experience with France and Switzerland. What you
| say is true - they all start as naive optimists who get
| treated brutally by whole healthcare system first 7-10 years
| after school, everybody knows it, often illegal from
| hospitals but good luck suing your employer. Burned out,
| 60-70 hour work weeks with weekends is the standard, night
| shifts, a lot of responsibility with little help/oversight.
| Always 1 oversight away from harming/killing somebody. Many
| in Switzerland that are Swiss dropped out, foreigners don't
| have it so easy.
|
| 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.
| alex_duf wrote:
| Doctors burning-out is probably the worse red-flag you
| could have for a health system. It's frightening to think
| the person diagnosing my parents and children might not be
| in full possession of their capacity or make rash
| decisions.
|
| I'm seeing the same pattern for many crucial functions
| having been pushed over the line during the last two
| decades or so. Whether it's a doctor, a teacher, a nurse, a
| childminder, the police, etc. All the jobs that are
| essential for a developed society have crumbled down to the
| point I'd discourage any young person to pursue a career in
| that sector.
| jajko wrote:
| If that worries you (and it should), never ever go to
| hospital during night (unless serious emergency of
| course) or very early morning, or generally just before
| the end of shifts. You _will_ get potentially worse
| treatment by definition, depends on many things but
| probability is against you.
|
| Also, the bigger the hospital usually the better experts
| they have on critical stuff (and more chance you won't
| wait long for ie CT or MRI), smaller hospitals and
| clinics just forward serious patients to big ones.
|
| At the end healthcare is just another branch of market
| and all woes that apply to rest of us apply to them, no
| magical immunity due to more noble profession.
| flanked-evergl wrote:
| > 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 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.
| capnrefsmmat wrote:
| 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/fu
| l...
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915438/
| flanked-evergl wrote:
| I don't live in the US so the stat is not really
| relevant.
| gbuk2013 wrote:
| > 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.
| flanked-evergl wrote:
| > 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.
| IggleSniggle wrote:
| Not sure how it is outside the US, but subscribing nurse-
| practitioners (requires just 2 additional years after a
| nursing degree) have been quickly replacing GP docs in
| the US for this reason. They'll send you to a specialist
| just like a GP would. It's all the same problems in terms
| of the underlying model, but the financial and time costs
| to the system are lower.
|
| I'm not totally sold on what I'm selling though. My
| spouse has been a nurse practitioner for over 10 years;
| she had the option of becoming an MD but picked that
| route because she saw the grueling 80+ hr work weeks of
| older doctor friends and decided it wasn't for her.
| Unfortunately, she's still stuck with only 20 minutes for
| sometimes extremely complex patients that require a great
| deal of research and follow-through outside of work
| hours, and the extra slack in the system that is provided
| by her lower wages has just gone to hiring additional
| administrative middlemen that are seldom capable of
| actually filling in the gap, whether for reasons of
| liability, knowledge, skill, or motivation. These
| positions exist to try and ease the pressure on docs just
| like NPs exist to ease the pressure on docs, but it
| doesn't work because at the end of the day you need
| someone who can hold the liability (both legal and moral)
| and the knowledge (the correct diagnosis and the correct
| plan of action) within the same person.
|
| Just like in software, where throwing more developers at
| a problem doesn't guarantee your problem gets solved more
| efficiently, for much the same reason. You need somebody
| who understands the domain, understands the tools,
| understands the business framework, and is ready to take
| responsibility for solving the problem. Each additional
| person introduces information overhead that makes each
| one of those tasks more complicated.
| fer wrote:
| > > 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. :)
|
| I have absolutely no idea of what's involved when working
| as a GP/consultant, so I probably grossly underestimate
| their job, but in my interaction with them (involving my
| health as well as my family's) most of them seem to just
| put your case into a flowchart and prescribe along,
| because that's what reduces the liability to 0 and works
| most of the time. But if that's their job, they'll
| eventually be replaced by LLMs.
|
| When you don't fall into the typical case, you'll have to
| go through retelling the whole story to all the flowchart
| ones (easily 80%) only to find along the way snake oil
| salesmen (10%), honest "I can't take your case"
| individuals (5%), and the 1-5% which actually feel like
| scientists and problem solvers.
|
| (percentages pulled out of my rear but that's roughly my
| experience)
| vjk800 wrote:
| To be fair, most people probably are hypochondriacs. Somehow we
| have come to expect that all our nagging ailments should be
| fully treatable by either a pill or a surgery. In reality,
| human body is pretty good at self-repairing and self-regulating
| and modern medicine can help it only in certain clear cut
| cases. Medicine is just not that good and the doctors know it.
| flanked-evergl wrote:
| I'm certain in the sample of patients most GPs see,
| hypochondriacs are overrepresented, but that really does not
| in any way eliminate the problems I experience, so from my
| point of view it's still a real concern.
| admissionsguy wrote:
| Health anxiety high enough to prompt doctor visits is itself
| a serious issue that the medical system fails to help with.
| aantix wrote:
| Agree - most of the advice is WebMD level.
|
| 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.
| flanked-evergl wrote:
| In reality, there are few things a GP can do better than a
| nurse or some technician with an LLM, and the sooner that
| shift happens, the better for society.
| greenavocado wrote:
| It will be interesting when LLMs can do more to advance
| general public health more than the entire medical system
| in recent history.
| kvgr wrote:
| Something similar, u just switched to private clinic where i
| pay 500euros/year for general doctor(even when they work for
| insurance) and I pay like 100E for specialist. Never happier,
| fast and good communication.
| carimura wrote:
| In the US, my experience has largely been that it's not
| healthcare, it's sickcare. 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.
|
| 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.
| Swizec wrote:
| > 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.
|
| 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)
| Palomides wrote:
| the test isn't the problem, it's that doctors and patients
| aren't used to making decisions based on probability
| (patients demand something must be done, while doctors run
| on vibes and cover your ass)
|
| (context: spent some time working in a prostate cancer
| research lab and have doctors in the family)
| cameronh90 wrote:
| It's funny that we only apply this "more data = bad" logic
| to things that aren't readily visible.
