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Post by letitride on Dec 15, 2019 10:22:49 GMT -5
- people only took a single dose because they had other things to do. You make it sound like they have to carry a cinder block in to the bathroom, BETTER THINGS TO DO , taking a sip on a whistle... how busy are these people you speak of ...🤔 Life gets in the way. If you are doing something else you do not want the interruption of having to deal with your diabetes. That context switch is jarring and gets really annoying with time. It is hard to explain, but it's definitely real and that's where burnout starts (screw it, just mute all the alarms and don't bother with the insulin). I have seen burnout kill two people. This is why I would use an artificial pancreas. It removes that lack of control from your life - no distraction lurking at the back of your mind as to whether the alarm is about to go and you are going to have to deal with it. Today I avoid this problem by using a CGM but disabling all it's alarms. I now know the solution to afrezza sales we need to make it addictive. I would never let anything get in the way of stopping for a cigarette. |
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Post by agedhippie on Dec 15, 2019 11:09:51 GMT -5
Loop is a flavor of automated insulin delivery that is open-source and do-it-yourself (DIY). The Loop app runs on an iPhone and receives CGM values every five minutes from compatible Dexcom or Medtronic CGMs. The app communicates with a small bridging device called a RileyLink (white box in picture above), which allows the phone to communicate with old Medtronic pumps. The Loop app takes the CGM values, runs them through an algorithm, and automatically adjusts basal insulin delivery on the pump.
... ==================================================================================== Heh. Amazing type one's taking their care upon themselves and developing a system that works better for basal delivery. shawnonafrezza agedhippie are you using this? and how is this done? "Loop also allows me to bolus from an Apple Watch without touching my pump or phone." reading the article, plenty of tinkering with loop. diatribe.org/how-i-loop-two-years-using-iphone-app-automate-my-insulin-deliveryI should really let Shawn answer this because this is his area. Some of it I can answer. The comment about adjusting basal insulin can be a bit confusing. In a pump you mostly use RAA (some people use Regular) and never use basal like Tresiba, Lantus, etc. and instead simulate basal by continually dosing very small units of RAA - think of it like how it takes time when you take some drugs to reach the therapeutic level. A basal insulin like Tresiba delivers a steady does of insulin throughout the day but does that by using an insulin analog designed for slow absorption. This becomes an issue at night in particular because the body slows basal insulin between around midnight and 4AM because you don't need it, then around 5am onwards the body dumps extra glucose (dawn phenomenon) because your body will need the energy to get up. A basal insulin will overdose during the early part of the night, and under dose later. Pumps have profiles to fix this that change their level of dose through the night. So when a pump gives you a dose of insulin it is the basal amount plus any extra you need for food for example. The loop works by taking control of that setting and continually tweaking it to keep you in the middle of the road. This is where it gets interesting. The FDA will not currently allow commercial systems like the 670G or Tandem to make that extra corrections, they are only allowed to make small changes. The loop does not have that limitations so the loop can cope far better with food, and if you eat low carb you need almost no interaction, the loop does it all (Shawn has more knowledge than me on this). The Medtronics 780G is more aggressive about dose sizes which is why it exceeds 80% TIR. Having 100 as the target rather than 120 also helps. It is still not as advanced as the loop though. The JDRF and Helmsley Charitable Trust between them have put $6M into the Tidepool Loop trial to get that implementation of the loop FDA approved. The term loop is a bit generic these days and refers to several different implementations. |
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Post by agedhippie on Dec 15, 2019 11:16:46 GMT -5
.. "What I enjoy most about the Eversense CGM is that I don’t have to think about changing the sensor weekly or having to carry around tapes, an inserter, disinfectant, and all the plastic packaging. And of course – no more ripping out the sensor (which is one of the biggest advantages for me, since I have a special talent for ripping it out whenever I’m passing a door frame.) ... Catching it under the lip of a desk when I stand up is my specialty.  Right up there with dropping a pump and having it pull up short on it's tubing a foot or so off the floor dangling by it's site or ripping the catheter clean out (now you have remotes so this is less of a problem). |
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Post by peppy on Dec 15, 2019 11:19:39 GMT -5
