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 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
I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance. This is a fiction and has never existed.
The default state is for none of these services and protections to exist whatsoever. Everything beyond nothing is an imperfect and unstable solution held together with duct-tape.
Honestly, as a society we should be able to guarantee most if not all of those. Every single one of them is an economic trade-off and when you put for profit companies in the loop, it’s obvious that they will prioritize their profits.
The system is for profit by choice, it is under our control as society to guarantee that list or not, and we have chosen not to.
Might be the right or wrong decision, that’s up to each of you, but denying it’s has been chosen it’s very naive
> I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance.
I think that children are generally raised to not believe there is "risk" associated with listening to experts. This means specialists like Doctors but also politicians and military officials.
The idea that there could be a grift set up to take advantage of people in the medical space, for instance, which is highly regulated and supposed to be for the benefit of people first and for generating capital second, is not intuitive to children.
In fact a wide array of industries and services in the United States, and the world (to not be political, as some commenter said) are set up to take advantage of children or naive young adults.
Secondary education and student loans is a glaring example of this.
> The default state is for none of these services and protections to exist whatsoever
In all of human history this is mostly untrue. Humans have always formed societies, and those societies have always provided services for their people. In fact, before capitalism, most of these services were provided in-kind as a right of being a part of the tribe.
This idea that every person is born as an individual and nothing is granted to them belongs to a certain political ideology that is designed to make sure people feel entitled to nothing, and keep things in the private industry, and keep government small. But I digress.
Of course someone has to provide the service, and collect the materials for the service. And that person deserves to be compensated for that work. But the idea that the default state of a human is to be alone with nature and subject to pure individualism is simply not true, and never has been the norm, until that idea was used to justify not providing people with anything.
> Everything beyond nothing is an imperfect and unstable solution held together with duct-tape
This idea is also untrue. We've had a lot of time to perfect these things. If we can build skyscrapers and infrastructure to maintain them, we can provide these services. You are conflating political ideology and economic motivation with literal ability. The ability is absolutely there, and was in the past as well. There is something different going on that causes these systems to be "held together with duct-tape" and it's actually other humans actively trying to destroy these systems, not that they are impossible.
At the same time I would emphasize that people who offer any kind of advice online around life-threatening ailments do put down if they have a related degree, are currently practicing and are licensed in that or a very related field, or if they are conducting self experiments and sharing their results (with YMMV caveat to go along with it).
Reasons why should be obvious, but listening to podcasts, or reading pop-science books, connecting the dots and thinking you’re qualified to give, again, life-threatening advice, does not mean you’re actually qualified or you have an idea of how deep the rabbit hole goes (as we are learning, nobody really does).
Unfortunately, in my experience I encounter a lot of people who haven’t opened up an intro to biology book since their teenager days let alone an undergraduate biochem book, but they listen to podcasts and think they have it figured out and have the audacity to speak with confidence. I’ve been in situations where the practitioners are wincing but are too polite to call people out - it’s easier to let them just yap out what the podcast said and then change the topic. Don’t be one of these people.
I've realized similarly and by being "blessed" with very low-grade chronic conditions (family of diabetics, fatigue), I've created my own low grade insurance policy by creating lifestyle interventions in nutrition and exercise to maintain my health.
If I were to summarize the thousands of hours of what the Phd/MD health podcaster space has promoted, the jist of it comes down to:
- Get about 1 cup of 5 colors a day. Usually a smoothie is the way to achieve this. I make them in batches and they are conveniently available as grab and go.
- Prioritize sleep
- Exercise to improve v02 max as high as possible
I think _most_ of the population on hackernews has the financial privilege to implement the above 3 in various ways. But those will provide such a quality of life improvement to anyone dealing with chronic illness that it reduces the need for medicine a ton. And much of the damage from the environment can be mitigated by providing the body with the nutrition necessary to detoxify and deal with the various stresses they bring.
The way to look at modern medicine is that, modern medicine is very good at fast death scenarios. Heart attacks, randomly acute conditions, but they are terrible when it comes to slow death conditions like diabetes and dementia.
We need to look to rely on modern medicine for quick death, while creating interventions on the slow-death side ourselves, unfortunately.
It took me a long time to get to grips with the fact that you can't even take for granted that your own parents act in your best interest. We were all propagandized with love and kumbaya songs. In reality life is a lot more.. erm let's say self benefit driven with a lot of sprinkles of ego in it. People optimize their language output for their self benefit while actions don't really need to be aligned to get most of those self benefits.
agreed. I think we are at a unique time in history where the rose tinted glass can even exists. Where children can live sheltered in a low risk reality well into their 20's and then whiplash and disappointment and cynicism hits them like a ton of bricks.
I think that low baseline expectations is very important for mental health and general resilience.
When I was first diagnosed with T2 diabetes I was sent to a dietitian who handed me all kinds of pretty literature from the ADA about how great grains and pasta is for diabetics and food pyramids and “eat want you want in moderation and use insulin.”
After 5 years I decided that method was bullshit designed just to sell insulin. Went keto and was off insulin withn 2 months and haven’t had a drop of extraneous insulin since (7 years).
My doctors advised against me going keto because the ADA recommends their diet. When I explained I was going to try it anyway because it made sense that if my body was having trouble processing glucose, that eating a diet that minimized glucose would probably have a beneficial effect.
It was at that point that I realized that many doctors are simply following a treatment formula. Ultimately the ADA had to recognize that keto can be affective at managing diabetes. Yet, they still publish the pretty literature that advises type 2 diabetics to eat a diet that for them is significantly worse than a low carb diet.
