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Comment by samcday | Hacker News Reader

> Once ingested, water dissolves a disk of sugar, using a spring to release a tiny needle made up almost entirely of freeze-dried insulin. The needle is injected into the stomach — which the patient can’t feel, owing to a lack of pain receptors in the stomach. Once the injection has occurred, the needle can break down in the digestive tract.

That's some pretty impressive ingenuity. Also sounds kinda terrifying if the 1.0 has any kind of edge case that involves tearing holes in your stomach lining.

I'm not diabetic, but I still have vivid memories of sitting with my grandmother while she constantly pricked her finger to test blood sugar and jabbing insulin pens into her abdomen. It's always stuck with me as a particularly unpleasant lifestyle to have to endure. Even still, if I were a diabetic I think I'd still be waiting a year or two after the release of something like this to make sure all the kinks have been ironed out ;)

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What doctors and researchers get wrong about diabetes is that pin-pricks and injections are not even remotely bad. I don't know a single diabetic who cares about injections and blood sugar tests. You get used to that within the first week of diagnosis.

No, the unpleasant part of being diabetic is having to live every second of your life as an act of weighing how what you're currently doing is going to affect your blood sugar levels an hour for now:

- Have I been sitting in this chair too long? - Have I not been sitting down enough this morning? - Have I been drinking enough water? - Did I just drink too much water? - I haven't been to the bathroom in two hours; does this mean I'm screwed? - If I eat a piece of toast after dinner, will I be able to have sex with my wife without going hypoglycemic? - I'd like to go hiking, but it's hot outside and my insulin might spoil, so maybe I'll walk around the block instead. - I just plan on going to the grocery store for 20 minutes; do I need to bring insulin in case there's a traffic jam on the way home?

Etc., etc. Pharmaceutical companies can't solve the real lifestyle problems associated with diabetes short of inventing an actual cure.

T1 here. This is a perfect summary. I received my Dexcom G6 yesterday. If you dont have a CGM and insulin pump, I highly recommend both.

One thing I'm worried about WRT switching to a pump is the impact of heat on insulin. I can't have a Humalog pen exposed to 80+ degree heat for more than a few minutes without it losing efficacy. I live in Texas. What will stop the summer heat from cooking all the insulin in my pump's reservoir while I'm walking down the street?

Do you have any thoughts on this? I'd love to have more flexibility.

Our 7 year old lays on top of his pump regularly when he sleeps and despite it making the entire pump way hotter than 80 degrees, it’s never caused any efficacy issues. He’s played soccer for 3+ hours in the 95+ degree heat (4 days in a row), no problems with the insulin on board.

From the context of your message, I think I correctly understood you to mean you have had no problems with the insulin that is in the insulin pump's infusion set reservoir?

Trying to help and I don't want to come off as rude, so please forgive me in advance. The term "insulin on board" has a very specific meaning and it refers to the fast acting insulin that is currently in one's body and still active.

So let us say you are using fast-acting insulin, like Humalog, and it stays active in your body for 2.5 hours.

You take 3 units of insulin at Noon

1 hour later you take another 3 units of insulin

1 hour later you take another 4 units of insulin

At 2:00 you have 10 units of insulin on board

At 2:30 you have 7 units of insulin on board

At 4:30 you no longer have any insulin on board

You're right - I'm sorry, I shouldn't have been so careless with my words. What I meant was, we've never had a problem with the insulin in his pump's cartridge/reservoir even in 90+ degree heat for 3+ hours with him running and sweating.

Insulin efficacy isn't really an issue until you are about 90+ F, anything below 90 and it will take long enough to breakdown the proteins that you would already be due to swap your infusion set (every 3 to 4 days). But being in Texas, you might exceed 90F at which point, yeah it could go bad really fast. Not a big deal though, just get a cooling wallet for your pump; FRIO seems to be the popular choice https://www.frioinsulincoolingcase.com/frio-pump-wallet.html

Thanks for the pointer. I have a FRIO, and love it. I wasn't aware that they made FRIOs for pumps.

I use the Tandem t:slim X2 pump in conjunction with the Dexcom G6 continuous glucose monitor. The one thing I hate about the pump is that it's always clipped on or in a pocket. Literally, I'm always plugged into this thing. So that part does suck, but otherwise it's just a lot better than manual injections.