|
| If you have a palpable or visible likely-benign condition
| that isn't causing symptoms, such as a mole, rash, or lump,
| every doctor will recommend getting that checked out. Most
| of the time it'll turn out to be completely innocuous, but
| you'll go to the doctor and they'll decide between it's
| fine, monitoring, invasive investigation, and urgent
| treatment.
|
| Obviously if the test itself is invasive (e.g. has a dose
| of radiation) then that is something that needs to be
| compared against the potential benefit. I certainly would
| not have a preventative head CT scan.
|
| However if we're talking about things like an MRI,
| urine/stool test, or even something like a blood panel that
| has extremely low risks for most apparently healthy people
| (I donate blood 6x a year anyway - why not take some of
| that and test it), then why is it so different to a skin
| check, besides the cost?
| apwell23 wrote:
| > Obviously if the test itself is invasive (e.g. has a
| dose of radiation) then that is something that needs to
| be compared against the potential benefit.
|
| A test isn't always a binary 'you have X ' . Look at PSA
| screening for prostate cancer starting in your 40s is not
| recommended for that reason.
| cameronh90 wrote:
| I'm aware but also not sure how that changes anything.
|
| Say you're 40 and you get a positive PSA result, maybe
| that means your risk of having prostate cancer has gone
| from (for illustrative purposes) 0.1% to 2%. That means
| the next step is "what do you do to someone who has a 1
| in 50 chance of having prostate cancer?", and the answer
| is almost certainly not a biopsy or anything majorly
| invasive. The answer might be a finger up the butt, an
| MRI, monitoring for symptoms, repeat the test in a year,
| etc.
|
| The problem is that patients aren't used to handling
| these ambiguous results from tests because we don't do
| much routine testing, and doctors don't want to face the
| potential consequences for getting a positive test result
| and recommending against invasive treatment. However, in
| many cases, a test would still tell you something useful
| even if it won't directly be used to escalate to a more
| invasive test or treatment.
|
| For example, if a routine blood test shows prediabetes
| (which has happened to a few people I know when having
| blood tests for unrelated matters), you won't get any
| treatment for it, but you may be referred to a dietician
| and have a fire lit up under your ass to make those
| lifestyle changes you've been putting off.
| MajimasEyepatch wrote:
| None of those things are necessary most of the time, and
| they're usually just going to make you paranoid. It's why
| doctors don't generally like to do full-body scans on healthy
| people: they're rarely going to find anything clinically
| significant, but they're often going to find something that
| causes a scare and some unnecessary tests. (And if the scan
| is a CT scan, on average, the radiation may cause more
| cancers than it catches if you're scanning healthy people for
| no reason.)
|
| 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.
| wordpad25 wrote:
| People in high risk categories are warranted to go further
| than that
| MajimasEyepatch wrote:
| Sure, but most people are by definition not high risk.
| sersi wrote:
| I did a CT scan recently for something unrelated which
| found some soft tissue lesion in the thymus. Cue doctors
| trying to tell me that I should just remove the thymus
| since it's not possible to do a biopsy and anyway the
| thymus is useless. Read recent research in NJEM that shows
| that removing the thymus increases risks of getting cancer
| and that it's anything but benign.
|
| Eventually, I did a PET scan, got second opinions (that
| think it's most likely hyperplasia), determined that given
| the result of the PET scan, I don't have carcinoma or
| anything that is likely to be fast progressing. So, I won't
| operate, I will do regular MRIs to check the progress and
| monitor that it's not anything.
|
| All this to say, that yes, having that result mostly caused
| additional stress for something that is actually likely to
| have already been there for years and years.
| carimura wrote:
| Understanding the results does take education, I agree with
| that, but having more data over time seems much better than
| flying blind and then being surprised when something
| actually does happen.
| sadcherry wrote:
| If getting that extra data imposes a risk (eg. radiation)
| then the tradeoff is not so simple.
| carimura wrote:
| ya agree there. but most of those things aren't
| tradeoffs, aside from a bit of time and money (both of
| which go back to my original point about why I think the
| system is not working)
| apwell23 wrote:
| > broader blood panels, body scans (eg. Prenuvo), VO2 max,
| metals tests, mold tests, genetic tests, GI tests, etc etc.
|
| 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.
| dleink wrote:
| Are you asking if early detection of cancer results in
| better outcomes? Yes, the data unequivocally supports that
| diagnosing cancer before it spreads leads to lower
| mortality.
| apwell23 wrote:
| Yes I put those in quotes because that's how Prenuvo
| sells their product to the public. If fullbody scans
| truly improve survival then they wouldn't need kim
| kardashian to sell their product.
| MajimasEyepatch wrote:
| That's only true if it's actually a cancer that's going
| to spread. Certain things like benign prostate cancer are
| often not worth treating. Testing everyone for everything
| leads to overtreatment and anxiety and worse quality of
| life.
| dleink wrote:
| I see the distinction. Thank you for clarifying. I think
| generally speaking I would prefer to have more data on my
| health. I don't like the idea that this information might
| be held back because it would make me "paranoid". That is
| my decision.
|
| I can see that in the general case, it can lead to
| increased spending and worse outcomes.
| nradov wrote:
| I don't know why you would expect the healthcare system to do
| all of that stuff. If you want to know your VO2 Max you can
| just go to the local running track and execute a Cooper Test
| for free. But the results aren't really actionable.
| Regardless of the quantitative result, unless you're already
| an elite athlete the prescription will always be the same:
| exercise more.
| p_j_w wrote:
| >Annual checkups are a weight check, blood pressure, a few
| questions, maybe a blood panel if you're lucky
|
| 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.
| KittenInABox wrote:
| In my experience, a blood panel doesn't cover everything
| typically. My A1C, Insulin, and fasting Glucose levels are
| all within normal range, but actually I have insulin
| resistance, likely genetic that wouldn't appear in my
| general panel for at least two or three more decades. This
| is common in people whose family history includes poverty
| or subsistence farming. I'm glad I have the resources to
| address this while I'm still a young professional with no
| children of my own to manage and full healthcare benefits
| including out-of-network, but I had to find my own
| specialists to investigate what was going on with me.
