4 ms·

> Automated glucose control will be the next frontier in so many areas of healthcare. What areas do you have in mind outside of diabetes management?

by loeg 2mo ago

nemomarx 2mo ago
Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe
- hungryhobbit 2mo ago
  They are specifically relevant to trying to enter a fasted state. The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight). Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
  - cperciva 2mo ago
    whether or not (say) that coffee you just drank took you out of the fasted state A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state. Now, if you're talking about a cup of flavoured milk, that's a different question...
    - sroussey 2mo ago
      I think I drink coffee but I really drink lattes…
    - RHSeeger 2mo ago
      Adding any amount of milk to a coffee adds carbs. And a large number of people add _some_ amount of milk.
      - dredmorbius 2mo ago
        An 8oz serving of milk (236 ml) has 12 g of carbohydrate. People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g. That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.
        RHSeeger 2mo ago
        > both of which have less carbohydrate I never looked before today, but always thought it was the other way around. > That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g Also neat to know. I only know the impact that a Dunks coffee (with cream) has on my blood sugar (and how much insulin I need to take to counteract it). So this has been a learning experience for me. Thanks
joelthelion 2mo ago
Preventive medicine is a bit one. If your fitness watch could measure blood glucose, I think it would be a ton more impactful in terms of health outcomes.
- malfist 2mo ago
  In what way? Nondiabetic folks self regular glucose just fine on their own.
  - simmerup 2mo ago
    In the same way a step counter encourages people to walk more, a glucose monitor on your watch could discourage you from eating that extra donut
    - malfist 2mo ago
      Does a step counter do that? All studies I've seen say they don't cause people to adapt their behavior
      - cj 2mo ago
        This study says otherwise: https://med.stanford.edu/news/all-news/2007/11/pedometers-help-people-count-steps-to-get-healthy.html https://med.stanford.edu/news/all-news/2007/11/pedometers-he... Even if it doesn’t increase steps on average, it will absolutely still work with someone who’s self-motivated and not just looking for a quick fix.
  - jimbobimbo 2mo ago
    That's what I thought too, until I got my last bloodwork results and started wearing one of the OTC continuous glucose monitors. That device helped a lot to switch diet habits.
    - robbiep 2mo ago
      Can you be specific about what your bloodwork results showed and what special insights your CGM gave you and what behavioural changes it led to? My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary
ijustlovemath 2mo ago
Cardiac surgery, burn units, ICU, neuro come to mind. All have been studied to show mortality and complications improvements with AGC, but unfortunately the commercial technology has not materialized yet.
- sroussey 2mo ago
  Why is a hospital setting so different that AGC can not be used? Or is the temporary use of such not yet approved?
  - ijustlovemath 2mo ago
    Drug interference (with the sensor chemistry) and perfusion (which the sensor needs to function) are two major problems that a hospital presents that are not present in ambulatory (outside the hospital) use. Also the FDA has not approved any systems yet; the software is actually quite difficult to get right.
andy_ppp 2mo ago
I’m willing to bet we can see longevity improvements from better blood sugar control. Not 100% certain but extremely likely, this would include potential heart attack and dementia reduction…
- malfist 2mo ago
  This has been tested actually. A clinical trial looking at tight blood sugar regulation was aborted after it resulted in multiple cardiac events.
  - RHSeeger 2mo ago
    That's not a fair representation of what happened. That study was going for _aggressive_ control - beyond what any normal person would do. They were combining multiple drugs to force blood sugar down rapidly, including right after meals (when it _should_ be going up). Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks. From the AI > The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.
  - adinisom 2mo ago
    Interesting! Found this overview: https://emcrit.org/pulmcrit/tight-glycemic-control/ https://emcrit.org/pulmcrit/tight-glycemic-control/
  - deleted 2mo ago
    [deleted]
  - andy_ppp 2mo ago
    Nonsense, you can fast or live in ketosis for years without any adverse consequences.
ddorian43 2mo ago
Metabolic psychiatry is rising, though very slowly. You do "epilepsy keto diet", and may work in bipolar/schizophrenia (need GKI 1-2, it's not keto for weight loss). But you don't need the continuous monitor, normal ketone monitor is fine, because the food list is very narrow. The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.
algoth1 2mo ago
Also rare genetic issues like GSDs and FAODs may benefit immensely from dual glucose and ketone metering. Next we need potassium and magnesium meters and that will benefit the people with rare renal wasting syndromes like Gitelman and Bartters
sublinear 2mo ago
Metabolism, and the endocrine system in general, is very responsive to physical activity. Even in athletes, glucose can have significant ups and downs when it gets intense. It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.
jjk166 2mo ago
Blood glucose levels affect lots of health functions. Diabetes represents an extreme end of the spectrum where the body's ability to regulate these fluctuations fails, but just because your body can get your levels in control eventually doesn't mean you won't suffer from the negative effects of it needing to do so. Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out. Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.
- agumonkey 2mo ago
  sample of 1, but yeah changing my diet (very low sugar, more veggies) did alter my health visibly and rapidly. to the point that if I eat something too sweet too fast i have a very mild headache soon after, my system readjusted to not seek levels i grew up with
  - maddie0 2mo ago
    fwiw... if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail. other signs of digestive problems in this area may include: - a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like) - feeling generally flushed and hot after eating food (more histamine!) - waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine) - often having an upset stomach, and lots of stomach acid - increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge) - generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters) - serious nasal congestion contributing to sleep apnea, and extreme fatigue now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them! (and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)
VLM 2mo ago
"management" is the key word. Early diagnosis might help a lot not just with T1 but also T2. Early diagnosis would save a lot of pain and suffering... and money. I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan. Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis. If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable. Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario. IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.

