I'm a type 1 diabetic and I've been waiting for this. I'm not a big fan of watches but having a wrist mounted snippet of the email/Slack/text that I just received has been enticing, but not worth the 1 day charge time of the iWatch.
But even if the glucose testing function is somewhat above mediocre AND integrates well with a journal app of my ups and downs, I'm sold. No questions, line me up for a too-expensive band, the charging station, etc.
Are you currently using a CGM? I use the Dexcom G5 which has an iOS app and watch integration. I also have it set up to feed into a night scout instance and am working on a browser extension so I don't need to rely on the web interface so much (plus much more low key). I've found that I keep my watch on all night and really only charge it when in the shower and getting ready and it never seems to come close to dying. I literally just look at my watch and get my glucose. It's a game changer for sure.
I do have an integrated CGM but they're so goddamn itchy after the 3rd day, and they're designed to last 6 days. The cost of these things is too much to just use them for 3 days and change anyway.
If you like the ability to get notifications without having to charge often, try the Garmin VivoActive HR. You charge it once every week and receive the notifications snippet of the apps you want. Moreover it is a very programmable device with an SDK and so forth. I never used a watch before in my life, but to avoid looking at the phone so often is a great life improvement for me. The watch is also water resistant, so for instance, I can shower while there is some call I need to receive or something like that, and if I get it I just drop out: before I would not even adventure since I could not check the phone to see who was texting/calling and so forth.
Appreciate you sharing your perspective on this. Interesting to listen to the debate re: the merits of various technical approaches, but ultimately what matters is whether people will actually USE the product and derive health benefits.
I don't care at all, even if they notice I have high blood sugars and sell my info to some drug company market to me a drug claiming to lower them. The added benefit of tracking integrated in my watch trumps that.
Here's the thing about Type 1 diabetics- we'll take what we can get. No one caters to us because we're such a small subset of diabetics we may as well be a rounding error. Every treatment/study/drug you see in the media is aimed at Type 2 diabetics. Glucose meters are about the only thing we both benefit from.
In the U.K. it is very difficult to get a CGM - unless you are young or manage your Type1 very badly.
Even with doing finger prick blood tests 5 times a day, for years, I feel mostly clueless. And rely heavily on how I feel. Given how much time this condition (?) costs healthcare, this seems a poor way to manage it.
I'm desperate to learn more about my body's glucose trends. A watch that could do that would be awesome.
I suspect if you are a diabetic that actually cares about his/her blood sugar, you wouldn't give two hoots as to the company that made it easier to monitor. You would simply want the device.
Until insurances use the data to make your life miserable. Until companies buy black market database and your resume is rejected everywhere and you can't get a loan.
It's always the same with democracy. You have to make those decisions before something actually happens. After it's too late.
Are you familiar with the Helo? The Helo LX is a device already ahead of Apple's Engineers. You can find the Helo LX at http://Farmer.Helo.Life
look into who Antonio De Rosa is. In short, he is our chief designer and he was on that Apple iWatch team in 2010. We are ahead of Apple on this one. Those sensors exist today and guess who has them?! But this is great, Apple has a much bigger marketing budget than we do.
Yes and PRISM was a myth until we proved it was not.
You can't trust corporations to do the right things here. They will be tempted. Eventually one will give in.
Not only can they steal it in ways you won't notice, but they don't even need to. They can just do an update in the CLUA that people must accept or loose their 3 years of accumulated data, giving access to "anonimized health data".
The only way to be sure it's almost safe is to either:
- design en open source system so that you know it does no evil and you can control it
- avoid putting the data in the system in the first place
The article mentions that too. But if one company had the money and wanted to do the pseudo-altruistic thinking of getting it working by just throwing money at it until someone came up with a breakthrough, Apple has the money to do that.
The article is right, they could make a fortune in sales after doing it, and since I'm sure there would be a patent chances are no other smart watch company would be able to make such a thing. I'm not sure that would make up for $2 billion in research (just to make up a number); but Apple can afford it.
I have to hand it to you for not even trying hard enough to read the parent's point about type 2 vs. type 1, and then linking to an article that mentions type 2 in the very first sentance.
Great, which still has nothing do with type 1 diabetes being caused by diet (or affluence). You can certainly manage weight gain or side effects in different ways, but the point still stands that Type 1 diabete is an auto-immune disease where the immune system attacks insulin producing cells in the pancreas. It is a very different disease than type 2 diabetes, where the pancreas still works, but the person has insulin resistance, and is the one people think of when they talk about diet and obesity leading to diabetes.
