Comment by pimeys | Hacker News Reader

Comment by pimeys | Hacker News Reader

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I've had Diabetes since I was eleven years old. For the last seventeen years. To be in good health, every day I have to:

* Measure my blood sugar at least six times a day

* Take at least six shots of insulin

* Always think what I eat. How many grams of carbohydrates is in the stuff I put into my mouth.

* I have to be very careful with alcohol. I've once woken up by an emergency crew while having a hangover. Never again. (Weed is much better though.)

* I have lots of small annoyances which require medical care every now and then.

* Influenza is a catastrophe - it will take ages and my blood glucose is not going normal easily.

Try to forget any of these, and bam your general health is at risk. It's not so easy all the time to be fully with your body and take care of yourself.

What I would love is a bloodless way of measuring my glucose, a way to get the results to my iPhone and a way to calculate the amount of carbohydrates I have in front of me. No, a database of different foods is not enough. I have to do it 4-5 times a day, remember.

When you have to do something many times a day for the rest of your life, it should be as easy as possible.

Have you thought about a pump (no shots, more accuracy) and a DexCom CGM (only finger stick a few times a day, pretty accurate). I complain in the post but I will say this, of you're serious about staying alive, you MUST get an Insulin Pump.

MD here: (disclaimer - I'm A doctor, but not YOUR doctor, so ask YOUR doctor). Seriously consider a pump. Seriously.

A pump does not remove the need for shots and as for the accuracy, well that is up for debate. You still have to learn the bias of the readings it generates versus the manual test. It is a lifestyle change from shots, you will be moving the point of insertion quite a bit and some sports may be better served with a shot regimen.

There is one nice feature of having a pump, with an always attached device you can get warnings when your asleep which can save your life. Many of these devices will either beep or vibrate or both when you enter a danger range. Even if it does not alert you it could alert whomever your sleeping with; even pets will take notice and possibly wake ya.

Last note, most insurance plans expect the pump to be replaced after a couple of years so find out up front how many years before you should expect to replace it.

I've always thought the pump is not for me. It seems to be pretty big and you always have to carry around it with you. My life is still pretty fast paced and sometimes that kind of machinery is just an annoyance to get along with. The shots are not the problem, the everyday need of full control of your life is.

It's smaller than the phone you already carry around. It's mathmatically and demonstrably superior to shots. They have integrated CGMs now. Ask around, the folks with the fastest paced lives (diabetic Olympians, marathoners, world travelers, etc) ALL have pumps.

Unless you have a 6% HA1C on shots, get a pump and live decades longer.

My wife is Type 1, and was on the pump but went off of it after about a year. Says she feels in more control without it, and that it gave her a false sense of "security." And she has had better results since, and more stable sugars.

I don't know, obviously, not being diabetic myself, but I will say she went on the pump really soon after being diagnosed and didn't really have a chance to establish a routine first, and that probably played a large part in her doing better on shots right now. I've been encouraging her to start thinking about using the pump again, as I do feel that, used correctly, as I believe it is a better method, but she has to do what she feels works best for her.

Being a developer myself, the idea that she has to use a custom cable and custom software to manage the data she has in her meter drives me a bit nuts. But the meter industry is, IMO, full of companies that don't really want to help users, they just want to get rich off of diabetics. I know thats a bit cynical, and I'm sure there are companies that sincerely care as well, but it's how I often feel about the meter industry.

Will back up Scott here -- while not an olympian, I rowed for 4 years on the pump and have biked x-country w/ it.

I seriously doubt if I would've been up to doing either while managing injections instead of button presses.

Thanks everybody, I'll talk with my doctor tomorrow when I have an appointment.

I used to think the exact same thing, somehow I think I was really just afraid that someone would see thing thing embedded in me if I ever had my shirt off. When I finally got a pump I realized that it simultaneously keeps itself out of the way while allowing me quick access to my (approximate) levels. I can give my self insulin mid sentence in a board room meeting. I can see my levels dipping and get a lifesaver before it sets in. The worst that ever happens is that someone asks what the hell I am doing with a pager.

