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[IPk] Dreams, Nightmares, Visions and Clairvoyance

In message <email @ redacted>,
email @ redacted <email @ redacted> writes
>Thanks for speedy response. Wow if only diabetic health care manufactures were
>as efficient as you !
>I'm staggered at how slow progress is with diabetic health care!

And with pumps, even though the technology is there, tested, tried and
proved, it still isn't easily available to everyone who needs it ....

There have only recently been continuous blood glucose sensors, so the
'closed loop' or 'artificial pancreas' is slowly coming.  One of the
problems is there is going to have to be significant computing power
between the sensor and the pump, because the fastest insulin currently
available (humalog and novorapid) are, for most people, active over a 3
or 4 hour period.  The insulin people make for themselves is active over
a matter of minutes.

So, say you drink a glass of juice, and your bg shoots up from 4 to 8.
Say your meter is reading at every five minutes.  After a five minutes,
your bg has hit 5, so the pump delivers, say 0.3 units (enough to get
you down from 5 to 4 - and your numbers will vary -  in four hours.
Five minutes later, that bolus hasn't started to work yet, and your bg
is at 6.  Now, to get from 6 to 4 takes (for example), 0.6 units of
insulin ... but the device has to 'take off' the 0.3 units it gave five
minutes ago .... and so on. Because insulin gradually becomes active,
peaks, and then dies away, the pump will need to know that activity
curve, and so when to count the 0.3 units as '0.3 which has not started
to work yet', when it becomes 'a tenth-used 0.3 units, which means that
there are still 0.29 units to come', when it's half-used 'another 0.15
units to come' and so on.  Allowing for automatic insulin injections
every five minutes, and a life span of four hours, the pump must keep in
mind 240 injections, and how much of each of them is still to come.  

When you consider that: the amount of insulin it takes to reduce blood
glucose varies from individual to individual, and within an individual
can vary from time of day to time of day, and insulin sensitivity can
also vary depending what the bg level is.  The time it takes for insulin
to peak and to end varies from individual to individual (and also seems
to be affected by things like the weather, and, of course, whether or
not you are exercising that part of the body).

Now, suppose you drank that orange juice because you had just stopped
running, and measured your bg as 4, and you know your bg always drops a
couple of points in the hour after running ... you would want to hit 8,
because your body is going to need it!  So the pump is going to need
some kind of over-ride (but not too much over-ride, because if, for
example, you had not realised that the juice had added sugar, and half
an hour later you were at 14, you'ld want the pump to do something about
it, presumably automatically?

>We can build space stations etc etc but can't seem to make an insulin pump
>that is reliable or has REAL benefits over injections.

Believe me, the pump has very real benefits over injections, for some
people.  Perhaps you got this opinion because I suggested you try
multiple daily injections?  I pray to the gods that you are one of the
lucky ones for whom a pump really doesn't have benefits over injections
- drawbacks even.  But if you have 'dawn effect', or exercise
irregularly, or have different insulin sensitivity at different blood
glucose, or have anything which means your basal needs vary over the
day, or between days, you are going to find a pump has advantages over

>Surely it isn't rocket science for a manufacturer to develope a pump that at
>least RELIABLY & ACCURATELY monitors sugar level, relays the info to the user.
>The user can then RELIABLY & ACCURATELY (heaven forbid) manually admister the
>Am i the only person in the world who thimnks this?

Far from it. I am also continuously amazed that research money goes into
alternative methods of delivering insulin (ingested, nasal) when the
real pain/phobia lies around blood glucose monitoring.

I have a nasty capitalist mind (don't blame me, blame my milieu) so I
point out that it doesn't matter what you, I, and millions of right-
mined, nice people think.  What matters is the money.  

>Surely long term the cost savings of better treatment far out weigh the cost
>of future extra health care....

Other ways of putting this: Why do you elect politicians on their
performance over the past few years, rather than the effects their
policies will have over the next two generations?  Why is a NHT which
over-spends _this_ year a 'bad' trust?  Why is decentralising power,
giving local people the chance to set the priorities for health care
provision locally never seen as the flip side of 'postcode

Other questions for the Radical Diabetic: Why isn't numeracy and
literacy testing part of the diagnosis procedure for diabetics?  Why,
when the real problems with 'non compliance' as it is called, lie in the
lifestyle to which diabetics are forced to comply by insulin regimes
such as mixtard rather than in a personality defect in the diabetic, are
not doctors struck off for not suggesting multiple daily injections,
DAFNE, and pumps, as a matter of course to any diabetic who is not
achieving excellent bg results (both long-term and hour-to-hour)?  Why
is 'average hba1c of patient divided by a percentage of the average
decrease in hba1c' not a performance measure of diabetic clinics?

Best wishes,

(dm 30+, 508 2+, anarchist/phonemonologist/user of big words - oh, and a
firm believer in democracy - as an archaeologist, I get to look at all
known alternatives, and, believe me, they all have their flaws.  Apart
from me as Benevolent Dictator, of course)
Pat Reynolds
email @ redacted
   "It might look a bit messy now, 
                    but just you come back in 500 years time" 
   (T. Pratchett)
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