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 ;)
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.
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.
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'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.
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.
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.
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.
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! :-)
Of course this is anecdotal, but the point is that your mileage may vary.
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.
To be fair, that could be just xDrip+ that wants calibrations.
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.
My checks take about 5-10 seconds but I can see where after a while it can make you hesitant.
> "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."
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."
Also, try a Freestyle Libre. It’s closer in behaviour to a finger prick but still gives the trend info.
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.
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!
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."
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.
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.
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.
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.
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.
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 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.
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 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.
^^ Sorry, this makes no sense at all. Maintaining a routine is one way to express a preoccupation with diabetes management!
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.
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.
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.
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.
Do you have any thoughts on this? I'd love to have more flexibility.
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!
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.
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
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.
Dude, you don't know many diabetics then. Companies spend billions of dollars to solve this 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.
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.
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.
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.
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.
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.
Tell that to my wife who has had diabetes for 4 years.
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.
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.
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.
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.
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.
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.
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.
That said when MEMS meets medicine there could be a vast change.
(Sorry, if you don't get this reference please ignore.)
The injections are really not a significant problem for me. A lot of people may recoil at the thought of injecting themselves often, as though it's painful. It's either not painful or maybe a little, but I just don't care much.
Much worse things about being diabetic are:
* Danger of low blood sugar
* Trying to get the right dose
* Timing the dose so it is effective at the right time
* Carrying around a bunch of stuff that I need or may need, like insulin and glucose tablets
* Trying to keep the insulin cold enough or fresh enough that it retains its potency
* Keeping my phone on and charged all the time, which has my blood sugar readings, and checking it at times where it might seem like I'm rude. I'd rather use a watch or special device, but the special devices are strangely bulky and don't hold a charge, and watches apparently can't receive blood sugar readings yet (without a phone also present).
None of those things are very terrible. Treatment is much better now. But they are all way worse than the tiny insulin needle injections.
Check out XDrip. Its an opensource community built collector for CGM data. They have a version that runs on Google Wear so your android watch can act as a collector. You can also still use your phone to collect and just have the data appear on your watch.
Nightscout is another good related resource
If you’re want to see the future of medical care using smart devices, start there.
xDrip allows you to configure various care settings and then will provide real time blood sugar feedback and dosing suggestions.
There’s (almost) nothing else like it in this space.
Nightscout is a cloud service to store data reading and treatments. Again its community developed opensource solution which gives you complete ownership over your data. Some of its earlier game changing features are now common in the OEM solutions, but I still like the idea of owning this and it being opensource. Nightscout is a really big help for us managing our son (whos 6) since it makes it really easy to give real time access to his CGM and treatments to anyone anywhere.
Nightscout is also the unofficial hub for the Opensource development in diabetes. They've contributed so much that is now being used by OEMs. Im a big supporter.
Also check out https://openaps.org/ - its a community developed closed loop solution. Very cool.
Thanks, I will check those out!
Works with xDrip.
I use Spike on iOS https://spike-app.com/ to get it on my apple watch (it does this by creating new meetings in the calendar) works ok.
Its amazing to me that Pebble can allow real time updates to the watch face and apple severally restricts this feature for third party apps.
The blood checking pokes are much worse, because they have to actually draw blood. Usually fine but sometimes quite painful or difficult. Now I use a continuous glucose monitor (CGM) and it's much better.
Many many people don’t really notice or care about the needles (me included) because as OP parent posted, we have other stuff to deal with that takes up way more mental space.
I guess this isn’t apparent because the needles are the obvious bits but then rest is all the “thinking” that invisibily surrounds the injection.
There are however many people who just can’t wrap their head around needles and can’t do it. The needles themselves are tiny so it’s not that - it’s just how they perceive the world.
Any technology that helps these people and makes their lives easier should be embraced.
McDougall has lots of other interesting insights in the lecture and discusses how he treats diabetics. He goes into some detail about how he decides how to adjust medications and why he recommends his diet.
I'm posting this here because it may be of use to people who may not have heard this information from their own doctors.
