Taking my diabetes treatment into my own hands (2024)

What I've learned that, as an adult in 2024 in the United States, you cannot take for granted:

- That your medical professionals are acting in your best interest

- That your insurance company is acting in your best interest

- That your medical professional knows what they are talking about

- That things that are legal to put in your body will not cause irreparable harm to you

- That the legal level of pollutants in the water, air, ground, walls, floors, etc are actually safe or even being measured properly

- That you aren't being subjected to something that later will be found to be unhealthy, even if it is currently known, until it is litigated in retrospect

- That you can afford the treatment that would be necessary to make yourself healthy

- That anyone in the industries that would normally protect you (healthcare, insurance, public health, government, etc) even care to do so

I understand that some people would look at that list and say I should have never expected some of those, but pardon me for being propagandized at a very young age that we lived in a country that was good and just. That's my bad.

So I am not surprised to see this, and expect to see more of it.

I'm prediabetic with two T2 parents and a T2 grandparent and my primary care doctor is entirely unconcerned about it.

My lowish tech solution to delay (and hopefully prevent!) the onset of T2 is to use a glucose monitor every 2 hours, every day, and create a database of foods with my postprandial blood sugar reaponse at 1.5 and 2 hours. I also keep track of how exercise affects my blood sugar.

Over the last couple years, I have gotten great data on the foods which spike me and the foods which are neutral to my blood glucose.

A lot of foods doctors/the internet tout as "diabetic friendly" (like beans, lentils, corn in any form, brown rice, buckwheat groats, non-granny-smith apples) spike me like crazy. Other foods are totally fine (bananas, snap peas, nuts, steel cut oatmeal, fermented dairy, fish).

Having an autoimmune disorder on top of the prediabetes, I've learned that the only one who cares about my health and longevity is me. My doctors care about my inflammatory markers and nothing else.

I highly recommend the book "The Diabetes Solution" by Dr. Bernstein. It's written by a T1D-since-childhood who was a manufacturing engineer and used his engineering skills to "debug" his diabetes despite his doctor's efforts to the contrary. However the medical industry rejected his findings on blood sugar control because of lack of medical credentials so he went and got an MD and suddenly more doctors started listening. He basically got ahold of an early glucose tester and turned it into a CGM by pricking himself dozens of times a day and around meals to collect data.

I'm T1D and currently working on something like this because diabetes healthcare in the UK is effectively non-existent past diagnosis.

Managing the condition isn't too difficult after 30 years of it, but dealing with the politics of NHS diabetes care is astronomically more difficult than it was in any decade previously. In my experience, if you are not pregnant, or you aren't at risk of passing out in the next 15 minutes, they don't care. Whatever long term consequences you experience are another department's responsibility.

A trend I've seen is that younger diabetes nurses and doctors are extremely dependant on tech (CGMs, insulin pumps), but don't comprehend how they work or what the data means. They don't know what patterns to look for beyond a 24hr window and generally seem to think everything is a bolus ratio or basal problem, overlooking other settings such as correction factor, duration, etc.

Because they are tech illiterate, vendor lock-in is becoming an issue, as no health tech companies want you using another tool except the one they get paid for. So I find myself being swapped from platform to platform as they change my devices every year or so, each one being less workable than the last. Glooko only allows 6 months of historic data to be viewed, and only through their web UI. Abbot refused to let me download my data after I was forced off their platform to Glooko. I was happy on Tidepool, but it doesn't work with my current set of devices.

No, more funding will not fix this. Threats of criminal punishments for lazy medical professionals and unlimited fines for anti-competitive behaviour from diabetes tech manufacturers will.

Not a diabetic and I live in one of the richest countries with a social medical system, but the medical industry is an abject failure. My experience with most Doctors who are not surgeons has mostly been that are overpaid for doing essentially nothing and think all their patients are hypochondriacs.

It’s all vibes! Type 1 here for 28 years.

You are on the right path here but I think you are missing the “big players” for lack of a better term. The prediction software available now (open source) is quite good and works with different types of CGMS and pumps. You are really going to want to look at Loop.