No amount of diet change is going to reverse the damage to the pancreas in Type 1 - it is not a "disease of affluence"
OK, so are you suggesting that a vegan diet or otherwise avoiding animal proteins will somehow prevent and/or cure juvenile diabetes then...
I give up, and suggest you learn to Google something more than just source to try to confirm (poorly!) your own biases about what diabetes is or isn't.
Also consider that tech like this has applications beyond just diabetics. Glucose could be correlated with caloric intake. Tech like this could be a step toward the Apple Watch actually monitoring how much you are eating passively.
I would put money on that being the reason why Apple is developing it; not to directly help diabetics, but to add fitness features to the Apple Watch.
This reminds me of a project that Texas Instruments was working on a number of years back. They invested in and helped fund the development of a wire that could work suspended in fluids.
The startup that invented it and was further developing it was doing the work to develop an optical implant that would allow the blind to see. TI didn't care about helping the blind re/gain their eye sight, they just cared about getting their hands on a wire that didn't short circuit in fluids.
> Apple Watch actually monitoring how much you are eating passively
This is a technology grail for me. I'm for calorie counting and there's no doubt that it's integral part of weight loss. But entering all my meals in forms. Blerg. I only ever do it for a few months at a time before throwing in the towel.
Have you ever heard of the HELO LX? You would find this an extremely interesting device. Wearable Technology with Life Sensing Sensors. Check out our 2 minute video at http://Farmer.Helo.Life
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This is fantastic. The Helo LX is a device already ahead of Apple's Engineers. You can find the Helo LX at http://Farmer.Helo.Life
look into who Antonio De Rosa is. In short, he is our chief designer and he was on that Apple iWatch team in 2010. We are ahead of Apple on this one. Those sensors exist today and guess who has them?! But this is great, Apple has a much bigger marketing budget than we do.
As someone knowing about blood sugar I found the lack of technical discussion around that topic surprising. Is it even possible (obviously yes?) to measure blood sugar optically? (electrically?)
I always wondered if it was possible to use the iPhone's camera & flash to measure the shift in the apparent color of blood seen by pressing the camera onto a finger, caused by the slight change in refractive index from increased blood-sugar.
In a watch form factor, it would be dramatically less intrusive to an individual's daily life.
With automatic periodical measurements, data logs and trends, food intake recommendations, alerts and notifications, and so on, management of the disease would be quite effortless.
I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of __treating__ diabetes is technology that helps maintain excellent blood glucose control. Diabetes Mellitus (T1) is not a curable disease right now except through pancreas transplants. Diabetes is therefore a disease that has to be treated. The treatment for diabetes is personal, non-uniform, active, and adaptive. Every ingestion of food or liquid affects your body and needs to be considered.
Diabetes is a disease that needs its symptoms to be monitored and managed at a high granularity. Both monitoring and managing blood glucose can be really invasive though, with needles and finger-sticks causing extensive scar tissue development. Minimally invasive glucose monitoring technology that generates high-resolution time series data (such as Dexcom systems) literally transforms the way that people can manage their disease. Going from glucose reading every 6 hours (test strips) to every 5 minutes (CGM) is life changing. Monitoring that is non-invasive is the next technological step.
The holy grail for treating diabetes should actually be stabilized monomeric human insulin. Afrezza[0] is exactly that, and inhalable no less. The company that makes it just can't break through the insulin cartels and insurance-pharma exclusivity, so they are having a hard time. They did what was unachievable for 100 years though, and they are amazing chemists.
I can really relate with your read on the treatment of type 1 diabetes.
My father was involved in some of the early long-term diabetes control trials which began at the University of Washington in the '80s. One group was randomly selected and told to keep doing what they were doing. The other group was to keep as tight of control over their blood sugar and insulin administration as humanly possible, and was continually given state of the art tools to do so. He was in the later group.
Despite having excellent leading-edge advice, and being one of the most disciplined people I've ever known - marathon runner / Mormon* / literal boy scout (master) - it was a constant battle to keep things under control. It's a myth that diabetics can't have sugar; rather, it's easier avoid it because it ends up being such a pain in the ass.
I wasn't really paying attention, but still knew what a basal rate was as a kid.
* I never realized how much more difficult Diabetes could be until college, when a roommate was relieved to hear I knew what a glucagon shot was, and how to administer it. Alcohol & everything else was something my dad never had to deal with.
Drugs really did improve since then. My grandmother had trouble managing her diabetes until she was put on metformin, which was only introduced in the US in 1995. https://en.m.wikipedia.org/wiki/Metformin
> Every ingestion of food or liquid affects your body and needs to be considered.