While all that is true... the other part is that it's not like non-medical professionals are particularly good at knowing what they are talking about or acting in their own best interest either. In many cases, the institutional care is both horrible and better than what you'd get without it.
It took me a long time to get there, but I eventually did - I agree with every one of things that you listed. Fortunately, I have also learned that there are a whole lot of things that you can do to overcome each of those challenges. It does require a good bit of time to research, understand and apply them - as well as some luck.
Having experienced healthcare in multiple countries I can say most of the items on your list are pretty much universal, unfortunately. Skipping over the capitalistic and legal issues, which people more or less expect, I'd like to zoom in on your item #3. The fact that doctors are (often) clueless for complex diagnostics (not talking about a broken arm, etc.) is shocking to many people.
I think the two main factors driving this outcome are:
1. Due to the complexity of the problems they face and the quick diagnosis expected from them, medical professionals are taught to think in an expert system-like if-then statements. Some of these are rules of thumb, some may no longer apply due to latest research, and some may not be applicable to you.
2. Metabolisms may differ in important ways. A new doctor is trying to make a decision in a highly complicated high dimensional space with the few data points that you provide. This is OK, but they get too confident with their diagnosis.
I don't mind point one, and it can be improved in many ways. AI being a huge one.
Point two, though, is just an example of how preventive medicine is forgone due to its cost. The system doctor's use to share data could also stand massive improvements.
You're likely as old as my kid, so I am sad to see this. Yes, take your health into your own hands. Medicate as little as possible - but this won't work for many people - in fact it could be dangerous. I am lucky to not have chronic conditions so I could afford not to believe my medical professional.
In my case - just to get the facts on Blood pressure took quite a bit of digging - thanks to some independent doctors who went against the grain and had a conscience and courage to dissent. Cholesterol is an even murkier pool. Its amazing how muddled the picture is.
Any idea how to remove the most common pollutants we run into everyday? I try to avoid high VOC materials and use charcoal filters for water. Kinda lazy to set up reverse osmosis system right now.
1) You're pretty much just screwed unless you're both very wealthy and make this topic your primary hobby/past-time. To really answer this you'd need to do an incredible amount of testing. Like buy 10 of everything you're considering and send off to labs for $100,000 of tests. Or install a million dollars of chemical air quality monitors in and around your home.
2) Large activated carbon air scrubbers. For air filtration you really need not just HEPA particulate filters, but robust VOC capture. The tiny bit of activated carbon in things like a Winix C535 or Coway Mega/AirMega really don't clean much. Instead, consider something like buying two 10"-12" carbon scrubbers from https://terra-bloom.com and get a matching size of their in-line "Silenced Ultra Quiet EC Fan". You can just stack these three items together and it forms a tall but not horribly ugly appliance that doesn't take up much floor space. You'd probably need to replace the filters once a year, and have quite a few around a normal-sized house, just like standalone HEPA filters (which you'd also probably still want as well).
3) Wash everything often - bedding, clothes, carpets, floors, walls, appliances, etc. Obviously, attempt to use a soap that won't add additional pollutants. Wash them twice, once with soap then again without soap.
4) Time. Assuming similar materials, something that is 5 years old should have already leeched out a lot of the chemicals which are going to off-gas/transfer/leech from it. So the polluting rate of something 5 years old that's been washed 50 times and already worn and broken in should be assumed to be lower than an identical, new, version of the same thing.
Outside of switching things up like using glass containers, enabling the body to detoxify itself and repair itself by ensuring that it gets adequate nutrition (daily) and exercise is the key.
But for a simple pill solution, consume sulfur. For as important as it is, it's not widely front of mind in the health space. So much focus on Vit D, Magnesium, Omega 3s, etc, which are all absolutely necessary.
Some great sources of pill based sulfur are Taurine, NAC, and MSM (methylsulfonylmethionine). My preference to recommend blindly as a general pill is MSM. But sulfur is key for the liver's detoxification functions to work ideally.
There's quotes flying around that say something like: 80% of the population (US or world) is deficient in X.
Usually X is omega 3's, Magnesium, Vit D, and also to add to the list, Sulfur is a huge one. Outside of being in a culture like Koreans that consume cruciferous veggies 3x/day (via kimchi), most americans only get it from meat, garlic, onions and broccoli. If one has brittle nails or hair doesn't grow as quickly, that would be the sign that something like MSM in pill form would be helpful. Otherwise, folks are probably fine if they are consuming daily amounts of anything containing sulfur.
And this makes for a pretty lonely and downright harmful society, when viewed through that lens.
And I'm not going to feel stupid or naive for feeling like children are tricked into believing the opposite is true.
I want to also say, this state that everyone is acting in their self interest is not something we should promote, or be proud of, or assume is the natural state of things. It is a state that we are being forced into, and we are being convinced to accept.
People as individuals are actually very good. And if we were to get over a few little logical fallacies, we could extend that goodness onto our whole society. But there are many reasons why that is considered harmful by some in power, and then many more who are propagandized into agreeing with them.
This is naked political activism that clearly breaks the HN guidelines and offers zero informational content, intellectual gratification, or other value to me or anyone else here. Please don't put stuff like this on HN.
Like, it behooves one to know enough about one's car or house or computer in order to not get scammed/idiot-screwed by mechanics and contractors and tech support
It would be surprising if one's body were different. The general level of faith there seems inconsistent with reality
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.