| nradov wrote:
| Why would a genetic tendency towards insulin resistance
| be correlated with a family history of poverty or
| subsistence farming? Is there any research on that? Which
| specific genes are involved? Which tests were used to
| diagnose your insulin resistance?
| KittenInABox wrote:
| I don't know the details. This was just something that I
| was informed after I was speaking to a specialist about a
| separate issue at a world-class medical campus, who
| happened to also be studying the effects of insulin on
| the thing I was actually there to get examined and after
| some testing and calculations that are more used in
| research than clinicals.
| meroes wrote:
| Was dorm-mates with a T1D. Four of us total. His bunk mate and
| best friend basically saved his life twice in that semester.
|
| How come the disease gets so little publicity??
| mjaniczek wrote:
| In my _checks the calendar_ 15 years with the disease, I 've
| thankfully only had a hypoglycemic coma once, at a summer camp.
| I was leading a bass guitar workshop and just suddenly started
| making less and less sense. It was the only time my blood sugar
| dropped so fast my brain didn't notice, didn't alert me to eat
| something, just went straight into being unusable.
|
| 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.
| globular-toast wrote:
| I wonder if the emergence of type 2 diabetes has had a negative
| effect. Many practitioners call it something like "fake
| diabetes" as it has very little in common with type 1. It's not
| uncommon to meet people who are "diabetic" today, but most of
| them are type 2, they don't need insulin and you probably won't
| have to save their life.
| Scotrix wrote:
| 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 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...
| e40 wrote:
| Please share more.
| sjhatfield wrote:
| Are you still announcing meals? I know some people use iAPS
| with no meal announcement which sounds amazing. We are moving
| our T1D son from OP5 to Loop but would consider iaps in the
| future. Hoping we can recreate our 92% average time in range
| with less work needed
| caseyy wrote:
| I completely agree with the author. T1Ds must take care of
| themselves.
|
| 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.
| nerdponx wrote:
| > 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.
|
| 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.
| caseyy wrote:
| This is definitely at least one contributing factor to the
| situation. But another one is that many medics sadly refuse
| to learn from a patient. Even when the patient is an expert
| in practice.
|
| A cure for these kinds of issues in medicine and in software
| engineering is humility. We must understand our knowledge is
| incomplete. Our learnings are often the best that
| circumstances allowed us to learn, but not the best one could
| learn.
| tornadofart wrote:
| I'm a T1D and I mostly agree with the author. I think this
| simulation is very interesting.
|
| 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.
| mjaniczek wrote:
| You're definitely making me reconsider it, thanks! Along with
| the person in another thread saying walks after meals help as
| well. With a fully remote work these risky "oops I injected but
| there's no food yet" situations should not happen as often,
| considering the time-to-fridge is like 10 seconds.
| InvaderFizz wrote:
| Knowing little about the subject. If Insulin is a 20 minute
| lag, and eating is a 20 minute lag. Shouldn't you just dose
| immediately before eating so they hit at the same time?
| mjaniczek wrote:
| It's a very rough rule of thumb, take these numbers with a
| grain of salt. It could very well be that some food
| activates in 5 minutes etc. Different insulin types also
| have different curves.
|
| Anyways there are studies about the "inject 15min before
| food" approach: eg.
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945151/
| tornadofart wrote:
| You forget one very important rule: it's all vibes :D No
| but seriously: insulin starts to act after 20mins. Its
| action is more like a flat parabola.
|
| Glucose acts more in harsh peaks. So you want the glucose
| peak to hit when you are at the maximum of insulin action.
| Hence the 15mins delay.
|
| This is all roughly speaking, YMMV.
| tornadofart wrote:
| It's hard at first. It is a habit to take, and you have to
| withstand a bit of social pressure first, when you're late
| with taking insulin and still want to wait. But I root for
| you, you can do it!!
| tornadofart wrote:
| one more tip I want to share: when you have a dramatic hypo
| or your blood sugar is dramatically high, double-check with
| the old school prick-test device. Your CGM might exaggerate.
| That stopped some nefarious cycles of being too high, then
| too low etc. for me.
| croemer wrote:
| Fellow T1D here. Switched to a pump (tslim) 2 years ago, which is
| a stock/market semi-closed loop requiring no homebrew when paired
| with Dexcom.
|
| 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.
| mjaniczek wrote:
| The LibreLink app allows me to use different alarm tones for
| lows and highs, and I'm _still_ getting alert fatigue. To the
| point that my wife needs to ask "is that your phone telling you
| you have a hyper?" for me to actually start doing something
| about it, sometimes.
| interludead wrote:
| Your experience underscores the importance of user-centered
| design in medical devices
| heraldgeezer wrote:
| >You should also lose weight, when you started coming here you
| had 80kg, now you're a centurion. Like seriously, WTF. OK cool
| bye, see you in 3 months!"
|
| a centurion? an officer of the roman army?
|
| I do not understand the phrase, is the author fat or not?
| mjaniczek wrote:
| 100kg+. It's a joke :)
| heraldgeezer wrote:
| I see. And won't weight loss help in even Type 1? Is it not a
| valid argument?
| mjaniczek wrote:
| It will help, definitely! As will exercise itself etc. It
| is a valid argument and the doctor is right.
| janandonly wrote:
| 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? Then what? Do we die? Or is there some form of
| diet that we could live on??
| throwaway454590 wrote:
| I'm not a medical expert, but as far as I'm aware even a 100%
| ketogenic diet would still have fluctuations in glucose levels
| which would require insulin to manage. But, it's entirely
| dependent on how much insulin a T1 or T2 diabetic's body is
| still capable of producing which would determine if they would
| still need exogenous insulin. (Because the quantity required
| _would_ be much lower than on a higher carb diet)
| DougWebb wrote:
| T1 and T2 are completely different diseases. T2 should not be
| called diabetes. It should be called insulin resistance or
| chronic carbohydrate overdose.