Loop basically collects the inputs in the app automatically for insulin if you use a pump. I’m on the Omnipod DASH and Loop works with a few, Omnipod being my favorite. You can also input injections. It can also collect CGMS data automatically from that system. It works with Dexcom and others (I think Libre). You manually input carbs, and you are still gonna do that based on VIBES. After that, you get these magic prediction lines that show you where you are headed. And with the pump, it can add or lower insulin amounts (closed loop mode) to keep you in range. Pretty common to be 75-90% in range!

Check it out:

https://github.com/LoopKit/Loop https://www.loopnlearn.org/

I‘m T1D and using Freestyle Libre + Omnipod Dash and iAPS + Apple Watch. Apple Watch is for me primarily to automate physical exercise detection and target adjustments but also works great with iAPS to control bgs and inject insulin from your watch without taking your phone out of pocket. All built as a homebrew closed loop.

While it was somewhat difficult initially to make it work I managed to get over the last year to 85% in range continuously over weeks with a (for me in comparison to before) very low amount of hypos (3 or 4 per week).

Happy to share more and the challenges I had if someone is interested...

>Aside: what do you .NET folks use nowadays?

Winforms lol, it just works and I don't have to spend most of my time trying to work out xaml stuff. Just add the components to the window, set up some event handlers, done

Interesting read.

My wife is T1D, moved to a closed loop last year. It has been life changing for her - this is not an understatement. Her mental health has massively improved because she isn't having up to 3-4 hypos a day.

One thing not mentioned in the intro, hormones hugely affect T1D. She's started perimenopause and everything went out of the window.

Closed loop has made this much more manageable.

The fat thing mentioned in the post: fat seems to slow down absorption in my experience, though not to the extreme that some self-described “body hackers” (who don’t have DM) seem to think.

I basically consider my malfunctioning pancreas to have been replaced/augmented by my brain, assisted by a cgm. My diet is rather boring but keeps me alive and keeps the BG in a pretty tight range.

My biggest problems are hypo (usually due to being in “flow” for long periods…bliss) and DKA (when I’m backpacking or on long bike rides, which my doctor recommends I not do, but I do anyway).

Hey fellow T1D, this is good stuff. As a tip, I’d recommend taking your daily insulin dose, splitting it in half and doing twice daily. It helped me quite a bit in dealing with the inconsistency of it all. I personally inject around midnight and noon if I can remember.

Also, if you have an android phone (I have a separate android exclusively for CGM use), there are open source apps that can connect to Libre 3 sensors and let you export data in several formats[0]. You can even connect it to home assistant if you’re into that. It would be really great to have these app readings integrated into your simulation.

Can’t wait to see where this project goes!

[0] - https://github.com/j-kaltes/Juggluco

Very dumb question here, but I don’t dare ask it to ChatGPT.

What would happen to T1 or T2 diabetics if we would stop eating all sources of sugars and carbs? So no fruit, no rice, no potatoes and so on?

Would it be possible to survive and live comfortably in a state of Ketosis? Or is a 100% ketogenic diet simply not possible on diabetes?

I’m asking because my true question is: what if insulin becomes too expensive? Then what? Do we die? Or is there some form of diet that we could live on??

One thing that I would object to is this characterization from the article:

>There are people who take insulin pumps (which provide insulin in very small very frequent doses and are ~permanently injected into your body, but are otherwise dumb as a brick) and combine them with continuous glucose monitors, and make the glucose measurements inform and control the pump. This is called “closed loop” or “artificial pancreas”, and getting one officially is very hard or impossible: not FDA approved yet / you need to be part of an university study to get one / … It’s one of those things that “will be here in 5 years”, they say every year for the past 30 years.

I've had a Medtronic CGM and pump for 6 years now (680G, now 780G). It is an FDA approved system with feedback from the CGM to the pump. The only thing I needed to get insurance approval was a blood test showing that I was T1 and not T2.