Life gets in the way. If you are doing something else you do not want the interruption of having to deal with your diabetes. That context switch is jarring and gets really annoying with time. It is hard to explain, but it's definitely real and that's where burnout starts (screw it, just mute all the alarms and don't bother with the insulin). I have seen burnout kill two people. This is why I would use an artificial pancreas. It removes that lack of control from your life - no distraction lurking at the back of your mind as to whether the alarm is about to go and you are going to have to deal with it. Today I avoid this problem by using a CGM but disabling all it's alarms. I now know the solution to afrezza sales we need to make it addictive. I would never let anything get in the way of stopping for a cigarette.which the FDA controls. |
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Post by agedhippie on Dec 15, 2019 11:49:02 GMT -5
Life gets in the way. If you are doing something else you do not want the interruption of having to deal with your diabetes. That context switch is jarring and gets really annoying with time. It is hard to explain, but it's definitely real and that's where burnout starts (screw it, just mute all the alarms and don't bother with the insulin). I have seen burnout kill two people. This is why I would use an artificial pancreas. It removes that lack of control from your life - no distraction lurking at the back of your mind as to whether the alarm is about to go and you are going to have to deal with it. Today I avoid this problem by using a CGM but disabling all it's alarms. Aged - life gets in the way for sure but its become part of life to check your cell phone and most people do this more than once an hour. PWD CGM users as a result also check their BG as a result of checking the phone. Thats just the way it is and much different than 5 years ago or even 3 with the CGMs. Times have changed just as many here predicted they would as others (they know who they are) argued CGM users were outliers and CGM use would not become mainstream. They even still argue today taking slow acting RAA shots for meals is better than taking ultra acting afrezza which mimics first phase release. As was predicted here on this board years ago about the coming adoption of CGM, let me predict with pediatric approval afrezza will change how the kids are treated. I will also bet life won't get in the way of their mom's checking their kids CGM for second dosing of afrezza. Aged - insulin is a "tool" . When you have a screw its best to use a screwdriver. When you have a nail its best to use a hammer. Lets not forget why "second dosing" in most during Affiinity 1 and 2 was not done. Its was discussed during the ADCOM. In fact the FDA analyst accused the one doctor who did second dosing and whose PWD A1c numbers blew the RAA numbers away of "Cheating". In fact the FDA told the doctor if he second dosed his RAA PWDs like he did with afrezza they would have gotten numbers as good as his afrezza PWDs. The doctors response to her was chilling as he said "If I did as you suggest, I would have killed my patients". The reality is for T2s afrezza should be Step 1 and will slowly get there. Dr Kendall seems to be making progress on the SoC front. For the T1 kids I just don't know why any parent would not want afrezza for meals. For the AI Loop/pump developers the complicated problem they have been trying to solve is nearly solved with afrezza so I am sure they will find other jobs. I think Sanofi's departure from the R&D space speaks volumes. Paul Hudson knows he can't do better than Tresiba and afrezza and he knows when Ollie bet the farm on Toujeo he rolled "Snake eyes". By stepping back on Onduo he has now unshackled them so they no longer need to use Sanofi only products. Taking those in order; I don't continually check my phone, and certainly wouldn't if I was in a meeting, or concentrating on a task. My work involves 20% sitting around not doing much (to those who ask how can I spend the time I do on this - that is how), and 80% dealing with crisis. There is nothing I receive on my phone that cannot wait an hour or two - if it's urgent they will call. CGM users are still a definite minority even within the Type 1 community, and even more so in the Type 2 community. This is a combination of cost in countries with national health care, and, a different aspect of cost, insurers fighting a rear guard action in the US. I believe CGMs will become more common, but to reach a majority you are talking decades. There are some outliers like Belgium where 80% of Type 1 diabetics have CGMs (the remainder refused them). There is another aspect of CGMs that people don't talk about. There is a difference between having a CGM and using it. I know plenty of people who have a CGM and yet very rarely use it (the two weeks before your endo visit is a popular time for CGM wear  My bet is that the moms will all be out of luck. Your kid is in school and you have their CGM shared so you can see it. The CGM says they need a second dose, what do you do? Drive over, yank your kid out of class and make them take Afrezza? You will be really popular with both the school and your kid. Can you imagine the kid's reaction to have you continually nagging them to take insulin? Be prepared for them to stop sharing their CGM readings! The doctor who said a second dose of RAA would kill their patients is a complete idiot. Provided you account for insulin on board it's completely safe - pumps have done it for years without the user even being aware. I think insulin should be used earlier in the process with Type 2. Interestingly the two countries that delay the use of insulin the longest are the US and India. I want an APS so I am against the idea of pump and loop makers stopping any time soon. Absent a cure what I want is a system where my engagement