|
| 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.
| fortran77 wrote:
| There are some people with T2D--a minority of them--who are
| not overweight. I think T2D with overweight or obesity should
| be called something else.
| mono812 wrote:
| It's actually a quite complex question that does not have a
| clear cut answer. In case of T2D you can 'go into remission'
| meaning you can get your blood glucose levels to 'normal
| levels' with little or even no medication (T2Ds are not
| necessarily using insulin, they can also use medication that
| increases insulin sensitivity such as metformin). Generally
| weight loss, exercise and a healthy diet are what allows them
| to accomplish that and a keto / low carb diet can definitely
| help there.
|
| 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.
| _qua wrote:
| 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.
| lolc wrote:
| I've lived low-carb as a T1 and my blood sugar was very stable.
| I would still take sugar to stabilize levels when dipping low.
| A completely ketogenic diet would be very hard for a T1 and not
| a sensible goal. Insulin management was simpler, but still
| required. On many days I would just do the one injection of
| long-lasting insulin.
|
| 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.
| SystemOut wrote:
| This may be a terminology thing but as a T2 I will always
| carry that diagnosis. However, mine is in remission because I
| manage it through medication/diet.
|
| 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.
| lakhim wrote:
| It's worth while reading the literature on pre-insulin
| treatments, but for type 1 diabetics, the answer is: you might
| be able to live, if just, for a while (a decade or so), but
| lifespans are greatly shortened. Probably depends exactly on
| the particular characteristics of the disease for a patient.
|
| 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...
| oldgradstudent wrote:
| It would probably a very good idea if you can keep to it.
|
| 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
|
| https://garytaubes.com/rethinking-diabetes/
| kayodelycaon wrote:
| A ketogenic diet can do some pretty wild things to medication.
| I'm bipolar and I am unable to do a ketogenic diet without
| serious side effects, like loss of motor control. If done for a
| prolonged time, it is possible those side effects become
| permanent.
|
| I can reduce sugar but not carbohydrates as a whole.
| sgt101 wrote:
| T1 needs insulin, some T2 are ok without it.
|
| 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/
| mono812 wrote:
| 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 if your meal is really
| 'slow' or your blood sugar level is low). Going for a 20-30
| minute walk during a meal spike (mostly after breakfast and
| lunch) does wonders for me too.
|
| 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.
| mjaniczek wrote:
| 99% TIR... that's crazy. Well done. You're an inspiration!
| vallassy wrote:
| 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.
| mono812 wrote:
| 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.
| vallassy wrote:
| I didn't mean 'requires no insulin at all,' I know T1D
| requires some insulin to regulate blood sugar and to
| perform other functions in the body.
|
| What I meant was that, for example in the OP article, a 60g
| bolus of carbs brings blood sugar from the bottom of
| healthy range all the way to the top of the healthy range
| in one go.
|
| It just seems like an unnecessarily large and (for most)
| difficult to control jump in blood sugar. A lower-carb
| diet, say under 50g total carbs per day, should reduce
| blood sugar swings and increase their controllability,
| letting patients be in the healthy range of blood sugar for
| a higher percentage of the day.
| photon_lines wrote:
| Type 1 diabetic as well here - I do this and I can
| confirm that I have much better control over my HB1C
| (average blood sugar reading) since I eat mostly a keto
| and plant based healthy diet (composed of minimally
| processed foods). One issue that I have though deals with
| hypoglycemia (low-blood sugar levels) since type 1
| diabetics don't just require immediate insulin after
| meals - they require long-term acting insulin which works
| throughout the day. I've had multiple cases where I lost
| consciousness and woke up either in an ambulance or in a
| hospital feeling like someone hit me with a truck and
| having no recollection of how I got there. There is no
| 'magic' in managing type 1 diabetes unfortunately. The
| issue with us is that our blood sugar can swing in both
| directions - with the lower swing possibly resulting in
| death.
| paulcole wrote:
| > 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.
|
| 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...
| jhoho wrote:
| 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...
| gitfan86 wrote:
| Type 2 has had a high correlation with obesity and high carb
| diets.
| Engineering-MD wrote:
| But interestingly also a very high genetic factor with 90% of
| identical twins both having T2DM (which is greater than that
| of type 1 which if I remember correctly is 40%)
| telgareith wrote:
| Sounds like Nature vs nurture to me. Until there is a
| proposed genetic marker... it's just another item confusing
| the public about correlation vs causation.
| CRConrad wrote:
| > very high genetic factor with 90% of identical twins both
| having T2DM
|
| Or both _not_ having it, I hope?
| telgareith wrote:
| Looked at the first paper. I have significant concerns that,
| frankly, I didn't finish reading.
|
| 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.
| jhoho wrote:
| There are several more studies and dietary recommendations
| regarding oat, just search Google Scholar and similar.
| mvidal01 wrote:
| I'm skeptical of any claim that says consuming carbs is helpful
| when it comes to type 2 diabetes.
| cpwright wrote:
| 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.
| mjaniczek wrote:
| Hey, thank you for the correction! I am not keeping up to date
| with how are the closed loops progressing, and from quite a few
| of comments here it seems like the future is already here :)
| Maybe just not evenly distributed - I just need to wait for it
| to get from US to CZ. I'm glad closed loops are already helping
| people around the world!
| brandall10 wrote:
| I recently worked for a company called Tandem Diabetes which
| has multiple closed loop, FDA-regulated systems going back 9
| years:
|
| "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.
| Neff wrote:
| My wife is T1D and she is really scared about the idea of
| moving to a closed loop system with a pump, but her endo is
| constantly pushing her towards it even though she is keeping
| her A1C at like ~6% with her Dexcom CGM.
|
| 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...
| cpwright wrote:
| I don't find the Medtronic solution to be that off. But the
| closed loop solution _can 't_ raise your blood sugar, it can
| only lower it. It only has insulin which it can dial back or
| increase. The real danger would be if it detected you very
| high and then tried to rapidly decrease it.
|
| 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.
