Comment by templaedhel | Hacker News Reader

Comment by templaedhel | Hacker News Reader

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As a type 1 diabetic I'm super excited to see apple working in this space, even if they're focusing it on type 2 to start (a logical move, considering there is something like 30x more type 2 diabetics in the US). I think making it easier to track glucose levels in real time is the number one thing that can be done to improve quality of life for both types of diabetics.

The "CGM" (continuous glucose monitor) has really come into it's own over the last 10 or so years, and I would encourage all diabetics (but especially type 1) to use one. Currently the only 2 real options on the market are:

- http://www.dexcom.com/ - Connects directly to your phone using bluetooth and will send glucose warnings etc as notifications.

- https://www.medtronicdiabetes.com/products/enlite-sensor - Designed to work with Medtronic (who is a market leader) insulin pumps.

Both these options are expensive (even with insurance for many), invasive, and not really tailored towards "casual" glucose monitoring. I think if Apple enters the space with a non-invasive tool it'll be a huge boon for causal glucose monitoring. I also think it could be a more accessible option for people who are interested using a CGM to treat their diabetes but can't/won't use one of the existing options due to cost or inconvenience.

This seems like a win win and I'm excited to see where it goes.

Here in Germany the Dexcom G4 system with Animas Vibe insulin pump became fully covered by the health insurance last November and a couple of weeks ago I got my system working. It is a pretty amazing improvement to my life: both the pump and CGM.

The G4 transmitter has a 2.4 GHz radio and I built an extra device with Wixel and Bluetooth to transfer the data so my Android phone so xDrip+ and my Android watch can display the glucose values real time. It works so great that my A1c levels been going down from over 7% to 5-6%.

If you are in Europe and have a Type 1 Diabetes, you should ask your doctor about your options.

If you have an insulin pump (best if it's an older one, since newer ones are harder to hack) you should look into OpenAPS (open artificial pancreas system) https://openaps.org/. People have code/schematics available to build a closed loop system between CGM<>insulin pump which automatically adjusts the dosage based on glucose levels and keeps you in range better than even the best attempts at manual dosages. Seems like you've already done half the work, which is connecting the CGM to a device you can run custom code on.

Medtronic just came out with their first closed loop system (https://www.medtronicdiabetes.com/products/minimed-670g-insu...), but OpenAPS has been around for years, and not sure how Medtronic will go about getting the 670 approved in Germany.

The Medtronic 670g was my other option, but I took the Animas Vibe + Dexcom G4 just because it's easier to hack, lots of German Diabetes hackers use it, its CGM seems to be more accurate and you can use the G4 sensors way longer than the 670g.

670g is a closed loop system, but what it does is it stops giving you the basal insulin when it thinks you are getting a hypoglycemia soon. What it doesn't do is to give you correct amount of insulin automatically when you've been eating carbs or doing exercise to keep your glucose level in the 5.5 mmol/l target. And with the new Fiasp insulin automatic adjustments would be possible.

To be able to build the OpenAPS, you must have an older Medtronic pump which are not covered by German insurance anymore. My Animas doesn't allow to tweak the insulins remotely.

The 670G completely controls basal rates; the "suspend on low" functionality arrived in a previous generation. But it won't keep your blood glucose at 5.5 mM -- it targets 6.7 mM, and there doesn't seem to be any way to change this. :-/

Sounds nice. I still think I'm going to manage my insulins manually until the next generation of artificial pancreas. This system what I have is already the biggest ever improvement for my diabetes I've ever had.

Isn't it a bit scary to run the auto-insulin code on an android phone?

I do not have an insulin pump and I'm presuming you don't with my response. The pumps I have seen make noise when they are pumping and also have an alarm (I'm not sure if that's from the pump or the reader) if your levels are on either extreme. I'm guessing malfunctioning code would only execute once by pumping too much or not pumping at all and the user would figure it out very quickly.

I'd argue the users can't identify anything if they are rendered unconscious:

https://en.wikipedia.org/wiki/Diabetic_coma

You definitely don't want anything buggy with medical devices.

I agree about the importance of medical devices but I don't think diabetic coma happens as easily as you think for most (if they are on one of those full-systems). From what I've seen from insulin pumps/systems:

1. There is a max rate that it can pump

2. There are alarms that go off if the numbers are above or below your settings (I believe there are also max and mins for those so you can't accidentally set it to a 'fatal' number)

3. The systems seemed 'independent.' The reader did not take for granted that the pump was pumping, but rather continually monitored glucose levels and would still set off an alarm if the numbers weren't within the bounds.

Unfortunately I can't get this in the UK. I asked, but they only give out to kids or people who poorly manage their T1. :(

There's https://www.freestylelibre.co.uk/libre/ which I believe you can just order online (I'm considering one myself). You have to scan the sensor yourself(it stores the data between scans) so it doesn't trigger alarms like the dexcom but for gathering data about how exercise/diet effects your levels it should do the job nicely I think.

edit: The starter pack costs £159.95, see https://www.freestylelibre.co.uk/libre/products/starter-pack...

These were recently included in the coverage given by the danish government (at least in my area) and this is probably the biggest quality of life improvement I have received in at least 10 years of diabetes. Even though it's not as clever as some of the other systems, being able to get an idea of the level without having to find a secluded spot and prick my finger is a really great feeling. It also means I can actually check my levels while at a party for example, where previously I would put it off for a bit because it was inconvenient.

German insurance companies cover these too and I had them about six months before switching to Dexcom system. The NFC scanner provided is not accurate at all. The values are what they are and you can't calibrate them. Luckily if you own an Android phone with NFC reader you can use xDrip+ to scan the values and xDrip+ allows calibrations, so the measurements reflect your blood sugar much more accurately.