It keeps track of my insulin on board so I don't have to worry about stacking and getting a low nearly as much. It's programmed with my carb ratios so I just type in the carbs and it doses accordingly, it will even take your current BG into consideration and increase/lower the insulin dosage to help get you at target BG.

With manual injections, you have to give 1 full unit of insulin; the pump can give doses as small as .04 units of insulin so the dosing is much more precise. You are no longer saying, "Well should I round up or down..."

The pump has a closed loop with the CGM, so the pump knows if my blood sugar is going to be low BEFORE I'M LOW. So it just automatically quits giving insulin to help prevent the low before it ever happens.

Honestly, it's pretty amazing to me how far these things have come from just 10 years ago.

Agreed with the other user's assessment of pumps. I've had T1D since 1990; been wearing a pump since 2004. My A1C has averaged 6.3 since 2000 (so I was in control before I started on the pump) - and I lived in Los Angeles from 2000 to 2008 (so I've dealt with the heat).

Personally, I've rarely had an issue with the heat affecting my pump's reservoir - except when I would go skydiving up in the Mojave desert, where temps would reach north of 110 degrees F. Would simply pack it in a bag with a cool pack when I was outdoors, then put it back on once I got to the ground and was back inside.

Since I was in good control, my biggest reason for transitioning to the pump was convenience. I was up to taking 7 injections a day (when I was working from home and couldn't resist the urge to snack). Once I made the switch, I was amazed at the convenience - I could eat almost anything and take the insulin to cover it (of course, moderation is the key here - and knowing how quickly and persistently some foods elevate your blood sugar. For instance, I'd much rather have a snickers bar than Chinese food. The high fat content and the rice carbs wreak havoc on my BG).

Point being, it's well worth looking into it, if you have the means and the desire.

I've been on a Medtronic pump since making the switch, but will likely be jumping over to a Dexcom CGM and compatible pump once my latest pump warranty is up. (I've stopped using the Medtronic CGM due to some hassles with calibration issues; the Dexcom is supposedly more reliable overall).

Regardless, good luck!

Yeah; it's really too bad that the Medtronic CGM is not better. I think Medtronic's pump is slightly ahead of the Tandem pump today on the closed loop, but I'm hoping Tandem catches up this summer if they get their new predictive algorithm approved for automating correction dosing for high BG.

Grats on the Dexcom. It's a game changer. I don't use a pump myself for a variety of reasons (chiefly, my current routine is working well, no reason to change it), but I dearly miss the Dexcom when I have to go without for some reason.

My friend is T1 and uses a Dexcom as well, it seems like a way better solution. He recently got a diabetic alert dog too which seemed to give him a lot more piece of mind, although I realize that's a pretty expensive route and not for everyone.

> I don't know a single diabetic who cares about injections and blood sugar tests.

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.

Have you tried alternative test site meters? I test on my forearm and it doesn't hurt and mostly takes a couple of quick lanceting. I use Freestyle lite test meter with a multiclix lancet. No finger damage, no mess, just have to have forearms visible. Easier for your wife to do too since lancet placement is trivial (anywhere on forearms). Hope the CGM works for you ofc

I have a strong aversion to needles but I’ve been a type 1 diabetic for many years. I use an older Medtronic pump and want to move to a CGM soon

My checks take about 5-10 seconds but I can see where after a while it can make you hesitant.

Have you tried using the intermediate segments of the finger instead of the fingertips? It makes a big difference for me in pain perception. Drawing blood is a bit harder sometimes but I still prefer that over having to prick the sensitive tips. (Not that I fret over it. Luckily I lost that within a week of doing regular measurements.)

Hospital staff is surprised when they see where I draw blood but so far none told me to change it. I still let them prick the fingertips so they don't have to change their routine.

The suggestion in the manual of the lancet I used was to use the fingers on the less dexterous hand. It seems logical (but may not actually be correct) that you have more precise/sensitive feeling in the dominant pair.

...more sinister hand

The paw further down south.

I used to alternate hands, but I dislike pricking my tips on either hand. Using the other two segments of the finger doubles the amount of available segments so now I only prick the right hand, as I'm somewhat left-handed.