| umvi wrote:
| I highly recommend the book "The Diabetes Solution" by Dr.
| Bernstein. It's written by a T1D-since-childhood who was a
| manufacturing engineer and used his engineering skills to "debug"
| his diabetes despite his doctor's efforts to the contrary.
| However the medical industry rejected his findings on blood sugar
| control because of lack of medical credentials so he went and got
| an MD and suddenly more doctors started listening. He basically
| got ahold of an early glucose tester and turned it into a CGM by
| pricking himself dozens of times a day and around meals to
| collect data.
| PhilipJFry wrote:
| n++
|
| Dr. Bernstein's book is a must read for every diabetic person.
| His YouTube channel:
| https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag
| winddude wrote:
| are you familiar with LoopKit (an opensource automated pancreas)?
| I'm looking at moving from injections like yourself to this, it
| looks more complete than the closed systems, and also the closed
| systems aren't approved in my country.
| underdeserver wrote:
| (2024)? We're still in 2024, aren't we? (@dang)
| mjaniczek wrote:
| I saw this format in the other HN submissions so I assumed it's
| always supposed to be there. Is it optional when the article is
| current-year?
| underdeserver wrote:
| Interesting, I don't see this in the guidelines or FAQ.
|
| The idea as I understand it is that articles that are not
| from the current year should be marked to highlight they
| might be out of date.
|
| There's no reason to put the current year on it, and as you
| can tell from the home page, most articles don't state the
| year (and they're recent).
| noodleman wrote:
| I'm T1D and currently working on something like this because
| diabetes healthcare in the UK is effectively non-existent past
| diagnosis.
|
| 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.
| dbspin wrote:
| I feel your pain, but 'threats of criminal punishments for lazy
| medical professionals' isn't a great idea. There are already
| laws against medical malpractice, but it's pretty obvious why
| prosecuting doctors and nurses for 'laziness' would be
| incredibly counterproductive and result in a massive increase
| in bureaucratic ass covering rather than improved care. Ask
| yourself - what caused the NHS to get into this situation?
| Certainly reversing those causes would be a good first step to
| improving the service and fixing the issues they've caused.
| According to the doctors and nurses themselves, it's all about
| cost cutting, increases in hours and generally the financial
| starvation of the service. They're literally out there striking
| to be allowed to treat you better.
|
| https://news.sky.com/story/the-nhs-sold-out-its-staff-doctor...
|
| https://www.telegraph.co.uk/news/2024/05/15/doctors-forced-t...
|
| https://www.bbc.com/news/uk-england-birmingham-64938278
| rhinoe wrote:
| This is a surprising view given that I'm T1D in the UK and the
| healthcare I've received, along with the tech, support and
| collaboration with diabetic consultants has been first class.
| You are making an assumption that every doctor is like the one
| you have (I guess), but its simply not the case.
|
| Good luck with your programming, but the agenda you're pushing
| for it is remarkably short-sighted.
| sgt101 wrote:
| This is counter to my experience - my daughter has received
| fantastic care. We have regular time with the endocrinologist
| and get phoned up inbetween clinics. They have provided a
| closed loop system and all the backup we could have asked for.
|
| I agree about Glooko, it's not as good as diasend was.
| sgt101 wrote:
| What is it that Camaps + dexcom doesn't do that you want?
| mapt wrote:
| You guys are decades deep into an ideologically propelled plan
| to "Starve the beast" by denying the NHS funding so that care
| quality declines, and use that as justification to privatize
| the NHS entirely.
|
| 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?
| GenerWork wrote:
| Isn't one of the selling points of universal healthcare that
| it's overall cheaper in total cost than private insurance? If
| so, the UK should be celebrated for having such a low
| percentage of its GDP being spent on universal healthcare.
| mapt wrote:
| Why not reduce it to 1% and see what happens?
|
| It is possible for this class of approach to be cheaper,
| but also for this particular implementation to be spending
| too little.
| s1artibartfast wrote:
| UK spends about 11% of GDP on healthcare This is comparable
| to France, Germany, and Switzerland, which spend ~12%, and
| less than the USA at 16% of GDP.
|
| Things get a little more interesting when you take the
| overall GDP of each country into account:
|
| Switzerland: 106K, ~$12K per capita
|
| USA: 85k, ~$13.5k per capita
|
| Germany $54K, $6.8k per capita
|
| UK: $51k, $5.8k per capita
|
| France: $47k, $5.8k per capita
|
| https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS
|
| https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nom
| i...
| Spooky23 wrote:
| The issue is that the Britain is stagnating, so that
| percentage of GDP is growing slower than costs.
| bluedino wrote:
| > The starting salary for a first-year doctor is below the
| national median income
|
| 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.
| hollerith wrote:
| >The starting salary for a first-year doctor is below the
| national median income
|
| Here you are comparing a doctor at the start of their career
| with a population consisting mostly of workers with decades
| of experience.
| HL33tibCe7 wrote:
| > You guys are decades deep into an ideologically propelled
| plan to "Starve the beast" by denying the NHS funding so that
| care quality declines, and use that as justification to
| privatize the NHS entirely.
|
| 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?
| neves wrote:
| Are you receiving your tech for free from NHS?
| petepete wrote:
| > Abbot refused to let me download my data after I was forced
| off their platform to Glooko
|
| 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."
| dazc wrote:
| '...diabetes healthcare in the UK is effectively non-existent
| past diagnosis.'
|
| 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?
| digitalsin wrote:
| When my wife was diagnosed with T2D, we went through the typical
| process many do - meet with a dietician, learn what to eat and
| how much, learn about insulin types and injections, etc. etc. She
| followed the process to the letter, and what we saw was the
| insulin injections make you gain weight, weight gain causes more
| insulin resistance, more insulin resistance means more insulin,
| more insulin means more weight gain, and on and on you go in this
| cycle that gets worse over time.
|
| 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.
