> Once ingested, water dissolves a disk of sugar, using a spring to release a tiny needle made up almost entirely of freeze-dried insulin. The needle is injected into the stomach — which the patient can’t feel, owing to a lack of pain receptors in the stomach. Once the injection has occurred, the needle can break down in the digestive tract.
That's some pretty impressive ingenuity. Also sounds kinda terrifying if the 1.0 has any kind of edge case that involves tearing holes in your stomach lining.
I'm not diabetic, but I still have vivid memories of sitting with my grandmother while she constantly pricked her finger to test blood sugar and jabbing insulin pens into her abdomen. It's always stuck with me as a particularly unpleasant lifestyle to have to endure. Even still, if I were a diabetic I think I'd still be waiting a year or two after the release of something like this to make sure all the kinks have been ironed out ;)
What doctors and researchers get wrong about diabetes is that pin-pricks and injections are not even remotely bad. I don't know a single diabetic who cares about injections and blood sugar tests. You get used to that within the first week of diagnosis.
No, the unpleasant part of being diabetic is having to live every second of your life as an act of weighing how what you're currently doing is going to affect your blood sugar levels an hour for now:
- Have I been sitting in this chair too long? - Have I not been sitting down enough this morning? - Have I been drinking enough water? - Did I just drink too much water? - I haven't been to the bathroom in two hours; does this mean I'm screwed? - If I eat a piece of toast after dinner, will I be able to have sex with my wife without going hypoglycemic? - I'd like to go hiking, but it's hot outside and my insulin might spoil, so maybe I'll walk around the block instead. - I just plan on going to the grocery store for 20 minutes; do I need to bring insulin in case there's a traffic jam on the way home?
Etc., etc. Pharmaceutical companies can't solve the real lifestyle problems associated with diabetes short of inventing an actual cure.
I am type 1.5 and disagree with both parts of your post. While learning to use them routinely only takes a few days, needles and lancets do bother people for anxiety reasons, but also for physiological reasons. Lancet areas develop callouses, can have blood flow issues and in more advanced stages of diabetics can risk infections/damage. Injection sites go bad over time or appear to; right now I am dealing with an issue where I think some of my preferred injection sites are becoming less effective, but I can’t really tell, which is preoccupying. I don’t think research into alleviating the need to use needles and lancets is getting anything wrong just because it solves a need not every diabetic has.
Secondly, I think your description of diabetes is overblown. If you’re checking BGL frequently with a CGM, then you have a good understanding of what will happen in routine situations. If you’re not, you aren’t going to sweat 30 minutes in the car or the delta between the carbs from dinner plus toast and physical activity (I do like the humble-brag here, though!) because you don’t know what’s going on anyway. Hypoglycemia has the advantage of being treated with glucose tablets, which don’t spoil and can be stashed everywhere. Moderate activity and water intake are important but not going to swing your BGL wildly like a bottle of soda or an intense workout.
This disease can be a hypochondriac’s dream and I think that teaching other diabetics to be so preoccupied is dangerous to them because it increases the temptation to give up on the daily routines that actually make a difference.
"Hypoglycemia has the advantage of being treated with glucose tablets, which don’t spoil and can be stashed everywhere."
Umm... glucose tablets do in fact spoil. I've never seen an unopened bottle spoil, but once they are opened they can spoil over time mostly from the humidity. I found this out the hard way.
Sure, I replace them periodically. They don’t spoil quickly, though, in the sense that insulin spoils just from being outside too long. You don’t have to curtail your physical activity to avoid hypoglycemia because glucose is portable and durable.
"You don’t have to curtail your physical activity to avoid hypoglycemia because glucose is portable and durable."
Between this and your "humble-brag" on your other post, what I'm led to believe is that you're pretty ignorant on how variable insulin sensitivity and blood sugar management is from individual to individual.
I've maintained an A1C of less than 6.5 for more than a decade so I'm the picture of "perfect" control and I can tell you that physical activity is a pain in the ass. I'm hypersensitive to insulin during physical activity. When I go to the gym I want zero insulin on board because just 10 minutes on the treadmill could drop me from 160+ to 30. Just walking is enough to cause me to have low blood sugars, so I have to reduce or skip insulin with food accordingly. I'm required to elevate my blood sugar to 200 before I can scuba dive and then I can still only dive for a maximum of an hour because there is too much risk I will pass out and drown.
And then you say, "I am dealing with an issue where I think some of my preferred injection sites are becoming less effective". Preferred injection site? WTF dude? Of course it is becoming less effective, that is why they tell you to constantly change the location. Preferred injection sites are a huge no-no.
I'm like you when I do any activity having insulin on board. I'm a T1 using a pump, and I really like the combination of a pump and CGM for staying away from surprises. I use AndroidAPS to monitor my glucose and insulin on board, taking a temporary basal setting of 0% if needed before any activity, so my insulin on board drops to the base level or a bit below.
Soon the insurance replaces my pump to a Dana RS, which supports closed looping with AndroidAPS. Then it's just setting a temporary glucose target to a higher value and the system takes care of the basal rates to keep the glucose from dropping.
The article here is kind of weird. How am I supposed to dose e.g. 0.3 units or 0.75 units of insulin with the pills? The ability for a very fine granularity and the possibility to automate my medication are much more interesting compared to the pills mentioned in the article.
You are spot on.
The temporary reduction or even suspension of insulin depending on my activity are key in preventing lows for me.
The closed loop pumps are the biggest improvement I've seen for living with T1. There's always lots of promises, but this is one of the few things that really improves my life on a day to day basis and it just keeps getting better.
Right now it seems there is official support only to prevent hypos, but not to give you more insulin at night when you ate something too heavy and didn't guess the right TBR.
Only the open source AndroidAPS for Android and Loop for iOS do this. And then you have a very limited set of pumps you can use.
The Medtronic 670g is the only pump that currently will automatically correct highs, but it only works with the Medtronic CGM which is untrustworthy.
The Tandem t slim x2 only has support for hypo prevention today, but it supports at home firmware/software updates and they are pretty far along with the FDA on getting approvals for their auto dosing for highs. They anticipate a release this summer.
I wish that OmniPod was further along on this front. I would love to have a tubeless solution and the convenience of not needing to disconnect every time I'm going to get in the water, but the trade-off just isn't worth it IMHO.