And as we're deep into the nitty-gritty: My device (Accucheck Mobile) shows the count of remaining strips when turning it on. If I take modulo 8 of that number I always know which segment to use, so I automatically distribute wear. Except that the cartridges start at 50, which means my index finger gets more pricks. I should really lobby Accucheck to make a cartridge with 56 checks! :-)

I was on a CGM (Dexcom) for about 3 months until my new insurance would not cover it. Even though it's convenient, it comes with its own set of problems - having to restock every month (with copays) got tiring and somewhat expensive compared to strips. I also had false low reads a number of times. And the amount of wasted plastic (the applicator gun) is concerning if you are environmentally conscious.

As for lancets, you might want to try the AccuCheck fastclix. It's a pen shape device with a cartridge that holds 6 lancets. One cartridge can last me a couple months as I tend to use the same lancet 10 or more times (I know, probably not recommended). It's also the most painless lancet I've ever used and it's easy to carry around.

I second the AccuCheck fastclix. The needles are silicon coated so they don't tear tissues -- so very little pain. I hated using the other brands of lancets. The needles are encased in a cartridge, so you can throw them away in a trash can and don't have to worry about anyone getting a stick or punching through a trash bag.

I third the FastClix. My biggest problem is that they charge about 10x the cost of the cheap lancets. I also reuse them to keep the cost down.

I had one of those for a while, and it does say you should only use each lancet once. Realistically, I don't know if there are any real risks to reusing them though?

I have been mostly reusing (up to a point) both the lancets and insulin pen needles. I don't go overboard, i.e .weeks, but ... how much contamination is possible? well... i never reused syringes, however. The idea of doing that makes me wary.

I reuse them until it becomes mildly discomforting at which time I know the lancet has dulled. Of course AccuChek prefers that you use it once;)

> I tend to use the same lancet 10 or more times (I know, probably not recommended)

I'm not a diabetic or anything else that needs to use needles regularly, so I can only vaguely imagine the economic downsides of only using a needle once. Especially when your insurance doesn't cover them.

But this picture kind of freaked me out and would me make think twice: https://i.imgur.com/Sh8lteI.jpg

It shows microscope pictures of a needle after 0, 1, 2 and 6 reuses.

Thank you for that. I re-use them myself - I justified it as a harm-reduction technique because I test and inject myself more regularly then. This will make me take the extra effort.

If you were on the G5, you might want to look at the G6 if/when your insurance begins to cover it. I've had both, anf the G6 seems much more accurate. Plus, you never need to poke yourself to calibrate it (I still do sometimes, but you don't _need_ to)

Blush. I hardly ever change my lancet. Maybe every other month (about 100 sticks per month).

I'm using Freestyle 14 day and yea the waste for each sensor is pretty amazing. For a tiny sensor the size of a fat nickel I end up with a box of waste that's huge. Reminds of Amazon shipping. 8-)

I've been pretty happy with the accuracy compared to blood sticks - within 10% so far for each reading.

I also have a needle aversion. A couple things that helped me.

1) Playing the guitar helped me build calluses big enough that I can't feel my finger tips anymore on my left hand.

2) I like to put an ice cube on the skin about an inch away from where I give himself a shot in my stomach. For me my brain really focused on the cold sensation from the ice and I notice the needle much less. It's nice too because the ice melts a little and I can use that water on the skin to wipe away any blood that drip out after the injection.

Have you talked with a mental health professional about your anxiety? They may be able to help you with techniques to reduce it.

Yeah, I've done a good bit of therapy (which I never found effective) and I'm on a cocktail of meds (which are remarkably effective, but they can only do so much). Anxiety's effect on my life has been drastically reduced over the years, but there are some areas where it's still quite bad; this is one of them.

Are you aware of monitors like this https://www.freestylelibre.us/? A friend of mine has it and is really happy about it.

I used Freestyle for awhile and was mostly happy, but then had to deal with a series of them that were so inaccurate, it was a waste of money despite the replacements. The less than ideal accuracy was a bit concerning, but for understanding larger general trends, it was good.

Just so you know, those days there are ways to monitor glucose levels without finger pricking, google: glucose monitor without needle.

source:RN

Most (maybe all?) CGMs need to be calibrated regularly with finger pricks. In fact in the case of both the Dexcom G5 (haven't known anyone on the G6) and Medtronic Guardian sensors they can occasionally sort of derp out and ask for multiple calibrations in a row for utterly mysterious reasons. I just asked and my partner says the most times she has had to test to get a Guardian sensor back to normal was seven times in two hours.

