
A $250 Biohack That’s Revolutionizing Life with Diabetes - rbanffy
https://www.bloomberg.com/news/features/2018-08-08/the-250-biohack-that-s-revolutionizing-life-with-diabetes
======
jimrandomh
The article, strangely, leaves out the name of the project it's reporting on.
It's OpenAPS,
[http://openaps.readthedocs.io/en/latest/](http://openaps.readthedocs.io/en/latest/)
. I use it and have worked on the code. It's a _massive_ health and quality of
life improvement over anything that exists which is FDA approved. The core
problem is that the FDA-approved devices are optimized not for getting the
best result, but for ensuring the manufacturer can't be blamed if something
goes wrong. But that in practice means kicking most of the important things to
the end user and their physician, who can't do nearly as good a job as
software can.

~~~
dekhn
Hi- I used to work in regulated pharma and I want to be clear: " The core
problem is that the FDA-approved devices are optimized not for getting the
best result, but for ensuring the manufacturer can't be blamed if something
goes wrong" is a misleading statement. The reason everything is regulated is
that sometimes things do go wrong, and it's necessary to have root cause
attribution so the problem can be remedied and a fix deployed, _and_ , if
somebody did something illegal or dumb, they can be sanctioned.

I wish your project success, but I think (and I've got a bit of experience) if
you can't accept that regulation of health products is almost certainly
necessary, and that not producing the "best" results is a reasonable if
conservative approach, I will never trust your product.

~~~
davidgrenier
Somehow I can't help but read you've smuggled endorsement for: It's ok if the
product is more dangerous when bundled with the benefit that we can blame it
on some organization.

~~~
candiodari
And what do you suggest we do when an open-source "biohack" results in
something like this ?

[https://en.wikipedia.org/wiki/Thalidomide](https://en.wikipedia.org/wiki/Thalidomide)

Note the mistake made, and just how subtle it was. During testing a somewhat
more ad-hoc process was used to produce the drug that did not result in the
bad isomere, and then it was sold with multiple isomeres in the actual drug.
Regulators at the time thought that isomeres did not matter and it took years
for the effects to become clear. Of course regulators did not test for things
they didn't know about. Neither did the companies (not just one). Crucially
the drug was NOT tested for the effect on pregnancies (and was therefore not
to be taken by pregnant women, like many drugs and even some non-drug products
like famously alcohol).

Furthermore: there is at least some amount of "guilt" on the part of some of
the mothers: the medicine was NOT approved for use during pregnancy, and
stated this.

Result: >10.000 crippled children.

Where is the guilt to be placed for this incident ? I would argue that the
primary guilt is with the regulator (government) and a small amount with (most
of) the mothers for taking unapproved medicine, with the rest of the mothers
following doctors' prescriptions (which of course means those doctors
prescribed unapproved medicine). Needless to say, the company was blamed, and
forced to pay (essentially in trade for not going to prison). The German
government denied any responsibility, and several other governments (famously
Spain) went further: they denied anything had happened at all.

So let's say there is a timing bug in this "open source pancreas", and it
starts pumping insulin into the patients bodies without cause, say at the unix
epoch transition. I would guess that at least half of them won't survive.

What happens next ? Given the Thalomide incident we can make an educated
guess: whatever the law says, and despite patients "accepting the risk", even
when the patients explicitly make mistakes in the treatment, you can bet the
government will go after whoever they can arrest, and force them to pay
millions of euros, or throw them in jail for the rest of their life.

People cannot be trusted to accept responsibility for the result of picking
their own treatments, even when fully informed about the risks.

~~~
dekhn
I have to add: Thalidomide is still prescribed today as it is a very effective
drug. Also, as a response, the US has a much stronger system for evaluating
drug safety.

~~~
daveguy
US regulators did not approve thalomide until after the risks were known.
Their system for evaluating drug safety is the strongest in the world and that
is why there were no thalomide induced birth defects in the US. Those
problems, subtleties and failures of regulation were in European markets where
thalomide was approved more quickly (and new manufacturing processes were less
closely regulated than the drug itself). EU has stronger regulatory practices
in place as a result.