Just anecdotal. Was T2 and getting kidney stones every two or three months (cause not related but treatment was). Cut out oxalates which restricted diet. Monitored sugar 3-5 times daily. Switched to carnivore diet + onions and mushrooms and went on Metformin. All at the same time. Did this for 2.5 months with no additional exercise. This dropped me down below T2 level. Went off Metformin and am maintaining with same daily testing. Off carnivore for paleo minus anything with oxalates after the 2.5 months strict carnivore.
Strict carnivore for me was steak, hamburger, stew meat fried in butter, mushrooms and onions in butter, bacon, and very sharp cheddar (only on burgers or raw). Eat every bit of gristle and fat. It is very hard to get enough fat.
Brain fog lasted for 10-11 days. Felt fantastic after that.
To keep your carnivore costs down I would recommend stew meat from Costco fried with onions and mushrooms when you can't stand steak or plain burgers.
This has worked for me for the last 6 months. I have no idea what it will be long term. Maybe someone will find something useful in it.
Sumo wrestlers kind of fascinate me in this regard. It's very rare to find a professional who is diabetic, even though they eat one big carb-heavy meal a day and are morbidly obese. IIRC, this is explained by their low visceral fat levels, which are driven by high adiponectin levels that are themselves driven by their intense workouts and consistent sleep habits. Their high subcutaneous fat proportion is actually thought to be protective. T2D catches up to them after they retire and stop exercising and sleeping well.
Their experience touches on 3 factors:
>Exercise volume (which, according to newer research, should be spread out over the course of the day)
>Diet (which should be focused not just on maintaining steady, low blood sugar levels, but on dietary factors that encourage subcutaneous rather than visceral fat deposition)
>Sleep quality
The last, I think, is extremely undervalued. My father developed T2 in his 30s, and it progressed consistently until he was diagnosed with sleep apnea and received treatment. Around the same time, his work schedule finally became more reasonable after a career of early mornings and late nights. This is someone who had to pass annual physical fitness exams for his job, cooked and ate relatively healthily, etc. I'm convinced it was the years of poor sleep that set him up for insulin resistance.
I've found I do best with a very similar diet... mostly meat and eggs, some cheese and sometimes onions, mushrooms etc. I notice that some starchy foods hit me worse than others. Legumes are pretty bad on how I feel, and spike me to no end. Similar with wheat products. Corn, rice and potatoes spike my glucose, but I don't feel physically ill the next day like with many other foods.
It sucks, and I wind up cheating 2-3x a week (I live with people that eat different than I do).
I like to add that the reason why the carnivore diet seems to work really well is a couple of things.
- compliance is straightforward
- on average, will tick all the boxes for nutritional needs. (ie. vegans eating only oreos would not be very healthy, while vegans eating 5 colors a day would be far better off)
What have you used as a source for low oxalate foods? My husband has to avoid them for the same reason but it seems like superficially reliable sources disagree on which foods to avoid.
Get a continuous glucose monitor. You should be able to convince your doctor to write you a prescription for it. If not, there brands that will do the prescription for you after a quick video call with a doctor (but they're more expensive).
Also the FDA cleared at least one brand of CGM to be sold without a prescription, starting "summer 2024": https://www.dexcom.com/stelo
You should expect to pay $80 - $200 per device, and they last one 14 days, but the insight they give is really worth it.
I was diagnosed with T2 last year, and started a CGM (Freestyle Libre 3) like you did. I started off with lists of foods I could eat, but the monitor let me see actual data on what was happening. Its not very accurate, but the absolute numbers don't matter as much as seeing the actual trend effect on my own body. I never let it go over 150, ever. I can eat some legumes in moderation, but your specific body may be different. I initially took Metformin, but discontinued. My last A1C was 5.1 and and endocrinologist I was consulting with put in his notes that my diabetes is "remission." So, if you're prediabetic, keep at what you're doing. I eat very little meat, btw, so while that might work for some people, its not strictly necessary.
Is it conclusively proven that glucose spikes influence the risk of T2D by a big margin? Like imo calorie balance is more influential than glucose spike. This is all assuming that you are currently healthy. I don't think spiking blood glucose is a good idea of you are diabetic
There is no conclusive proof that occasional blood glucose spikes by themselves significantly increase the risk of T2D. In particular we know that the stress hormones produced during high intensity exercise cause temporary spikes by stimulating glucose release from the liver. But we have fairly good evidence that such exercise actually decreases the risk of T2D. Insulin resistance seems to be triggered more by chronic elevation of blood glucose and not clearing the spikes quickly enough.
I already mentioned some of this in another response, but I'll include it here as well: you can take measures to not have to take medication / insulin if you have type 2 diabetes. The number one thing to avoid it is to stay lean and not be over-weight, but some other things which can greatly help out:
- Exercise: 'Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. ' - Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup and mostly stick to low-glycemic index minimally processed foods. 'Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.' - Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1
They're doctors, not CEOs. They are advising based on the behaviors they see from most of their patients, who probably come in asking for quick solutions and are unable to make lifestyle changes stick. Patients who are educated about their own conditions, willing to listen to advice, and able to keep to that advice over the long haul are a very small proportion. Not that doctors shouldn't offer this sort of advice anyway, I am just asking you to please try to understand why they behave in such a way.
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.