Of course this is anecdotal, but the point is that your mileage may vary.

Freestyle Libre isn't strictly a CGM, but it doesn't need calibration.

Dexcom 6 doesn't need to be calibrated anymore. Well, it still needs the first calibration when you insert it, but none other than that. Lasts for some 2-3 weeks before sensor needs replacing.

The Dexcom G6 system does not require any calibration, insertion is remarkably pain-free, and it lasts for 10 days. I've had it for a few months (after a couple of years of using the G5 system) and I can't imagine living without it.

Yeah I like it too, but it still asks me for the 2 calibrations right after insertion.

To be fair, that could be just xDrip+ that wants calibrations.

Apparently there's a problem with the Guardian transmitter that causes the multiple calibration requests. Minimed is taking orders for free replacements: https://info.medtronicdiabetes.com/bgcheck

I switched to the Dexcom G6 though. It's amazing. I'm using it with open source closed loop pump software for iOS called Loop. There's also a Linux based solution called OpenAPS.

Why do diabetics use one of the most sensitive parts of the human body for blood testing? Why not prick your forearm, or your leg, or anywhere else?

Apparently there are accuracy problems when testing other sites (though they can be used).

> "The downside to using alternative test sites is that the readings may not be as accurate under certain circumstances. In particular, if blood glucose levels are changing rapidly — as would be expected after a meal, after an insulin injection, or during exercise — there may be a significant difference in the blood glucose level measured in a fingertip sample and in an alternative site sample. Therefore, using a fingertip sample is recommended if you are monitoring at these times."

(source: https://www.diabetesselfmanagement.com/managing-diabetes/blo...)

Better source, WebMD:

> "When the amount of sugar in the blood was rising or dropping rapidly, only the finger prick testing accurately caught these rapid changes. It took about 30 minutes for the forearm values to catch up to those reported by the finger prick tests."

(https://www.webmd.com/diabetes/news/20010709/accurate-blood-...)

Latency

CGMs are great for this.

Also, try a Freestyle Libre. It’s closer in behaviour to a finger prick but still gives the trend info.

A few responses have brought up alternate site testing. Have you tried the palm of your hand? The bottom of 1/4 of your palm, below the pinky. It was life-changing for me. Rarely painful (at worst a sting if my palm is sweaty or my skin is dried out), as accurate as a finger prick, and it bleeds as easily as my fingers. I had the same anxiety for years, and now it’s like nothing. You need a special cap (usually clear) for your lancet device. Sometimes it’s included, sometimes you have to call and ask for one.

Although I'm type 2 I just starting use a CGM (Lifestyle 14 day) and it's a revolution in data collection for me. I had no issue with finger sticks but you miss a lot of data. Now I get a full and complete set of blood sugar reading for a full 8 hours even if I don't scan the sensor.

It's really helping me decide how much medication I need and when it's most effective. And it's not economically difficult - if I finger stick 3 times a day then I need about 100 strips which costs me about $30. 2 14 day sensors covers a month which cost about $15 (insurance) and since I can read it with my iPhone the actual meter is optional.

I find the sensors read within 10% of a blood stick which is perfectly fine for me. I don't know if that's acceptable to Type I.

Nicely FreeStyle has an online website to access the data from the sensors and it has full download capabilities of the raw data so one can do all kinds of stuff with it.

Yeah. I've been T1D since I was 13 (now 30) and I can't even imagine what it's like to live without it. It's literally a constant thread in my mind, every waking moment, and a few times a week while I sleep. I carry glucose tablets and a few granola bars on me, and you're right about carrying insulin. Am I likely to eat on this trip, or can I leave it at home so it doesn't spoil?

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.

Also a T1D here. I once had my test meter go bad on an international trip; by the time I realized it wasn't working I was on a deserted island that was an about a 4-hour boat ride away from the nearest pharmacy, which was closed.

Talk about stress levels going through the roof!

> Talk about stress levels going through the roof!

(Which, of course, is EXACTLY what you want to have happen when you have no way of monitoring your BG.) Yikes!

LOL, yeah. Looking back on it now, five years later, it's a bit humorous. I went and found the resort manager and explained the whole situation to her. She didn't know anything about diabetes, so she really wasn't understanding how severe the situation was.