with it is topping up the insulin and changing the site every three days. Between those times I want nothing to do with it - I have things to do. What I do not want is having to take 6 or 7 doses based on CGM alarms every day, and that is aside from any extras for snacking (having to an immediate dose and another one later based on a CGM alarm for a cupcake is an ideal diet enforcer!) Now there are people for whom this is a trade they are happy to make and who get significantly better results on Afrezza as a result. I am all in favor of that. I want diabetics to have the maximum number of options possible to help them in whatever way they want. I expect I would get better results if I followed that regime, but I the level of involvement required would negatively impact me in other ways and my A1c is where I want it so I don't do it. The cost/benefit is just not there for me personally. |
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Post by letitride on Dec 15, 2019 12:39:23 GMT -5
When you pull up to the window at your favorite fast food spot you order bigger than ever hit the whistle and drive on this is the way to
Let It Ride!
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Post by shawnonafrezza on Dec 15, 2019 12:40:31 GMT -5
peppy agedhippieFor myself, I have used Loop, OpenAPS, and AndroidAPS. I currently am on Tresiba/R/Afrezza. Aged got it mostly but I'll weigh in more. The article is a bit outdated. AndroidAPS/openAPS can and do deliver what are called super-micro-boluses (SMB) so they do bolus (the Tandem X2 just got approved for that next month as well but as boluses, not SMB. The distinction I'll leave out.). Loop has an experimental version that can do micro boluses (not super). We'll focus on Loop since that was the direct question. There is also a great video from one of the many moderators/parents. www.youtube.com/watch?v=qw_u1lqboCsThere are three components to Loop, your iPhone, the pump (old Medtroic or Omnipod work right now), and a dongle called a "RileyLink". Like sayhey24 pointed out, the RileyLink was made by a parent (most of Loop was) and is named after his daughter Riley. The RileyLink is what allows the pump to talk to the phone, in the future when the newer omnipods are supported it will not be needed. Optionally you can also have an Apple Watch. What Loop, or any DIY version, really does it it takes in your main inputs which are basal, insulin sensitive factor, and carb ratio, and runs math on those every 5 minutes. This is a gross oversimplification but we'll go with it. You also need to tell it when you ate and roughly how much, it does allow user error so if you're not sure if you ate 40g or 80g of carbs just put 60g and it'll work it out for example. Most closed loops operate on the assumption that your blood sugar will be more or less flat if you do not eat and your basal is correct. They also have "carb models" which already existed from scientific literature for how fast carbs will digest. Now with all that information the program will forecast what should happen either due to food or the lack thereof and any deviation it takes action. If you're last few blood sugars were 100, 102, 105, 110, 118 and it predicted they should've been 100, 101, 104, 109, 111 it'll start either giving the SMB or increase the basal because it know what what "should" happen and what did happen differed (delta of +7mg/dl) and obviously you need more insulin. It does the inverse of this as well. There are, of course, limits to this. There are first the safety settings. If the delta is massive there is only so much insulin the system is allowed to add/subtract to make sure it cannot put you in a dangerous system. The second is it operates with assumptions all of the above settings are mostly right. If you go to town on a bowl of rice and don't tell it it'll notice the delta and try to fix it (and eventually will) but because of the other safety settings it can only do so much/be so aggressive. The reason this + low carb works well is low carb has minimal impact on blood sugars so the deltas are always small and the system can compensate without much issue. The deltas also happen slower, you don't get changes like 110, 119, 130, 145 eating veggies + protein. ------------------------------------------------------- On to pumps, the limiting factor I won't go too much in to this but I'll mention it because it's good to know. All the above works well. Correction, it works REALLY well but pumps, or more accurately their infusion sets, can fail. They can get occluded or bent. Insulin sensitivity can change from one site to the next. These things can cause issues with the algorithm or straight up stop the insulin from working. There are more moving parts to go wrong, what if your sensors fails? Obviously then you're back on manual pumping so not a huge issue but it can/does happen. Putting a lot of RAA (~140 U over 3 days for me) into a single spot over the 2-3 day wear can have issues. Sites can rip out, sites can sweat off. What I'm getting at is there is still a physical limitation to all of this, where the software meets the hardware. Some people also do not like pumps or the idea of them. Pumps cannot go in water (except the omnipod). For most, or the overwhelming majority, of T1DM I do believe they would get better outcomes with a closed loop than they do but it is a person decision on to if you want a pump or not and if you feel comfortable with something else making decisions. Ultimately, the best treatment is the one you do reliably.