~~~
dekhn
The narrative is more complicated than that, see
[https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey](https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey)
and [https://blogs.fda.gov/fdavoice/index.php/2012/02/50-years-
af...](https://blogs.fda.gov/fdavoice/index.php/2012/02/50-years-after-
thalidomide-why-regulation-matters/). In particular: athough Kelsey did
correctly identify issues, there wasn't legal support for that kind of
regulation until her work led to
[https://en.wikipedia.org/wiki/Kefauver_Harris_Amendment](https://en.wikipedia.org/wiki/Kefauver_Harris_Amendment)
which was necessary legal support for the FDA regulation process.

~~~
candiodari
True, but the point is more about that the government (and the people) went
after the producer of the drug, despite that producer not really having
screwed up, and left the ones that had screwed up (state, mothers and doctors)
alone.

Furthermore, the law did not really support these cases. But when you cripple
10.000 babies, law does not matter. Plus we all know they went after the
company, not because it was at fault, but because they could band together
against it.

If that were to happen to an open source project (and that seems a reasonable
guess for open source "biohacks"/medicine when they screw up) ... the authors
will go to jail for life and die bankrupt. It doesn't matter what license, it
doesn't matter what contracts say, it wouldn't even matter if you have
personal videos of every user saying they will never hold you responsible with
a paper around it signed in blood by both the user and a public notary.

THAT's why we have the pharmaceutical industry we have.

------
femto
Reading around, it's the controller software that is DIY, and it's grown to
the point where a DIY device has been built to run the controller software.
The sensor and pump/actuator are proprietary Medtronic devices, connected to
the controller via wireless links.

The DIY controller came about because Medtronic didn't secure their wireless
traffic and the protocol was reverse egnineered. New units now come with a
secured wireless link, but the existing units remain unsecured. Consequently
the project is constrained by the number of unsecured units remaining in the
field?

Reading the project's website the FDA has been in touch with the project and
so far the interaction has been constructive. The makers seem keen to have the
safest system they can and the FDA seems to want to engage. I'd guess the
project's future lies in being able to team up with someone who can provide
ongoing access to sensors and actuators?

Wishing them much success!

~~~
jakobegger
Near the end of the article:

> A European team recently created an app for Android phones and cracked the
> code in a popular pump from Roche Holding AG

So even if they don't find a partner, they'll probably find pumps they can
use.

~~~
close04
A friend of mine "automated" his infusion pump (not diabetes) by 3D printing
an arm and actuators attached to the physical buttons of the pump and
controlling that remotely. Basically most actions consisted of automated
sequences of button presses in the correct order.

How feasible is this for an insulin pump? I know it adds bulk to a device that
has to be worn constantly and inconspicuously but it may be a worthwhile trade
if you can't find a compatible pump.

As long as it can be controlled by the wearer's finger it should be possible
to automate it with an "artificial finger".

------
ThJ
I have type 2 diabetes and I've always been a bit envious of insulin pumps,
not because I love having a machine plugged into my body (I don't), but
because they offer better control of blood glucose peaks, since they use fast-
acting insulin exclusively. The pancreas secretes insulin in pulses and pumps
can mimic that. What has turned me off from pumps (apart from doctors
generally not recommending them for type 2 diabetes) is the lack of a sensing
mechanism. This DIY system sounds absolutely perfect. It could keep my blood
glucose perfect at all times. At the moment, I'm injecting in the mornings and
the evenings and have little control over my peaks apart from adhering to a
strict diet (and we all know how hard that can be), and every peak does a
little bit of damage to my eyes, nerves, etc. I've always wanted to have a
more sophisticated treatment option, and this may be it.

~~~
ThJ
Why don't doctors recommend them for type 2 diabetes? Well, my general
impression is that doctors live under this illusion that patients will somehow
succeed in making lifestyle changes that will cause the disease to go into
regression or disappear altogether. Also, they prefer to try medications like
glucophage before they resort to insulin. There just seems to be less
eagerness to finely manage type 2 diabetics, maybe because it is felt that the
patient is partly to blame for the disease, whereas type 1 diabetics are
innocent victims of their own immune systems. I honestly don't know what
they're thinking. An artifical pancreas would vastly improve the situation for
type 2 diabetics too.

~~~
gumby
> my general impression is that doctors live under this illusion that patients
> will somehow succeed in making lifestyle changes

> Also, they prefer to try medications like glucophage before they resort to
> insulin.

A couple of points: 1- the targets set by associations like the ADA actually
assume the patients _won 't_ be able to make significant lifestyle changes;
for example the ADA A1C targets are higher than for healthy patients. The diet
changes they preach are not that radical, e.g. cake is bad for you but you can
have a really tiny slice and offset it by not eating bread. This belief isn't
that unreasonable; FDA requires that medical labeling be targeted at a 5th
grade reading level.

2 - And glucophage is _much_ easier for patients to manage than insulin both
in dosing regime and simply caring for the drug.

3 - Finally the insurance companies' actuaries have figured out that
maintenance therapy of this nature has the best cost/outcome ratio.

To that last point: I had "adult onset type 1" due to an autoimmune condition.
The endocrinologist I was sent to was only interested in maintenance therapy
and not at all in looking for root cause, even though I presented with a body
fat of about 14%. She finally admitted that even if she did look into it the
insurance companies would hassle her for going off the reservation without a
good excuse.

But my no-insurance primary doctor and I and a rheumatologist were able to dig
into root cause and now I am "cured" (of diabetes at least) thanks to treating
the underlying condition (note: this is glossing over a lengthy period of
unpleasant work). Which is actually cheaper for the insurance companies, but
honestly how many patients have the training to be able to be involved in
their care to this degree?