You know, it's funny. I've had Type 1 Diabetes since I was 13, more than 15 years ago. I just can't imagine what it's like to not think about everything you eat. I have to do several math equations every time I eat just to survive. At this point it's just a part of eating, there is no alternative. The idea of eating a donut and not worrying about feeling like shit for the next two hours is totally foreign to me.
I always say, if you want to monitor your food intake, just become a Type 1 Diabetic. You will consider everything you eat :)
I'm not sure inhalable is a feature. Insulin pumps/pods micro-dose fast acting insulin throughout the day to cover your basal dose, you can't do that with fast-acting insulin via inhaler. You can't close loop your inhaler with a CGM to adjust your basal based on your current BG and automatically control for overnight highs/lows. You can't dose your kid from across the room from your smartphone.
Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...
I think alternative delivery mechanisms to injection are a feature. Ask any diabetic if they would like less needles in their bodies. There is work and patents on adjustable dose inhaler systems, but its never going to be a basal insulin that is being delivered. It's prandial.
The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers.
I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.
I don't have a link available, but I will try to describe it.
Insurance company A needs to help with a wide variety of prescription needs -- cholesterol management, heart disease, kidney disease, cancers, MS, diabetes. Insurance company A negotiates with pharmaceutical companies B, C, and D for how much A will pay for any drug and what copay A will charge to the insured patient.
Pharma B makes a deal to ensure that their diabetes drugs are on tier 1 or preferred status (most likely to be approved/used/paid) in exchange for a very good deal to the insurance companies on the price for each prescription and a lower tier for their cholesterol drug. The agreement also states that all other diabetes drugs (insulin, let's say) will be tier 3 or need prior authorization. This is a contract that might last a year or 5 and is not public.
Company C makes a deal to get their MS drug as the only reasonably priced option in exchange for basically giving away their foot fungus drug. The insurance company is happy because every foot fungus prescription is pure profit. Company C is happy because they are they only game in town for MS treatments on that insurance provider.
Pharma D wants to get their insulin at a higher tier so that patients can afford it and not buy out of pocket. But Pharma B already has an agreement that all other insulins will be tier 3 or lower, so Pharma D is locked out of that insurance company.
The current health insurance and prescription system in the US __heavily__ favors large pharma companies that can negotiate on multiple grounds and leverage competing health interests. Small pharmas that offer a singular stellar product have a tremendous fight to even get past prior authorization.
We already have automated continuous insulin injection pumps that work well. It's a big improvement over shots every few hours. But they still need manual setting of pump rate, based on manual periodic measurements.
A noninvasive sensor that measures blood glucose accurately, even just once a minute, would give you the ability to close the feedback loop and remove all human input from the system. No "oh shit I forgot to measure and adjust". Especially for kids it would be a big breakthrough. In essence, you'd have an almost-perfect artificial pancreas.
I'd say closed loop ish system. It uses the CGM data to make temp-basal adjustments. It's not like a full autopilot or anything.
Since modern fast acting insulin still takes time to kick in, you need to dose to cover carbs about 15 minutes before eating. So there will always be some level of involvement of you want to avoid actually going high and then coming back down (proactive vs reactive).
Don't get me wrong, it's great to know you're going to wake up at your target even if you screwed up your dinner-time bolus a bit.
That is, assuming the CGM is functioning properly. My experience with the Dexcom G4 with my kids was much less than stellar. Lots of '???' readings or having it off by over 50 points, extremely painful insertions and being mostly useless the first 24 hours and then sensors failing long before 7 days was the norm and ultimately we abandoned it.
Anxiously waiting for the auto-inserting CGM to come out of trials.
That's too bad. I got my Dexcom about 18 months ago and while it's not perfect and very expensive, I really do miss it if I have to go a week without it. I can imagine having to use it on children would be pretty nasty, though. Putting the sensor in is not a fun time for a grown adult.
You have multiple kids with T1D? That's a stroke of bad luck :(
I wonder if kids are harder on the dexcom sensor or something? I have a family member with the G5, and it works well. Not perfect by any means, but a lot better than what you're describing.
Everyone responds differently to the same inputs. My BG spikes hundreds of points if I eat a banana. It drops 50pts an hour when sitting in intense sun. Make sense? No.. is it repeatable, for me, yes.
Would ubiquitous sensors help me identify more of these patterns? Absolutely.
Seriously. You'd think genetic therapy, or even just a sensor-injector automatic combo (which to my knowledge already exist) might be more worthy of the title.
But then, it's evident that the article is giving Apple too much credit already - even a life-saving sensor wouldn't be able to make a several-hundred-dollar gimmick worth buying.
