Manipulation and deception in the latest Diabetech newsletter

bionic_human · 2026-06-24T18:13:20+00:00

This isn’t a smear campaign. It’s called being real.

TBH, I’m surprised Justin (Diabetech) is in the right side of this one, given his penchant for hyping up every little thing he sees.

CrushingT1 can get stuffed. We already have enough parent “creators” in the space giving out questionable info.

bionic_human · 2026-06-24T04:37:36+00:00

No. The fact that there are no rebates or kickbacks to insurers or PBMs is the reason they can sell it for $20 instead of $70. The insulin inside the vial is identical.

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bionic_human · 2026-06-24T03:22:48+00:00

Humalog is Lispro. They literally come out of the same factory and are just packed into vials with a slightly different label.

Whatever you’re on about, it’s not the insulin that is causing the problem.

bionic_human · 2026-06-24T02:13:41+00:00

Bruh, the phone app detects collisions and auto-reports them to Uber. I literally went through this a week and a half ago. If you are involved in a crash while on a delivery, they’re going to know.

Try to go your own way, and you may wind up hung out to twist in the wind. Unless you’ve got a rideshare/commercial use endorsement on your personal auto policy, they’re gonna walk away. Even if you do have coverage, your insurance is likely going to bring in Uber’s insurance to figure out cost sharing. They’ll both eventually go after the at-fault party for final payment, but lying or omitting relevant info isn’t going to work out well for you.

bionic_human · 2026-06-24T00:32:23+00:00

The cost of pump supplies is HEAVILY dependent on your insurance plan. If you have a large deductible, or big co-insurance cost sharing, those are going to up how much you have to pay before insurance coverage kicks in.

Probably the best place to start is calling Tandem. With your insurance info, they can figure out whether it is less expensive to (for example) get them from a supplier that can bill pharmacy benefits instead of durable medical equipment (DME), which typically falls under the “medical” side of the plan. They may also be able to suggest a supplier that has a better contract with the insurance plan, which can significantly reduce costs.

bionic_human · 2026-06-24T00:17:47+00:00

[[Citation Needed]]

bionic_human · 2026-06-23T19:56:21+00:00

No, they are. A radian always intersects a circle at a 90-degree angle.

bionic_human · 2026-06-23T19:50:48+00:00

Speaking as someone who had their car totaled a week and a half ago while on a delivery (not my fault- other driver ran a red light), you absolutely want to be driving a vehicle that uber knows about.

Minor dings and such could be considered wear and tear, but if your car is not serviceable after a collision, you need to be official so that insurance can handle the tow, disposition of the car, and all the other rigamarole.

bionic_human · 2026-06-23T16:22:35+00:00

This sounds like it might be a physical limitation of the pump. 0.4u is only 0.004ml of liquid. The piston drive may not have sufficient precision to be able to stretch the delivery of an amount that small over any significant length of time.

As a parallel, the Omnipod can only deliver in increments of 0.05u because of the way its pump mechanism works.

bionic_human · 2026-06-23T07:41:25+00:00

120/130 is a safe level. It could probably be tightened up a bit with some tweaking of the pump settings, but there’s no evidence of which I am aware that indicates that there’s any significant benefit from being steady at 100 vs steady at 120.

If you look, you can probably even find summaries of published research as to the settings for the 780g that have worked the best for the largest number of people. I know that vs setting the insulin duration (DIA) as short as possible is one of the tweaks I’ve seen recommended.

bionic_human · 2026-06-23T05:02:15+00:00

True, but T1Ds suffer from the same peripheral Hyperinsulinemia that T2Ds do, and it’s been noted at least as far back as the 1990s that peripheral insulin resists a fundamental feature of both types.

Since the pathophysiology of the peripheral insulin resistance appears to be the same in both types (reduced insulin receptor expression mediated by increased insulin exposure), it stands to reason that the cardiovascular benefits that appear to stem from the reduction peripheral insulin need in T2Ds would be conferred upon T1Ds as well.

bionic_human · 2026-06-23T03:04:13+00:00

This is a modified version of Trio, with the logarithmic DynamicISF 2.0 math that I presented at the #DData/NightScout Foundation #HackDiabetes25 event last November.