The lecture is found here: https://youtu.be/UgE2IdL6tMw?t=1103
The link starts the video at the point where McDougall starts discussing type 2 diabetes specifically. Before this he talks about insulin and type 1 diabetes.
...which is the key. McDougall's claim to fame is fad diets and prepackaged food for the same since the 80s, and anything where his bottom line is involved is suspect. He's the vegan equivalent of Robert Atkins, basically.
McDougall is not who I look to for nutritional (or really any) advice. I'm sure he's right sometimes, but his credibility is so compromised by his business that I'd need to hear it from someone else first with their data proving it before I'd ever believe it. If he told me the sky is blue, I'd get a second opinion.
His diet is cheap and accessible. You can follow his diet by eating locally produced wheat, potatoes, oats, rice, corn, millet, beans, etc, in all parts of the world that have an agriculture season. A feature of his diet is that starchy foods store well. Indeed, he says that the reason humans became so successful is because they were able to have a food supply that was high in energy and could be stored.
McDougall does not sell pills or supplements. He specifically counsels against them, saying that they are unnecessary with a good diet and potentially harmful.
In addition to a lot of free educational content, his website (drmcdougall.com) features different programs, including a 10 day live-in program which includes medical care plus meals and education for $6,060 for a single, full participant. You can also buy books, podcasts, and apparel. I didn't see any prepackaged food on the site.
I've considered him a source of high-quality, unbiased advice for several years. His presentations are clear and logical. He's not trying to sell me something. He is conservative in the sense that he prefers cheap, simple solutions before expensive, complex ones. For example, he would recommend that before you try medication and surgery, you should first try to change your diet. If you're not feeling well, make sure you're eating eating a low-fat, whole food, starch-based diet before trying to find a missing miracle vitamin or supplement.
* Hepatitis A/B and C (A and B were cured early on so name should be livervirus or whatever, C should remain hepatitis until it's eradicated)
* Herpes types 1 and 2 (1 should be renamed to cold sores since almost everyone has it, 2 should remain herpes until it's cured)
* Nonfatal cancers (especially of the skin) need new names to prevent scaring people, especially if they've been largely cured.
* SSH "private key" and "public key" (should have been called "secret" and "share" so that people would know which to keep secret and which to share.. yes I realize they are symmetric)
I could go on, but you get the drift. I think a problem here is that experts in various fields may have exceptional problem solving skills but be terrible at naming things. I've met many programmers with this affliction!
Once you're diabetic, a lot of "bad things" happen. People don't take insulin then just to continue eating...
If you spend a lot of time around diabetics you'll met many people who have lost appendages and continue to live an morbidly unhealthy lifestyle.
I have spent a lot of time around 4 diabetics in my family, none of which had morbidly unhealthy lifestyles. Sure, they could all use a little more exercise and moderation in their diet, but then again most people can.
Hogwash. If that were true, I'd be skinny. Aside from the standard low fat calorie restricted diets preferred by nutritionists, I've noticed that there seems to be two prevalent themes with respect to currently marketed dietary advice targeted towards T2 diabetics:
Theory #1. High fat intake or the "wrong" fat intake causes insulin resistance by infiltrating the cells or "clogging up" the insulin receptors on cells. Solution: buy my low fat vegan diet plan.
Theory #2. Eating carbs spikes glucose, which intern spikes insulin. "Insulin resistance is a function of having high insulin levels all the time." Solution: buy my low carb diet plan, or buy my book on intermittent fasting.
I don't know, but here is my guess:
At the beginning of the lecture McDougall talks about there being three kinds of diabetes: type 1 (pancreas produces no insulin), type 2 (pancreas produces enough insulin, but it doesn't work because of insulin resistance), type 1.5 (not enough insulin is being produced to cover the body's needs). Significant weight loss seems to fit in the type 1 and type 1.5. McDougall will prescribe insulin if a person is in danger of losing too much weight.
Openness around rebates will be a great first step to help lower prices, but the PBMs have gotten the industry into a reverse price war where everyone is overbidding each other on price in order to provide the larges rebate to PBMs. Something big has to change to revert that cause.