The auto mode has been greatly improved in the 780G pump vs. the 680G pump. I only need to stick my finger a couple times a week, and my control has improved. Without the pump and MDI it was quite a bit higher. It's nowhere near as good as an actual pancreas, but it is definitely not vaporware by any stretch of the imagination.

The Medtronic support is (mostly good), and I have a pretty high degree of confidence that it will keep me alive. I do have Kwikpens as backup in case of malfunctions - which do happen. The biggest things for me are as simple as ripping your infusion set out while away from home, or the thing has an intractable Bluetooth communications problem or other kind of hardware error.

The author is pretty much 100% right about "vibes" though, even with a pump.

One thing you would really benefit from that you don't need a doctor for is getting your BG displayed on a smartwatch.

Assuming you have an Android phone and a compatible smartwatch (Galaxy Watch4 in my case): 1. You need to install G-Watch Wear App on your phone and watch 2. You need to replace the official Libre app with a 3rd party app supported by G-Watch like xDrip or Juggluco. There are a few of those, mostly not on the app store and you can even feed their data into eachother, I'm not going to go into detail here. 3. Set your watch face to one of the two available godawful ugly G-Watch Wear App watchfaces and enjoy a live glucose graph on your wrist

Depending on your datasource it updates every minute or every 5 minutes with some smoothing applied - again, lots of fiddling here.

There are some alternatives for iPhone and probably other watch apps for Android as well.

T2 diabetic. Metformin, and Trulicity. Although Trulicty has been hard to find recently, so I'm doing without and working harder on my management practices, which is working well. I am not a doctor and I don't know you.

Interesting range of comments.

I think that whatever you do to manage your diabetes, logging data (meds, food, glucose, weight and bp for me) makes it more effective.

I've found that managing my diabetes and weight is better when I log. Just a text file. It keeps me honest with myself, and keeps my management practices front-of-mind. It's encouraging when I'm doing well, even very slightly exciting. And since I've learned not to beat myself up, it's gently self-corrective.

Going off logging, I slide out of control.

Anyway, that works for me, so it should work for anyone. Right? :-)

Definitely get the "vibes" statement on how much insulin... I can literally have the same meal two days in a row, and one day it takes half as much to manage, or I'll overcorrect need to drink some tang or something similar.

I'm T2D, with a completely borked metabolism and gastroperesis (thanks trulicity/ozempic). If I can manage to stick to mostly meat and eggs, I hardly need any insulin and am very stable. Unfortunately, I live with people who don't eat that way, and I'm weak in terms of temptation.

My uncle died after getting into a hypoglycemic coma at night. I think it is a real shame that technology hasn't been able to solve what looks like a medium-complexity feedback loop system.

When my wife was diagnosed with T2D, we went through the typical process many do - meet with a dietician, learn what to eat and how much, learn about insulin types and injections, etc. etc. She followed the process to the letter, and what we saw was the insulin injections make you gain weight, weight gain causes more insulin resistance, more insulin resistance means more insulin, more insulin means more weight gain, and on and on you go in this cycle that gets worse over time.

We researched more and more and found cutting out carbs heavily helped more than anything else, but she still needed some insulin. When mounjaro started getting a lot of attention, she tried that along with metformin. With those two drugs combined, she was able to get completely off insulin. She lost the weight gain from the 2 years of insulin, which reduced her resistance. She started having hypoglycemia and was able to reduce the metformin by half to get back to normal levels.

Her A1C is now 5.5 and has been < 6 for over a year now. Although the metformin was recommended by her endocrinologist, both the carb change in diet and trying mounjaro was something she had to take upon herself, none of her docs told us about this.

It's an absolute shame, and it feels like you're meant to be kept sick if you go strictly by the guidance from the ADA and even the doctors.

Interesting stuff! I'm a late T1D and there is just so much that subtly influences your blood sugar levels. I adhere to quite a strict diet and adapt my insuline dosage based on not just the carb contents and glycemic load of the meal, but also the starting point / trends I see in my libre readings. If you can predictably consume carbs (and glycemic load) you can also inject early with confidence (or even post-meal if your meal is really 'slow' or your blood sugar level is low). Going for a 20-30 minute walk during a meal spike (mostly after breakfast and lunch) does wonders for me too.

