New pill can deliver insulin

I'm diabetic and the sole reason I don't check my blood sugar (unless I think something is drastically out of whack) is that it takes me upwards of 30 minutes to do a finger prick for testing. My anxiety skyrockets and nothing I do can tell me that it's not going to be excruciating. Most of the time I end up having my wife do it, which isn't a fun process for either of us.

It's not the worst thing, but it's deeply, deeply unpleasant for me. Come at me with a 10ga needle, I won't flinch; come at me with a 30ga lancet and I'll be a mess. I'm going to be switching to a CGM purely for this reason.

I once failed to bring my insulin on an international trip. That was a doozy!

Making injections easier would be nice, sure. Not having to worry about finding a bathroom or bleeding into my pants or whatever. But that's a real minor set of issues compared to the constant attentiveness that managing it well requires.

Secondly, I think your description of diabetes is overblown. If you’re checking BGL frequently with a CGM, then you have a good understanding of what will happen in routine situations. If you’re not, you aren’t going to sweat 30 minutes in the car or the delta between the carbs from dinner plus toast and physical activity (I do like the humble-brag here, though!) because you don’t know what’s going on anyway. Hypoglycemia has the advantage of being treated with glucose tablets, which don’t spoil and can be stashed everywhere. Moderate activity and water intake are important but not going to swing your BGL wildly like a bottle of soda or an intense workout.

This disease can be a hypochondriac’s dream and I think that teaching other diabetics to be so preoccupied is dangerous to them because it increases the temptation to give up on the daily routines that actually make a difference.

Those are typically a person who's insurance is so lacking that test strips end up as a financial burden. Typically, well insured diabetics will partner with someone who is less well off and share strips. The test strips from a good insurance provider are typically much more than enough to cover the time period that they are prescribed for (exp: you are given 1000/mo, but only use 300/mo).

It's a fascinating side of life, somewhat like the deaf community, that exists in plain sight and yet is invisible to anyone outside of that particular community. Sociologists should investigate that partnering process if they have not already, despite the uproar that insurance companies would make over these kind acts.

[0] https://www.gannett-cdn.com/-mm-/519e70b3dd198a728f9efe74a59...

Pin-pricks and injections aren't even on my radar; they're nothing at all next to the problems of needing to maintain at least some level of vigilance at near all times. Additionally, needing to constantly have plans for carrying around carbs, insulin, monitoring equipment, ensuring various prescriptions have refills and there will be pharmacies around, that the event you're attending has things you can eat, etc.—and still having periodic interruptions to whatever you're engaged in from lows or highs, or just needing to stop and check because it feels like you might be dropping low—that's the terrible stuff.

I have a hard time imagining how someone could even compare the small bother of injections to the above. I suppose if you're morbidly fearful of needles or something, but otherwise I'd be very confused at how a mild quick pain could match up to having your life dominated by this constant attention sink.

EDIT: I should also add: I got the FreeStyle Libre a couple months ago (it's effectively a CGM—or at least far far closer to the CGM side on a spectrum from finger-prick monitor to CGM), and it does help significantly with the attention problem.

And, I'm guessing how much the attention problem affects you depends on your personal standards for acceptable BG levels. I don't like how I feel when it's above 140 or so, and it's supposed to negatively effect cognitive performance to be too high, so my standards are very high (I've now had two doctors say I had the best A1c scores they'd seen).

Probably also depends on your inclination for analytical introspection / self-monitoring. I would bet I'd have ranked high on that even before the diabetes diagnosis, off-the charts high for several years after, and now, after spending years working on meditation etc.—moderately high.

A lot of non-t1d folks seem to fixate on the needle/lancet parts of management because it is visceral, but have difficulty grasping the huge amount of stress and responsibility around managing time, activity, boluses, diet etc.

For example, managing stress can itself be stressful. Some people with t1d have sever anxiety, and a panic attack can trigger a cortisol dump into their bloodstream, which in turn causes a significant spike in blood sugar. I once saw a panic attack spike a person from 80mg/dl to over 400 mg/dl with no eating, no pump/infusion site failure, or incorrect basal rate.

Also, concerns about your ability to engage in sexual activity with regard to blood glucose is the furthest thing from a humble brag. It is an issue for many, many diabetics and is often a point of embarassment. Kudos for mentioning it!

Recently my partner (23yrs with t1d) and I made accounts on the twitter-like site called Beyond Type 1 which has actually been a really great community of diabetics (and diabetic-adjacent people like me) sharing their concerns and advice and we have both loved it.

Even then, I am still going to die earlier than a non-diabetic. So why should I kill myself for 50 years going to the n-th degree when n-1 or n-2 is ok enough? That is my justification for keeping h1bc below 8 or 9, never mind below 7.

All the effort into projects like tech for snorting insulin is just surface stuff, much like all the glitz in the IT world that accomplishes superficial stuff (but takes lots of VC money). I am reminded of the CueCat... 30 years ago, they said there'd be a cure by now. I am still waiting and am going to die before it ever happens. Snortable insulin is sexy, but not that useful in the grand scheme of things.