Disclaimer: I work for Novo Nordisk.
I know, before insurance, it costs around $240 a vial, and I know personally I go through roughly 3 vials a month. I would guess I use a lot less insulin than a lot of others too.
So I know the manufacturer isn't the only one to blame, and maybe its unfair to completely blame them, but as much as the manufacturers are donating to politicians I cant imagine they are doing a lot to fight it either.
Slightly off-topic, but could you talk about what pharmacy benefits managers are supposed to do and actually do, for insulin especially, and their effect on the market?
I Googled this term but can't make of sense of your comment based on what I've read. (The definitions of pharmacy benefits managers that I found have nothing to do with what you wrote.)
Regardless, I suspect he meant that more different types of insulin allow diabetics to take insulin in more different ways aka lifestyles. e.g. closed loop CGM vs a daily long acting insulin plus a short acting for meals.
In other words, more T2D patients take insulin than exist in all of the T1D population.
In Novo's case, they have two kinds of long-acting insulin analogue taken 1-2 times per day for both T1 and T2; they have to my knowledge the only ultra-long-acting insulin on the market, taken once every 2-3 days, most appropriate for T2, but also viable for some T1 lifestyles; they have very-rapid-acting insulin for T1 diabetics only, and they have older kinds of insulins appropriate for older patients.
They offer all of these products in good supplies. I've never seen or heard of a Novo product's being unavailable at the pharmacy. So, as far as I can tell, their only influence on insulin prices is downward pressure, not upward pressure. Every new product they produce lowers the price of insulin despite industry-wide changes.
So, with that I dont feel like there really is any competition. A good step forward might be to disallow insurance companies from having 'preferred' brands.
Novo Nordisk's profits have seen a similar rise.
Now, im no economitician, but I'd wager a vial of Fiasp® that there's more than just supply and demand going on here.
> Novo Nordisk also published data for two of their insulin products, NovoLog and NovoLog FlexPen. Since the early 2000s, the CAGRs for the list prices for NovoLog and NovoLog FlexPen (Fig. 7) have been in the range of 9.8–9.9% (22). This translated into large total increases in the list prices: 353% (2001–2016) for a NovoLog vial and 270% (2003–2016) for a FlexPen. In contrast, net prices received by the manufacturer increased at a more modest rate (3–36%) with CAGRs of 0.2–2.1%. Novo Nordisk, Eli Lilly, and Sanofi have reported that rebates have grown rapidly in recent years, representing more than 40% of U.S. gross sales in some cases
 - http://care.diabetesjournals.org/content/diacare/41/6/1299.f...
A lot has changed in the last 20 years. A lot of regulatory and insurance law changes. When the law mandates that we pay for all our medicine via 3rd party intermediaries, you can expect a corresponding price increase as those 3rd parties add their intermediary markup.
Those numbers are partially generated by pricing insulin products out of reach of many people who died from not being able to afford it.
Sorry if I don't have a lot of sympathy for them.
The price of insulin is already rising: there aren't all that many generic manufacturers of it, leaving them in a competition-free market. If this takes off it's going to suck up a good chunk of the marketplace, and probably leave us with maybe one or two generic manufacturers - enough to have an effective monopoly. Insulin prices will spike the same way epi pens did.
Good tech. But sad re. what it's going to do to patients for a while.
That really is a sad state of affair, insulin is cheap to produce and we shouldn't live in a world where such a basic medicine is controlled by for profit organizations.
At least in countries with a proper health system the cost isn't impacting on an individual level.
Ended up switching back to generic novolin R (regular) as injections which allows me to use different areas of the body, eat low carb, and dropped my a1c down 3 points. Reduced my standard deviation of blood sugars by about 45 as well.
Every diabetic is different though as others have found great success with novolog, insulin pumps, etc.
What I’ve heard from other diabetics is that the older Novolin drugs take a lot more effort to get constant insulin levels than the newer ones.
I guess not true for everyone!!
Is there any reason this wouldn't be subject to the normal laws of supply and demand?