Resort Manager - "Won't you be ok for a week until the boat makes a trip back to the mainland for supplies?"

Me - "No, I'll be dead before then."

Resort Manager - "Is it really that serious? Do you know how much it will cost? It's really going to cost a lot of money; you will have to pay for the gas, the boat crew, and the pharmacy isn't even open on Saturdays. This is really going to cost a LOT of money."

Me - "I don't care how much it costs. I'm a dead man without it. Go wake up the boat crew and call the emergency line for the pharmacy and have someone come in."

From what I've seen with friends, CGMs seemed to be a pretty big lifestyle improvement through technology.

"What doctors and researchers get wrong about diabetes is that pin-pricks and injections are not even remotely bad. I don't know a single diabetic who cares about injections and blood sugar tests. You get used to that within the first week of diagnosis."

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

I’m Type 1 and I agree with him. Injections are not a problem worth solving for me. It’s the constant mental grind of tight-rope walking blood sugar through balancing food, insulin, exercise, and random body events (that you never quite figure out) that is the problem.

Blood sugar testing is an annoyance, but the main problem is not the actual test, but the inadequacy if testing your sugars a few times a day as a method of control. There we do have solutions coming out; the latest generation of continuous blood glucose monitors are life-changingly good.

I've been using Dexcom now for two years, and it finally helped me to really understand certain weird things about my blood glucose, after having a type1 diabetes over 20 years.

a) The morning peak is a dawn phenomenon. Solved with a higher basal setting 3 hours before waking up.

b) Going to sleep with a 100 mg/dl and waking up in the middle of the night with a glucose of 300 mg/dl? Usually because eating fatty and heavy food for dinner. Depending on your meal, a 150% temporary basal or if looping, letting the oref1 super multi bolus to take care of it.

c) Having a cold and suddenly there is no way to keep your glucose levels down? I use AndroidAPS's profile multipliers here. Last time I was sick I set the multiplier to 160%, which means more basal, more insulin for carbs and correction.

d) Doing sports? Get the insulin on board settings right in AndroidAPS, and try to do exercise only when the IoB is back to the base level. Use 0% TBR if needed.

And still I have an alarm almost every night for a hypo/hyper. Soon closing my loop and letting the automation take care of the nightly surprises. It used to work great with my Accu-Chek Combo pump until the pump broke. Now hopefully getting a Dana RS soon, so I can automate lots of things for the software to take care of.

I’ve been using Dexcom for about 6 months, and it’s taught me that the situation was utterly hopeless without it. I’ve figured out a few patterns like the huge nighttime sugar spike with fatty dinners, but overall I have unpredictable reactions to food and even moderate activity. Like you, I have usually spikes in the morning without eating, but sometimes dips.

The CGM has allowed me to be more like a reaction machine. Going up? Injection. Heading close to to low? A few sips of juice. I can be more aggressive with my dosing know I can see those lows coming. It’s a huge cognitive load off, and has taking my control from poor to excellent.

But yeah, those night time alarms, huh? I’ll close the loop when it’s all done with my phone.

Oh yeah. More than two beers in the evening: hypos in the morning, either 4am or sometimes when I woke up around noon.

Also instead of taking sugar when going low, try using a system that counts your basal rates to the IoB. Then after a meal you start going down a bit too early, you turn the TBR to 0%. Loop or AndroidAPS helps with this a lot.

Yes, and many of them have failed. Pfizer's inhaled insulin was a flop and MannKind's isn't doing well. They were positioned as "no more needles!" and what they realized is that it's not enough to get people to switch.

I think people who don't need to inject don't realize how benign it really is: I'm not diabetic, but I did need to give myself 3/daily subcut injections (same style as insulin) for a month after an injury. It was absolute agony for the first week or so; often I'd need to psyche myself up for a good 15 minutes before injecting. But by the end of the process it was a 15 second endeavor that I didn't mind in the slightest.

Insulin is pretty temperature stable these days: http://link.springer.com/content/pdf/10.1007%2FBF00277482.pd...

I am type 1.5 and disagree with both parts of your post. While learning to use them routinely only takes a few days, needles and lancets do bother people for anxiety reasons, but also for physiological reasons. Lancet areas develop callouses, can have blood flow issues and in more advanced stages of diabetics can risk infections/damage. Injection sites go bad over time or appear to; right now I am dealing with an issue where I think some of my preferred injection sites are becoming less effective, but I can’t really tell, which is preoccupying. I don’t think research into alleviating the need to use needles and lancets is getting anything wrong just because it solves a need not every diabetic has.