> Automated glucose control will be the next frontier in so many areas of healthcare. What areas do you have in mind outside of diabetes management?

by loeg 2mo ago

> Automated glucose control will be the next frontier in so many areas of healthcare. What areas do you have in mind outside of diabetes management?

nemomarx 2mo ago

Ketones have some dieting and weight loss applications, so I guess you could do better real time tracking of how you're digesting carbs and when it's okay to eat? maybe

hungryhobbit 2mo ago
They are specifically relevant to trying to enter a fasted state. The presence or absence of ketones in your blood can tell you whether or not (say) that coffee you just drank took you out of the fasted state (that you were in for not eating overnight). Whether or not you are in a fasted state matters not just for weight loss, but also for things like longevity (when you are in a fasted state your body cleans up dead cells that contribute to things like cancer, whereas in a non-fasted state it leaves them lying around).
- cperciva 2mo ago
  whether or not (say) that coffee you just drank took you out of the fasted state A cup of coffee has zero carbohydrates, trace lipids, and about half a gram of protein. That's not going to pull anyone out of a fasting state. Now, if you're talking about a cup of flavoured milk, that's a different question...
  - sroussey 2mo ago
    I think I drink coffee but I really drink lattes…
  - RHSeeger 2mo ago
    Adding any amount of milk to a coffee adds carbs. And a large number of people add _some_ amount of milk.
    - dredmorbius 2mo ago
      An 8oz serving of milk (236 ml) has 12 g of carbohydrate. People tend to add single or double cream (1/2 & 1/2 or whipping / heavy cream, respectively, in the US) to coffee, both of which have less carbohydrate, and generally add a tablespoon or two (15--30 ml) per cup of coffee. The carbohydrate content is < 2g. That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g. That's about two full cups (450 ml) of single cream.
      - RHSeeger 2mo ago
        > both of which have less carbohydrate I never looked before today, but always thought it was the other way around. > That's unlikely to bring someone out of a ketosis state, which requires a daily intake of < 15--30g Also neat to know. I only know the impact that a Dunks coffee (with cream) has on my blood sugar (and how much insulin I need to take to counteract it). So this has been a learning experience for me. Thanks

joelthelion 2mo ago

Preventive medicine is a bit one. If your fitness watch could measure blood glucose, I think it would be a ton more impactful in terms of health outcomes.