| zamadatix wrote:
| The doctors didn't tell you to cut all the carbs you can and
| went straight to "take insulin until it's low enough
| goodbye"??? That's fucking wild, I couldn't make it seconds
| into being diagnosed type 2 with an A1C of ~20% without being
| bombarded about diet to the point I almost couldn't get any
| information besides "change your diet and try metformin and
| we'll see what other options make sense once we know that
| impact". I can see why the doctors had not been pushing
| tirzepatide in that timeline though, in the timeline "mounjaro
| started to get a lot of attention" was really "mounjaro was
| approved as safe to treat diabetes with by the FDA".
|
| 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.
| jklinger410 wrote:
| What I've learned that, as an adult in 2024 in the United States,
| you cannot take for granted:
|
| - 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.
| stonethrowaway wrote:
| At the same time I would emphasize that people who offer any
| kind of advice online around life-threatening ailments do put
| down if they have a related degree, are currently practicing
| and are licensed in that or a very related field, or if they
| are conducting self experiments and sharing their results (with
| YMMV caveat to go along with it).
|
| 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.
| 0xdeadbeefbabe wrote:
| > with YMMV caveat to go along with it
|
| Isn't it suspicious to offer YMMV caveats in a situation that
| is obviously dripping with caveats?
| s1artibartfast wrote:
| >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
|
| 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.
| xeromal wrote:
| Every day is a good day to be alive whether the sun is
| shining or not.
|
| I'm with you. One quick look at history shows nothing is set
| in stone and it can always get worse.
| jklinger410 wrote:
| > 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.
|
| 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.
| s1artibartfast wrote:
| I almost completely agree, and think we mainly disagree on
| the nuances.
|
| >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.
|
| The first thing I wanted to touch on is the idea of grift.
| Just because some has their interests ahead of yours
| doesn't mean they are a grifter. I think the childish view
| is the expectation that other people put your interests
| above their own, like the selflessness of a loving parent.
| A doctor doesnt put your individual wellbeing above their
| own, but that doesnt make them a grifter or a bad person.
| Expecting that kind of selflessness is entirely
| unrealistic, and is what causes cognitive dissonance when
| it clashes with reality. Thats not to say that grifters
| dont exist, who actively manipulate and deceive, but simply
| having unrealistic expectations for something does not make
| it a grift.
|
| One example would when a doctor doesn't provide the depth
| of care and consideration the patient wants or would expect
| from a selfless caregiver. Most people come to the
| realization that they need to provide the drive and
| motivation for their own care, and doctors are just hired
| experts to help with things you cant do. You have to manage
| them and tell them what you want them to do. If you dont
| manage them like hired help, they will do very little
| indeed.
|
| >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.
|
| I didnt mean to say that everyone is an island and forever
| alone. I mean that these things are not guaranteed
| entitlements, but conditional on human relations, standing,
| and mutual exchange. That is to say, they took work to
| maintain and were subject to constant scrutiny and mutual
| consent. Even in a tribe, goods and services were not
| provided unconditionally as some human birthright
| associated with tribal membership. Instead, they were
| conditional on good standing and mutual consent.
|
| >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.
|
| Im not arguing that beneficial institutions and functional
| societies are beyond human ability. Im saying their
| existence should not be taken for granted.
| dleink wrote:
| The quality of the American medical system has
| deteriorated to such a point that if the Doctors are not
| the grifters they may at least be culpable for enabling
| the grift.
| s1artibartfast wrote:
| That hasn't been my experience. I have never experienced
| or heard of a doctor deceiving or lying in real life. I
| dont think I can think of an example from hospitals
| either.
| jklinger410 wrote:
| My dental surgeon refuses to design or install an
| implant. They will only put in the screw for the implant.
|
| Why? Because of a pyramid scheme.
|
| That might not be a direct "lie," but it is misleading.
| Doctors mislead constantly. They tend to accept norms
| that are harmful because they are systems outside of
| their control.
| jklinger410 wrote:
| I love when I am arguing with someone who I secretly
| agree with. I appreciate your response.
|
| > A doctor doesnt put your individual wellbeing above
| their own
|
| I think an example we could both agree on, would be
| something like...let's say you have several indicators
| that you might have a type of cancer. But the doctor will
| say, well let's not do a whole biopsy, because it's
| expensive and it's not covered by your insurance, and
| there's a low chance you have this cancer anyway. That
| might seem like a sensible conclusion to draw, but
| actually if we were simply caring for every person in a
| real way, like we would wish to be taken care of
| individually, we would do that biopsy anyway, because the
| alternative is death.
|
| Now to draw a parallel to ancient tribes as I was doing
| earlier, the resources of the tribe dictates the care
| each tribe member can have. Okay. But we live in one of
| the most abundant eras in the history of the world. And,
| strikingly, we also have insane wealth inequality. So
| what I am positing here is that the default resource
| allocation for you is much lower than you might assume.
| People are going to make cost-cutting decisions that
| impact you greatly. And the only resort is for you is to
| manage your own health. Not that you SHOULDN'T manage
| your own health anyway, but this cost cutting resource
| allocation acts as a kind of betrayal. Things being "held
| together by duct-tape" is not the vision that children
| are raised with. We don't assume we are still in a period
| of being "left behind by the herd" because of how great
| everything is. But in fact, you will realize, when you
| see someone deny treatment for their advanced cancer due
| to finances and "the odds of survival" that in fact, you
| can be left behind by the herd. And the more you look
| into the way the healthcare system is structured, you
| realize that there really is no herd at all. At every
| step you are paying for help from someone who, in many
| instances, could care less.
|
| What I am also saying is blatantly that these people make
| mistakes and sometimes do not care. And there is little
| recourse for that. Which isn't a point that you
| addressed, but anyway.
|
| > Instead, they were conditional on good standing and
| mutual consent.
|
| And this good standing has been converted to currency.
| Which is a much more isolated and cut throat version of
| good standing. In many ways it is more unfair. And what
| you don't realize as a kid is also how EXPENSIVE this
| "good standing" actually is. To receive the benefits of
| the technological state we purport to be in you usually
| have to be upper-class. The poor are often much closer to
| being completely alone. As if no society exists for them
| at all.