I feel your pain, but 'threats of criminal punishments for lazy medical professionals' isn't a great idea. There are already laws against medical malpractice, but it's pretty obvious why prosecuting doctors and nurses for 'laziness' would be incredibly counterproductive and result in a massive increase in bureaucratic ass covering rather than improved care. Ask yourself - what caused the NHS to get into this situation? Certainly reversing those causes would be a good first step to improving the service and fixing the issues they've caused. According to the doctors and nurses themselves, it's all about cost cutting, increases in hours and generally the financial starvation of the service. They're literally out there striking to be allowed to treat you better.
You guys are decades deep into an ideologically propelled plan to "Starve the beast" by denying the NHS funding so that care quality declines, and use that as justification to privatize the NHS entirely.
The starting salary for a first-year doctor is below the national median income, and for a nurse significantly below. Their inability to requisition funds & time for care is something there is repeated labor action about. The NHS budget is 5.9% of GDP versus the 17.3% of GDP that the US economy spends on healthcare or the 11.3% of GDP that the UK economy spends on healthcare overall.
> The starting salary for a first-year doctor is below the national median income
Is it really that low?
In the USA an entry level doctor will make around $130,000 and the 'Average doctor' makes $200-$350,000/year depending on what website you want to believe.
And we're running like 13% of the population having diabetes.
Isn't one of the selling points of universal healthcare that it's overall cheaper in total cost than private insurance? If so, the UK should be celebrated for having such a low percentage of its GDP being spent on universal healthcare.
My diabetes consultant is on more than the national median income and only works part time in a low cost of living area of the UK. They are far from hard done by. Throwing money at them will not change what is effectively a systemic error in how they approach the disease.
The NHS is underfunded, but this isn't a problem of funding. The lack of a scientific approach to managing diabetes is strictly down to ineptitude.
> You guys are decades deep into an ideologically propelled plan to "Starve the beast" by denying the NHS funding so that care quality declines, and use that as justification to privatize the NHS entirely.
Mind providing some sources for this? Rather tired of hearing this unfounded conspiracy theory from people
This is counter to my experience - my daughter has received fantastic care. We have regular time with the endocrinologist and get phoned up inbetween clinics. They have provided a closed loop system and all the backup we could have asked for.
I agree about Glooko, it's not as good as diasend was.
This was my experience when I was first diagnosed, too (minus closed loop - it was the early 90's). They put more effort in with children, as it's a dedicated team. Same as gestational diabetes care.
Expect to start having appointments cancelled and to go years without hearing from them once she is passed to the adult diabetes team.
> Abbot refused to let me download my data after I was forced off their platform to Glooko
So I've been using Abbot (LibreLink) since 2019 and if you log into LibreView (https://www.libreview.com/) there's a 'Download glucose data' link in the top right of the screen.
There's also a handy PDF report that I send to my diabetic nurse before my annual meeting, I think I'm the only one of her patients who knows how to do this because she's always thrilled and spends half the appointment going through it in amazement at the data/trends.
Abbot have been quite good overall despite the fact I reported a bug to them in their Android app in 2022 and they still haven't fixed it. If you add LibreLink to the whitelist of apps that can interrupt DND, then enabled DND, LibreLink alerts you saying "Alarms unavailable."
'...diabetes healthcare in the UK is effectively non-existent past diagnosis.'
I was referred to a dedicated team with a specialist nurse who checks in with me regularly. Maybe I am fortunate not to live in a big city where most NHS facilities seem to have descended into third world standards?
I think it depends where in the UK you are, as I believe different areas healthcare is run differently. This has not been my experience, I've found the care to be good, as long as I'm willing to put in the work on my side and be proactive on occasion about looking for help. In my local area the diabetic team is stretched thinly (that's what the staff said to me themselves) and I am relatively proactive with reaching out, research and asking questions. With that said they really want me to succeed in keeping in a healthy range and have been a massive support as much as they can. Also the fact I don't have to pay for Insulin or my CGM is something I am really thankful for. Threats of criminal punishments for lazy medical professionals doesn't sound like a good fix to be honest.
This is a surprising view given that I'm T1D in the UK and the healthcare I've received, along with the tech, support and collaboration with diabetic consultants has been first class. You are making an assumption that every doctor is like the one you have (I guess), but its simply not the case.
Good luck with your programming, but the agenda you're pushing for it is remarkably short-sighted.
I've had 4 consultants over the past 10 years. The first, who was forward thinking and kept up with the latest in the field, helped me acquire an insulin pump. Sadly, I had to transfer clinics when I moved across the country and have never had another consultant that helpful.
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.
Anything outside the check list leaves them scratching their head. They’re terrible debuggers.
I had early high blood pressure since high school. Four blood pressure medications, one being a diuretic. Signs of edema.
It’s not like my condition required any complicated diagnostics. I met the checklist.
5 cardiologists 2 nephrologists in my lifetime. Nothing but more pills for treatment. Over two decades.
I had to be the one to research and then ask to see an endocrinologist because I thought it might be hyperaldosteronism. They were dismissive when I asked but reluctantly made the referral.
Yes, it was unilateral hyperaldosteronism. Had my left adrenal gland removed because of it.
And now my BP is much more stable. I still take a couple of BP drugs, but in smaller doses. And my BP is much more normal and stable.
No more wild, 3am ER visits where my BP was 200/120. And I lost about 15 lbs of water weight.
If have long lived resistant hypertension, please ask to see an endocrinologist to get screened for hyperaldosteronism.
In reality, there are few things a GP can do better than a nurse or some technician with an LLM, and the sooner that shift happens, the better for society.
In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.
I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.
A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars.
[edit] Reading more of the comments this seems par for the course in many "wealthy" countries.