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.

teaching other diabetics to be so preoccupied is dangerous to them because it increases the temptation to give up on the daily routines

^^ Sorry, this makes no sense at all. Maintaining a routine is one way to express a preoccupation with diabetes management!

I mean: there are a few things you need to do each day to manage diabetes. These are important. What you don’t need to do is worry about it between those times. If you convince someone they need to do too much to manage the disease, they’re more likely to give up on the whole thing.

More likely, as measured how? How do you know this? Spending more time thinking about my condition is a great way to improve blood glucose control, at least in my experience.

Of course. I spend plenty of time thinking about diabetes and I stay involved in the data measuring communities (Nightscout, Spike, etc.) I enjoy knowing what’s going on with my body and I try to get like-minded diabetics to look into that. I also help people figure out how to get a CGM prescription and sell them on it by loaning mine out for a few weeks (and just that much data eases worry once they see their actual operating parameters. It’s worth my going without for a bit.)

I know this because I know diabetics who have lapsed out of control, or retreated into a rather small life, because they felt the excessive personal rules they’d either self-imposed or been taught by others were burdensome. When possible, teaching them a lighter set of principles to follow has had a positive effect.

"Hypoglycemia has the advantage of being treated with glucose tablets, which don’t spoil and can be stashed everywhere."

Umm... glucose tablets do in fact spoil. I've never seen an unopened bottle spoil, but once they are opened they can spoil over time mostly from the humidity. I found this out the hard way.

Sure, I replace them periodically. They don’t spoil quickly, though, in the sense that insulin spoils just from being outside too long. You don’t have to curtail your physical activity to avoid hypoglycemia because glucose is portable and durable.

"You don’t have to curtail your physical activity to avoid hypoglycemia because glucose is portable and durable."

Between this and your "humble-brag" on your other post, what I'm led to believe is that you're pretty ignorant on how variable insulin sensitivity and blood sugar management is from individual to individual.

I've maintained an A1C of less than 6.5 for more than a decade so I'm the picture of "perfect" control and I can tell you that physical activity is a pain in the ass. I'm hypersensitive to insulin during physical activity. When I go to the gym I want zero insulin on board because just 10 minutes on the treadmill could drop me from 160+ to 30. Just walking is enough to cause me to have low blood sugars, so I have to reduce or skip insulin with food accordingly. I'm required to elevate my blood sugar to 200 before I can scuba dive and then I can still only dive for a maximum of an hour because there is too much risk I will pass out and drown.

And then you say, "I am dealing with an issue where I think some of my preferred injection sites are becoming less effective". Preferred injection site? WTF dude? Of course it is becoming less effective, that is why they tell you to constantly change the location. Preferred injection sites are a huge no-no.

Yes, I deal with all that besides Scuba diving (interesting!) These routines around everyday exercise are not constant worries as represented in the earlier post. After exercising a few dozen/hundred times you know what to expect and don’t need to think about what to do. I will say that inconsistently performed intense exercise can be challenging; a regular exercise schedule is less effort to manage for diabetics.

I rotate injection spots but have favorites based on convenience, sensation, etc. like anyone else. The variation in effectiveness I’m seeing is small enough that I’m not sure what’s happening yet. It’s not really a big deal because my numbers are fine.

It’s not a disease that varies so much from individual to individual that lessons can’t be learned and shared, and it’s a disservice to misrepresent the mental effort to new diabetics and people potentially lapsing into poor control.

I'm like you when I do any activity having insulin on board. I'm a T1 using a pump, and I really like the combination of a pump and CGM for staying away from surprises. I use AndroidAPS to monitor my glucose and insulin on board, taking a temporary basal setting of 0% if needed before any activity, so my insulin on board drops to the base level or a bit below.

Soon the insurance replaces my pump to a Dana RS, which supports closed looping with AndroidAPS. Then it's just setting a temporary glucose target to a higher value and the system takes care of the basal rates to keep the glucose from dropping.

The article here is kind of weird. How am I supposed to dose e.g. 0.3 units or 0.75 units of insulin with the pills? The ability for a very fine granularity and the possibility to automate my medication are much more interesting compared to the pills mentioned in the article.