|
| > Im saying their existence should not be taken for
| granted.
|
| I, on the other hand, think that they don't go far
| enough. They aren't good enough. I'm actually not so sure
| what is being "taken for granted" in a for profit system,
| I pay every fucking dime of it. I am not impressed with
| its state.
| xeromal wrote:
| There's a time in every human's life where the rose tinted
| glasses wear off and the reality of human living hits you.
| s1artibartfast wrote:
| agreed. I think we are at a unique time in history where the
| rose tinted glass can even exists. Where children can live
| sheltered in a low risk reality well into their 20's and then
| whiplash and disappointment and cynicism hits them like a ton
| of bricks.
|
| I think that low baseline expectations is very important for
| mental health and general resilience.
| kinleyd wrote:
| It took me a long time to get there, but I eventually did - I
| agree with every one of things that you listed. Fortunately, I
| have also learned that there are a whole lot of things that you
| can do to overcome each of those challenges. It does require a
| good bit of time to research, understand and apply them - as
| well as some luck.
| moffkalast wrote:
| You can always trust people to act in their own self interest,
| everything else (including your list) can be proven from that
| first principle.
| jklinger410 wrote:
| And this makes for a pretty lonely and downright harmful
| society, when viewed through that lens.
|
| 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.
| shrimp_emoji wrote:
| Children aren't tricked into believing it because it's
| actually true. As you point out, people are inherently
| good, and they act against their self-interest all the
| time. It's always a mistake though. ;D
| Jun8 wrote:
| Having experienced healthcare in multiple countries I can say
| most of the items on your list are pretty much universal,
| unfortunately. Skipping over the capitalistic and legal issues,
| which people more or less expect, I'd like to zoom in on your
| item #3. The fact that doctors are (often) clueless for complex
| diagnostics (not talking about a broken arm, etc.) is shocking
| to many people.
|
| 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.
| jklinger410 wrote:
| I don't mind point one, and it can be improved in many ways.
| AI being a huge one.
|
| 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.
| xkcd-sucks wrote:
| Like, it behooves one to know enough about one's car or house
| or computer in order to not get scammed/idiot-screwed by
| mechanics and contractors and tech support
|
| It would be surprising if one's body were different. The
| general level of faith there seems inconsistent with reality
| sizzle wrote:
| Any idea how to remove the most common pollutants we run into
| everyday? I try to avoid high VOC materials and use charcoal
| filters for water. Kinda lazy to set up reverse osmosis system
| right now.
| reaperman wrote:
| 1) You're pretty much just screwed unless you're both _very_
| wealthy and make this topic your primary hobby /past-time. To
| really answer this you'd need to do an incredible amount of
| testing. Like buy 10 of everything you're considering and
| send off to labs for $100,000 of tests. Or install a million
| dollars of chemical air quality monitors in and around your
| home.
|
| 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.
| supertofu wrote:
| I'm prediabetic with two T2 parents and a T2 grandparent and my
| primary care doctor is entirely unconcerned about it.
|
| 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.
| mpreda wrote:
| What is your weight situation?
|
| Eat less, exercise more, and you may delay T2D. Reduce or avoid
| fast carbohydrates. Reduce carbohydrates.
| coldtea wrote:
| > _My doctors care about my inflammatory markers and nothing
| else_
|
| They care about your payments, more likely...
| jvossy wrote:
| They're doctors, not CEOs. They are advising based on the
| behaviors they see from most of their patients, who probably
| come in asking for quick solutions and are unable to make
| lifestyle changes stick. Patients who are educated about
| their own conditions, willing to listen to advice, and able
| to keep to that advice over the long haul are a very small
| proportion. Not that doctors shouldn't offer this sort of
| advice anyway, I am just asking you to please try to
| understand why they behave in such a way.
| LeifCarrotson wrote:
| I was talking to my physical therapist this morning about
| my experience with the recent exercises he'd given me, and
| I pulled up my Garmin workout calendar to show him my
| inconsistency. He'd told me to do a particular stretch
| every 3 hours or 6x/day, and I'd been having several days a
| week where I'd only completed the routine 4 or 5 times.
|
| He said that level of consistency was fantastic, that at
| least a third of his patients flat-out told him they hadn't
| done any of the exercises at all, another third showed no
| improvements above baseline and he suspected they had lied
| about it, and the remainder had moderate compliance. When
| he'd told me 6x/day, he was anticipating 2x on the high
| end. We adjusted to 4x/day, where morning, lunch break,
| after work, and before bed were easier habits to stick to
| than trying to drop and do press-ups in the middle of my
| 9:00 meetings.
|
| And that's at a sports and fitness-focused PT organization,
| not an average general practitioner working with median
| diets and advising a society that by default trends towards
| diabetes.
| beauzero wrote:
| Just anecdotal. Was T2 and getting kidney stones every two or
| three months (cause not related but treatment was). Cut out
| oxalates which restricted diet. Monitored sugar 3-5 times
| daily. Switched to carnivore diet + onions and mushrooms and
| went on Metformin. All at the same time. Did this for 2.5
| months with no additional exercise. This dropped me down below
| T2 level. Went off Metformin and am maintaining with same daily
| testing. Off carnivore for paleo minus anything with oxalates
| after the 2.5 months strict carnivore.
|
| 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.
| tracker1 wrote:
| I've found I do best with a very similar diet... mostly meat
| and eggs, some cheese and sometimes onions, mushrooms etc. I
| notice that some starchy foods hit me worse than others.
| Legumes are pretty bad on how I feel, and spike me to no end.
| Similar with wheat products. Corn, rice and potatoes spike my
| glucose, but I don't feel physically ill the next day like
| with many other foods.
|
| It sucks, and I wind up cheating 2-3x a week (I live with
| people that eat different than I do).
| nextos wrote:
| Check the work of David Unwin from NHS, who has reversed T2D
| in many patients using dietary interventions:
| https://www.diabetes.co.uk/blog/2015/08/dr-david-unwin-
| publi...
|
| 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/ea
| rly/2023/01/02/bm...
