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Comment: Re:Insta-death (Score 1) 119

by levork (#44993613) Attached to: FDA Approves Wearable "Artificial Pancreas"

Well, I can't speak to the evidence to or against the protocol for massive insulin overdose. Family members of diabetics are drilled on how to deal with hypoglycemic events, certainly moderate insulin overdoses (from e.g. underestimating the bolus for a meal) just come with the territory and that's about all I'm equipped to deal with. I think the protocol is simply based on: low brain blood sugar = seizure/brain damage/coma/death, avoid at all cost. Just based on that, delivering sugar directly to the bloodstream makes sense.

I'll point one relevant complication: diabetics often have neuropathy, sometimes this neuropathy affects the digestive system. This is a doubly cruel issue: low blood sugar causes neuropathy in the long term, and if it affects the digestive system then trying to ward off low blood sugar simply by eating is hard. I doubt protocol assumes potential stomach nerve damage in all patients but it's something worth considering.

We do have some experience with hospital diabetic protocol: they err heavily on the side of keeping your blood sugar high, like over 150 mg/dL high. And yes, you can still run into nurses who are ill-equipped to deal with diabetic patients - we ran into one who refused to push dextrose even though my wife's blood sugar hit 15 (I have no idea how she was still able to argue with the nurse at that point).

Re: your question on glucagon - as I mentioned elsewhere in this thread, yes, the liver glucagon cache depends heavily on your last meal and exercise level. I believe it fluctuates from 50-200 g or so. If you've just run a marathon, a glucagon shot is not going to help you.

Comment: Re:Insta-death (Score 1) 119

by levork (#44989587) Attached to: FDA Approves Wearable "Artificial Pancreas"

We do have glucagon rescue shots around, I mentioned it in another post on this thread and it would definitely be something to use in a theoretical pump overdose emergency.

But keep in mind that glucagon is not a fixed dose of sugar: it's a hormone that triggers the liver to convert stored glycogen into blood glucose. So, it all depends on how much stored glycogen your liver happens to have, which is a function of your recent meals, time of day, whether you've been exercising or not, etc. Dumping your liver's entire store of glycogen may not be enough to counteract a massive insulin dose. Basically, it'll just tide you over until emergency services arrive.

Comment: Re:Insta-death (Score 1) 119

by levork (#44989365) Attached to: FDA Approves Wearable "Artificial Pancreas"

The problem here is that insulin dose tends not to be linear to carbohydrate consumed, so while my wife knows e.g. that if she eats 40 g of carbs she'll only have to give 2 units of insulin, she may actually have to cover 60 g of carbs with 5 units of insulin. I'm making up these numbers but the point is they're numbers worked out over years of trial and error, and also vary at different times of day.

So basically there's no way she would know how much glucose she would need to consume for very high doses of insulin; it's not something you try to experiment for. In a situation where her pump catastrophically failed and dumped all 6-7 days worth of insulin (that's the capacity of her unit; that's probably typical for a external pump user), her immediate priority would be to start eating as much glucose as she can: high blood sugar is better than low blood sugar. Even then, there's no way she could digest it fast enough without having her blood sugar drop precipitously low, leading to seizure etc, so emergency services would need to be called and told that she needs a dextrose IV drip. At this point it's a race between her digestive system and the rate at which the insulin kicks in, and the insulin is likely to win. If I happened to be around I'd stand by with a glucagon shot - this is an emergency injection that tells the liver to dump glycogen, essentially also raising blood sugar - but even then? Unlikely to be sufficient.

tl;dr I would say it's impossible to eat your way out of a catastrophic insulin overdose - you really need IV dextrose and a hospitalization. My earlier comment about box of cookies notwithstanding. The pump manufacturers know this and one would hope they have umpteen safeguards against it in, both in the hardware and software.

Comment: Re:Insta-death (Score 1) 119

by levork (#44989301) Attached to: FDA Approves Wearable "Artificial Pancreas"

Yes, dried fruit is very concentrated carbohydrate. Re: glycemic index - not sure how typical this is for diabetics but my wife ignores glycemic index in her diet and focuses entirely on carbohydrate content. As far as she's concerned, the type of carb only matters by a few minutes; she can back this up by looking at her blood glucose chart after a meal vs her CGMS. In a life or death situation a few minutes might matter, so your point re: honey vs cookies is a valid point, but actually honey IS a better substitute than cookies because of the fat content in the cookies: the fat gets in the way of fast digestion of the carb content. I was being a bit facetious about the cookies earlier.

Comment: Re:Insta-death (Score 3, Insightful) 119

by levork (#44988531) Attached to: FDA Approves Wearable "Artificial Pancreas"

My wife is a long term Type One Diabetic and has worn a pump and CGMS for years, so I'm somewhat qualified to answer here:

If the insulin pump fails to deliver insulin, won't the diabetic notice with their next glucose test?

Yes, the diabetic will notice. In fact, the CGMS (continuous glucose monitoring system) itself will notice and should alarm (and the article is about a pump with a CGMS built in). Keep in mind that the pump can actually fail to deliver insulin because the tubing is kinked, or the injection site is occluded - so this can be a more common occurrence than you think and isn't actually directly due to pump failure.

Don't most travel with spare insulin and a few syringes, in case of pump failure, at least for long distance travel?