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Post by peppy on Dec 15, 2019 13:47:25 GMT -5
Regarding type two.Look what works. Look what didn't work.  |
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Post by mytakeonit on Dec 15, 2019 17:02:24 GMT -5
I'm type 2 and I say you don't need bariatric surgery. Just have some self discipline and cut your intake. My weight now has stabilized about 10 pounds lower and I'm definitely in the prediabetic zone. BTW, that gut guy pic was not me.
And Let it Ride is saying what I said about Brazil sales of Afrezza. Give it to them at cost ... cut them off when they get addicted ... then return when we can get a good profit margin.
But, that's mytakeonit
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Post by lennymnkd on Dec 15, 2019 17:53:36 GMT -5
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Post by ktim on Dec 15, 2019 18:46:30 GMT -5
peppy , VirtaHealth has whole cohorts doing the above. Dr McDougall says and I quote: "The goal is to keep their fasting blood sugars between 150 mg/dL and 300 mg/dL. I discourage blood sugar measurements at any other time of the day unless they suspect hypoglycemia (too low a sugar). The finding of elevated sugars later in the day after eating just upsets the patient and does not add any useful information in deciding on the next dosage of insulin to be given." So you can follow McDougall if you want but then supporting Afrezza also makes no sense. Personally I'd stay away from his advice if you want to keep your eyes and feet!! Mr. Shawn Flynn - that was an interesting article. I may just reach out to Dr. McDougall to get his thought on Joslin's work in the root cause of T1 and T2 diabetes - viral infections. hms.harvard.edu/news/insulin-goes-viralIf Joslin is correct, and I suspect they are much can be explained. In an early post you said T1 have anti-bodies and T2s don't. Well Joslin's research says T1s are under an active attack and T2s are not but rather the attack happened and the damage has been done. For the T2s the anti-bodies are gone or nearly gone. However for the LADAs we see a more recent attack or an active attack which has not devestated the beta cells. The first question Dr. McDougall has to answer is if "fat" is the root cause then why are not all fat people diabetic? In fact the body naturally adapts in non-PWDs. Obese non diabetics naturally grow huge clumps of beta cells and they naturally release more insulin. That is mother nature's approach to a healthy but over-weight persons need for additional insulin. However, if Joslin is correct what the PWD is releasing is an insulin like virus which attaches to the insulin receptors which causes the resistance. I think CGM use and the numbers we get from them are at odds with Dr. McDougall's thoughts. In fact I will say his approach to keep the goal of their fasting blood sugars between 150 mg/dL and 300 mg/dL. in todays world is malpractice. We know sugars above 140 for 2+ hours cause vascular degeneration. We also know the chance of hypos in a T2 with the use of afrezza is extremely low. In 118 ZERO when taking afrezza and not eating. I 100% agree with you - "if you want to keep your eyes and feet!!" then "stay away from his advice". Same reason that less than 100% of people who smoke get lung cancer despite it being incontrovertible that smoking is a huge contributing factor in causing most lung cancer. By the way, in the article you cite from Joslin they state that these viral peptides might just as well be protective against developing insulin resistance as contributing to it... and a logical inference would be that it might play no role. So Joslin is simply saying it's an interesting area for research, not making the assertion that you claim they've made, at least not in that article. |
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Post by prcgorman2 on Dec 15, 2019 19:08:20 GMT -5
AND, this continues to be the most interesting thread this year...
