1. Insulin helps get sugar into cells. Glucagon gets stored sugar out of the liver into the blood. Diabetes management in 2025 only deals with supplying external insulin.
2. There are several variants of diabetes. Type 1 is an autoimmune disorder where the body attacks the cells that make insulin.
3. Too much insulin equals all the sugar getting sucked out of your blood and lymph and into cells. This is really bad in an acute way. Your brain cannot run without sugar. Accidentally give yourself too much insulin for the sugars and wind up dead or in a coma in short order.
4. Highs are also bad, but generally in a less acute way. There are exceptions, but being too high with blood glucose for a period of time doesn't have the acute risks of being too low. Diabetics (or their caregivers) carry around quick absorbing sugar sources to help against a low.
5. The peak action (fastest reduction in blood glucose level) of the common insulin, in the way we dose it, peaks 90 - 120 minutes after the dose. The long tail is about 5 total hours of action from the point of dosing. So you should give insulin in advance of when you expect digestion to move glucose into your bloodstream. This is tricky. Also, as insulin ages, the peak of the action happens later. If a new vial is 90 minutes, an nearly empty vial might be 120 minutes after dosing for peak action.
6. CGMs, the on-body instrument in question here, are both flakey and amazing. There's a novel of good and bad here. I'm glad they exist, they can be cantankerous. They are a tiny potentiostat, if that is something you happen to be familiar with.
7. Very high blood sugar is treated with extra insulin to overcome the osmotic pressure of having too much glucose in the bloodstream. There's also a lot of chemistry here (glycocalyx to get you started). If your blood sugar is high you generally need more insulin to get past the hysteresis effects. Once the blood sugar starts to come down, that extra insulin is still around, and can cause a dramatic low. CGMs let you observe this, and "catch the low" by eating sugar to replenish the baseline sugar trapped in circulation.
8. Diabetes management is challenge every day, multiple times a day. Especially with small child who doesn't communicate to you about what they believe about their blood sugar. This is my personal circumstance.
9. Endocrinologists have suggested some wild stuff to my wife and I. For instance, keep a tube of cake icing around, as you can administer it rectally to a child who is passed out (or worse) from a deep low blood glucose. This is how poor the standard of care can be.
Father of 4.5 YO son with Type 1 diabetes, and materials engineer by education.
as a parent of a healthy child I was getting anxiety just from reading what you are going through with this. my dad and sister are diabetics but I can’t imagine dealing with a child…
Our almost 5 year old has had T1D for two years. We ended up going the way of a controlled lower carb diet for our entire family. Other than the greatly increased cost to eat this way, it has been transformative for diabetes management of our son, the amount of sleep we get, and the lessened risk of aggressive lows.
We've managed to keep our sons A1C in the 6-7% window after we changed our diet to be heavily carb controlled.
That sounds like great family teamwork. I wish my partner would entertain changing their diet to accommodate this (I've asked). I imagine the challenges of life are slightly more tractable when you genuinely deal with serious adversity as a family unit.
I understand it means an extra burden for all; but to me, voluntarily doing something challenging together for a family members' benefit seems preferable to facing each adversity largely independently.
As an aside, while likely much better than uncontrolled, 6-7% A1C still seems on the high end for lifelong. You probably already know this, but exercise immediately after carbohydrate consumption can also help - e.g. family walk after dinner (another thing my partner isn't interested in)
Although it's possible for someone with type 1 to have an A1C below 6%, it's very difficult. I've known a few people like that, and they are all super users. It's also going to depend somewhat on the lab running the A1C test, personal biology (A1c is not only affected by blood glucose levels) etc. 6-6.5% is superb control! Parent should be very proud. 6.5-7% is still very good, I haven't looked at the distribution of A1c's for T1D recently, but that would be much better than median which I think is above 8%.
Especially with kids, it's difficult since you don't control how much they decide to eat making pre-bolusing meals challenging (part of why reducing carbs tends to be helpful for people is it reduces the need to pre-bolus and makes it less risky since you need less up front meal insulin).
I didn't mean to say it's not superb control for someone with T1D, only that there are likely still some negative health consequences at 6-7%, and that exercise after carbohydrates is one mechanism of potentially getting some additional marginal improvement.
This is good advice for pre-diabetics and type 2 diabetics but in type 1 diabetes exercise after meal often makes things worse. It makes insulin dosing less predictable.
We changed the entire family diet in part to help him not develop any complexes around food.
We would like to get him in the 5's, and I believe we'll get there. He was below 6.5% every checkup so far except the most recent one.
Between honeymooning and growth hormones, it's difficult to keep him in range from 10pm to 3am, while also not triggering a low after his stomach is empty.