malfist 2mo ago
In what way? Nondiabetic folks self regular glucose just fine on their own.
- simmerup 2mo ago
  In the same way a step counter encourages people to walk more, a glucose monitor on your watch could discourage you from eating that extra donut
  - malfist 2mo ago
    Does a step counter do that? All studies I've seen say they don't cause people to adapt their behavior
    - cj 2mo ago
      This study says otherwise: https://med.stanford.edu/news/all-news/2007/11/pedometers-help-people-count-steps-to-get-healthy.html https://med.stanford.edu/news/all-news/2007/11/pedometers-he... Even if it doesn’t increase steps on average, it will absolutely still work with someone who’s self-motivated and not just looking for a quick fix.
- jimbobimbo 2mo ago
  That's what I thought too, until I got my last bloodwork results and started wearing one of the OTC continuous glucose monitors. That device helped a lot to switch diet habits.
  - robbiep 2mo ago
    Can you be specific about what your bloodwork results showed and what special insights your CGM gave you and what behavioural changes it led to? My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary

ijustlovemath 2mo ago

Cardiac surgery, burn units, ICU, neuro come to mind. All have been studied to show mortality and complications improvements with AGC, but unfortunately the commercial technology has not materialized yet.

sroussey 2mo ago
Why is a hospital setting so different that AGC can not be used? Or is the temporary use of such not yet approved?
- ijustlovemath 2mo ago
  Drug interference (with the sensor chemistry) and perfusion (which the sensor needs to function) are two major problems that a hospital presents that are not present in ambulatory (outside the hospital) use. Also the FDA has not approved any systems yet; the software is actually quite difficult to get right.

andy_ppp 2mo ago

I’m willing to bet we can see longevity improvements from better blood sugar control. Not 100% certain but extremely likely, this would include potential heart attack and dementia reduction…

malfist 2mo ago
This has been tested actually. A clinical trial looking at tight blood sugar regulation was aborted after it resulted in multiple cardiac events.
- RHSeeger 2mo ago
  That's not a fair representation of what happened. That study was going for _aggressive_ control - beyond what any normal person would do. They were combining multiple drugs to force blood sugar down rapidly, including right after meals (when it _should_ be going up). Paying more attention to your blood sugar and acting reasonably to keep it in check isn't giving anyone heart attacks. From the AI > The concern was not that lower glucose is inherently bad. Rather, pushing blood sugar down rapidly and very tightly—especially with insulin and multiple glucose-lowering drugs—caused more episodes of hypoglycemia, weight gain, and treatment complexity. Severe low blood sugar can trigger abnormal heart rhythms and other cardiovascular stress. The intensive-treatment arm was stopped early after about 3.5 years because it had a higher death rate, although the exact mechanism was not definitively established.
- adinisom 2mo ago
  Interesting! Found this overview: https://emcrit.org/pulmcrit/tight-glycemic-control/ https://emcrit.org/pulmcrit/tight-glycemic-control/
- deleted 2mo ago
  [deleted]
- andy_ppp 2mo ago
  Nonsense, you can fast or live in ketosis for years without any adverse consequences.

ddorian43 2mo ago

Metabolic psychiatry is rising, though very slowly. You do "epilepsy keto diet", and may work in bipolar/schizophrenia (need GKI 1-2, it's not keto for weight loss). But you don't need the continuous monitor, normal ketone monitor is fine, because the food list is very narrow. The continuous monitor should help until you get the hang of the diet, it's a bit hard to maintain, but if it works, worth it.

algoth1 2mo ago

Also rare genetic issues like GSDs and FAODs may benefit immensely from dual glucose and ketone metering. Next we need potassium and magnesium meters and that will benefit the people with rare renal wasting syndromes like Gitelman and Bartters

sublinear 2mo ago

Metabolism, and the endocrine system in general, is very responsive to physical activity. Even in athletes, glucose can have significant ups and downs when it gets intense. It would be interesting to see this technology branch out into monitoring hormones, minerals, vitamins, etc. For all of human history, the closest we've had to realtime monitoring is just our mood. It would be life changing for anyone to have this feedback.