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Post by sayhey24 on Dec 15, 2019 19:48:34 GMT -5
ktim - the human body does not tranform to protect smokers. They do not develop extra lung capacity. I have never heard of a third lung growing.
However, in the case of the body requiring more insulin to meet the body's needs it does. It grows clumps a beta cells which we can touch and see through autopsy. Needing extra insulin is a natural need for which the body adapts. Sucking high rates of tar into your lungs is not.
Is Joslin's theory correct about the root cause being viral, maybe. Then again maybe not. What we do know is we have diabetic hot spots like Pottsville PA. and certain American indian tribes which was assumed because they are all genetically related. What we do know is the human body will adapt for increased insulin needs by growing more beta cells. If its not growing new cells, something happened to stop that. A viral infection killing the cells is highly plausible.
What we do know about the Joslin research is their experiments proved that the VILPs could indeed bind to human insulin receptors. That would indeed cause insulin resistance. We also know T1s show for antibodies and we know when we test T2s some also show for antibodies so then we call them LADAs. I wonder what we would see if we tested all T2s which is not currently done.
Most important we know early insulin intervention has shown to stop progression. Look - losing some weight and taking a walk is a good thing. At the same time giving them the T2 afrezza early can only help. Has a T2 only using afrezza every gone to the hospital for a severe hypo? I have never heard of any.
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Post by mnkdfann on Dec 15, 2019 20:20:22 GMT -5
ktim - the human body does not tranform to protect smokers. They do not develop extra lung capacity. I have never heard of a third lung growing. Actually, the human body does transform to protect smokers from certain diseases and afflictions. www.livescience.com/15115-5-health-benefits-smoking-disease.htmlNo third lung, though. |
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Post by ktim on Dec 15, 2019 22:09:25 GMT -5
ktim - the human body does not tranform to protect smokers. They do not develop extra lung capacity. I have never heard of a third lung growing. However, in the case of the body requiring more insulin to meet the body's needs it does. It grows clumps a beta cells which we can touch and see through autopsy. Needing extra insulin is a natural need for which the body adapts. Sucking high rates of tar into your lungs is not. Is Joslin's theory correct about the root cause being viral, maybe. Then again maybe not. What we do know is we have diabetic hot spots like Pottsville PA. and certain American indian tribes which was assumed because they are all genetically related. What we do know is the human body will adapt for increased insulin needs by growing more beta cells. If its not growing new cells, something happened to stop that. A viral infection killing the cells is highly plausible. What we do know about the Joslin research is their experiments proved that the VILPs could indeed bind to human insulin receptors. That would indeed cause insulin resistance. We also know T1s show for antibodies and we know when we test T2s some also show for antibodies so then we call them LADAs. I wonder what we would see if we tested all T2s which is not currently done. Most important we know early insulin intervention has shown to stop progression. Look - losing some weight and taking a walk is a good thing. At the same time giving them the T2 afrezza early can only help. Has a T2 only using afrezza every gone to the hospital for a severe hypo? I have never heard of any. The article you yourself cited indeed said that they didn't know whether it might possibly contribute to insulin resistance or prevent it. Read the article you linked to. Unless you've seen research going beyond that, you aren't representing it accurately. I's all very speculative at this point, and it seems quite strange if the root cause of T2 were to be viral, why do these viruses seem to attack people that eat too much and exercise too little at such a higher rate than overall population. Unless one has totally destroyed their health, overweight people aren't shown to be more susceptible to viruses. Overwhelming evidence is that eating too much and getting too little exercise are major contributors to T2, just as smoking is major contributor to lung cancer, and alcohol to liver disease (and liver as you stated about pancreas does have some ability to grow and regenerate to counter high levels of toxins, but it as with the pancreas can simply be overwhelmed and burn out in the one case and scar and die off in the other). Our body has regenerative capability, but not unlimited. And some more than others. A few people eat, drink and smoke up a storm their entire lives and don't succumb to the diseases linked to the behaviors. There is some genetics and luck of the draw in it. |
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Right up there with dropping a pump and having it pull up short on it's tubing a foot or so off the floor dangling by it's site or ripping the catheter clean out (now you have remotes so this is less of a problem).
