The Arithmetic of Life
chronic condition | metabolism
David Gordon does strategy at Intel. He's had diabetes for 15 years. He talks about diabetes and the importance of numbers from the perspective of a type 1 diabetic. He discusses how diabetes Type I is really the interplay of a way of life, carbs, your blood sugar, and the amount of insulin you inject.
Blood glucose monitor
If I’m going to eat and ice cream, and I can eat ice cream contrary to thought, if I know it’s 27 carbs then I need to inject second units and there is a simple division that needs to happen. So how do we know blood sugar, some of you may know, we prick and a small bit of blood that tells you how much glucose is in your blood is measured. And so you may want to correct it. Sometimes your blood sugar goes up and in certain conditions you want to correct. If you want to correct from 230 to 130 in my case it is to units of insulin you inject in a pen. And in office hours I can assure you the pen.
There is an uncomfortable situation called hypoglycemia, when your blood sugar can drop and for me it’s about 80. And if I want to take it up from 80 to 130, I need 25g of sugar and you learn to know what is the portion.
And if I’m about to have a swim, which I typically do 40 minutes, which is 1200 m, contrary to what doctors would say even I bring my sugar up to 230 because it ends up to be 100 and as I told you below 100 is hypoglycemia.
So we live by the book and that’s how we know, and actually all of these factors are not the same. Every diabetic has different numbers, but if you record enough you can do the computation and I won’t bore you exactly how. We do this by the way, the person that really knows this is the dietician.
The doctors do have a way to see how you are doing over time, and it can measure three months of average testing your hemoglobin and the amount of sugar that glues into it and hemoglobin 1C is the name.
This roughly maps into blood sugar levels, but it doesn’t do it accurately. Furthermore, insulin, the way it works over time and you need to know how much you inject and when you inject it because you need to take that into consideration, otherwise you are risking hypoglycemia.
So the digital way of life of a diabetic is swing between too high and too low and trying to mimic the pancreas of other people in the rest of the world that have this working. And it’s a continuous battle or gain if you like, because it is for life and there is no winning or exiting this process and hopefully there is no losing.
So, what have I learned? Jointly with what the industry has learned, for me it’s the 15 years, several things. Most strangely the first thing that you actually learn is that it works, because a lot of doctors are not well educated and will say you know, diabetes is a complicated thing. There are many factors, and a multifactor thing, and if it doesn’t work for you, well, for some people it doesn’t work.
What I also have learned is that you need to adhere to your system, because you can’t cheat, you can’t consume and not and say, well that’s okay. I didn’t see that. It has to be if you have got a system, it has to be taken into consideration.
Now, why is this a world of mystery for the doctors? It’s not because they are ill-educated, it’s because they do not have visibility. And there are a lot of blind spots we don’t know, and if we know as patients we don’t tell them, because we don’t have the tools to tell them. But that’s improving nowadays and as you know glucometers can be uploaded into the system, and more and more there are continuous glucometers.
Furthermore, in terms of learnings, there is an amount of guilt embedded into this. You want to be okay, and you know you’re not penalized immediately, but you know that down the road there are horrible complications and you really do want to avoid them.
The good news is that there are small wins, because every day is a new morning. You’re fasting until the morning, so you start fresh and you can win the next day. And even if you lose 21 days, you can win the last month. And as I said, it is a never ending game so you have a lot of winning and losing to do. And there is a lot of joy being in control if you are successful, like I said for diabetics, type I is a doable thing. And that is pretty much in the advantage of medicine, and this wasn’t the case 30 years ago.
Another thing to note is that the medical system is giving in the hands of patients of various levels of intelligence and knowledge a deadly weapon. You can kill yourself by the wrong dosage of insulin at any given time. It’s pretty scary.
So you know a wish list for myself would be part of the industry, not the medical devices that can compute. Some of these things are happening, but these are what I would really appreciate.
First of all, there needs to be an element of fun here, because as I said, it’s a never ending game and let’s make sure it’s a game. Those who are interested I can talk off-line of a pilot system that we did in Israel, which is working with and proven that it can improve the physiological and psychological state of children that need to be educated, and complying with the lifestyle. This we did with Schneider Clinic, which commands 1700 children.
A simple thing that does not exist yet, the pen is the injection device does not record and is not downloadable. And unfortunately were not getting younger and we don’t remember every time what we injected, how much, and when. And as I said it’s important the timing.
Now, the watches are coming up. We need badly a watch that will show us a non-intrusive way of how much glucose is in the blood at any given time, and it needs to be continuous. Because we prick ourselves normally seven times a day or 5 to 8, maybe.
Furthermore, it would be great if we knew exactly how much carbs are in everything that we eat, and it’s not easy to calculate. The big problem is calculating the portion specific portion that you took. So how about let’s go back to TV dinners. Many TV dinners, and each one says – even if I’m travelling on the plane. They will tell me how much carbs are in this one specific meal I would be very happy.
Of course, artificial pancreas is in the way, and measuring your glucose, applying insulin, and what we would like to add to that is applying glucose as well. And we would appreciate a cure, but you know, until we get a cure let’s settle for the other stuff which is probably more less doable. So I hope you agree with me that this is really an IT managed condition and is really in my mind, the mother of all Quantified Self applications out there. I could show you all you know all of my graphs which are pretty similar to the graphs that other folks showed and the data that they measured on their own incentive, and rules with they are inferring. Here there is a huge scientific establishment that worked and managed to come up with interesting correlations and rules. Of course, we are rolling now into a new age and there will be more correlations with new parameters. So this is evolving well.