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Comment by arka2147483647 | Hacker News Reader

I have had Type 1 for 30 years.

To be honest, i don't do the math. I choose the amount of units to inject by feel. I mean, i know by eating a banana, i get something like 20g of carbohydrates, and i should take 3u. But if i feel, that the correct dose is 6 units, then i take that.

I cant really explain it. But i kind of feel the state, where i am going, and can adjust instinctively. Works more often than not. I have never passed out.

Edit:

I measure blood sugar A LOT, though.

Most important things are what i think as the Morning Gate, and the Night Gate.

For Night, must have blood sugar under 10mmol/l. Preferably without pending effects such as food or recent injection. If i get that right, the night blood sugar is steady.

In the morning, must account for the morning blood sugar raise phenomenon.

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I'm at 10 years, and this is basically how I do it as well. The math just doesn't work, because there are too many factors at play, most of which you don't even know about, and can't plug into a simple equation. You might have the exact same meal and the exact same insulin dosage on two different days, and go low on one and high on the other.

You eventually gain an instinct for it. Doesn't always work, but for me it works better than the formulas...

> I measure blood sugar A LOT, though.

That is the most important part, you can really live a good life if you have that. I hope we get more powerfull and cheap way to do that continously. At the momemnt it's at least 300 USD a month for a CGM device that can measure every five minutes. It's abit like monitoring traffic load and adding more servers as you go, except too many servers kill you.

That with knowing how you react to changes in life works wonders, e.g. exercise, eating fat foods, sitting all day.

> It's abit like monitoring traffic load and adding more servers as you go, except too many servers kill you.

Not even just that, but with fairly primitive monitoring tools. The built-in stuff for Dexcom can only alert on highs or lows, not on things like the rate of change, which would be much more useful IMHO.

The Dexcom G6 is capable of alerts for rate of change, but it's about what the rate was, not what it will be. It still can be helpful.

(When looking at the app, there are "trend arrows," also, but they unfortunately are misleading in some situations. Often looking at the data points can give you a sense of your situation, though.)

TIL that this must be in the main app somewhere, but not Follow. (and yeah, the arrows are all over the place, sometimes different between Follow and the main app... the data points is the best, for sure.)

There are open source apps such as xdrip that can alert on a trend change, and androidaps that turns off insulin delivery way before you get to a hypo.

The official one from Dexcom is not very good.

Yeah, if you're technical, there's options. But if you're not, it can be harder.

Well, I have had the incredible luxury of being born in Finland, so state/municipality pays everything. Insulin, Glucose-test-supplies, Doctors. I truly fell sad when i hear what US based persons have to go through. Though, i suppose i pay it in taxes :)

About devices.. The first Glucose-test-device (what are they even called in english) took 5min to process the results. Current one is 5sec. A massive improvement in both speed and accuracy in these things.

I hope a good non-invasive device is developed, though i'm not sure it is essential, for me anyways.

I'm not diabetic, but I tried a FreeStyle Libre 2 continuous glucose monitor to measure my blood sugar, and I think it's basically what you are asking for. Tap your phone on a patch on your arm to get a instant view of your blood sugar, plus see the previous 8 hours. It is pricey though.

My understanding is that all current devices like this use a thin sensor "fiber" that is inserted under the skin, which is then connected to the coms-unit, which is in the sticker which remains on top of the skin. So they are still somewhat invasive.

And also annoying if your body really doesn't like them since they clog up after at most a day with me... (I've used them a few time since they were the size of bread boxes with long wires and the results after about a day always become erradic and unpredictable)

It is expensive, but testing with strips >5x a day can easily end up costing more. When I was on strips I usually needed at least that to have anywhere near decent control.

300 USD? That is incredibly expensive! In Germany, the general public can order a Libre 2/3 from their website for 60 EUR. That's 150 USD per month (assuming 26 devices per year). Though that's a purely theoretical price: As with insulin, the mandatory health insurance seems to pay for it anyway.

Even with import taxes/tariffs applied, I could imagine a vacation to Europe being massively subsidized by just bringing back one or two years of GCM supplies (obviously Vimes theory of socioeconomic unfairness[1] applies).

[1] https://www.goodreads.com/quotes/72745-the-reason-that-the-r...

In Germany a Dexcom G6 sensor is 80€ per 10 days. A transmitter about 400€ per 90 days. TK pays for all of this if you can show nightly hypos and jumpy glucose values, which should be easy for any T1d...

Dexcom is the only one accurate enough to use with SMB looping. And the only one in germany that sends the glucose numbers to your phone with BLE. Libre 2 can be hacked to do the same though.

Hm, possibly? I mean, I luckily don't have diabetes and know the Libre 2 only second-hand (my Dad uses it to monitor his non-T1d). So I am not too familiar with the details, hence first of all thanks for the clarification of what that device can or much rather can not do.

However, I was under the impression that the GP [emj] was "only" considering good monitoring to improve their decision about insulin application. Not a closed loop system. But yeah, if they meant a closed loop and if the Dexcom is the cheapest option here, then the 300 US$/month is actually cheaper than the 380 US$/month you outlined.

> honest, i don't do the math

Also 30 years here. I have exactly the same thing as you describe though when I switch insulin I do start calculating again to be sure it matches with my assumptions. Blood glucose measuring is required though as you mention. I'm one of the lucky ones with very lineair and predictable response to every unit more or less of insulin. Not everyone is that lucky though.

There are some pros and cons to managing T1D but not being the person actually managing it. The main con is that I have no idea how he is feeling, which makes us very numbers obsessed, hence the post :)

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