I'm having trouble with not feeling hypoglycemias and I'm having them quite often at night. Freestyle Libre by default doesn't automatically measure your glucose levels, but there is a hack with Sony Smartwatch 3, a strap and very custom and hacky android version which enables the NFC reader in Sony and you can get alarms to your phone on low glucose levels. It worked and saved me a couple of nights, but the Libre chips break easily and the system was kind of a drag to use in the end.

The sensors are quite pricey to get, each lasting roughly 2 weeks. Unfortunately the sensors aren't available on prescription yet. Let's hope this changes.

As an American this is the single biggest fear I have about a nationalized healthcare system. I've been using the Dexcom CGM for 4 years and never had to pay more than a standard co-pay. It seems to me systems like the NHS are set up to serve the majority and people people with (relatively) rare diseases get screwed.

When parent says "I can't get this" they mean {I can't get this free, but I could buy it and I wouldn't have to pay the sales tax}.

In England there are some weirdness with treatment for people with diabetes.

If you use insulin of medication to manage your diabetes you're entitled to free prescriptions. This is free from the time you're diagnosed to your death, and for all medications not just insulin. (But not free dental or optician care)

Prescriptions are low cost in England. Currently they cost:

http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptionc...

>> The current prescription charge is £8.60 per item (£17.20 per pair of elastic hosiery). A three monthly PPC is £29.10 and will save you money if you need more than three prescribed items in three months. A 12-month certificate is £104.00 and will save you money if you need more than 12 prescribed items in a year.

(I think this is right, but it might have changed) I feel that it's an injustice that glucose monitors and test strips and these new devices are not covered by this medical exemption certificate, and that people with diabetes need to pay for them, even if they don't have to pay the 20% VAT.

England has an independent organisation called NICE that decides on best current practice treatment (with an eye to cost effectiveness). Clinical Commissioning Groups (the local organisations that commission NHS services) need to pay regard to NICE guidance. Here's their standard for type one diabetes: https://www.nice.org.uk/guidance/ng17

Here's their list for blood glucose management: https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendati...

You can get still get private coverage in the UK (e.g. Bupa), the NHS is there for people who don't want that.

I suspect it's only a matter of time, if it leads to better management of blood sugar levels the long term cost savings will be huge.

Can you pay for it yourself with their discount?

Europe is not a country. I'd wager less prosperous countries do not cover such devices.

My partner is type 1 diabetic, and CGMs were a game changer for her (they started rolling out in Switzerland last year).

She's been using the FreeStyle Libre (https://www.freestylelibre.co.uk/libre/), which uses NFC and on select markets has an Android app available, but here we still have to use the handheld reader.

I seriously recommend testing xDrip+ with the Libre. Better results and you don't need to carry an extra reader device with you all the time:

https://github.com/NightscoutFoundation/xDrip

Pull requests are welcome too :)

In what way does it offer better results?

There's an official android app for libre too, i'm not sure if it's available everywhere though.

The libre measures the glucose from the interstitial fluid, which doesn't map directly to the value measured from blood. Think about coordinates, where X is the value from interstitial fluid and Y is the value from blood. You must draw a line somewhere to map the values correctly and the Libre is calibrated in the factory. For me the Libre reader was just an ok indicator about the trend, but the actual value was sometimes not even near the value shown. It's ok between the normal range 4.0-8.5 mmol/l, but I'd be suspicious about every value outside of that range.

With xDrip you can input values measured from blood and the software will try to estimate as accurate values as possible, meaning that in the best case you can be quite sure about the reading, but always better to check from blood.

Remember, that calibration should happen only when the levels are steady and you should calibrate from the whole range to trust the readings. Anyways at least 2-3 measurements per day from blood is suggested, even with the more expensive CGM's.

I find the non-official Android Libre reader app 'Glimp' useful. Even though I have the official one, I keep both installed, because Glimp does less smoothing/extrapolation of the readings.

The Libre only gives you a reading when you manually check it, right? Or did I misunderstand that? I wouldn't want to lose the low/high/rate of change alerts the Dexcom gives. Even if you're sleeping, it'll wake you up if the blood sugar starts getting low.

Officially, it stores 8 hours of data in five minute intervals and you have to read it with an NFC device, so automatic alarms are a no-go.

If you want to hack, it is possible to turn the Libre to have automatic alerts. I did it, it's not perfect, but if you have nightly hypos which you don't notice, this can be helpful:

https://github.com/pimpimmi/LibreAlarm/wiki

http://www.freestylesticker.com/product/freestyle-libre-cgm-...

If you're in Europe, I have one modded Sony Smartwatch 3 which I can sell :)

> they started rolling out in Switzerland last year

Wow, do you know why this is? The Dexcom G4 is already 5 years old and is absolutely a life-saving system.

That's because there are so few of us Type 1 diabetics and not enough political pressure to get the new stuff faster. There are some activist doctors and nurses that help in Germany, but we also got the G4 for free only on last November.

The insurance companies are conservative and see the systems as very expensive investments and the technology is something scary in a country which is still very suspicious about Internet and computers in general.

There were also some privacy/bureaucratic slow downs (my girlfriend had to sign a monster of T&C regarding data sharing with her doctor).

It is quite annoying when you are getting intimate though.

The libre or the pump? I usually just unplug the pump for sex and take some extra insulin when I plug it back. Small price to pay for the luxury of steady sugars.

The libre. I am afraid to tightly grab that arm and it's distracting when caressing that arm so I just keep my hands away from it which creates this weird spot I am afraid to touch...

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