In short, the pump CGM combo it is the best thing I have ever done.

I wrote them off as too experimental and bulky when I was first diagnosed just over 10 years ago. I guess technology has advanced since then. I'll make an appointment with my doctor to chat about it. Thanks for the reminder to re-evaluate.

Totally. I don't even care if someone sees it and I'm happy to explain if they do. It's a lifesaver.

You DO have to constantly calibrate the pump though. It's not a perfect solution.

I am astounded there is not a close loop system yet.

Are the papers here [1] relevant? I sat in on this conference session as a student, and don't have access to the full papers to check my recollection. As I recall, most of the papers revolved about the theme of closed loop control of blood sugar.

At the time this was presented, the results were billed as the biggest advance in Intensive Care in recent history. The authors claimed to have hard numbers, showing that closed loop control of blood sugar for ICU patients was delivering (something like 40% if memory serves me???) fewer deaths for ICU patients. I'm not in the ICU area, so I don't know if the techniques outlined in the paper made it into clinical practice or real products. If so, you'd think it would trickle down into diabetes management. As a non-diabetic, am I completely misunderstanding the problem?

The International Federation of Automatic Control (IFAC) is the peak body for control research, so there's a good chance you will read about any new closed loop system there.

[1] http://www.sysid2006.org/Wednesday.html#web4

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Edit: A couple more links from my poking around. Might provide some reading if closed loop control of diabetes is of interest.

http://www.medschl.cam.ac.uk/paediatrics/pages/wilinska.html

Closed Loop Insulin Infusion for Critically Ill Patients (with pictures of an actual device):

http://www.clinicip.org/

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Edit: Found the actual numbers here: http://cordis.europa.eu/search/index.cfm?fuseaction=proj.doc...

42% reduction in mortality, compared to the old insulin control method, which I presume is open-loop?

You mean calibrate the CGM? There's no pump calibration needed.

My relative is definitely calibrating some instrument related to the pump multiple times per day.

Ah, then they are calibrating their CGM (likely integrated into the pump, as they are likely using either an Animas Vibe (outside the US) or a Metronic Minimed Paradigm). They aren't calibrating the pump, they are calibrating the pump's CGM vis a vi their meter via finger stick.

Not an expert, but maybe he's talking about the relative changing the basal rate (correct words? The 'give me this amount continuously' rate a pump will inject) or (this is something my type I ex-gf did a lot) he mistakes some 'correction shots' after meals for calibration?

Definitely involves blood and a small oval thing with a LCD screen.

Please don't consider this as a plug, just trying to help.

Our company, MyNetDiary, provides an awesome food diary app (the only 5-star paid diet app on the iPhone). It's highly polished and uses some very advanced tech under the hood. The most frequent word in user review is "easy".

For almost a year, we are working on a special diabetes tracking app built on top of it. It does not integrate with BG hardware (would need FDA Class 1 approval), but we are exploring options.

The app will help you keep track of foods, exercise, and - with manual entry - your BG readings and insulin.

We've been doing this for 5 years and know what we are talking about - this is the best app for tracking diabetes.

It's a couple of weeks from release, we are testing release candidate. If you are interested in trying it sooner, we can provide an Ad-Hoc build for iPhone. More info: http://www.mynetdiary.com/diabetes-tracker-for-iPhone.html

My contact info is in profile.

You, and everyone with diabetes, should seriously read the first chapter of this book [1]. The author discovered he could treat his wife and son's diabetes with a major diet change, by eliminating all foods that cause a blood sugar (and resulting insulin) spike - sugar, HFCS, grains, most processed food, etc.

His assertion is that he current method of treating diabetes is based on classical mechanics, 1-in-1-out, etc., where you measure your blood sugar and try to manually maintain it at a certain level with sugar and insulin.

