High blood sugar should be considered a symptom. High blood sugar can be caused by:
1) Having enough basal or "baseline" insulin but eating too many carbohydrates. This will lead to a high blood sugar reading but no immediate danger (this will cause long term health issues like kidney failure, blindness, etc if you run a high average blood sugar over time.)
2) Not having enough insulin which is incredibly dangerous. This will often presents with high blood sugar but not always. Your cells are not getting enough glucose. Your body responds by releasing lots of short term energy stores. The stores that become glucose still can't enter your cells since there is not enough insulin so your blood sugar will often read high. Your body also breaks fat into ketones which use a different mechanism to enter the cells and don't require insulin. Ketones can provide the energy your body needs and keep you alive for the short term, but they are acidic and will kill if the concentration gets too high (diabetic ketoacidosis -- your blood pH changes enough that it interferes with the normal chemical reactions your body requires)
So the real test for dangerous situations when experiencing high blood sugars is to test your urine for ketones.
From the FDA article, it sounds like the CGMs were incorrectly reporting low blood glucose values for extended periods of time. The closed loop pumps respond to a low blood glucose by lowering the basal rate of insulin. The is dangerous if done for too long a time. Also note that insulin response varies wildly by individual.
From the pumps I use, there is a maximum basal rate adjustment allowed before the pump alarms and kicks you out of the "insulin auto-adjust mode". This was with both medtronic and tandem pumps.
I haven't used the abbot cgm or pump. I would expect there would also be limits to how much the pump will lower your basal insulin rates before alarming. I haven't seen any specifics, but I bet the software bug is allowing a lowered basal rate for too long under continued false low glucose readings and patients going into DKA. (IMHO bad sensors should be accounted for in software and user alerted under any suspicious circumstances)
Needless to say, this is a horrible situation and my heart goes out to everyone impacted.
The unfortunate part is gimp is intensely useful software with many amazing features...buried under such an awkward interface.
I used it today for doing a color range selection to get an estimate for parameters to use in image magick. It had the easiest dynamic visualization of the matte for the selected range as I was selecting. It did exactly what I needed, very well.
I also tested out krita and nuke. Was easier in gimp.
But gimp is still the tool of last resort as it is just so painful to use. I wish there was a more positive engagement between the graphics community and the gimp devs. It feels very combative and negative compared with tools like krita and blender.
I work in vfx, and we had a lecture from one of the art designers that worked with some formula 1 teams on the color design for cars. It was really interesting on how much work goes into making the car look "iconic" but also highlight sponsors, etc.
But for your point, back during the pal/ntsc analog days, the physical color of the cars was set so when viewed on analog broadcast, the color would be correct (very similar to film scanning).
He worked for a different team but brought in a small piece of ferrari bodywork and it was more of a day-glo red-orange than the delicious red we all think of with ferrari.
If you want a book that is more technical and really gives a sense of what the scope of the project was, I'd highly recommend The Los Alamos Primer by Serber which was the intro lecture given to scientists when they would arrive. Serber did a great job of annotating the lecture to explain in more accessible detail each section. A quick read, and well worth it.
I remember seeing a very similar system at wright-patterson afb in ohio that was used for a flight simulator. The model was mounted vertically on a wall and at a much smaller scale. This was in the early 80's and it was no longer in use. But the model detail was incredible. They had the camera hooked up to a monitor and seeing the camera "fly" through the scene at an appropriately scaled speed was amazing -- even on a tv screen. You could see the camera moving over the model...but on the monitor the view looked real.
I really love Guy Ritchie's tip of the hat in The Gentlemen from Hugh Grant's character where when talking about watching a conversation through a telephoto lens he says, "But I filmed it, had it lip-read, translated, and transcribed. Rather like the classic 1974 film The Conversation starring Gene Hackman and John Cazale. You know, Coppola slipped that one out between the Godfathers. It wasn't really for me. It's a bit boring to be honest...."
I don't know why but that makes me laugh every time. (And I agree w/ The Conversation being underrated)
I have a love/hate relationship as well, mostly because I grew up within bicycling distance and spent way too much time at the museum.