You are spot on.

The temporary reduction or even suspension of insulin depending on my activity are key in preventing lows for me.

The closed loop pumps are the biggest improvement I've seen for living with T1. There's always lots of promises, but this is one of the few things that really improves my life on a day to day basis and it just keeps getting better.

Right now it seems there is official support only to prevent hypos, but not to give you more insulin at night when you ate something too heavy and didn't guess the right TBR.

Only the open source AndroidAPS for Android and Loop for iOS do this. And then you have a very limited set of pumps you can use.

The Medtronic 670g is the only pump that currently will automatically correct highs, but it only works with the Medtronic CGM which is untrustworthy.

The Tandem t slim x2 only has support for hypo prevention today, but it supports at home firmware/software updates and they are pretty far along with the FDA on getting approvals for their auto dosing for highs. They anticipate a release this summer.

I wish that OmniPod was further along on this front. I would love to have a tubeless solution and the convenience of not needing to disconnect every time I'm going to get in the water, but the trade-off just isn't worth it IMHO.

If you can to get the right pump, I highly recommend compiling one of these apps. Just wipes out all the competition from the commercial axis, truly life changing apps if you learn how to use them.

https://github.com/MilosKozak/AndroidAPS/

https://github.com/LoopKit/Loop

These open source projects, written by people who actually have Type 1 are light years ahead of doing what I want a closed loop system to actually do. The medtronic 670 is so unusable. I can't say enough good things about OpenAPS AAPS (android) and Loop(iphone). For those living in the US, we are forced to use a very old medtronic pump because it's the only way with a programatic means to control the pump's basal and bolus actions.

OmniPod support is coming to AndroidAPS. Development has already started.

https://androidaps.readthedocs.io/en/latest/EN/Getting-Start...

Yeah, I noticed that. I went and took a look to see how the project was coming along after you reminded me of it.

I would be seriously interested in a closed loop Omnipod, but it will be awhile before I’m eligible for a new pump under insurance.

I was kind of "lucky" Animas went bankrupt and they will take all the pumps back paying money for the insurance, so I get a new Dana RS earlier in a couple of months.

I’m not diabetic but just reading your comment is making me feel queasy and on edge.

I just stopped caring and accept that I have to die sometime. I have good A1C control, test regularly, and am very physically active. But thinking about it constantly just drives me nuts so I go about my life and if it's what kills me, so be it. And if in the (hopefully far) future my physical health is compromised to the point that I don't want to deal with it anymore, I'm at peace with that, too.

Don't feel required to answer, but I'm curious, does that mean you just run high (>150mg/dL) all the time? I find being low (<70mg/dL) or high makes me feel physically poor, and keeping in that narrow range is what I mean when I say it takes constant attention.

No. I rarely go over 150-160. I'm usually around 100 on waking and am between 70-140 for 90+% of the day. Most common lows are during/after a long run or when I overcorrect for a high.

Me and my wife are T1D since childhood. I have started with reusable glass syringe with bovine insulin then Insulin pen and recently switched to pump. Living in developing county and having diabetes is nightmare. Constant mood changes due to sugar imbalance and highly chaotic environment of developing county make the things more difficult. People and even doctors are not able to understand about this decease related situations. Since last 5 years, we are not able to decide whether we should have baby or not.

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.

> I don't know a single diabetic who cares about injections and blood sugar tests. You get used to that within the first week of diagnosis.

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

This seems like the perfect job for a machine. Is there a reason CGMs and insulin pumps aren't more common? Cost?

Cost seems to be the major factor. I believe the NHS doesn’t supply them for this reason. That said, CGMs cost about £150 a month. Worth sacrificing just about any optional expense for I would say.

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.

By happenstance I have spent about half of my life living with people with T1D and this post echos pretty much exactly what I have heard over the past decade or two.

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.

Type 1 for 30ish years... I wish there was some way to move this comment to the top of this thread. You pretty much hit the nail on the head. Yeah, injections suck, but the real sinister issue is the constant attention it requires, and if you don't pay attention, you can get in trouble (hospital, death) real fast. Longer term, lose limbs, eyesight, etc.

Ditto for me. I don't mind the insulin pens or the blood tests - it is the constant monitoring / science experiment aspect of all this that is exhausting. Even if I had a phone app that graphed my levels for the past 24 hours, counted carbs for me, and calculated insulin doses, I'd still find it all irritating and would slack off on the 24 hr a day 'mindfulness' it takes.