None of those things are necessary most of the time, and they’re usually just going to make you paranoid. It’s why doctors don’t generally like to do full-body scans on healthy people: they’re rarely going to find anything clinically significant, but they’re often going to find something that causes a scare and some unnecessary tests. (And if the scan is a CT scan, on average, the radiation may cause more cancers than it catches if you’re scanning healthy people for no reason.)
If you want to have the best shot at preventing disease and living a long, healthy life, it’s not complicated: eat a healthy diet, exercise, get a good night’s sleep, avoid drugs and alcohol, and have fulfilling relationships with other people. Beyond that, you’re spending a lot of money on things that are going to have a negligible or even negative impact on your health and quality of life.
> But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.
Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it?
Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time.
Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)
>Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky
This isn't my experience. Every time I've gone in for an annual check, the doctor has either suggested that I get or asked if I would like a blood panel. Maybe you should try another doctor.
I don't know why you would expect the healthcare system to do all of that stuff. If you want to know your VO2 Max you can just go to the local running track and execute a Cooper Test for free. But the results aren't really actionable. Regardless of the quantitative result, unless you're already an elite athlete the prescription will always be the same: exercise more.
> broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc.
Do you really need VO2 max test to tell you that you get out breath climbing a set of stairs? What genetic tests are you even talking about( brca ? ).
Is there any actual proof that "catching cancer early" has any long term impact on survival ?
ppl can go waste their money if they really want for entertainment but I don't suggest burdening public healthcare with voodoo science.
> Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.
What do we want them to do. They are not going to come to your my home and switch out your burger and fries with a salad.
I don't get where this notion that you need to go to doctor to keep yourself healthy even comes from. Its not a secret how to be healthy.
To be fair, most people probably are hypochondriacs. Somehow we have come to expect that all our nagging ailments should be fully treatable by either a pill or a surgery. In reality, human body is pretty good at self-repairing and self-regulating and modern medicine can help it only in certain clear cut cases. Medicine is just not that good and the doctors know it.
I'm certain in the sample of patients most GPs see, hypochondriacs are overrepresented, but that really does not in any way eliminate the problems I experience, so from my point of view it's still a real concern.
Something similar, u just switched to private clinic where i pay 500euros/year for general doctor(even when they work for insurance) and I pay like 100E for specialist. Never happier, fast and good communication.
I also lived in two of the richest countries with a social medical system
My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc.
I'm talking about the situation in France and the UK, not sure where you are, my point is that I agree about the system failing us, there's a lot to be said about what could be done but that's outside my area of expertise. I'm just being a little nicer to the doctors, as there's only so much they can do given the means they're given.
> My experience is that GPs are over-worked, under paid (given their responsibilities
Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible.
> and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient.
My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medical industry is too incompetent to figure out what it is and that there are people who have worse problems, even though he has no idea what is actually wrong.
My wife is a doctor (GP, before internal medicine in biggest hospitals), experience with France and Switzerland. What you say is true - they all start as naive optimists who get treated brutally by whole healthcare system first 7-10 years after school, everybody knows it, often illegal from hospitals but good luck suing your employer. Burned out, 60-70 hour work weeks with weekends is the standard, night shifts, a lot of responsibility with little help/oversight. Always 1 oversight away from harming/killing somebody. Many in Switzerland that are Swiss dropped out, foreigners don't have it so easy.
Then afterwards they are put into position where they have 30 minutes for patients (in France its ridiculous 15 mins, saving money = worse diagnosis/treatment, no way around it). Don't expect miracles if they see 20 folks like you daily, ideally with very vague problems like chest pain which can be anything from sprained muscle due to bad sleeping position last night to heart attack, while having 10 other comorbidities and taking various medication.
Doctors behave as whole system forces them to behave.
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!
Off topic, but if skip your first sentence and the later mention of insulin, this reads like an acronym and jargon filled comment that could be about anything. Like you could refactor the comment to be about AI LLMs or something.
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...
Are you still announcing meals? I know some people use iAPS with no meal announcement which sounds amazing. We are moving our T1D son from OP5 to Loop but would consider iaps in the future. Hoping we can recreate our 92% average time in range with less work needed
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
Unironically I use React or htmx with Typescript if I need a UI in front of dotnet. Having spent far too long dealing with all the dotnet thrash, all to build a GUI that only works on Windows desktops, I said enough is enough and learned how to build a web front end.
Best decision ever. I know plenty of dotnet folks who would rather eat a shoe than learn how to build a web front end, but frankly it's still better than what I would get with Winforms. There's so many great free libraries, tutorials, and resources for webdev.
And best of all, now I have something I can host on a free GitHub site and share with people, instead of figuring out how to build an installer.
AvaloniaUI is nice and a commonly recommended choice nowadays if you are targeting desktop.
It is interesting that the author chose to use Elm to describe C# code. If it is their preference, they could have gotten all that with writing the "core" of the project with F#, without having to change examples neither in the actual implementation nor in the blog post (the author does mention F# but not whether they looked into using it).
Yeah, I do have some passing experience with both F# and C#, and since the example code provided by the university was in C#, I kept that code and built on it. But I would have felt better in F#.
... and it works on every platform from BlackBerry, iPhone, MacOS, Windows, Linux, desktop, and mobile! Has lots of tools to handle different resolution sizes and alternate languages!
Of course it's often a little less performant and requires Learning New Things. But generally the trade-off is worth it for the significant benefits if you want to share it with the most people.
Readit News
- 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 think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance. This is a fiction and has never existed.