~~~
inetsee
I have latent autoimmune diabetes in adults (LADA), sometimes called type 1.5
diabetes. Onset was in my early 40s, and I am now insulin dependent. I have
reasonably good control (estimated A1C about 6.5) without a continuous glucose
monitor and insulin pump. I have been looking into the Freestyle Libre glucose
monitor to get better monitoring of my glucose levels, but the cost is still
quite high.

I would really like to know more about how you and your doctors cured your
condition.

------
amluto
Why exactly is a phone app involved? If I were designing this thing, DIY or
otherwise, the CGM would talk to a dedicated micro controller, which would in
turn talk to the pump. A phone, if used at all, would get an extremely limited
API to read the glucose level, see the pump history, and perhaps change the
control parameters within a narrow range. The point would be that no input
from the phone should be able to kill or incapacitate the user.

And the controller would beep if communication were lost.

There would not be an Internet API to change any parameters at all.

~~~
jimrandomh
You need something with a screen somewhere in the system to be able to monitor
it and input data, which means a phone app or a web app. In the case of
OpenAPS, it works mostly as you described: an Intel Atom SoC talks to the CGM
and to the pump, and syncs with a webapp (called Nightscout) for monitoring
and user input if internet access is available, but continues to operate
autonomously if it isn't. The webapp sends an alert if the microcontroller
hasn't connected for awhile (30 minutes), which is how you find out if it's
lost communications or powered off.

Users have to be able to input when they're eating carbs. It's possible to do
that through the pump (that's how I do it), but there are some ways in which
that's not ideal. Most people enter carbs through the webapp. This _is_
capable of creating a dangerous situation for the user (not of killing them).
It's a security risk, but also a practical necessity.

Some peoples' setups are more internet dependent than that, though. For
certain models of CGM, the way you get data from them is by giving them an
internet connection and using a web API provided by the CGM maker. (This is
built on abusing APIs that were intended for eg family members monitoring
glucose values of children who might not be close by.) And, in the case of
Loop, the decision algorithm executes on a phone.

These setups aren't ideal, but they're all made by hackers with limited time
and resources desperate to get something that works, because the market isn't
providing anything acceptable.

~~~
amluto
> Users have to be able to input when they're eating carbs

I’m not diabetic, so I’m probably missing something, but why? I would have
expected the CGM to detect the extra glucose quickly enough without any extra
input from the user. Kind of like how people with pacemakers don’t have to
tell the pacemaker before they start jogging.

------
Raphmedia
One of my coworker has a DIY glucose monitor he uses to monitor his kids from
work with a Raspberry Pi. He made a blog post about it. Here's the link if
that can help anyone: [https://www.robotshop.com/blog/en/xdrip-bridge-
type-1-diabet...](https://www.robotshop.com/blog/en/xdrip-bridge-
type-1-diabetes-19323)

------
gtspotscom
Headline: "The $250 Biohack That’s Revolutionizing Life With Diabetes"

Article: "Sydney, now 15, is still using an updated version of that DIY
system, which, __because a fellow DIYer donated the pump __, cost only $250 to
make. "

------
zaroth
A continuous glucose monitor (CGM) uses a very thin gauge wire to sense
interstitial fluid as a proxy for blood sugar.

My kids have tried Dexcom G4 CGMs a couple years ago. The G4 was never
approved to dose insulin directly off the CGM reported value, we would confirm
with a finger prick before dosing a correction. The G4 also required
“calibration” where you would type in the reading from a finger stick and it
would shift the curve a bit in that direction if it was off base.