I manage to maintain roughly 99% TIR (4-10mmol/l) on my Libre with this, virtually no hypos and just the occassional bit of hyperglycemia when I just don't want to care. Although obviously this does require you to plan a lot of things in advance and requires effort and all of this is just based off of personal experience and experimentation and does not necessarily translate to anyone else.

I'm still really hoping for a more low-effort solution to T1D treatment (or even a cure), but I'm skeptical that we'll see that anytime soon.

Was dorm-mates with a T1D. Four of us total. His bunk mate and best friend basically saved his life twice in that semester.

How come the disease gets so little publicity??

A little tangential to the discussion and anecdotal, but I hope this can generate some discussion.

I've found different types of exercise affects my insulin response differently. I have T1D, had it for a little over 20 years. I've noticed that high-intensity short-duration exercises (hill climbs on/off bikes, burpees) have me requiring noticeably lesser insulin (both basal and bolus) for the same carb/calorie intake. This effect lasts for a couple of days, before gradually reverting back. I'm fairly active and play a few sports every other day for about an hour or two at the most, but none of them (in isolation), except for soccer, have shown similar effects.

Another curious effect I've noticed is great sleep (>= 8 hours) and managing my stress levels (which goes hand in hand with sleep quality) helps increase insulin sensitivity even further, but not overly so if I haven't been active over the previous few days.

Have any other T1Ds noticed something similar?

I'm a Type 1 diabetic living the United States and my experiences have been a bit different.

> This is called “closed loop” or “artificial pancreas”, and getting one officially is very hard or impossible: not FDA approved yet / you need to be part of an university study to get one / … It’s one of those things that “will be here in 5 years”, they say every year for the past 30 years.

These exist now. I've had one for a few years now. Medtronic 670G.

> My treatment is usually: keep the Freestyle Libre app on my phone open as much as possible and when I see my BG’s getting high, I inject a small amount of insulin. How much? No idea. IT’S ALL VIBES.

Your correction factor is

CF = 100 / (Total Daily Dose).

To make a correction you do

Additional insulin to administer = (current blood glucose - target blood glucose) / CF

Now, even after doing this you'll still have blood sugar spikes and dips but this should get you most of the way there when combined with diet and exercise with very little "vibes" involved.

It's kind of sad how slow some technology progresses. 10 years ago, I thought that by now we'd have self-powered machines which can manufacture insulin inside the body or replace essentially any organ.

It's crazy that we still can't replicate biological processes. Literally a peace of meat can do this stuff but we can't replicate it.

As a software dev, I feel like the industry has slowed to a crawl. Most of the jobs are about building gimmicky software as part of some weird corporate acquisition scheme. There are very few jobs available to build real useful stuff. Those jobs involve taking risks... But private equity firms don't see the point of taking on risks when they can just as easily get risk-free profits.

I find the risk-aversion of private equity firms very weird because at their scale, with their finances, you'd think they could make a large number of risky bets and get relatively predictable results but that's not what they're doing. The alternative approach I'm suggesting clearly works; just look at what happened when companies started investing in AI. The level of risk in that case was off the charts, yet clearly, even that bet paid off. The productivity gains of recent AI innovation are broad and obvious. Why isn't this approach the standard?

If incentives are the issue, we need to reform the socio-economic system to align incentives to prioritize useful innovation. Remove perverse incentives which reward useless schemes. Encourage broad bets, prioritize technical skill. Funding should be easily accessible to skilled tech people and shouldn't be based on social connections or arbitrary metrics of past financial success.

Technical success and financial success rarely align these days because technological alignment with financial schemes is the main determinant of financial success in the tech industry.

A lot of innovation is brushed under the rug. Useful innovations which could have provided a solid foundation to build upon are completely deprived of funding. Almost every useful innovation becomes a dead end.