The default state is for none of these services and protections to exist whatsoever. Everything beyond nothing is an imperfect and unstable solution held together with duct-tape.
I'm with you. One quick look at history shows nothing is set in stone and it can always get worse.
The system is for profit by choice, it is under our control as society to guarantee that list or not, and we have chosen not to.
Might be the right or wrong decision, that’s up to each of you, but denying it’s has been chosen it’s very naive
What a depressing worldview... :(
I think that children are generally raised to not believe there is "risk" associated with listening to experts. This means specialists like Doctors but also politicians and military officials.
The idea that there could be a grift set up to take advantage of people in the medical space, for instance, which is highly regulated and supposed to be for the benefit of people first and for generating capital second, is not intuitive to children.
In fact a wide array of industries and services in the United States, and the world (to not be political, as some commenter said) are set up to take advantage of children or naive young adults.
Secondary education and student loans is a glaring example of this.
> The default state is for none of these services and protections to exist whatsoever
In all of human history this is mostly untrue. Humans have always formed societies, and those societies have always provided services for their people. In fact, before capitalism, most of these services were provided in-kind as a right of being a part of the tribe.
This idea that every person is born as an individual and nothing is granted to them belongs to a certain political ideology that is designed to make sure people feel entitled to nothing, and keep things in the private industry, and keep government small. But I digress.
Of course someone has to provide the service, and collect the materials for the service. And that person deserves to be compensated for that work. But the idea that the default state of a human is to be alone with nature and subject to pure individualism is simply not true, and never has been the norm, until that idea was used to justify not providing people with anything.
> Everything beyond nothing is an imperfect and unstable solution held together with duct-tape
This idea is also untrue. We've had a lot of time to perfect these things. If we can build skyscrapers and infrastructure to maintain them, we can provide these services. You are conflating political ideology and economic motivation with literal ability. The ability is absolutely there, and was in the past as well. There is something different going on that causes these systems to be "held together with duct-tape" and it's actually other humans actively trying to destroy these systems, not that they are impossible.
Reasons why should be obvious, but listening to podcasts, or reading pop-science books, connecting the dots and thinking you’re qualified to give, again, life-threatening advice, does not mean you’re actually qualified or you have an idea of how deep the rabbit hole goes (as we are learning, nobody really does).
Unfortunately, in my experience I encounter a lot of people who haven’t opened up an intro to biology book since their teenager days let alone an undergraduate biochem book, but they listen to podcasts and think they have it figured out and have the audacity to speak with confidence. I’ve been in situations where the practitioners are wincing but are too polite to call people out - it’s easier to let them just yap out what the podcast said and then change the topic. Don’t be one of these people.
Isn't it suspicious to offer YMMV caveats in a situation that is obviously dripping with caveats?
If I were to summarize the thousands of hours of what the Phd/MD health podcaster space has promoted, the jist of it comes down to:
- Get about 1 cup of 5 colors a day. Usually a smoothie is the way to achieve this. I make them in batches and they are conveniently available as grab and go.
- Prioritize sleep
- Exercise to improve v02 max as high as possible
I think _most_ of the population on hackernews has the financial privilege to implement the above 3 in various ways. But those will provide such a quality of life improvement to anyone dealing with chronic illness that it reduces the need for medicine a ton. And much of the damage from the environment can be mitigated by providing the body with the nutrition necessary to detoxify and deal with the various stresses they bring.
The way to look at modern medicine is that, modern medicine is very good at fast death scenarios. Heart attacks, randomly acute conditions, but they are terrible when it comes to slow death conditions like diabetes and dementia.
We need to look to rely on modern medicine for quick death, while creating interventions on the slow-death side ourselves, unfortunately.
Or they're delusional and legitimately believe the nonsense they're up to (insert your personal childhood gripe here) is in your best interest.
I think that low baseline expectations is very important for mental health and general resilience.
After 5 years I decided that method was bullshit designed just to sell insulin. Went keto and was off insulin withn 2 months and haven’t had a drop of extraneous insulin since (7 years).
My doctors advised against me going keto because the ADA recommends their diet. When I explained I was going to try it anyway because it made sense that if my body was having trouble processing glucose, that eating a diet that minimized glucose would probably have a beneficial effect.
It was at that point that I realized that many doctors are simply following a treatment formula. Ultimately the ADA had to recognize that keto can be affective at managing diabetes. Yet, they still publish the pretty literature that advises type 2 diabetics to eat a diet that for them is significantly worse than a low carb diet.
I think the two main factors driving this outcome are:
1. Due to the complexity of the problems they face and the quick diagnosis expected from them, medical professionals are taught to think in an expert system-like if-then statements. Some of these are rules of thumb, some may no longer apply due to latest research, and some may not be applicable to you.
2. Metabolisms may differ in important ways. A new doctor is trying to make a decision in a highly complicated high dimensional space with the few data points that you provide. This is OK, but they get too confident with their diagnosis.
Point two, though, is just an example of how preventive medicine is forgone due to its cost. The system doctor's use to share data could also stand massive improvements.
In my case - just to get the facts on Blood pressure took quite a bit of digging - thanks to some independent doctors who went against the grain and had a conscience and courage to dissent. Cholesterol is an even murkier pool. Its amazing how muddled the picture is.