The XB-70 used to be parked outside right in front of the main entrance. The cool thing is they also have the X-3, which seems like the same design family so you can see the test article then the attempt at a usable aircraft.
It was also the location of one of the most bonkers thing I've ever seen which was when they relocated an SR-71 to the museum and landed it on this very short old runway at the site. That thing was so big and so fast and that runway even at the time seemed so short. Here's a vid. I saw it from the road off the end of the threshold and it looked like it was going to hit the fence on the landing pass.
As a funny aside, I had applied to lucas arts around 1996 and never heard back from them. I ended up getting a job at industrial light and magic (as they were both companies under lucas digital) thinking I could then transfer over to lucas arts.
But we would visit for the company store, and I would be nosy and go talk to people. This was during production of grim fandango and there was a tangible ramp up of stress in that building as the release approached. I remember one of the testers sitting there staring at the manny character on his screen and bemoaning, "I used to love playing games".
And the voice acting was amazing. Especially for a game.
I think I have rose colored glasses as I remember the game being difficult in the sense of lots of walking around trying to find the solution to the last couple of puzzles. Having played the remaster, it was clear how clunky the controls were. But wow, I still love that game.
Ack --> I misread your article and thought your child was 14 years old, not 4. I don't believe kids that young qualify for any of the auto-adjusting toolkits. The medtronic has a minimum age of 14 (I think). In any case, the best advice I can give is to get your child on something like medtronic's pump + cgm + smartguard as soon as you can. Ideally the minimum age limits will drop and the quality of the treatment will keep improving.
I left the no-longer-relevant-to-you comment below in case it would be interesting to others.
This is a different suggestion than you were talking about in your article, but:
If possible, I would highly suggest trying out the medtronic minimed 780g with guardian 4 or simplera using the "smartguard" feature. This is the first out of the box solution I've ever tried that almost (but not quite) felt like magic in terms of achieving good control that was mostly automated.
This setup provides 3 things not yet available in the dexcom associated systems:
1) auto adjusts your basal rate (via a weighted average or 6ish days)
2) aggressively adjusts basal rate to avoid lows
3) aggressively micro boluses to help prevent highs.
I have recently switched from a tandem x2 with dexcom g6 and g7 and used with xdrip+ android phone app (similar or same as the nightscout you mention, depending on where you get it.)
The dexcom cgm with the tandem auto correct would typically take (for me) 6 hours to correct a high from something like too low meal bolus. The medtronic usually takes less than 2 hours and doesn't peak nearly as high.
More importantly, the hypoglycemia prevention is a complete game changer. I have not had a severe low blood sugar since switching -- and this means avoiding the hypoglycemia followed by 24-48 hours of higher insulin resistance.
The out of the box systems are getting really good, and are advancing at a quick pace now (which until recently hasn't been the case). The quality of control I have now is much better than with xdrip+ and the auto controls available in the tandem x2.
I used to eyeball my android phone many times during the day to follow trends and try and catch highs or lows early. Now, I don't need to adjust basal rates. If I miss calculate the carb counting for a meal, the auto correct takes care of it. Now I only need to pay attention to longer trends relating to meals boluses and relying more on a1c values to double check that the control is really ok.
I really like the welch labs series on imaginary numbers which covers the first part of what you talk about -- leveling up the notion of what a complex number is. Though his focus was more on solving simple equations with no real roots, but really detailing how/what is really going on.
It is a great precursor to then thinking about quaternions
Second, if you aren't aware or in case others are interested, the main dev from the xdrip project released a custom watch as well: https://bluejay.website/
There are some posts on reddit from the dev. (for others -- the watch is available for purchase, and allows integration w/ xdrip).
Third --> we've come a long way in a short time. When I was diagnosed I had to collect urine samples and drop chemical tablets in them to see how much glucose was present. And now you are building an custom solution tailored to your and your son's needs...wow. I really applaud you.
Fourth --> I'm hoping the new discoveries in the synthetic signaling w/ insulin will finally give us a biological solution and the tech will no longer be necessary. Here's to hoping!