Fellow T1D here. Switched to a pump (tslim) 2 years ago, which is a stock/market semi-closed loop requiring no homebrew when paired with Dexcom.

Works pretty well in that it keeps things in range when not eating/exercising. Nights in particular now are chill, no more waking up in sweat.

Unfortunately the pump vibrates/alarms far too much, causing notification fatigue. I don't even look at them anymore. I wish there was more information in the vibration pattern: just morse code or something, so I can know what the pump is saying without having to do 3 taps to unlock and see whether it's just telling me something I know already. I wish the developers had to dog feed their product.

> https://github.com/SmartCGMS/core/blob/dffdd89a274144d0e9ecb...

> Especially, a diabetic patient is warned that unauthorized use of this software may result into severe injury, including death.

I like the idea of the post - I have actually been thinking about including some biophysical models for medications in my app - but I do think that if you don't understand what a system of differential equations is, maybe trying to use a software library as a black box is a bad idea. For example... genetic algorithms... really? Like use a shooting method or bisection or something. If you have 3 doses you have 3 variables and it is all continuous so searching the space of inputs should be much easier than examining 51^4 discrete possibilities.

I'm a T1D and I mostly agree with the author. I think this simulation is very interesting.

I disagree with the author however on the following point:

"injecting insulin ~15min before you start eating would do wonders for neutralizing the BG spike, the issue is, nobody does it, because what if you then get a smaller serving at the restaurant or it gets delayed?"

My doc told me the same, which I think is insane. "Here is a hack that solves 80% of your problems but nobody does it, so don't bother." WTF?

If you get a smaller serving, order some bread or eat some of your emergency snacks you should always have. If it gets delayed, do the same. You don't need to cover the whole insulin dose, just delay the hypo a little bit.

Relax. We live in an industrial world where glucose bombs are available always and everywhere. You'll be fine.

Injecting 15mins beforehand has made my life so much easier that I would not miss it for anything.

Feel free to ask me anything.

This is very cool. I am fortunate enough to have access to a pump and have been hacking closed loops for a few years now using software like Nightscout, AndroidAAPS and xDrip+. My understanding is that none of these are exclusive to pump users, they just work a little easier with them. Maybe there is some interplay with these tools that you can leverage?

Fantastic post. Great job Martin Janiczek! Fellow T1D here. Please keep posting because it is useful and interesting! I am a programmer and more glad to help you in any way with databases, SQL, Python, R, C#.

Resources that helped me achieve excellent control of my type 1 diabetes. My TIR is 95-100% and lowered my A1C from 11.9 to 4.1 (not low carb, I’m high carb in fact):

Fat and protein in meals require insulin 1-2 hours after eating via extend bolus (aka temp basal). Learn how to post-bolus (give yourself insulin AFTER meals) “Fat-Protein Units” (FPU).

Fat x .09 x 8 ÷ I:C = units of insulin Protein x .04 x 8 ÷ I:C = units of insulin

Sum both. Then dose insulin as a temp basal (extended bolus) over n-hours per the Warsaw Method time schedule linked below.

And continue to pre-bolus for carbs like usual 15-30 minutes before you eat (data driven approach is pre-bolus and eat meal AFTER blood glucose values on CGM trend down for 3-4 consecutive readings)

https://waltzingthedragon.ca/diabetes/nutrition-excercise/re...

https://drlogy.com/calculator/warsaw-method

Starting point to determine your insulin-to-carbohydrate ratio: 300 ÷ Total Daily Insulin Dose = 1 unit insulin covers n-grams of carbohydrate

https://diabetesjournals.org/diabetes/article/68/Supplement_...

Two books: https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin...

https://www.amazon.com/gp/aw/d/0593542045/ref=tmm_pap_swatch...

One podcast: https://www.juiceboxpodcast.com/diabetesprotip

Howdy! My startup involves tons of glucose simulation, and I'd be happy to show you what you need to do to get more realistic parameter modelling based on your actual real world data, if you like! Just drop me an email :)

Not sure how widely known this is, but recent studies have shown great, sustained results for type 2 through dietary interventions using wholegrain oat (as it contains beta-glucan): https://www.thieme-connect.com/products/ejournals/html/10.10... https://www.sciencedirect.com/science/article/pii/S221479931...