| nradov wrote:
| Other researchers have also achieved T2D remission in many
| patients through nutritional ketosis (carbohydrate
| restriction).
|
| https://doi.org/10.1007/s13300-018-0373-9
| kshacker wrote:
| And here I am following a WFPB diet with high carbs and
| reversing my A1C + some other markers.
|
| My philosophy is that many diets work, you just can not
| have a cocktail. Our body is not a hybrid car. It takes
| time to switch/
|
| Choose what you can live with - high carb, low carb, keto
| - and stay focused.
| thrwwyfrobvrsns wrote:
| Sumo wrestlers kind of fascinate me in this regard. It's very
| rare to find a professional who is diabetic, even though they
| eat one big carb-heavy meal a day and are morbidly obese.
| IIRC, this is explained by their low visceral fat levels,
| which are driven by high adiponectin levels that are
| themselves driven by their intense workouts and consistent
| sleep habits. Their high subcutaneous fat proportion is
| actually thought to be protective. T2D catches up to them
| after they retire and stop exercising and sleeping well.
|
| 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.
| hombre_fatal wrote:
| Sounds like a good way to trade one problem for another.
| gregschlom wrote:
| Get a continuous glucose monitor. You should be able to
| convince your doctor to write you a prescription for it. If
| not, there brands that will do the prescription for you after a
| quick video call with a doctor (but they're more expensive).
|
| 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.
| rdedev wrote:
| Is it conclusively proven that glucose spikes influence the
| risk of T2D by a big margin? Like imo calorie balance is more
| influential than glucose spike. This is all assuming that you
| are currently healthy. I don't think spiking blood glucose is a
| good idea of you are diabetic
| galago wrote:
| I was diagnosed with T2 last year, and started a CGM (Freestyle
| Libre 3) like you did. I started off with lists of foods I
| could eat, but the monitor let me see actual data on what was
| happening. Its not very accurate, but the absolute numbers
| don't matter as much as seeing the actual trend effect on my
| own body. I never let it go over 150, ever. I can eat some
| legumes in moderation, but your specific body may be different.
| I initially took Metformin, but discontinued. My last A1C was
| 5.1 and and endocrinologist I was consulting with put in his
| notes that my diabetes is "remission." So, if you're
| prediabetic, keep at what you're doing. I eat very little meat,
| btw, so while that might work for some people, its not strictly
| necessary.
| photon_lines wrote:
| I already mentioned some of this in another response, but I'll
| include it here as well: you can take measures to not have to
| take medication / insulin if you have type 2 diabetes. The
| number one thing to avoid it is to stay lean and not be over-
| weight, but some other things which can greatly help out:
|
| - 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
| kapitanjakc wrote:
| Dumb question here :-
|
| 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...
| shrimp_emoji wrote:
| > _Can I avoid getting it ?_
|
| 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.
| jevogel wrote:
| FFor more context:
|
| Type 1 diabetes (T1D) is an autoimmune disease. Your own
| immune cells attack your insulin-producing beta cells in your
| pancreas, leading you to lose the ability to produce insulin
| to absorb glucose from the blood. You will lose weight, be
| frequently thirsty, and have to pee frequently. T1D seems to
| have a genetic factor which you can be tested for.
|
| Type 2 diabetes (T2D) is a lifestyle disease where you become
| less sensitive to the insulin that your body produces. It can
| be prevented by maintaining healthy diet, exercise, and
| weight, and it can usually be detected early as prediabetes.
| There may be a genetic factor predisposing you to T2D, but I
| don't know if there are tests for it.
|
| You need to know which disease your family had to know which
| answer it is. They are two totally different diseases that
| just happen to both be related to insulin.
| sgt101 wrote:
| It depends on genetics and luck.
|
| 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.
| photon_lines wrote:
| I can't answer this question for you, but some life-style
| factors which I think will help you avoid getting it are
| provided below:
|
| - 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
| tekgnos wrote:
| It's all vibes! Type 1 here for 28 years.
|
| 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:
|
| https://github.com/LoopKit/Loop https://www.loopnlearn.org/
| Suppafly wrote:
| Off topic, but if skip your first sentence and the later
| mention of insulin, this reads like an acronym and jargon
| filled comment that could be about anything. Like you could
| refactor the comment to be about AI LLMs or something.
| pneumatic1 wrote:
| I understand the entire comment and it literally could not be
| about anything other than managing diabetes.
| tracker1 wrote:
| Definitely get the "vibes" statement on how much insulin... I can
| literally have the same meal two days in a row, and one day it
| takes half as much to manage, or I'll overcorrect need to drink
| some tang or something similar.
|
| 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.
| qwerty456127 wrote:
| Why does hypoglycemia happen in people with diabetes? Healthy
| people can stay active for weeks without food and for many years
| almost without dietary carbs (on just fats and proteins - see
| carnivore and keto diets). How comes gluconeogenesis from
| triglyceride glycerol and from amino acid fails to cover the
| essential glucose needs?
| mjaniczek wrote:
| I suspect it happens because of your externally provided
| insulin (as in, you caused your hypoglycemia by injecting too
| much).
|
| 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?
| DavideNL wrote:
| I think it's simple: because they injected too much insuline at
| some point before the hypoglycemia;
|
| Which obviously "never" happens to non-diabetics, because the
| pancreas regulates this automatically, adjusting to
| circumstances as required.
| davidthewatson wrote:
| The previous commenters are correct. T1D here. Sorry for the
| book.
|
| 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...
| a3n wrote:
| T2 diabetic. Metformin, and Trulicity. Although Trulicty has been
| hard to find recently, so I'm doing without and working harder on
| my management practices, which is working well. I am not a doctor
| and I don't know you.
|
| 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?
| :-)
| CollinEMac wrote:
| I'm a Type 1 diabetic living the United States and my experiences
| have been a bit different.
|
| > 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.
| helsinki wrote:
| Just get a Tandem T-Slim and Dexcom G7. My A1c went from 7.8 to
| 6.2.
___________________________________________________________________
(page generated 2024-07-24 23:04 UTC)