jjk166 2mo ago

Blood glucose levels affect lots of health functions. Diabetes represents an extreme end of the spectrum where the body's ability to regulate these fluctuations fails, but just because your body can get your levels in control eventually doesn't mean you won't suffer from the negative effects of it needing to do so. Maintaining consistent glucose levels improves mental health, weight management, sleep quality, muscle recovery, systemic inflammation, cardiovascular health, and may even slow aging. There isn't much clinical data at the moment on how to use blood glucose measurements to control glucose levels outside of people with diabetes (there are lots of things that impact it besides just sugar intake), but there are definitely major theoretical benefits if it can be worked out. Also, just reducing the incidence of diabetes would be no small accomplishment. About 3.5% of global disability adjusted life-years (DALYs) are due to diabetes. As of 2021 it was the 7th largest contributor of global DALYs.

agumonkey 2mo ago
sample of 1, but yeah changing my diet (very low sugar, more veggies) did alter my health visibly and rapidly. to the point that if I eat something too sweet too fast i have a very mild headache soon after, my system readjusted to not seek levels i grew up with
- maddie0 2mo ago
  fwiw... if sugar gives you a headache, this may be related to a gastrointestinal issue (e.g. gluten sensitivity, dietary histamine sensitivity, small intestinal bacterial overgrowth possibly causing its own sensitivities...) The specifics of the cause in your case are between you and your doctor, but i'd like more people to know, especially since these sorts of problems disproportionately affect people with autism and ADHD, long a core Hacker News demographic, and most of us have trouble paying attention to everything our body is feeling in exquisite detail. other signs of digestive problems in this area may include: - a pattern of early-afternoon fatigue and brain fog (this is mediated by histamine, which in turn can be caused by a food allergy, a non-allergy food sensitivity, bacteria in the stomach that don't belong there, or the like) - feeling generally flushed and hot after eating food (more histamine!) - waking up in the middle of the night, ~4am, especially if you're feeling too hot (also a sign of excess histamine) - often having an upset stomach, and lots of stomach acid - increased sensitivity to heat or exercise (mast cell degranulation because your body is already on edge) - generalized hard-to-place fatigue, brain fog, depression (the whole histamine-response pathway is shot through with various neurotransmitters) - serious nasal congestion contributing to sleep apnea, and extreme fatigue now, this is going to be different from person to person, but your doctor's not going to know anything's wrong if you don't tell them! (and if something like this is the case, it's also the sort of condition that might sometimes has an instant miracle cure, because if you stop releasing the feel-bad neurotransmitters every time you eat, then you suddenly stop feeling terrible!! go figure.)

VLM 2mo ago

"management" is the key word. Early diagnosis might help a lot not just with T1 but also T2. Early diagnosis would save a lot of pain and suffering... and money. I worked with an older T1 and apparently a bit less than half of kids diagnosed with T1 are diagnosed unconscious during a DKA event in the ER. "Treatment" cost, or at least requested revenue LOL, is at least $30K for an ER visit like that, and it also costs at least some months (years?) off their expected lifespan. Figure about 0.5% of the population in the USA is T1, you read stuff like "about two million T1 diabetics" in the USA. So early T1 diagnosis would save the country overall about $30B just in DKA treatment alone at time of initial diagnosis. If you could screen an entire population for less than $30B total lifetime cost, it would be financially rational to prescreen for T1 rather than waiting for ambulances to present incredibly sick kids. And potentially profitable. Prescreening the entire population for metabolic disorders is quite plausible as a "tech startup idea" as the alternative is waiting for them to arrive in an ambulance while extremely sick/nearly dead. Lets say it could be done for $10B, leaving $10B for startup profit (charge insurance companies $20B which is not bad....) and $10B in lowered health care costs for the country in general, not to mention less suffering in the population. A win-win scenario. IF blood sugar related disorders could be pre-screened for less than $10B total cost. A solid "maybe"? Plausibly a startup doing blood sugar prescreening would be a "multibillion dollar company" although not a trillion dollar unicorn. Still a good idea.