But ...

1) the human body is a complex, non-linear, dynamic system. It is based on and responds to signalling, genetic triggers, etc., and ...

2) you don't need to micromanage your body, it will take care of itself as long as you don't essentially poison it.

3) the old method presumes there is something wrong with your body, when in actuality, the problem is with the way your body reacts to 'modern' (post-agricultural) foods. Diabetes is a symptom of that, so cut those foods out, and diabetes goes away.

It may not apply to all types of diabetes, IANAE, but seriously, stop by a bookstore and spend 20m reading just the first chapter (maybe 2, can't recall exactly), and figure out if it's something worth looking into further.

1. http://www.amazon.com/The-New-Evolution-Diet-Paleolithic/dp/...

First of all, the distinction needs to be made between type 1 and type 2, these are two different things.

If you respect Ray Kurzweil's ideas, which I think a fair number of people here do, then I would suggest anyone with diabetes concerns (at risk, got it, etc) read his book "Transcend."

Direct quote:

"Largely because of excessive consumption of simple carbohydrates and sugary foods, the number of people with type 2 diabetes in the United States has increased tenfold in the past 35 years, and as of 2008, type 2 diabetes affected over 21 million Americans. In just the 10 years between 1997 and 2007, the incidence of type 2 diabetes nearly doubled in the United States, from 4.8 to 9.1 per 1,000 people."

The reason why Paleo is recommended is because high glycemic index carbohydrates are virtually eliminated. That certainly is not the only diet that accomplishes this. In Transcend, a low calorie somewhat Japanese diet is encouraged. That is something that is extremely difficult, behaviorally, for Westerners to strictly adapt. In my own experience it took about 3-4 years of behavior modification to do that, and I ended up medically underweight. "Paleo", at least for males from what I've seen, is fairly easy.

If you disagree with Kurzweil, well then I can't say much else, he certainly knows more about this than I do.

I realise your intentions are good, but most diabetics get the paleo advice every other day.

...and they should take it to heart.

I went from >12% to <6% A1C by cutting out carbs, taking a low dose of metformin (750mg slow release per day) and throwing in a bit more light to moderate exercise.

Credit to Dr. Bernstein (http://www.diabetes-book.com/) who is a type I diabetic himself, but really we're now hearing the same things from Taubes, Lustig, the Paleo folks and many others.

Obviously low carb diets alone aren't the whole solution. Berstein's book contains a wealth of information on living with diabetes well into old age. It's a great read for diabetics or for anyone caring for a diabetic.

You're a Type 1 on metformin? That's highly unusual. Or are you Type 2?

I'm type 2.

Just to clarify, I'm not selling notions of curing type 1 diabetes through diet. If you're type 1 you will need insulin. Even type 2 may require insulin.

The point I'm trying to make is that in both diseases (type 1 and 2) control of blood sugar is key to reducing mortality. Reducing carb intake will result in lower blood sugar rises which will require less insulin to counter. Less insulin means less chance of hypoglycemic events. By minimizing these control inputs you can balance your blood sugar in the normal range and prevent and even reverse the damage to your body from diabetes.

Yeah, but I have the type 1 diabetes, which is btw. the national disease in Finland.

One of the things that started the disease was an influenza back when I was kid. I also have the genes from my family, so suddenly I didn't have insulin in my body anymore. It has nothing to do with my lifestyles.

I've been taking care of my disease since I was a kid and believe me, I need my daily shots of insulin.

Yep, totally. I do Paleo and while it but reduced my daily insulin in half, I still use a total 20U a day. It's definitely needed. Type 1 is NOT Type 2. It's a shame, frankly, that they are both called "Diabetes."

> ... the old method presumes there is something wrong with your body ...

The comment you replied to is presumably about type 1 diabetes, an inflammatory disease that destroys the body's ability to produce insulin. You are referring to type 2 diabetes.

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