We would routinely find the G4 reporting numbers up to 100 points off, or
simply dropping out and reporting “???” for hours at a time. Bad or unreliable
data being worse than no data, we discontinued using the G4.

The Dexcom G5 kept the same sensor but switched the transmitter (which
connects to the sensor and sits on your body) to use standard Bluetooth to
communicate the glucose readings. This is when Nightscout was really able to
step in and intercept the glucose data and do neat things like put it in the
cloud so you could watch your kids’ blood sugar throughout the day. And with
the addition of a programmable pump, also try to build a “closed-loop” system
which constantly adjusts basal insulin dosages to react to highs and lows.

The problem is the underlying sensor of the G5 was still not approved for
direct dosing, a finger-stick still being the only method accurate enough. You
don’t want to dose to correct a 250 blood sugar level and then discover you
actually were 150 all along and now potentially heading for a dangerous low.

Early this year we started buying Freestyle Libre sensors which use a NFC
reader to poll the latest readings on demand. This is a less ideal method
because it can’t independently alert you of an impending high or low without
you actively swiping the reader up against the sensor on your arm. Accuracy
was significantly better (reading would often be within 15-30 points, and we
didn’t see any that were more than 60 points off from a finger stick reading)
and there were a couple times when it would stop reporting data but dropouts
where much less common than what we experienced with the G4.

Fast forward to last month when we got brand new Dexcom G6 CGMs. These are FDA
approved to dose directly off the readout, and the accuracy is frankly
unbelievable. We have regularly had finger sticks _exactly_ match the CGM
display, and even finger sticks have variation when you test multiple times
back-to-back. The G6 does not require daily calibration (although you have the
option if you find the numbers are off). It is not perfect, and once we did
find it was 40 points off, but after 60 days of use my experience is that with
the G6 we have finally arrived at a stable, trustworthy, reliable CGM which I
would feel comfortable driving a closed loop system.

The only failing I have with the G6 is that we were promised it would work
directly with an Apple Watch running the Dexcom app and syncing with the
sensor over Bluetooth. In fact, as of now, a full fledged iPhone is required
to pull data from the sensor, and then it can relay from the phone to the
watch. I’m told that the FDA is pending approval of a stand-alone Watch
operation, which would be exceedingly useful in my case. The goal is for the
kids to wear LTE Watches which can read from their sensor directly and push
glucose data to the cloud for us to watch on our phones. This would mean just
the $5/mo cost to add a Watch to the plan versus having to add lines and gives
full fledged iPhones to the kids in order to track their numbers remotely.

Both our kids use OmniPods as their insulin pumps, which AFAIK have not been
hacked yet to allow 3rd party control of the pump. OmniPod is a self enclosed
pump which sticks on your arm an auto-injects a cannula, and you control it
wirelessly with a dedicated remote which is like a 1990s PDA. OmniPod has an
ongoing study with their next-gen “Horizon” product which adds Bluetooth
control and interfaces with the Dexcom G6 to automatically adjust basal rates.

Last thing I’ll mention is that this is not by any means an “artificial
pancreas”. Even with a closed loop system you still must bolus (administer
insulin) before meals in the correct ratio based on the number of carbs, and
the glycemic index (speed of absorption). The closed loop is more rather a
slight adjustment in the _baseline_ insulin which is being automatically dosed
every few minutes to cover your basal metabolic rate. If the CGM sees you are
high or low, a closed loop system will temporarily increase or decrease the
basal insulin rate to try to subtly move the needle so-to-speak and bring
blood sugar back in range. This works best overnight when no new carbs are
being eaten and blood sugar is usually more stable. So the idea is with a
closed loop you are more likely to wake up with a blood sugar around 100
because it’s been working to gently bring you to that level all night long.