You don't think an Apple Watch (which starts at about $350) which could monitor your glucose more or less continuously would be far more preferable to a huge chunk of people then occasionally sticking themes with a lance and then trying to record the reading of a portable meter they have to carry around? Don't forget you have to buy the little strips.
Let's ignore the idea of insurance paying for this or any other kind of help. I imagine the Apple Watch would end up paying for itself for a type one diabetic within what, a year or two? I know those little testing strips aren't cheap.
But the Apple Watch would give you much better monitoring, no pain, no testing, far more data… Oh yeah and every feature that the people who already have an Apple Watch like.
As others have mentioned in this thread, I'm sure it's INCREDIBLY easy to get small children to test their blood glucose when necessary. I imagine this would easily be worth it to a lot of parents as well.
I think the technology would be better put to use on something other than the Apple Watch, unless an equivalent sensor minus Apple's other contributions also somehow starts at $350. You're conflating the sensor with an overpriced and rather useless piece of technology, which I say as the owner of one. I'm in full support of a non-invasive sensor for diabetics, but if we manage to come up with one, I would be against giving it an Apple price tag.
Apple could invent this an then license the sensor to other people. They gave away health kit. And they could choose not to license it to their competitors, only medical companies. But surely they'd put it on their own devices as well.
Seems like a weird attitude though: If company X can afford to (possibly waste) billions of dollars to make a medical breakthrough in Y, I don't want them to because then they'd use it themselves and charge money.
Where did I say that I don't want Apple to pursue this research? I just said that I don't want it to be solely available on Apple devices, and I certainly wouldn't support a company being congratulated for providing a medical service at an incredible cost.
Not a gimmick at all... if I could track my blood sugar in even 5 minute intervals, it would be nice to know, and help a lot. As it is, I'm LADA, which has aspects of type 1 and 2, and my body is also very adept with gluconeogenesis... even if I have nearly no carbs (no refined sugars, no bread/pasta, minimal overall intake) for a few days, my blood sugar can start spinning out.
It's about keeping things as level as possible. Also, genetic therapy could be amazing... but it's still, afaik a very long way off.
Yesterday my Healbe GoBe 2 healthband arrived, it has an array of non-invasive sensors which values can be used to take a good guess at how much calories are burned from carbohydrates, proteins and fats. Each time you eat you have to push a button.
https://www.techwalla.com/12049437/healbe-gobe-2-is-a-fitnes...
If they do claim that it works based on noninvasive blood glucose monitoring that's also a red flag; many have tried to solve that problem, and the obvious application would be a monitoring device for diabetics.
and supposedly they have improved the device in generation 2 which I'm currently testing. Sleep, step, hydration status and heart rate tracking work well, based on these reviews, a science article on bioimpedance and non-invasive glucose monitoring
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500977/
I have hope I can confirm that calorie tracking works.
I've investigated every device that claims to be able to accurately track calories expended and/or calories ingested.
On the calories expended side, the clear winner is a power meter on a bicycle. The power meter measures actual power output and energy expenditure, which is easily and accurately converted to kCal.
For the indirect devices, it's a massive mixed bag with some very unexpected observations. Measuring galvanic skin response ended up being quite inaccurate. Garmin devices without a heart rate strap were insanely inaccurate, sometimes reporting 300% higher-than-actual calories expended. The best device has actually been the Apple Watch paired with an iPhone. The calories reported are usually within 5% of actual.
As for the devices claiming to track calories ingested, every device has been either outright fraudulent or, at best, vaporware.
I am sorry but I cannot see how the power meter on a bicycle is "accurate" in this context. I am not trying to measure the part of the energy expended to run the cycle (which the power meter accurately measures) but the total energy expended by me while biking.An example; what if I put on some ankle weights while biking. How does the power meter know that?
To explain with an almost farcical extreme example, if I attach a power meter to a step/chair while doing a step up step down exercise, it will register zero calories burned always. But I would most certainly be burning calories doing the exercise.
You're not understanding how the power meter works. Nor did I say that a power meter can be applied to every possible workout or piece of equipment.
In your ankle weight scenario, the added weight would, in effect, cancel out. You'd get a free boost to power output for 50% of a pedal stroke, and added resistance to the other 50% of the pedal stroke. These forces are being applied simultaneously on either side of the cranks. While one side is combating the added weight, the other side is feeling the boost of the additional weight.
And sure, there are additional caloric expenditures while cycling - increased heart and respiration rate, utilization of muscles in your arms and torso, etc. - but they are marginal compared to the generation of 300-400W using, primarily, the muscles in your lower body.
Further, these differences are factored into the athlete's efficiency in turning calories into mechanical output. A trained cyclist is 25% efficient.
