So, many people, including myself decide that since the lowest dose is most predictable, use zero (this is a Type 1 speaking)—zero meal-t...

So, many people, including myself decide that since the lowest dose is most predictable, use zero (this is a Type 1 speaking)—zero meal-time insulin that is—and compensate by eating an extremely small number of carbs. Yes, a lot of T1s find that keto diets work well for them. (It doesn't work for me, unfortunately; if I drop below about 80g/day of carb my liver decides that I'm starving it and dumps crazy amounts of glucose into my bloodstream.) Better blood sugar monitoring tech (e.g. continuous) and quicker meal-time insulins would seriously improve things. We have continuous blood glucose monitoring. It's expensive and not very accurate right now, but it does exist. Faster insulins are one of the big targets for use in insulin pumps, because they would make a closed-loop system much easier (less need to predict where blood glucose is going if you can just wait 10 minutes, measure a new value, and give a new bolus), but there are two difficulties: 1. Diffusion from subcutaneous tissue into the bloodstream depends mostly on the molar mass, and insulin monomers are quantized; diffusing half of a monomer would be faster, but it wouldn't be useful. 2. People need to be able to "unplug" pumps from time to time without dying, and if ultra-ultrarapid insulins leave the body too fast the mere act of taking a long shower could become life-threatening.

Posted by cperciva on Mar 20, 2015, 5:45 AM

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