The pdf here:

https://news.ycombinator.com/item?id=14667430

Suggests muscle protein impacts insulin resistance.

If you have glucose in interstitial fluid, physical activity may help.

See:

https://news.ycombinator.com/item?id=25427090

I did a paper on Functional Hypoglycemia a zillion years ago. I have a condition which puts me at high risk of diabetes. Some thoughts I'm not going to try to give citations for because it's based on decades of reading etc:

The liver stores sugars that the body calls upon when you are hypoglycemic. Liver support, such as milk thistle, may help. (Tldr: you need to provide the building blocks for glutathione, which the liver uses a lot of. It cannot be consumed directly and must be manufactured in house.)

Diabetes is associated with inflammation which may be caused by either infection or high acidity. You could get pH test strips to pee on and track your pH levels as another data stream and IF you see a correlation, treat that as well.

Functional Hypoglycemia was traditionally managed with diet. I managed mine that way for years. Avoiding sugars and having fatty, high protein foods late in the day helped prevent middle of the night severe hypoglycemic attacks.

Studies show aloe vera does good things for diabetes. Will it help T1? No idea.

But you could read up on that and firsthand experience suggests to me it may remedy other issues that are pertinent to diabetes but maybe not recognized as directly related because it's more like an underlying issue.

Dumb question here :-

My father has diabetes since he was 30, my grand father had it too in his 30s.

I am beginning my 30s, will I get it too ?

Is it guaranteed that I'll get it ?

Can I avoid getting it ?

Both my father and grandfather had heart attacks...

A friend of mine had to take insulin dose daily. Talking around with people, he found out that diet with carbon hydrates (bread, potato, rice…) increased blood sugar.

For the past few years, he is now on keto diet and eats 2-3 eggs per day, due to some missing aminoacyd (not entirely sure why). His blood sugar is normal and he doesn’t have to take insulin anymore.

If anyone needs some more info, contact and I can ask him for more details.

One of the first things I figured out on my own right away is my carb ratio.

15 minutes before eating is a must or else you’ll be on a wild chase.

We’re somewhat insulin-resistant in the morning. Plus some glucose is dumped into the bloodstream to wake us up. This requires some units of a fast acting insulin or else the BG will go up even if you don’t eat anything. This is also why carb heavy foods are the worst breakfast foods.

My dad had a strange case of Type-1 diabetes that manifested later in life, at the same time he also got hit with rheumatoid arthritis.

> injecting insulin ~15min before you start eating would do wonders for neutralizing the BG spike, the issue is, nobody does it,

My dad did. Yeah, it did cause a couple scares. He had very well-controlled numbers but it was all-consuming and I can’t imagine the average person being as thoughtful or on top of it. I’d probably become quite depressed.

Why does hypoglycemia happen in people with diabetes? Healthy people can stay active for weeks without food and for many years almost without dietary carbs (on just fats and proteins - see carnivore and keto diets). How comes gluconeogenesis from triglyceride glycerol and from amino acid fails to cover the essential glucose needs?

Interesting read. It's crazy how artificial pancreas aren't yet broadly available. It seems like a big market and represents a big problem that people would be willing to pay substantial money to solve. Surely it's not that technically difficult.

I would suggest to drink psyllium husk mixed with water, 15 minutes every meal. It would prevent glucose spikes which is the number cause for diabetis, lowers cholesterol level, regulates bowel movement and it is also an instant relief during hyperacidity.

Treating your diabetes is surprisingly simple, actually; stop eating carbs and plants.

