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Comment by manmal | Hacker News Reader

AFAIK in type 1, most of the beta cells get destroyed, and it happens because of autoimmune processes. To me this means that immune-modulating medication or perhaps stem cell injections could help a great deal.

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The problem with those are that they're more complicated (even when perfected) than current treatment. Immune modulation would require either suppressing the entire system (or very large chunks of it) which is done with some other diseases but generally has super high costs, as it leaves you quite vulnerable. Or you're targetting only the handful of cells responsible (my DM I knowledge is rusty but I'm guessing b-cells?) in which case you're on your way to solving a bunch of different diseases.

Stem cells has a similar issue, in that once you made new beta cells your immune system will just react to those.

Current treatment is quite alright. There's ground to be gained in earlier prediction and treatment, and a ton (this should excite people here on HN) in bettering the treatment method—create a proper feedback loop with insulin/glucose readers that automatically push out insulin when needed instead of a huge shot of it when you're guessing you'll need it.

My doctor wants me to start thinking about a closed loop system on this year so I don't need to wake up every night for CGM alarms. One interesting project would be the open source pancreas, I've heard lots of good about it, of you have the right insulin pump and CGM.

https://openaps.org/

Until there’s a dual (glucagon, insulin) pump released, you’ll still be waking up to deal with those low BG alarms. You may be dealing with fewer alarms because of the predictive suspend feature, sure.

Our 6 year old has had a Medtronic 530g which (you probably already know) suspends basal delivery when it reaches a low threshold. I’m pretty sure it’s saved his life a few times (at night) over the past 4 years. He’s due for a new pump and we were hoping the Beta Bionics dusk chambered pump would be ready by this time, but sadly it still looks to be a couple of years away. The Medtronic 670g is likely his next pump, which will add predictive suspend and IIRC will also auto increase his basal rates to account for highs.

OpenAPS looks interesting but for now I’m not willing to experiment with it on our son.

My doctor's colleague in US uses the 670G and when they met he showed her how now every night he has a straight 6.5 mmol/l line and no wake-ups anymore. My need for basal changes quite often and this feature would be nice.

I use xdrip which wakes me up before I got hypo or hyper. I'd prefer to have eight hours of sleep every now and then.

Yeah we use a Medtronic MySentry (basically think of a baby monitor with a screen that displays his BG level...and relays CGM/pump alarms, loud enough to wake the dead.)

xDrip / parakeet looks awesome, but that looks to be Dexcom-only as far as I can tell.

Our son carries a medtronic Minimed Connect (pump<->bluetooth adapter) and an iPhone (yeah a kindergartener with an iPhone) so it can relay his BG when he's in school using Nightscout.

Unfortunately neither the MySentry, nor the Minimed Connect are supported with the 670g so we're a little concerned that we won't be able to monitor him remotely (while he's sleeping or when he's at school...the two times he's most vulnerable.)

I'd love to switch him to a Dexcom, but there are currently no pumps that support predictive / suspend functionality at this time (though the T:Slim X2 is getting close to getting this type of update.)

Thanks for the heads up on xDrip!

Yeah, I wrote the InfluxDB module to xDrip. Be sure to check the Nightscout version from github. The best tool for my personal diabetes care.

You could use https://github.com/pazaan/600SeriesAndroidUploader with your medtronic.

There's an enormous amount of research into both understanding the autoimmune reaction and into safe insulin producing cells that could be introduced.

Turns out they are both really hard problems.

It's a reason to be pretty excited about medicine over the coming years. Doctors are starting to tease apart some of the specifics of the immune system.

Immune-modulating medication maybe, but unless this is identified very early, they won't help. Once the beta cell destruction is complete, you are left without any. Even if the immune system stops attacking, at some point it no longer helps.

In fact, a long time ago some experimental treatment was tried, where active beta cells were transplanted into type 1 diabetes patients. They were very quickly destroyed by the patient's immune system.

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