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.

As an aside, you ever see those 'Cash for Strips' signs on the side of the road[0]?

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...

Completely agree.

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.

Once ingested, water dissolves a disk of sugar, using a spring to release a tiny needle made up almost entirely of freeze-dried insulin. The needle is injected into the stomach — which the patient can’t feel, owing to a lack of pain receptors in the stomach. Once the injection has occurred, the needle can break down in the digestive tract.

With the right compound in the needle, thst sounds like an incredible way to assassinate someone without leaving any traces which are unlikely to be found. The combination of a tiny needle mark on the inside of the stomach, a lack of dissolved pills in the gut, and a likely delay between administration and onset of effects, it’s sort of perfect.

Sorry, I don't think so. Getting someone to swallow a pill sounds strictly harder then getting them to swallow a liquid.

It’s a sugar pill, if the target eats candy or takes any other pill it would be doable. It would also be easy to slip into food. Liquid is easier, but will leave unavoidable forensic evidence. If making something look like natural causes even under extreme scrutiny is the goal, this is a hell of a way to do it.

How often do you swallow candy without chewing?

Yeah... that’s a good point. Candy is probably out, but with the number of supplements and pills people take, that’s probably easier. Then of course you have the challenge of accessing them at some point, but no one said that attempting an assassination like this would be easy. More of a problem would be that if it didn’t work, and was discovered, it would be very clear that a government or similarly powerful organization was involved.

So good for secrecy, bad for deniability. All told, strangling someone and making it look like a suicide, or “helping” someone make a jump is probably still simpler and safer.

>> With the right compound in the needle, thst sounds like an incredible way to assassinate someone without leaving any traces which are unlikely to be found.

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.

I don't think that myth would work out although it is a common one. Namely it would show up on a tox screen in some way presumably. Since that is usually how poisonings are found - granted they would need to do an autopsy in the first place.

The interesting thing that isn’t usually an issue with tox screens is the they are limited. You can search whole classes or drugs, but ultimately a truly novel poison would be detectable in principle, but likely to go unnoticed. Now for you and me that’s enough, because we have the resources of individuals, but a large lab and especially a government can afford to engineer toxins that are not tested yet.

Having said that, such a toxin that could also be frozen and the resulting “dart” being strong enough to survive being fired into someone, is not perfect. Like the poison umbrella, you’d expect traces of toxin to be found around the wound, and even small wounds become evident under ALS.

What is ALS? I'm presuming you don't mean amyotrophic lateral sclerosis.

Sorry about that, you’re right too, it’s Alternate Light Source.

Perhaps this is a "peace dividend" of a military project, much like the Hubble Telescope.

Seems like a very complicated and expensive way of administering poison.

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.

I test my insulin willingly with no diabetes. One hard squat hurts way more Than either of those activities. I have actually teared up from hard lifts. Needles are just a nuisance. The real downside to beetus is having to think about it constantly, IMO. (And managing it for kids, who don’t have perspective on blood/needles)

> The real downside to beetus is having to think about it constantly, IMO

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.

~meditation or similar mental massaging seems to be key at one point. Avoiding the damages of constant stress is important.

Do you mean you test your blood glucose levels, or are you really testing your insulin levels somehow? (I don't know if that's a thing?)

Yeah, sorry, blood glucose.

Yikes! Just a quick follow up to my original comment... After reading a lot of the replies I realized I have never actually given serious thought to what it would be like to have diabetes. Sure I shared my little anecdote, but I’m currently a reasonably healthy (read: lucky) person who doesn’t have to grapple with any illnesses.

Given that, it was quite improper for me to share my thoughts about how I would respond to an interesting development in medicine like this. So, thanks to all the thoughtful replies to the parent, they were very eye opening.

I can't help but smile at the idea of using sugar to deliver insulin

Less painful but it's hard to see how this would be as reliable as a standard dermal injection. Pumps definitely have reliability issues but they tend to alert in most cases.

I'd have hoped for needle-less operations (lack of pain is not the best of arguments).

That said when MEMS meets medicine there could be a vast change.

"...and you don't have to prick your fingers anymore!"

(Sorry, if you don't get this reference please ignore.)

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