You seem to be attempting to be deliberately obtuse.
A trained cyclist is roughly 25% efficient, and 1 kCal = 4.184 kJ. The power meter precisely measures kJ. The end result is a near 1:1 ratio between kCal burned and kJ measured.
Sure, the power meter under reports total expenditure. For example, it doesn't exactly account for BMR, increased expenditure due to elevated heart and respiration rate, utilization of muscles in your arms and torso, etc.
However, it is extremely accurate compared to the alternatives.
Quite an interesting device. But sounds a little too good to be true for $179? It'd be great to have clinical trials and also qualified people (doctors, diabetic users etc.) to review it and compare with other devices
>It'd be great to have clinical trials and also qualified people (doctors, diabetic users etc.) to review it and compare with other devices
If there is no potential for harm (like with medications), throw it out there and see what happens. The market will validate the technology, one way or another.
Hi gedrap, even if the calorie-intake tracker doesn't work, it has a gsr, heartrate, sleep, steps and hydration tracker which work for certain (i'm using it now).
This seems like a simple thing to disprove. Anyone with access to high quality sensors could compare results. Any professional with a bit of spare time... I'm sure if it was inaccurate that it would come out pretty quickly on review sites.
Edit: the article the person above linked to includes exactly that
> When the first GoBe band was released in 2014, it was the target of some harsh criticism. The medical blog The Doctor Weighs In, for example, made this call based on Healbe's marketing pitch [...]
Most of the scientific breakthrough were preceded by improvement of measure instruments. IMHO a constant monitoring of some health indicators of many people good give invaluable data for researchers.
Grew up in a household with an adult-onset type-1 diabetic whom had little remaining biological control, either high or low:
Interstitial monitoring has been "around the corner" for 30 years.
Let's hope some shop can deliver a reasonably-priced, accurate-enough interstitial or tiny implantable device that can replace daily/routine blood sampling.
Is anyone else doing good quality home-testing/monitoring devices for other metrics? I occasionally look around for e.g. cholesterol and find that home kits are not thoroughly reviewed or unreliable if reviewed more thoroughly. In addition, they often miss important values or are considered painful/awkward to use. You could think of a few other metrics you might want to collect at home (say, kidney/liver function), and urine sticks seem the best option right now.
For blood glucose the problem seems more-or-less solved at a basic level (I've tried an Aviva Nano, seems pretty good) due to diabetic demand. I'm sure integration and further improvements are possible but I personally would like to see more frequent monitoring of more metrics.
Whatever.
HN may appreciate that there is a small force of nature callled #WeAreNotWaiting comprised of diabetic engineers and more that is tired of waiting for innovation to help manage the EVERYDAY in the life with out a pancreas.
Come on now. This shouldn't be dismissed as trivial. The most critical component of Nightscout (#WeAreNotWaiting's OSS) is continuous glucose monitoring. THIS provides THAT. And all by (what sounds like) wearing an Apple Watch 3 or 4.
Right now I have to drive a 1.5 inch needle into my gut every time I need to swap out my subcutaneous sensor, which is 1/week. These sensors are made of platinum and other precious metals and are expensive, especially without insurance. Plus, you have a lil nub sticking off your body, not the worse thing but it can get caught in door frames and what not.
I'm wearing an Apple Watch right now that shows my glucose readings (217 --> for the other T1Ds ;]). If I could remove the sensor from the equation, maybe even be liberated from my iPhone every now and again, it would ease dealing with my condition a good amount.
Simply put, one needs to monitor glucose passively to allow for the closed loop artificial pancreas these guys are working towards. This technology would make that monitoring so much easier, cheaper, more efficient and less wasteful.
Some of those folks have even automated blood sugar detection and insulin management, creating basically an artificial pancreas. It's pretty cool (open source) software if people want to learn more, called Nightwatch.
I saw a presentation at Stanford around 2000 of the science and engineering behind a watch-like device that would measure glucose levels in the interstitial fluid extracted from the skin with an electric zap. I think it is the GlucoWatch, which seems not to have worked out well in practice.
http://www.mendosa.com/glucowatch.htmhttps://en.wikipedia.org/wiki/Cygnus_Inc
One would hope this would also lead to better data on things like diabetes. From what I have read, we really don't understand it as well as a lot of people seem to think. It would be nice to have more comprehensive data sets so we can figure out better treatment modalities.
The holy grail for treating diabetes is not a continuous glucose monitor -- not even a noninvasive one. The holy grail for treating diabetes is regulating the immune system so that it doesn't attack beta cells.