As the article states, this means a better nights sleep for both parent and
child :-)

~~~
jcims
Does the G6 interface with OmniPod at all or do you just use it like a
continuous finger-prick test?

My youngest (now nearly 16 years old) was diagnosed about two years ago. She's
currently on Medtronic's closed loop system (860), but honestly it's so
finicky I'm starting to look at switching systems. My daughter is basically at
the point of burnout and sees the whole thing as nothing more than a major
annoyance. She regularly lets her sensor expire, goes without calibrating for
hours and hours or will look at a mid-day reading of 280 and just do nothing.
It doesn't help that she seems to have acquired a profound craving for carbs
that has her sneaking food and binging when she's unsupervised.

I'm thinking that maybe a system that doesn't purport to be automatic at all
will make her role in the process more clear and hopefully get her in a better
place to self-manage before she heads off to college. As it stands right now I
can't imagine leaving her to her own devices for more than a couple of days.
(FWIW we also have her working with a therapist to help manage some of the
emotional aspects of this, but we really need to find one that is experienced
dealing with T1D patients)

~~~
hycaria
Someone wants to lose a foot and become bionic!

~~~
slavik81
I don't have diabetes, and I don't really understand what it's like to live
with diabetes. But, I found this story to be very powerful:
[https://tink.uk/losing-sight/](https://tink.uk/losing-sight/)

------
Nasrudith
I can't help but wonder what it would take to develop a legitimate artificial
pancreas that fits the standards precisely. Would animal testing even be that
useful or required given precedent of other insulin pumps?

I suppose being able to adapt to a wide range of pancreas removed animal sizes
and life-states could help to show some adaptability but I'm uncertain of how
much that would help humans since diverse curve fitting may not be a good
thing. Since for instance for humans protein is bad for the kidneys at too
high of a percentage even if say cats wouldn't have problems with it.

I'm curious what the back of the envelope budget sizes, time tables, and
liabilities would be for organic pancreases as opposed to an official approved
smart insulin pump pancreases.

------
arendtio
So some people are concerned that their cars have an internet connection and
others connect their bodies to it (via the smartphone) and at the same time,
both have good reasons to do so :-D

Sometimes it is a strange world we are living in.

While I admire open source and DIY solutions in general, they often lack the
quality assurance a company specialized in medical equippment is used to. So I
hope that soon there will be more devices from established manufacturers at
reasonable prices. I would consider everything above $1k unreasonable if the
hardware alone costs just $250 (for consumers).

~~~
mcherm
You want the quality assurance, yet you don't think that it is acceptable to
pay more than 4x the cost of parts. How do you expect that these tests (which
are insanely expensive and take decades to run in some cases) will be paid
for?

~~~
arendtio
Well, I think for a device like this the most important thing is a very
reliable, high quality software (the hardware components are already out there
and have been tested already). As the software is the same for all devices, I
would expect that it should be possible to cover the overhead of software
development, QA, etc. by the number of devices you would sell.

After all, we are not speaking about running medical studies here, just about
letting a secure software bridge the different components. So building a
software which is well tested (in terms of software tests) and does not inject
you when its not supposed to do so, should not be that impossible.

------
trampypizza
Can you imagine how much money big pharma could make if they pulled their
fingers out and actually created and supported a solution?

If a bunch of parents on the internet can hack it together, it's hardly
impossible (I'm not trying to detract from the awesome work these people have
done, but my point is that they have nowhere near the same kind of resources
as pharmaceutical companies).

As a Type 1 Diabetic it's really frustrating seeing how stagnant treatment
technology is.

~~~
DavideNL
> If a bunch of parents on the internet can hack it together

I can imagine people will think this after reading this article, but in my
opinion this is not how it is in reality - which is why this article is very
poorly written/exaggerated. The article presents this comparison as black &
white: DIY = simple and cheap, whereas pharmaceutical companies = difficult
and expensive. The reality however, is not black and white.

In a nutshell: You and me can drive around in a car without wearing seat belts
our entire life and in the end, this article would say "see nothing terrible
happened, it's been completely safe to drive around and seat belts are
ridiculous".

It all comes down to statistics, and i believe that the people doing this DIY
stuff are unaware of the risks they are taking.

~~~
trampypizza
I agree with you, and frankly, hacking something together on your own or in a
small group is not necessarily going to produce a product that you can then
sell, especially considering the potential ramifications due to faults or
misconfigurations, specially if you start using the data to automatically
adjust your dosages. I suppose what could be nice is if the manufacturers
could open up roads to hacking your own gear, but I think that this is highly
unlikely as creating an 'official' route to 'mod' is going to open you up to
all kinds of liability.

I get frustrated by the lack of visible innovation in diabetes treatment
technology, because in most other areas of our lives we are surrounded by tech
which is constantly innovating. Unfortunately it's a reality that if you are
designing systems and technology that manage critical functions then they are
going to take a long time to develop, let alone test, distribute, and support.

------
BBrew
Does anyone happen to have a Medtronic device on the compatibility list that
they are looking to sell?