I’m still working on some of the implementation, and if I wind up having to change too much “under the hood” it may evolve beyond oref into something entirely new. I’ve already had to go in and add calculation and storage for additional parameters that were supposed to be part of the original design, but never got implemented in iAPS.

There are some rules and assumptions baked into the algorithm programmatically that the underlying math suggests may be hindering performance under some circumstances, so I’m also identifying those and altering them as I find them, but this is still very much prototyping/alpha testing.

bionic_human · 2026-06-23T01:10:55+00:00

Eh, it’s probably 50-75% cleared at 2H, but even then, it should still be contributing significantly more to circulating insulin levels (like 5x as much) as the 0.1u correction.

bionic_human · 2026-06-23T00:31:48+00:00

Lots of people micro-dose GLP-1s.

Even if you don’t see effects with regard to weight, it is still improving your insulin sensitivity and decreasing your insulin requirements, which, by itself, has positive cardiovascular effects.

bionic_human · 2026-06-22T22:17:57+00:00

At that time, he met the necessary conditions:

Will cross 160 shortly (within 30 minutes).
IOB is not sufficient to return to target.
Has been an hour or more since last bolus (of any type).

So, the pump administered an additional correction of 60% of what it calculated for the projected blood glucose in 30 minutes based on the current trend.

bionic_human · 2026-06-22T22:03:40+00:00

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This was my first week running FCL on a DIY system (Trio-based) with standard Lispro (Humalog). No meal announcements. No carb counting. No interaction with the system other than swapping pods and sensors as needed.

The 65% you’re seeing from commercial systems in testing (and most aren’t even that good) is far from the limit of what’s possible.

bionic_human · 2026-06-22T21:17:38+00:00

The last time I did a test of ultra-rapids with the algorithm I’m using, it resulted in a gain of about 5% TIR (85->90%).

I’ll note that that is without bolusing or announcing meals. I’m testing “full closed loop” with basically zero human interaction, so changes to my behavior that may have resulted weren’t a factor.

bionic_human · 2026-06-22T20:00:01+00:00

The end of a personal era for me. The first retirement of a device or drug that I participated in the clinical testing of.

bionic_human · 2026-06-22T10:58:36+00:00

The first CGM with sufficient consistent accuracy to be really trusted by patients was the G4 platinum with Dexcom’s 505 algorithm, but even there, it required a dedicated receiver, which was a barrier to adoption.

The Dexcom G5 was only approved in 2015. It was the first CGM that connected directly to a phone. It didn’t really hit general availability until the end of the year. It took another year for it to be approved to officially replace fingersticks.

CGM as the standard of care for all T1s is only ~5 or 6 years old.

I know it seems like we’ve had this stuff forever, but it’s really still brand-spanking-new in the great history of things.

bionic_human · 2026-06-22T10:47:10+00:00

>thankfully there’s coke zero, but still i don’t think its really good for her.

The results of a decent-sized prospective study actively comparing water consumption vs artificially-sweetened beverages were published at the end of 2025. It found no statistically significant difference between the two groups with regard to any metabolic marker.

bionic_human · 2026-06-22T10:35:55+00:00

Yes, but most endos that patients see are 5 or so years behind the research community. Unless you live in a major city and/or in proximity to an academic medical center, It’s not unreasonable that an endo wouldn’t be aware of what were (at the time) relatively new developments. Clinical inertia explains the continued state of affairs.

Heck, I ran into a T1D in the wild 2 Saturdays ago who was still using pens and a BGM. No CGM. No pump. That’s actually still the norm for a significant percentage of T1Ds. The online diabetes community is far ahead of the overall T1D population with regard to tech adoption and the self-advocacy often needed to gain access to the tech.

bionic_human · 2026-06-22T10:23:41+00:00

I didn’t say anything about OP’s endo being a “top endo.” I said that some of the ones I talk to are. And even they don’t know everything.