Stupid me thinks that if they can measure data that is even indirectly related to blood glucose with sufficient quantity they can actually infer glucose level with quite accuracy. I.e. only with measuring heart beat, oxygen and co2 level at the skin, temperature and time of the day, and sufficient data crunching they can actually know the glucose levels.
Careful there. In this domain, you need the measurement to be accurate every time, and especially on atypical days: that one time you run a marathon or get stuck in the elevator with no food.
I get scared thinking of training a glucose predictor on big data. It could reach treacherously high accuracy scores, by secretly assuming every day is an average day.
For hyperglycaemia at least ketones would be a significant marker. In sufficient concentration they even have a characteristic smell detectable by humans. So, creating a sensor that measures ketone concentration shouldn't be too difficult.
Hypoglycaemia is more difficult to diagnose because apart from the actual blood glucose level there's no definite symptom that doesn't occur with other conditions as well (typical symptoms include headaches, dizziness, confusion, high pulse rate).
Measuring glucose makes little sense, no matter how precisely and non-invasively it is done. Physiologically speaking is glucose part of the solution in people with impaired insulin function, not the problem.
CodeSheikh, This is fantastic. The Helo LX is a device already ahead of Apple's Engineers. You can find the Helo LX at http://Farmer.Helo.Life
look into who Antonio De Rosa is. In short, he is our chief designer and he was on that Apple iWatch team in 2010. We are ahead of Apple on this one. Those sensors exist today and guess who has them?! But this is great, Apple has a much bigger marketing budget than we do.
This is fantastic. The Helo LX is a device already ahead of Apple's Engineers. You can find the Helo LX at http://Farmer.Helo.Life
look into who Antonio De Rosa is. In short, he is our chief designer and he was on that Apple iWatch team in 2010. We are ahead of Apple on this one. Those sensors exist today and guess who has them?! But this is great, Apple has a much bigger marketing budget than we do.
Not only do they have a much bigger marketing budget, but they seem to have a more experienced marketing team. Why is your site requiring me to send you personal information before I can watch a two minute clip that Fox did on you? Not only will I not send you that information, but I won't be able to watch your video and share with others what may or may not be some cool tech. You are shooting yourself in the foot using these "worst-practices".
This is great, we need more lifestyle approaches to disease. Not just people hoping a magic pill will fix it without them having to change their behavior.
Type 1 and Type 2 diabetes are completely different conversations, but regardless everyone should try to take lifestyle approaches to improving their health (in addition to whatever is medically necessary).
Even going very low carb, gluconeogenesis paths can still cause a diabetic to have very elevated blood sugar... It's about keeping things as level as possible and a non-invasive monitoring path can help a lot...
I was very low carb (fewer than 30g/day) for over a year, and was still hospitalized for ketoacidosis.
Ah yes, we would run across the savannahs, with our flint-tipped spears and hunt the wild HIGH_FRUCTOSE_CORN_SYRUP. At night, we would build a big cooking fire to roast they days catch of fresh MALTODEXTRIN.
I joke. But really, access to high carb, low fibre diets is pretty new. Too new for much natural selection, anyway. We've been eating rice for a long time, but brown rice. I can't find a definite source, but at least in Japan white rice only came into production in the 17th or 18th century.
> According to the New York Times, a 2010 Harvard study showed that people who consume white rice at least five times a week “are almost 20 percent more likely to develop Type 2 diabetes than those who eat it less than once a month.”
In paleolithic times, the average human diet included a lot of fatty meats. When the fatty game went extinct, and protein-heavy diets failed (protein isn't a fuel source except through gluconeogenesis,) carbohydrate-heavy diets became more common. It's not clear that a carbohydrate-heavy diet is the ideal human diet, just one we're compatible with. The human body can make almost anything work, for a time.
At the same time, tribes in Papua New Guinea who eat almost exclusively carbohydrates have been shown to be virtually free of heart disease.
Zooko and Amber Wilcox-O'Hearn maintain a fascinating blog on the science of ketogenic (very low carb) diets that I can highly recommend: http://www.ketotic.org/
"Recorded history" is too short for natural selection to occur. You don't get significant carbohydrates without agriculture, which is about as young. Besides, type 2 diabetes doesn't seem to have an impact on ability to pass on ones genes, so natural selection would be blind to it.
Agree up to "type 2 diabetes doesn't seem to have an impact on ability to pass on ones genes, so natural selection would be blind to it."
Individuals who have extensive family support do better than ones who do not. That's why we don't die the moment we stop being able to produce offspring. Grandparents care for grandchildren, and help pass on knowledge that is very helpful for survival.
So not blind to it. Reduced impact, yes, but not blind.