I had a very similar experience with eosenophilic esophogitis (EoE). It's an allergic reaction that causes your esophagus to constrict resulting in acute dysphagia (difficulty swallowing). It can get extremely unpleasant for me as well as anyone around me when an attack happens. The problem is that the latency between eating the food that triggers it and actual symptoms is many many hours, and the symptoms only appear if you happen to swallow something that's just a little too big, and by then it's too late. It was only by sheer luck that I managed to figure out what my trigger is (scallops). In order to be diagnosed you have to get an endoscopy, which is also the only indicated treatment (other than avoiding the trigger food if you can figure out what it is).

I had this idea of using gel caps to get a better read on my internal state because you can feel them going down but they don't actually get stuck (and even if they do they dissolve pretty quickly and don't cause too much discomfort). The idea is to have them in a variety of sizes, and to start with small ones and get bigger until you can feel one. That gives you much more fine-grained data which you can then correlate with what you've eaten the day before. Trick is, I can't find a source of placebo gel caps in assorted sizes anywhere. I can't even find a manufacturer to make them for me. Every manufacturer I've approach about this insists on having some active ingredient, and they also want minimum orders in the thousands of units.

The irony is that I would have no problem getting these on the market as homeopathic remedies of some sort.

are you familiar with LoopKit (an opensource automated pancreas)? I'm looking at moving from injections like yourself to this, it looks more complete than the closed systems, and also the closed systems aren't approved in my country.

The author can simply use the adjoint method to estimate their personal parameters, no?

Incredibly motivating to read.

Just get a Tandem T-Slim and Dexcom G7. My A1c went from 7.8 to 6.2.

>You should also lose weight, when you started coming here you had 80kg, now you’re a centurion. Like seriously, WTF. OK cool bye, see you in 3 months!”

a centurion? an officer of the roman army?

I do not understand the phrase, is the author fat or not?

(2024)? We're still in 2024, aren't we? (@dang)

I completely agree with the author. T1Ds must take care of themselves.

Doctors and nurses suffer from Dunning-Kruger massively. They will quite often be confidently incorrect. I’ve seen this living in large cities in the US and Europe. Or you can read about how medics often make potentially murderous decisions on diabetes treatment — there are plenty of stories. Humility is the cure. I say this as someone who went to medschool myself and I have a lot of respect for medics.

The most infuriating thing is when they say that diabetics just die in surgeries, but forget to mention that often the reason is medical negligence. Anyone who has had their T1D loved ones go through general anesthesia surgery knows some of the things doctors tend to suggest, like going off the pump for a number of hours with no insulin replacement. Or demanding significant diet changes just before the anesthesia with no insulin adjustment.

One doctor once told a patient I know their blood glucose is okay in the morning, so they don’t need to check before the general anesthesia surgery in the evening — the blood glucose only needs to be checked twice a day. I’m sure the care diagram in that hospital says that, but it’s with the assumption that the patient is conscious and actively managing blood glucose on their own.

Another way I agree with the author is about closed loops. Many T1Ds, I believe, cannot have adequate control with the “one basal pattern and set carb ratio boluses” approach. Much less with multiple daily injections. Their daily insulin needs just fluctuate too much for an appointment with the doctor or nurse once or twice a year for dose adjustment. If the patient has any sort of hormonal deregulation day-to-day (which many of us do), it will just not work. My closed-loop total daily dose of insulin fluctuates between 90 and 220 units with very good control. Any sort of “roughly one total daily dose every day” approach will fail spectacularly in this case. Such a patient cannot achieve good control with traditional treatment, in my opinion. Though they sure are shamed a lot by doctors who, once again, Dunning-Kruger their way into thinking that treatment absolutely should work.

All in all, closed-loop is leaving many medical teams dumbfounded, some are even afraid of it (and refuse funding or tell parents their treatment is good without closed loops), but it’s a life changer. And a patient with this disease always needs to take it into their own hands because the 30 minutes T1D of training in medschool that I got is absolutely nothing compared to years of first-hand experience patients like myself have. That’s why I don’t blame doctors for being misinformed, but I do blame them quite a bit for not realizing the shortcomings of an education that, once again, generally touches on the subject very little.

For those of you on the cusp of diabetes, immediately start working out intensely and reduce your sugar intake. There is still time! It’s not inevitable