2) Large activated carbon air scrubbers. For air filtration you really need not just HEPA particulate filters, but robust VOC capture. The tiny bit of activated carbon in things like a Winix C535 or Coway Mega/AirMega really don't clean much. Instead, consider something like buying two 10"-12" carbon scrubbers from https://terra-bloom.com and get a matching size of their in-line "Silenced Ultra Quiet EC Fan". You can just stack these three items together and it forms a tall but not horribly ugly appliance that doesn't take up much floor space. You'd probably need to replace the filters once a year, and have quite a few around a normal-sized house, just like standalone HEPA filters (which you'd also probably still want as well).
3) Wash everything often - bedding, clothes, carpets, floors, walls, appliances, etc. Obviously, attempt to use a soap that won't add additional pollutants. Wash them twice, once with soap then again without soap.
4) Time. Assuming similar materials, something that is 5 years old should have already leeched out a lot of the chemicals which are going to off-gas/transfer/leech from it. So the polluting rate of something 5 years old that's been washed 50 times and already worn and broken in should be assumed to be lower than an identical, new, version of the same thing.
But for a simple pill solution, consume sulfur. For as important as it is, it's not widely front of mind in the health space. So much focus on Vit D, Magnesium, Omega 3s, etc, which are all absolutely necessary.
Some great sources of pill based sulfur are Taurine, NAC, and MSM (methylsulfonylmethionine). My preference to recommend blindly as a general pill is MSM. But sulfur is key for the liver's detoxification functions to work ideally.
There's quotes flying around that say something like: 80% of the population (US or world) is deficient in X.
Usually X is omega 3's, Magnesium, Vit D, and also to add to the list, Sulfur is a huge one. Outside of being in a culture like Koreans that consume cruciferous veggies 3x/day (via kimchi), most americans only get it from meat, garlic, onions and broccoli. If one has brittle nails or hair doesn't grow as quickly, that would be the sign that something like MSM in pill form would be helpful. Otherwise, folks are probably fine if they are consuming daily amounts of anything containing sulfur.
And I'm not going to feel stupid or naive for feeling like children are tricked into believing the opposite is true.
I want to also say, this state that everyone is acting in their self interest is not something we should promote, or be proud of, or assume is the natural state of things. It is a state that we are being forced into, and we are being convinced to accept.
People as individuals are actually very good. And if we were to get over a few little logical fallacies, we could extend that goodness onto our whole society. But there are many reasons why that is considered harmful by some in power, and then many more who are propagandized into agreeing with them.
https://news.ycombinator.com/newsguidelines.html
It would be surprising if one's body were different. The general level of faith there seems inconsistent with reality
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.
Strict carnivore for me was steak, hamburger, stew meat fried in butter, mushrooms and onions in butter, bacon, and very sharp cheddar (only on burgers or raw). Eat every bit of gristle and fat. It is very hard to get enough fat.
Brain fog lasted for 10-11 days. Felt fantastic after that.
To keep your carnivore costs down I would recommend stew meat from Costco fried with onions and mushrooms when you can't stand steak or plain burgers.
This has worked for me for the last 6 months. I have no idea what it will be long term. Maybe someone will find something useful in it.
Their experience touches on 3 factors:
>Exercise volume (which, according to newer research, should be spread out over the course of the day)
>Diet (which should be focused not just on maintaining steady, low blood sugar levels, but on dietary factors that encourage subcutaneous rather than visceral fat deposition)
>Sleep quality
The last, I think, is extremely undervalued. My father developed T2 in his 30s, and it progressed consistently until he was diagnosed with sleep apnea and received treatment. Around the same time, his work schedule finally became more reasonable after a career of early mornings and late nights. This is someone who had to pass annual physical fitness exams for his job, cooked and ate relatively healthily, etc. I'm convinced it was the years of poor sleep that set him up for insulin resistance.
This publication is a good starting point to his approach. Early time-restricted eating of low sugar and low starch meals is the key: https://nutrition.bmj.com/content/bmjnph/early/2023/01/02/bm...
It sucks, and I wind up cheating 2-3x a week (I live with people that eat different than I do).
- compliance is straightforward
- on average, will tick all the boxes for nutritional needs. (ie. vegans eating only oreos would not be very healthy, while vegans eating 5 colors a day would be far better off)
Eat less, exercise more, and you may delay T2D. Reduce or avoid fast carbohydrates. Reduce carbohydrates.
Also the FDA cleared at least one brand of CGM to be sold without a prescription, starting "summer 2024": https://www.dexcom.com/stelo
You should expect to pay $80 - $200 per device, and they last one 14 days, but the insight they give is really worth it.
- Exercise: 'Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. ' - Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- Intermittent fasting: there's great evidence that IF (intermittent fasting) can put it in remission: https://www.endocrine.org/news-and-advocacy/news-room/2022/i...
- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup and mostly stick to low-glycemic index minimally processed foods. 'Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.' - Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1
They care about your payments, more likely...
Dr. Bernstein's book is a must read for every diabetic person. His YouTube channel: https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag
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.
https://news.sky.com/story/the-nhs-sold-out-its-staff-doctor...
https://www.telegraph.co.uk/news/2024/05/15/doctors-forced-t...
https://www.bbc.com/news/uk-england-birmingham-64938278
The starting salary for a first-year doctor is below the national median income, and for a nurse significantly below. Their inability to requisition funds & time for care is something there is repeated labor action about. The NHS budget is 5.9% of GDP versus the 17.3% of GDP that the US economy spends on healthcare or the 11.3% of GDP that the UK economy spends on healthcare overall.
Maybe more funding will fix it?
Is it really that low?