Diets have been (anecdotally at least) shown to be effective in the treatment of autoimmune diseases like Type 1 diabetes, multiple sclerosis, Chron's disease, and many others. A popular book on the subject is The Wahl's Protocol: https://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-...
Now, that's mostly anecdotal. There are very few studies on diet in general. As far as type 2 diabetes is concerned, though, low-carb diets have empirically been shown to reduce the need for insulin injections, slow progression of disease, and prevent the disease in the first place.
Serious question: how does a ketogenic diet work for people with type 1 diabetes?
Can you achieve stable blood sugar levels?
Does it mean lower insulin doses and less blood glucose testing?
Does it make you more vulnerable to hypos?
Is it too easy to slip from ketosis to ketoacidosis?
Can it be done safely?
Low carb or keto is helpful for type 1 (or any of the low/no insulin production types.)
Low carb means the range of readings the patient has to control is generally narrower. Lows are the result of too much insulin. Trying to get to 100 from 300 without going below 70 is riskier than from 150. Low carb/low insulin intake makes exercise safer.
Operating in a narrower potential range of readings means less development of insulin resistance and easier exercising safely.
It's challenging to start a low carb diet while taking insulin, so please be careful and talk to your doctor. For me, reducing my insulin "too much" while starting the diet made the transition nearly free of lows at the acceptable expense of fasting too high for a few days until the new situation became stable, but I realize not everyone can do that.
wow, can't believe China Study is still being referenced. It's been a while since my data stats class, but it was used as a case study for how data can be manipulated to explain a pre-conceived idea.
From memory entire counties were removed that didn't fit, one I recall ate more animal protein than whats found in Western Diets, yet had lowest incidence of heart disease, and some statistical correlations of higher significance were removed, because they didn't fit the narrative.
Yeah, I've been saying for years now we've cured most modern diseases, including diabetes: follow a strict low carb variant of the Paleo diet.
No grains, no refined sugars (that means no fruit juices as well), no legumes, no garbage oils (canola, corn, soy, etc); moderate protein, high (quality) fat (meat itself, olive oil and coconut oil), low carbs (and only healthy sources from whole actual foods).
Every diabetic, no matter how severe, who has successfully adopted this diet has gone on to not only managing their diabetes, but frequently moving on to no longer needing any medicine, and sometimes even healing at least some of the damage (something modern medicine claims is impossible).
Don't believe the hype that a cure is coming soon: it already came, and it isn't something you can shove into a pill, market, and sell for high prices.
Type 1 diabetes is an autoimmune disease. The body kills all of its insulin-producing cells, often in childhood. No matter what sort of food you eat, you need insulin if you want your cells to use the building blocks!
As an aside, the story of how insulin was discovered is super interesting. Diabetes used to be an incredibly lethal disease (part of why there were so many nobel prizes given out for insulin research)
It is amazing how few people know the difference between Type 1 and Type 2 diabetes, and their causes and effects, like jshevek.
I have had Type 1 since I was in grade school and have had to deal with countless teachers, friends, and relatives who have admonished me to just cut out sweets to treat my disease. Most of them never realize that if I stopped controlling my blood sugar with finger pricks, my insulin pump, and extreme attention to food and drink for even a day or two I would become so ill as to require hospitalization, and shortly after that, if not corrected, be in a condition which could be life-threatening (DKA).
Even a person with well-controlled diabetes faces long-term complications, and it is a disease that requires constant vigilance. Multiple glucose tests per day (even with a continuous glucose monitor, you need to calibrate it with a meter test), finely tuned insulin delivery rates, insulin sensitivity calculation, insulin to carb ratio calculation, how carbohydrates of different complexity or mixing a fat or protein into your meal might affect how much insulin you need or when you need it to avoid hyper- or hypoglycemia.
Minimed is coming out with an (almost) closed loop CGM/pump system, which will do continuous monitoring and also insulin delivery adjustment--I am hoping to get one, but it may be too expensive even with insurance.
The fact that any company with the brains and pockets of Apple is even approaching improvements for people with Type 1 is great news...
Judging by some posts I gleaned from /r/diabetes with a quick skim just now, even Type 1's who regulate their net carb intake benefit by being able to reduce their required insulin. In the US, that is a very significant personal financial factor with our broken healthcare system.
That forum is littered with Type 1's sharing prices of their insulin medications. From what I read, there are many different kinds of insulin, and even the generic kind that WalMart sells without a prescription (in some states) is not cheap for middle-income households. And unless you have gold-plated medical insurance, the really nice insulin can run into low thousands per month, depending upon your required dosage.
