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Interesting—had no idea the 24 hour insulins were so new. I think that also explains a certain trend I've seen with insulin usage guidelines (typically) given
by westoncb 12y ago
Interesting—had no idea the 24 hour insulins were so new.
I think that also explains a certain trend I've seen with insulin usage guidelines (typically) given by doctors, versus by learned users. I found at first independently, then later had the finding corroborated, that using meal-time insulin (e.g. Humalog) was too unpredictable: too many factors are involved; blood sugar almost always go too high or too low—and, unpredictability varies with dose size (even while 'appropriately' matched by carbs). So, many people, including myself decide that since the lowest dose is most predictable, use zero (this is a Type 1 speaking)—zero meal-time insulin that is—and compensate by eating an extremely small number of carbs. This is only possible because I have the 24 hour insulin running in the background, however. My perplexity about it was that doctors seem unaware of this strategy (in my experience, which, while limited does extend to several doctors, and I hear this consistently from other diabetics). Instead, there's this myth that you just calculate your carbs, match with insulin—everything's good! But if it's only been around for 11 years or so, I guess it takes a while for the literature to catch up.
The other side of the situation, at the risk of sounding unappreciative, is that it feels like I'm paying Tesla prices, but still opt to get out and walk most of the time since the car is so bad.
Better blood sugar monitoring tech (e.g. continuous) and quicker meal-time insulins would seriously improve things. Quicker is better since carbs convert to blood sugar more rapidly than the insulin acts—unless I take a large insulin dose. That's another aspect of insulin's unpredictability: its processing rate is proportional to dose size, so there isn't just one ratio of insulin-to-carbs—though one could still infer their dose->(insulin units/gram of carbs) function :)
- cperciva 12y agoSo, many people, including myself decide that since the lowest dose is most predictable, use zero (this is a Type 1 speaking)—zero meal-time insulin that is—and compensate by eating an extremely small number of carbs. Yes, a lot of T1s find that keto diets work well for them. (It doesn't work for me, unfortunately; if I drop below about 80g/day of carb my liver decides that I'm starving it and dumps crazy amounts of glucose into my bloodstream.) Better blood sugar monitoring tech (e.g. continuous) and quicker meal-time insulins would seriously improve things. We have continuous blood glucose monitoring. It's expensive and not very accurate right now, but it does exist. Faster insulins are one of the big targets for use in insulin pumps, because they would make a closed-loop system much easier (less need to predict where blood glucose is going if you can just wait 10 minutes, measure a new value, and give a new bolus), but there are two difficulties: 1. Diffusion from subcutaneous tissue into the bloodstream depends mostly on the molar mass, and insulin monomers are quantized; diffusing half of a monomer would be faster, but it wouldn't be useful. 2. People need to be able to "unplug" pumps from time to time without dying, and if ultra-ultrarapid insulins leave the body too fast the mere act of taking a long shower could become life-threatening.
- ptaipale 12y agoInterestingly, I know someone who's the chief scientist for a company that has developed a non-invasive blood glucose meter. It measures the glucose content from earlobe. http://www.groveinstruments.com/ http://www.groveinstruments.com/ Looking at that page, the funny part is that someone decided to use the marketing term "cutting edge" for a technology that specifically does not cut your ear to measure blood glucose...
- cperciva 12y agoConsidering the name "Optical Bridge technology", I'm guessing this is yet another company trying to use the slightly different absorption curves for water vs. water-with-dissolved-glucose? This is not a new idea; I've seen lots of companies try this and fail because they (a) weren't accurate enough, (b) needed frequent recalibration, (c) were thrown off by exercise, dehydration, or common medicines, or (d) all of the above. I'd love to see such a product become available, but I've learned not to hold my breath.