Looks like a patent issue (every new improvement in production methods has its own patent, so the insulins for which patents have expired are lower-quality in one way or another) plus shipping costs (refrigerated bottled liquids with a shelf life <6 months).
On the other hand, given that treating diabetes is more costly to the society in general (although more profitable for the pharma companies), shouldn't there be more research to ensure people don't get into the trap of becoming diabetic? One reason people become Type 2 diabetic is that they are completely unaware that their lifestyle and food they are eating are slowly creeping in to make them suffer with this disease. Healthy people only know about them becoming diabetic because the cycle to get your blood sugar measured (A1C Hemoglobin) is too far in between (annual checkups). If a person is more aware of his/her blood sugar levels at shorter intervals, then a proactive approach can be made so that the person can do changes that will help prevent diabetes.
How does one adjust the dose in a pill? Do I take more or fewer pills?
They mention the insulin is "freeze dried". What does this mean in practice? Do I need to carry around a climate controlled box with my insulin in?
"Freeze drying is a water removal process typically used to preserve perishable materials, to extend shelf life or make the material more convenient for transport. Freeze drying works by freezing the material, then reducing the pressure and adding heat to allow the frozen water in the material to sublimate."
You freeze it or shock freeze it and then "distill" the water of in vacuum. The ice goes into the vapor phase, skipping the liquid phase. This process is called sublimation and part of each first year high school chemistry curriculum.
The substance, insulin or other peptides, will be stable after this at room temperature for some time.
Also it saddens me to hear "I hope that company X will solve Y" instead of "I hope some university develops a method to solve Y".
But if someone is interested (speak investment interested) in non-invasive blood glucose measurement feel free to inquire. Peer reviewed publications available.
e.g. weight 150 pounds
1.5 pounds fruits before 1 pm
1.5 pounds raw vegetables for the day
If you are still hungry you can eat cooked food after completing daily raw fruits vegetable quota.
Avoid all animal,milk,processed packaged products and heated oils.
Will reverse diabetes in 3 days for newly detected patients.
Add 1 day for each year you have diabetes
lookup his youtube videos
It's tiring to keep getting suggestions of how to change diet when my body absolutely needs insulin from an external source. Further, while people may be able to reverse type 2, they still need insulin until they actually get there. So research into insulin delivery is relevant to all diabetics.
Also there are many ways of reducing carbohydrate intake. The diet you write about is just one of many ways to do that. Why single it out?
From the video:
> If you observe milk protein (casein) under a microscope it will appears as this - there are 17 links in it.
The video says "links", you say "rings". It's a small but important distinction. Proteins are made by linked aminoacids, so sing "link" is a good approximation, but most of them don't look like "rings".
I can't find where the "17" comes from. After a few google searches I found that casein has approximately 210 aminoacids, the number can vary, but it is not 17.
(Also, you can't see a single casein protein under a normal microscope, nor the parts of it. I guess it's only a metaphor, but it makes me suspicious.)
I don't find the part in the video that says that casein escapes to blood. (I didn't try too hard.)
Casein is split in the stomach by the enzymes IIRC they are the regular enzymes that also split the proteins in meat, and other food, not specialized enzymes.
(There is an specialized enzyme for lactose that is an special sugar in milk, but this is not what the video or you say. But if this were dangerous, we'd have a lot of babies with diabetes. Moreover, only some adults produce the enzyme to digest lactose, so it would be easy to test.)
I didn't find a source that says that beta cells have some proteins that are similar to casein. It is posible, but I doubt.
And IIRC most autoinmune diseases, where the body get confused and start to attack some part of it don't go away after you remove the initial agent that causes the reaction. So stopping drinking milk won't stop the reaction.
I'm not claiming a cure, or even an actual treatment. Just want to point some people to something that most people have never heard of.
I often hear good stuff about these guys: https://www.virtahealth.com/ (no affiliation)
edit: clarify that Virta is treating T2D primarily.
For T1s, eating less carbs might reduce the amount of insulin they need, and make swings in blood sugar less likely, but they're still going to need some insulin.