In the USA an entry level doctor will make around $130,000 and the 'Average doctor' makes $200-$350,000/year depending on what website you want to believe.
And we're running like 13% of the population having diabetes.
Here you are comparing a doctor at the start of their career with a population consisting mostly of workers with decades of experience.
The NHS is underfunded, but this isn't a problem of funding. The lack of a scientific approach to managing diabetes is strictly down to ineptitude.
Mind providing some sources for this? Rather tired of hearing this unfounded conspiracy theory from people
> Maybe more funding will fix it?
Where does the money come from?
I agree about Glooko, it's not as good as diasend was.
Expect to start having appointments cancelled and to go years without hearing from them once she is passed to the adult diabetes team.
So I've been using Abbot (LibreLink) since 2019 and if you log into LibreView (https://www.libreview.com/) there's a 'Download glucose data' link in the top right of the screen.
There's also a handy PDF report that I send to my diabetic nurse before my annual meeting, I think I'm the only one of her patients who knows how to do this because she's always thrilled and spends half the appointment going through it in amazement at the data/trends.
Abbot have been quite good overall despite the fact I reported a bug to them in their Android app in 2022 and they still haven't fixed it. If you add LibreLink to the whitelist of apps that can interrupt DND, then enabled DND, LibreLink alerts you saying "Alarms unavailable."
I was referred to a dedicated team with a specialist nurse who checks in with me regularly. Maybe I am fortunate not to live in a big city where most NHS facilities seem to have descended into third world standards?
Good luck with your programming, but the agenda you're pushing for it is remarkably short-sighted.
Anything outside the check list leaves them scratching their head. They’re terrible debuggers.
I had early high blood pressure since high school. Four blood pressure medications, one being a diuretic. Signs of edema.
It’s not like my condition required any complicated diagnostics. I met the checklist.
5 cardiologists 2 nephrologists in my lifetime. Nothing but more pills for treatment. Over two decades.
I had to be the one to research and then ask to see an endocrinologist because I thought it might be hyperaldosteronism. They were dismissive when I asked but reluctantly made the referral.
Yes, it was unilateral hyperaldosteronism. Had my left adrenal gland removed because of it.
And now my BP is much more stable. I still take a couple of BP drugs, but in smaller doses. And my BP is much more normal and stable.
No more wild, 3am ER visits where my BP was 200/120. And I lost about 15 lbs of water weight.
If have long lived resistant hypertension, please ask to see an endocrinologist to get screened for hyperaldosteronism.
I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.
A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars.
[edit] Reading more of the comments this seems par for the course in many "wealthy" countries.
If you want to have the best shot at preventing disease and living a long, healthy life, it’s not complicated: eat a healthy diet, exercise, get a good night’s sleep, avoid drugs and alcohol, and have fulfilling relationships with other people. Beyond that, you’re spending a lot of money on things that are going to have a negligible or even negative impact on your health and quality of life.
Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it?
Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time.
Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)
This isn't my experience. Every time I've gone in for an annual check, the doctor has either suggested that I get or asked if I would like a blood panel. Maybe you should try another doctor.
Do you really need VO2 max test to tell you that you get out breath climbing a set of stairs? What genetic tests are you even talking about( brca ? ).
Is there any actual proof that "catching cancer early" has any long term impact on survival ? ppl can go waste their money if they really want for entertainment but I don't suggest burdening public healthcare with voodoo science.
> Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.
What do we want them to do. They are not going to come to your my home and switch out your burger and fries with a salad.
I don't get where this notion that you need to go to doctor to keep yourself healthy even comes from. Its not a secret how to be healthy.
My experience is that GPs are over-worked, under paid (given their responsibilities), and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient. That's explained by a slow but relentless dismantling of any operational margin that existed in the system, whether it's financial, time etc.
I'm talking about the situation in France and the UK, not sure where you are, my point is that I agree about the system failing us, there's a lot to be said about what could be done but that's outside my area of expertise. I'm just being a little nicer to the doctors, as there's only so much they can do given the means they're given.
Their work hours are no longer than anyone else, their pay is way above the average, and their liability is as low as possible.
> and can only afford to do shallow diagnostic in the 5-10 minutes they've got per patient.
My doctor spends it explaining to me how I should just not care that something is wrong and accept that the medical industry is too incompetent to figure out what it is and that there are people who have worse problems, even though he has no idea what is actually wrong.
Then afterwards they are put into position where they have 30 minutes for patients (in France its ridiculous 15 mins, saving money = worse diagnosis/treatment, no way around it). Don't expect miracles if they see 20 folks like you daily, ideally with very vague problems like chest pain which can be anything from sprained muscle due to bad sleeping position last night to heart attack, while having 10 other comorbidities and taking various medication.
Doctors behave as whole system forces them to behave.
Dead Comment
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/Loophttps://www.loopnlearn.org/
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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...
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
Best decision ever. I know plenty of dotnet folks who would rather eat a shoe than learn how to build a web front end, but frankly it's still better than what I would get with Winforms. There's so many great free libraries, tutorials, and resources for webdev.
And best of all, now I have something I can host on a free GitHub site and share with people, instead of figuring out how to build an installer.
It is interesting that the author chose to use Elm to describe C# code. If it is their preference, they could have gotten all that with writing the "core" of the project with F#, without having to change examples neither in the actual implementation nor in the blog post (the author does mention F# but not whether they looked into using it).
I wonder how the mobile support is.
Of course it's often a little less performant and requires Learning New Things. But generally the trade-off is worth it for the significant benefits if you want to share it with the most people.