~~~
Gregoriy
I am involved in this, what i want to say is that openaps are not the best
option anymore, and pumps of metronic are not required anymore, android app &
other pumps what we use right now.

~~~
DavideNL
With the poor state of Android security at the moment (in a nutshell, Android
9 Pie was just released while the previous Oreo release is installed on only
12% of devices), i cannot imagine anyone would want to connect a device that
"can easily kill you" to an Android phone.

Most non-technical people using this DIY solution are probably not even aware
of this...

~~~
Gregoriy
The way it works make in sort that it can't kill you easy at all, the system
does not regulate bolus insulin which is without a limit, but a basal rate
which is basically a rate of insulin distribution from slow to fast, even the
fastest mode will not kill you, and if the system disconects for some reason
pump uses a default average speed.

~~~
DavideNL
> the system does not regulate bolus insulin which is without a limit

I understand that but the issue remains;

all a hacker would have to do is set basal rate to 100000% and then you have a
"bolus that kills you".

Call it basal or bolus, it doesn't matter. The pump just pushes out insulin,
and the amount can be controlled if you can hack the system.

------
tuxguy
[https://diyps.org/2016/05/12/how-i-designed-a-diy-closed-
loo...](https://diyps.org/2016/05/12/how-i-designed-a-diy-closed-loop-
artificial-pancreas/)

------
thomasfedb
As a med student with a CS degree I wish we were further along with making
this a reality for every child with DM. If anybody knows who in Aust is
working on this - hit me up!

------
late2part
God bless Scott Leibrand and these folks.

------
woolvalley
How much are the continuous glucose monitors alone now? You could use it for
dieting.

~~~
exDM69
No, it's not usable for dieting for healthy (non-diabetic) individuals because
the pancreas will adjust glucose/insulin levels to a pretty flat level.

When a non-diabetic person says "I need some blood sugar" when they're hungry
and cranky, their actual glucose levels are pretty much at the same levels as
usual.

~~~
woolvalley
So what is happening when you stand up quickly and your vision goes slightly
black when you haven't eaten for a while?

~~~
exDM69
I don't know. Sounds like something related to blood pressure. Hunger affects
hormones and that affects lots of things.

------
6d6b73
Anybody knows of other projects like this?

------
keymone
ketogenic diet is what is revolutionizing life with diabetes, by, you know,
_curing it_ (not type 1 though).

automating the process of releasing a chemical that is roughly speaking the
cause of the disease is hardly revolutionary.

~~~
jcims
Do you know if any communities of folks managing T1D with keto diet?

I looked into it for my daughter when she was first diagnosed but had a hard
time differentiating fact from keto evangelizing and medical community hand
wringing.

~~~
keymone
unfortunately no, i don't know any.

it is frustrating indeed that keto is being appropriated by fad evangelists.
it's a diet that needs lots of reading and preparation.

i'm not a doctor, but common sense tells me that a diet that reduces the need
for insulin should also help managing t1d, but obviously it's better to
consult a professional.

~~~
exDM69
Keto diet done wrong may have lethal or life changing consequences for T1D
patients. Done right it might have positive effects but that is afaik not
backed by research at the moment.

Common sense in this case turned into potentially dangerous unqualified
medical advice.

------
mtgx
Or you could "hack" your body by eating keto-friendly foods:

[https://blog.virtahealth.com/with-sustained-
type-2-diabetes-...](https://blog.virtahealth.com/with-sustained-
type-2-diabetes-reversal-management-is-becoming-a-thing-of-the-past/)

[https://medium.com/@drjasonfung/type-2-diabetes-reversal-
the...](https://medium.com/@drjasonfung/type-2-diabetes-reversal-the-quick-
start-guide-6187210f14ce)

~~~
tomp
Can you please stop spamming idiotic comments all over this thread?! And read
the article!

It’s about diabetes Type I, which _cannot_ be cured by diet, as it’s caused by
_too little_ insulin in the body, not _too much_ as with Type II.

~~~
virtuallynathan
There do seem to be a decent number of T1D patients who use keto diets to keep
their blood sugar flat and reduce insulin requirements.

~~~
naiyt
Yes, but you still need insulin on keto. In fact, starting keto can be
dangerous for a T1D at first until you find out what your new, lower,
requirements are. You put yourself at risk of hypoglycemia, so you have to be
extra careful with dosing while you're figuring it out. Because of that, a
closed loop artificial pancreas could be incredibly helpful for a T1D going on
keto as well.