Yep. My wife's diabetic medical supplies easily take up half of her carry on baggage.

Conversely, what happens if the insulin is all delivered at once? An insulin pump holds what, typically, a few days of insulin? Can a diabetic keep ingesting enough sugar with juice or soda or candy to keep their blood sugar up for brain function, even if the insulin dose is overwhelmingly high?

This is the scary scenario. It's never happened to my wife, and the pump manufacturers had better go to great lengths to ensure it never happens. The type of insulin used in a pump is fast acting, so if all the insulin is delivered at once she will pretty much immediately need to eat a lot of sugar or go into a coma. We're talking entire bags of cookies within minutes.

Comment: Re:Really?!? (Score 1) 1448

by levork (#44239929) Attached to: Orson Scott Card Pleads 'Tolerance' For <em>Ender's Game</em> Movie

As I pointed out to another commenter, his explicit use of the phrase "whatever means is made possible or necessary" makes it pretty clear he wasn't just talking about overthrowing the government via the democratic process. There is nothing unclear about that. As you say: he's a writer, and the fact that he deliberately decided to add this phrase makes it very clear where his intentions lie.

Comment: Re:Really?!? (Score 5, Informative) 1448

by levork (#44238799) Attached to: Orson Scott Card Pleads 'Tolerance' For <em>Ender's Game</em> Movie

He never advocated overthrowing the government for it.

Yes he did. From an article he wrote for the Mormon Times:

Faithful sexual monogamy, persistence until death, male protection and providence for wife and children, female loyalty to children and husband, and parental discretion in child-rearing.

If government is going to meddle in this, it had better be to support marriage in general while providing protection for those caught in truly destructive marriages.

Because when government is the enemy of marriage, then the people who are actually creating successful marriages have no choice but to change governments, by whatever means is made possible or necessary.

And more:

Regardless of law, marriage has only one definition, and any government that attempts to change it is my mortal enemy. I will act to destroy that government and bring it down, so it can be replaced with a government that will respect and support marriage, and help me raise my children in a society where they will expect to marry in their turn.

I don't know about you, but "I will act to destroy that government and bring it down" is a pretty clear advocation of overthrowing the government.

Comment: Lytro's 3-D is inherently limited (Score 5, Informative) 79

by levork (#42767623) Attached to: Light Field Photography Is the New Path To 3-D

Wow, TFA is really glossing over an inherent limitation:

the "shiftability" of a Lytro image is a function of the width of the image sensor

If the goal of this is to produce useful stereo content that replicates the parallax seen by humans, then the image sensor needs to be at least as big as the average distance between two human pupils. That's roughly six centimeters. The Lytro's sensor is around six millimeters. Somehow I doubt they're going to increase their form factor by ten times in each dimension, and since the point of a Lytro is to avoid fancy lenses they can't bend the light path to compensate.

Comment: CA - took ten minutes to vote (Score 4, Interesting) 821

by levork (#41896995) Attached to: U.S. Election Day In Progress: What's Been Your Experience?

No one in line ahead of me. Filled out paper ballot, fed ballot into Sequoia machine. My ballot was three pages, double sided - over ten propositions to vote on in California! Spent more than a hour doing research on them last night.

Oh yeah, this is my first election! Newish American citizen - proud to exercise my right to vote :)

Comment: Re:Not sure why people are knocking it (Score 3, Insightful) 293

by levork (#35201146) Attached to: Watch IBM's Watson On Jeopardy Tonight

But it's not speech recognition. Watson is getting its input via text, it's not doing any speech recognition. And lest you think this gives the computer an unfair advantage, it's nominally the same advantage championship Jeopardy players can pull: they can read the text off the monitor screen faster than Alex Trebek drones it out.

Comment: Re:Desktop going away? (Score 1) 278

by jeff4747 (#30853494) Attached to: The Apple Tablet Interface Must Be Like This

For larger screens, you want to see multiple things at a time.

You do. And I do.

Novice users don't. They're just doing one thing at a time anyway, so multiple windows are just another way to confuse them.

And really, the need for multiple tasks depends on what you're using it for. If I'm working, I'm probably needing to keep track of more than one thing at a time, which yields multiple windows (and multiple monitors now). But I'm doing lengthy, complex tasks.

If I'm doing a single, focused task like cooking, multiple windows are bad. Or if I'm doing a single short task, such as checking the weather, having a bunch of windows just gets in the way.

Comment: Re:We'll see. (Score 1) 278

by 7Prime (#30853126) Attached to: The Apple Tablet Interface Must Be Like This

Explain to me, then, how, if they're going to get me to buy a tablet to replace my mac, they're going to allow me to operate my recording studio running Digital Performer married with NI Kontakt, with music written in Sibelius notation software, album art created in Photoshop, all organized by project?

Yes, the iPhone OS is great for simple communcation, but when you get into the serious business of project workflow, and use many different applications communicating with each other in tandum to output one finished product, the "grab bag" organization of the iPhone does not begin to cut it. You don't even have to go to my extreme to reach the level of complexity that the iPhone can't handle it. We're all doing projects and hobbies on the laptop/desktop that require this type of cross application organization.

Top Ten Things Overheard At The ANSI C Draft Committee Meetings: (9) Dammit, little-endian systems *are* more consistent!

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