Dude, you don't know many diabetics then. Companies spend billions of dollars to solve this problem.

One of my friend was telling me that I am not participating much in adventure activities I smiled and told that for me, living life itself is far more adventurous.

My father in law seems fine with the act of injecting itself, but he's very private about his health issues and seems very self conscious about injecting. I've known him about 15 years and he'll always leave the room to inject even in his own home with only family around. I'd imagine this might help someone like him in a small way.

Tell that to my wife who has had diabetes for 4 years.

If I recall correctly there was a story about a CIA weapon that shot a needle or dart made of a frozen toxin. It would penetrate the skin, melt, and cause a heart attack. There would be no evidence other than an incredibly hard to find hole in the skin with no physical object to be found.

The real question here isn't the delivery mechanism, but the properties of this magical compound - whether it leaves any traces in the body, and what symptoms it causes.

Pretty much this. Obviously needles and finger pricks are a bigger deal for some people, but most diabetics get used to it fairly quickly. The hard part is the constant mental drain of having to be your own pancreas. It's like you're constantly flying a plane where you have to manually maintain a certain altitude, because you'll crash and die if you fly too low or too high. It's exhausting.

If you’re want to see the future of medical care using smart devices, start there.

Also check out https://openaps.org/ - its a community developed closed loop solution. Very cool.

Thanks, I will check those out!

The blood checking pokes are much worse, because they have to actually draw blood. Usually fine but sometimes quite painful or difficult. Now I use a continuous glucose monitor (CGM) and it's much better.

Many many people don’t really notice or care about the needles (me included) because as OP parent posted, we have other stuff to deal with that takes up way more mental space.

I guess this isn’t apparent because the needles are the obvious bits but then rest is all the “thinking” that invisibily surrounds the injection.

There are however many people who just can’t wrap their head around needles and can’t do it. The needles themselves are tiny so it’s not that - it’s just how they perceive the world.

Any technology that helps these people and makes their lives easier should be embraced.

His diet is cheap and accessible. You can follow his diet by eating locally produced wheat, potatoes, oats, rice, corn, millet, beans, etc, in all parts of the world that have an agriculture season. A feature of his diet is that starchy foods store well. Indeed, he says that the reason humans became so successful is because they were able to have a food supply that was high in energy and could be stored.

McDougall does not sell pills or supplements. He specifically counsels against them, saying that they are unnecessary with a good diet and potentially harmful.

In addition to a lot of free educational content, his website (drmcdougall.com) features different programs, including a 10 day live-in program which includes medical care plus meals and education for $6,060 for a single, full participant. You can also buy books, podcasts, and apparel. I didn't see any prepackaged food on the site.

I've considered him a source of high-quality, unbiased advice for several years. His presentations are clear and logical. He's not trying to sell me something. He is conservative in the sense that he prefers cheap, simple solutions before expensive, complex ones. For example, he would recommend that before you try medication and surgery, you should first try to change your diet. If you're not feeling well, make sure you're eating eating a low-fat, whole food, starch-based diet before trying to find a missing miracle vitamin or supplement.

* Hepatitis A/B and C (A and B were cured early on so name should be livervirus or whatever, C should remain hepatitis until it's eradicated)

* Herpes types 1 and 2 (1 should be renamed to cold sores since almost everyone has it, 2 should remain herpes until it's cured)

* Nonfatal cancers (especially of the skin) need new names to prevent scaring people, especially if they've been largely cured.

* SSH "private key" and "public key" (should have been called "secret" and "share" so that people would know which to keep secret and which to share.. yes I realize they are symmetric)

I could go on, but you get the drift. I think a problem here is that experts in various fields may have exceptional problem solving skills but be terrible at naming things. I've met many programmers with this affliction!

I don't know, but here is my guess:

At the beginning of the lecture McDougall talks about there being three kinds of diabetes: type 1 (pancreas produces no insulin), type 2 (pancreas produces enough insulin, but it doesn't work because of insulin resistance), type 1.5 (not enough insulin is being produced to cover the body's needs). Significant weight loss seems to fit in the type 1 and type 1.5. McDougall will prescribe insulin if a person is in danger of losing too much weight.

I know, before insurance, it costs around $240 a vial, and I know personally I go through roughly 3 vials a month. I would guess I use a lot less insulin than a lot of others too.

So I know the manufacturer isn't the only one to blame, and maybe its unfair to completely blame them, but as much as the manufacturers are donating to politicians I cant imagine they are doing a lot to fight it either.

Slightly off-topic, but could you talk about what pharmacy benefits managers are supposed to do and actually do, for insulin especially, and their effect on the market?

I Googled this term but can't make of sense of your comment based on what I've read. (The definitions of pharmacy benefits managers that I found have nothing to do with what you wrote.)

Those numbers are partially generated by pricing insulin products out of reach of many people who died from not being able to afford it.

Sorry if I don't have a lot of sympathy for them.

Looks like a patent issue (every new improvement in production methods has its own patent, so the insulins for which patents have expired are lower-quality in one way or another) plus shipping costs (refrigerated bottled liquids with a shelf life <6 months).