Type 2 takes up a disproportionate amount of healthcare funds because for most patients diet and moderate exercise can mitigate it according to enough researchers that Sweden's national health system switched to advocating low-carb for Type 2 diabetics. Karl Denninger at Market Ticker is a vociferous advocate of low carb for Type 2's, based upon his first-hand experience, and has written a lot about the financial aspects.
EDIT: I'm guessing downvotes are from Type 2 patients here who get pissed off when told diet and moderate exercise can help them. I don't think folks in /r/diabetes, /r/fasting, /r/keto, Karl Denninger, Dr. Fung, etc. are saying you'll be cured; it sounds more like better control leading to fewer late-life complications (which is where the real healthcare expenses get out of control). I'm coming in at this from the life extension and the terrible US healthcare financial picture angle; I keep seeing interesting caloric restriction research intersecting with low-carb findings and keep running across diabetics fiddling around with the same protocols that caloric restriction life extension folks like me are experimenting with. As always, YMMV, but I keep seeing enough diabetics dabbling with low-carb and caloric restriction that it raises my eyebrow, and that Sweden thought it was enough to switch their recommendations should be given some consideration when putting together your own health plan.
For type 1 and type 2, the more insulin you take per day, the lower your blood sugar will be. If you a1c is too high, you unquestionably must take more insulin. Simple as.
Should you exercise more? Yeah. Should you eat better? Yeah. Should you cut refined carbs? Yes, you probably should. None of these are unique to diabetics, but they get levied on us when we talk about insulin prices or complications with our condition.
Also, you owe it to yourself to be extremely skeptical when looking at any "diet doctor" selling a book. Most stretch the cure factor of lifestyle far beyond its limit.
The advice to someone with a high a1c is the same in every case: take more insulin.
I gave you an upvote as I've been diabetic for 30 years (Type I) and what you say is perfectly reasonable, especially for Type 2s. I wish I'd been told of low-carb diets when I first developed it, but instead got the whole "simple carbs bad, complex carbs good" talk, which turned out to be BS once they actually did some actual research...
and the lack of any discussion about how mood disorders is a low level significant effect of chronic blood sugar chaos still annoys me as well. They are only really investigating that now, based on some study I glanced at. They should have emphasized that when I was younger, really emphasized it. But instead all I got was talk about effects that would be a long way off, when I was 50 and old and etc - so they were not really real. And high fat diets were used back in the 30s before they developed insulin, but zip was said about low carb diets. To hell with the ADA.
It is my fault for not developing good habits when I was younger, but also a lot of what I was told was BS. When I moved to the UK, I learned of a protocol that'd developed in Germany in the 70s that made more sense than the nth level of detail carb counting yadda yadda they taught in the States (don't know what it's like in America now, though I'm sure there is a lot more gadgets and etc available)
But insulin is free here and I have saved 60k in personal costs over the years. The US is ridiculous.
And no, insulin isn't the sole solution (replying to someone else). First you look at your behavior. Stop eating so much carbs. Carbs are basically poison to a diabetic (a loaded word, perhaps toxic is better). If you can't, then still adjust your diet and behavior as best you can. If you find you need lots of insulin because of insulin resistance or you are one of the small percentage who need 10x more insulin than normal, then do take it. Otherwise, get more exercise and lose weight if necessary. Blindly using more insulin only makes you get fatter and that should be a big concern, because the effects of that cascade into other problems. And caffeine... I have to cut that out, but ...I'm in IT dammit.
Treating diabetes first and foremost involves behavioral changes, not fancy insulin or more gadgets. But behavioral change is so hard. I can manage a low carb diet for so long and it works great, then stress and it all falls apart because of various personal failings, not because low carb is a bad idea. It is not a cure, but I really believe it could help so many people.
>Judging by some posts I gleaned from /r/diabetes with a quick skim just now
Well, at least you're being honest.
You're replying to some people who have been fighting this disease for close to their entire life and you're trying to tell them they're doing it wrong after skimming a few subreddit posts?
Our society values economic growth above everything. That means you get rewarded more for creating a problem and then making it go away than for solving the problem completely.
This is everywhere. Feeling lonely? You could just hang out in your yard with your neighbors and cousins, put some ice in the cooler and see what people bring over to eat. Or you could stop talking to them entirely, get dressed up in expensive clothes, and come to our exclusive lounge with other people who are up on the latest fashions as well, drink a fancy cocktail, and look down at the people who are drinking cheap beers out of a cooler.
Guess which of these does more for the economy? And which one gets the crap advertised out of it?
But even if the glucose testing function is somewhat above mediocre AND integrates well with a journal app of my ups and downs, I'm sold. No questions, line me up for a too-expensive band, the charging station, etc.