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Comment by jimrandomh | Hacker News Reader

This may be a useful adjunct to insulin therapy, but there is no possibility whatsoever that it will be a replacement for it.

Insulin is the molecule that signals to cells that it is okay to take in and use sugar that's in the blood. This is a molecule that buffers sugar; if there's a high sugar concentration in the blood it binds it together and if there's a low sugar concentration it releases it. This would normally be one of the functions of the liver, but the latter part (absorbing excess sugar for storage) won't happen without insulin signaling. If you give this to a type 1 diabetic without also giving insulin, all that will happen is that it'll absorb sugar until it reaches capacity; the cells that should be using sugar for energy still won't be able to.

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As a type 1 diabetic I can say (personally) the difficulties of managing my diabetes do not stem from taking insulin, that's a solved problem. Rather the difficulties come from taking the right amount at the right time. Insulin is slow acting (2-3 hours for it to fully take effect) so you're always trying to predict/aim for a moving target, and one that can shift rapidly depending on eating/exercise. If I could just set it and forget it, or even just have the ability to be 50% less accurate when calculating/planning dosage and activities, it would be a paradigm shift.

I find anecdotes help illustrate the problems people can face with health issues that might seem minor at first glance.

My father's doctor mis-prescribed his insulin levels a few years back. His doctor forgot about the potential interaction with another drug, which is a very common problem unfortunately in medicine.

The end result is that I got a call from my father who sounded as if he was experiencing a stroke, as his entire right side of his body was unresponsive and his speech was slurred and he sounded incredibly drunk. I rushed over and found him slumped in his living room unable to move and I carried him to my car for a hurried car-ride to the hospital.

He got to spend that night -Christmas Eve- in the hospital for observation until they were able to determine he was ok and that the culprit was the drug-interaction. Something like $10k of his retirement fund gone because he had been laid-off and his insurance wouldn't cover this sort of thing.

Responding to your main point: a drug mis-interaction is not really something people consider minor, and interactions are possible in every area of medicine, not just diabetes. While it's true that fatally low blood sugar is more likely for a diabetic than worst case scenarios are for some other diseases, developing a new diabetic treatment isn't riskier than developing insulin. Everyone involved in the drug pipeline knows what hypoglycemia is and that it can happen unpredictably.

I am concerned what might happen if the state of diabetes treatment advances and medical staff do not become significantly more educated, though.

Responses to the anecdote:

You didn't mention giving your father sugar. For others reading: tilt the patient so you can put things in the side of their mouth, and put in some sugar or soda (or something else that uses sweeteners with carbs/calories and is not fatty/fibery.)

Options for payment in this case were: negotiate discount or write-off with hospital, if insurance non-coverage was due to out-of-network negotiate insurance contribution as paid in full, to seek a medical malpractice settlement. But I understand how it is hard to get these kinds of things done, especially as a third party.

People who take insulin outside a hospital setting are normally responsible for monitoring their blood glucose levels, adjusting dosages themselves, and using sugar or glucagon to deal with hypoglycemia (which is what happened in this case). It sounds like the problem wasn't so much the doctor-selected dosage, as a failure to train him in other necessary aspects of using insulin safely.

> Something like $10k of his retirement fund gone because he had been laid-off and his insurance wouldn't cover this sort of thing.

This sounds like the sort of thing that one should sue over to recover the funds. This entire incident happened because:

> His doctor forgot about the potential interaction with another drug

it was the doctor's mistake that cost your father that $10k. That said, if your father gets all his prescriptions from the same pharmacy, I'm surprised that they didn't say something about it either.

Minor correction: Insulin has an activity time of about 5-10 minutes once it reaches your bloodstream. The challenge is getting it there; the measured activity time of insulin comes from the time it takes to diffuse through subcutaneous tissue.

(This is one of the reasons why healthy individuals, whose pancreata release insulin directly into the bloodstream, have tighter blood glucose control.)

As a type I a buffer like this would still be massive. Healthy blood sugar levels are a narrow target, and it can be very hard to balance and keep balanced throughout the day. If I could worry less that I ate slightly too much, or that I might pass out from walking a bit too far (or worse, in my sleep later), it would be a huge quality of life boost.

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