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Comment by dave8088 | Hacker News Reader

“ Most patients with Type 1 diabetes have to monitor their blood glucose levels carefully and inject themselves with insulin at least once a day.”

Once a day lol. Tell me you don’t know anything about Type 1 diabetes without telling me you don’t know anything about type 1 diabetes.

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If you have type 1, you too can lead a normal life if you don't do any physically demanding activity, eat nothing, have no stress, do not get any common infection like the common cold, do not have any natural metabolic rate changes.. etc etc /s.

There are so many things that affect blood sugar both in the short and long run. T1D treatment is constant correcting for the past hours, not just the moment and future.

I wish it was easier to communicate this to people and journalists, because there are so many misconceptions like the one quoted here that makes T1D an even more invisible disability.

Another T1 here, fast-acting insulin wasn't invented until recently. One large dose of mixed insulin and a fixed diet may have been prescribed back in the day.

Before fast acting there was human analog, this is also somewhat short term. What was quite common for a while was the mixed insulins (the cloudy ones you would have to make sure mixed before injecting) which you took twice a day. The same could be achieved with individual doses of course. In general the very long acting insulins are highly variable and not much subscribed (as in they work between 12 and 48h, good luck if it varies a lot).

Long story short, NPH insulins for medium length (about 18h to a day but still lots of variation) was available since the 50's and was usually combined with normal human analog in either a mixture taken twice a day or in separate doses. I was on the twice a day regime of mixtard for most of the 90's.

Thank you for enlightening us, I was diagnosed around 2004. At that time, fast acting insulin was the norm. But I knew that some patients used mixed insulin.

I still know T1Ds who continue to use mixed insulin, because it works for them.

Lantus was approved in 2000. Diagnosed in early 2001, I spent maybe six months on NPH before they got me switched over. There’s also regular which is a mix of nph and fast acting, I still hear of people using that now as it works okay and is very cheap.

> Another T1 here

There are dozens of us! Dozens!

Heya! You seem knowledgeable about this. What is a normal amount?

Thanks!

One fast acting insulin per meal and one long term insulin a day, 4 at minimum if you eat 3 meals. Most of us use insulin pumps where we can get insulin any time we want.

Before being on an insulin pump, my wife would be injecting 1-2 times a day with long acting insulin (to manage background levels) and then at least 3 times a day with food - not just meals, snacks too (and if levels running high). So realistically, 8-10 times a day would not be uncommon.

That’s after 3-5 times a day finger pricks too.

Now, she just has the pain of the libre once a fortnight and pump every few days (along with finger pricks when the libre is out).

People do not realise how all consuming T1D is - she has to be on the ball all the time. If she isn’t, then her numbers screw up and she can’t drive (or live, tbh).

This project could make a huge difference to her life - but there are always 5-10 years away

At the moment open source artificial pancreas systems are way to go.

Have you checked androidaps or loopkit?

I had a look over the years - the libre can pretty unreliable with levels, so I am concerned about someone else’s life being in jeopardy if I made a mistake (would be different if it was my own - I’d have done it a long time ago)

She’s waiting for a closed loop system from her hospital - should be within the next few months (omnipod is due an upgrade). That said, I’ll check out androidaps and loop kit, thank you!

The Libre has been life changing for me, but in particular during sleep I do find that the levels can be very unreliable if you end up sleeping on the same side as where you have attached the sensor.

I have a Dexcom, and it's frequently 10-20% off of manual finger sticks. When paired with my pump (Tandem T-Slim) it keeps me in a good range, but still not perfect.

I‘m actually using the Libre + Omnipod Dash with a closed loop and it works pretty well (almost „flat“ blood sugar with a few spikes here and there) beside that’s, for me as tech nerd, cool to inject insuline with my phone :-).

Those are the pieces I‘m using on my iPhone:

https://nightscout.github.io/ -> to store historical data

https://github.com/Artificial-Pancreas/iAPS -> to connect the libre and pump and control the pump and make the close loop

I briefly used the libre 3, and found it very accurate (but was skeptical as the 2 and 1 could not even warn you about a low/we're passive) and durable. Currently on the Dexcom G7, waiting for support for either of these with my pump.

The libre3 and G7 seem to be leaps and bounds better than anything else I've used (G4, G5, Guardian 3).

I hope you two find something that works well!

> At the moment open source artificial pancreas systems are way to go.

He said confidently lol.

I won’t give up multiple daily injections (Lantus morning and night, Humalog with meals and for corrections) unless I absolutely have to. Diagnosed in 2014 at around 30 years old. Been 5.5-5.9 A1C for the past ~6 years. Maybe one scary low a year and able to keep up with my marathon running and live a semi-normal life.

No clue why I’d want to mess with that to try some hacker project.

T1D that was also diagnosed somewhat later in life (24), the convenience of having something like a tandem that can buy and large manage my levels, is really nice. I definitely still keep needles around for when I need to do a larger injection, anything over about 20 units in an hour and you're going to have leakage and at that point you need to replace the infusion site.

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