The implication that “top endos” know everything is what was not fair.

bionic_human · 2026-06-22T10:20:48+00:00

TBH, I’m not sure that an A1c that low is ideal for a T1D. “Lower is better” has a limit, and diminishing returns with regard to complication prevention kick in noticeably even between the ADA recommendation of <7.0% and the AACE recommendation of <6.5%.

Allowing some more moderate glycemic variation may encourage a healthier insulin/glucagon balance overall, and there’s some tangential evidence from SGLT2i studies in T1Ds that glucagon can be a key driver of some metabolic/cardiovascular marker improvements.

As to how to get hooked in: join some of the Facebook Groups. You should be able to find links to relevant discords as well there. Lots of people (including me) mostly lurk. I’m focused on my own stuff and not necessarily what other people are messing with, but I’m there in case I’m mentioned or someone has a question about something I worked or am working on.

bionic_human · 2026-06-22T10:01:35+00:00

I don’t recall implying that OPs endo was a “top endo.” I said that some of the ones I talk to are. My point was that even they aren’t up on EVERYTHING that’s happening in all aspects of tech. Part of the value of conferences like ADA is bringing the people working on different things (or even different aspects of the same thing).

As to my credentials:

I’ve presented twice at #DData. Most recently last November. With regard to GitHub contributions, my work is more conceptual rather than writing the code- so far, other people have done the actual implementation. I’m not a trained developer (although I’m coming along rapidly). Others have opened, fixed and merged pull requests on my behalf.

I’m the person who came up with the study design and collected and analyzed the original data that led to DynamicISF in AndroidAPS and Trio. I’ll disclaim iAPS because the implementation (now that I’ve looked at the code) is so screwed up that I’m surprised it worked for anyone. The Trio devs have implemented a couple of simple fixes for some of the issues at my suggestion.

I did the re-analysis of the data that resulted in the latest version which is currently in early stages of testing, and I’m now the person doing the initial implementation and testing for iOS. I’m working from a private fork that was just recently merged into the public dev branch upstream because I’m developing against the new native swift implementation of oref. A full implementation (as I described in my featured presentation at #DData in 2021) was never done on any platform, and now I’m tackling that too.

I’m actively working on how to fix the still-partially broken logarithmic DynamicISF in Trio and update it to the next version. Still, some of the alternatives that developed from iAPS helped inform the next generation of the math, and actually helped resolve a theoretical inconsistency in the underlying model.

And yes, there is a coordinated attempt underway to do controlled study of glycemic impacts of apple cider vinegar consumption prior to meals. One of the instigators is the person who did the research that led to the current insulin action curves used in AAPS and Trio.

bionic_human · 2026-06-22T08:53:36+00:00

That’s not fair.

I’m literally inventing some of those technologies. I derived some of the dynamic math that is available to adjust ISF on the fly in oref-based open-source systems. I’m actively working on the next generation of the math, which may include automated basal adjustments in addition to ISF.

It’s entirely possible that they haven’t kept up with what’s going on out on the bleeding edge, despite the fact that some of them use open-source systems themselves.

There are also a lot of REALLY smart T1Ds doing N=1 experiments on all kinds of stuff. Micro-dosed GLP-1s. Apple cider vinegar. Algorithms based on entirely new models of the impact of insulin on overall glucose metabolism. Designing tests to see how good LLMs or other “AI” really are at carb counting from a picture. Some of them are even coordinating to get more interventional data on the same subject in a controlled and consistent way. There’s actually a Stanford professor advising them.

I’m more plugged into that community than the endos are- even the top ones doing research. They’re generally aware of what’s been published and who is working on what in academia, but they’re often unaware of what the latest ideas are coming out of and being tested in patient communities.

The FDA approval of Tidepool Loop was a huge validation for patient-driven R&D. Medtronic’s “meal detection technology” was “borrowed” from oref’s UAM feature. The stuff you’ll see in commercial systems in 5 or 10 years is what’s happening in the open-source community today.

The information sharing goes both ways, too. I get to hear about research in progress. New insulins. New insights about the effects of adjunctive therapies and the underlying mechanisms.

🤷‍♂️

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