Most smaller firms will require a retainer. $5k is fairly common. I've been able to work with several large firms for work, and several smaller firms for personal stuff.
Personally, I much prefer the larger firms. In general their work product, responsiveness, and timeliness is well ahead of small firms. They aren't even that much more expensive for some things. Unfortunately I don't know what the retainer $$ would be, if any, for a larger firm.
> bootstrapped startups from underprivileged people.
i dont think startups should be paying a retainer. You do this only after it's worth the money - ala, you either know your domain is a gray area and is definitely going to require a lawyer.
This has nothing to do with underprivileged people or not.
This might depend on where you are. In my area, it's unusual to have to provide a retainer at all unless you're doing something big or the lawyer suspects you might have trouble paying your bill later.
As the (non lawyer) who fell into managing all US legal firm interactions for my day job, I support this list.
If you are comfortable with legal documents; have a law dictionary to understand what specific language means; and read historical case law on the topic in question, you will be well prepared to have a seat at the table with your attorneys.
> read historical case law on the topic in question
Is this even at all accessible to anyone who isn't already in a major law firm? I'm assuming it requires some sort of thousand-dollar subscription to an exploitative publishing house?
Helmholtz absorbers have been used for some time in built spaces. Look for a pattern of slats or holes like perfboard, often on the rear wall of the space. Lecture halls, museums, performing arts, and the like.
The author acknowledges present use and also gives intriguing historical examples from Vitruvius and and Da Vinci.
An acoustic jar, also known by the Greek name echea (ηχεία, literally echoers), or sounding vases, are ceramic vessels found set into the walls, ceilings, and sometimes floors, of medieval churches. They are believed to have been intended to improve the sound of singing, and to have been inspired by the theories of Vitruvius.
Son of a COBOL dev... All this virtualization mess, minus the extra Java layer, started back in the 90s, courtesy of Unisys. I remember my dad pulling his hair out when I was in High School, though I did not understand why back then.
I think you get it now though. I've seen this whole industry up close for the last 40 years or so and it's absolutely incredible how we went from a machine with 32 M of RAM and 300 M of storage sufficient to serve 1400 branch offices of a bank to a phone with a very large multiple of that, that can barely serve a single user.
That is some thing that I can't stop thinking about. I get that banking software does more, like online banking, larger transaction volume, more account and loan types, but why is it that we can not run a small to medium bank on a single modern CPU and 1TB of memory?
1. Insulin helps get sugar into cells. Glucagon gets stored sugar out of the liver into the blood. Diabetes management in 2025 only deals with supplying external insulin.
2. There are several variants of diabetes. Type 1 is an autoimmune disorder where the body attacks the cells that make insulin.
3. Too much insulin equals all the sugar getting sucked out of your blood and lymph and into cells. This is really bad in an acute way. Your brain cannot run without sugar. Accidentally give yourself too much insulin for the sugars and wind up dead or in a coma in short order.
4. Highs are also bad, but generally in a less acute way. There are exceptions, but being too high with blood glucose for a period of time doesn't have the acute risks of being too low. Diabetics (or their caregivers) carry around quick absorbing sugar sources to help against a low.
5. The peak action (fastest reduction in blood glucose level) of the common insulin, in the way we dose it, peaks 90 - 120 minutes after the dose. The long tail is about 5 total hours of action from the point of dosing. So you should give insulin in advance of when you expect digestion to move glucose into your bloodstream. This is tricky. Also, as insulin ages, the peak of the action happens later. If a new vial is 90 minutes, an nearly empty vial might be 120 minutes after dosing for peak action.
6. CGMs, the on-body instrument in question here, are both flakey and amazing. There's a novel of good and bad here. I'm glad they exist, they can be cantankerous. They are a tiny potentiostat, if that is something you happen to be familiar with.
7. Very high blood sugar is treated with extra insulin to overcome the osmotic pressure of having too much glucose in the bloodstream. There's also a lot of chemistry here (glycocalyx to get you started). If your blood sugar is high you generally need more insulin to get past the hysteresis effects. Once the blood sugar starts to come down, that extra insulin is still around, and can cause a dramatic low. CGMs let you observe this, and "catch the low" by eating sugar to replenish the baseline sugar trapped in circulation.
8. Diabetes management is challenge every day, multiple times a day. Especially with small child who doesn't communicate to you about what they believe about their blood sugar. This is my personal circumstance.
9. Endocrinologists have suggested some wild stuff to my wife and I. For instance, keep a tube of cake icing around, as you can administer it rectally to a child who is passed out (or worse) from a deep low blood glucose. This is how poor the standard of care can be.
Father of 4.5 YO son with Type 1 diabetes, and materials engineer by education.