There is a lot of discussion here about IP theft. Honest question, from deepseek's point of view as a company under a different set of laws than US/Western -- was there IP theft?
A company like OpenAI can put whatever licensing they want in place. But that only matters if they can enforce it. The question is, can they enforce it against deepseek? Did deepseek do something illegal under the laws of their originating country?
I've had some limited exposure to media related licensing when releasing content in China and what is allowed is very different than what is permitted in the US.
The interesting part which points to innovation moving outside of the US is US companies are beholden to strict IP laws while many places in the world don't have such restrictions and will be able to utilize more data more easily.
Debt is a common trope in Korean shows and establishes the characters are destitute and answers why they would become contestants in this show. Then the show creator has the set up that allows them to start poking at class hierarchy.
In asking for a critique of debt in general, you are asking for a different show.
Squid Games is gets a lot of attention from the games and mass deaths of the contestants, but ultimately it is a Korean show using a different "language of film" than international audiences might be used to. Think of how silly a lot of hollywood tropes are if you stand back and look.
Try "My Mister" if you want a different take on a destitute character.
Eating carbohydrates cannot cause Diabetic Ketoacidosis.
Ketoacidosis is caused by not having enough insulin which means glucose can't exit your bloodstream and enter your cells, Your body starts breaking down fat into ketones to provide an energy pathway for your cells that doesn't require insulin. Ketones are acidic and at high enough levels will cause DKA. This can be fatal.
Eating potatoes without corresponding insulin will raise the level of glucose in your bloodstream to high levels. This is not immediately fatal. Having a high average blood glucose level over a long time span (years) will lead to lots of complications including nerve damage, kidney damage, blindness, etc. Obviously this assumes you have the appropriate basal rate of insulin which is separate from eating.
A more accurate way of making your point is that it is difficult to match insulin response times (even with modern fast acting insulin) to certain foods that are absorbed quickly, so eating potatoes may cause a time period may cause a higher post prandial glucose level. The goal of type 1 diabetic therapy is to keep your average glucose levels as close to a normal person's level as possible. So avoiding certain foods (or eating along with protein/fat/fiber) can help achieve lower average blood glucose levels.
He was so meticulous is setting up new identities and moving to random places around the country to avoid the authorities. But would then log back into his previously compromised systems in a way that would expose his current geographic location. It always seemed like such a glaring hole in his otherwise well thought out personal opsec. I'm sure the story was more complicated than what appeared in the press at the time, or in the 2600 knock-off zines that were going around at the time, or in his books. It always confused me. I could never figure out if that was an oversight, or he just wasn't aware he was being watched.
I think I share a similar pendulum swinging feelings about km as other folks here, especially as his story unfolded across many different phases of my life: from adulation as a teen, to realizing that he was just another a*hole who would lie to your face to get what they want. Recently it has swung waaay back the other way -- especially as more of our access to customer service for critical aspects of our lives get buried behind obstructionist systems -- to understanding that we always need people who can tear any system apart.
As an addendum...I think the term hacker should be handed to the sys admin that started was instrumental in getting km located by (If my foggy mind remembers correcly) by emailing logs or log stats to himself and noticing that size was shrinking so someone was deleting them -- that blew my mind at the time.
I'm not sure about power licenses, but for gliders (sailplanes, not hang-gliders), you could solo at 14 via a student license that required instructor supervision. You could get a full license at 16.
Growing up my family was into gliding (sailplanes) and I counted down the days until I was 14 so I could solo. Looking back, especially w/ a 14 yr old kid of my own...I think my parents were crazy for letting me fly, but I'm really glad they did. I have a medical condition and so couldn't reasonably fly power planes. This was before the power "sport-license" that is a good compromise between access for hobbyists and a regular license.
The comment about risks if very true. These types of activities can have real risks. It is sobering seeing a friend have a fatal accident. (With gliding it is almost always trying to make it back to an airport, getting too low and having a stall/spin close to the ground).
Can you tell me the difference between your product on the types of prescription cgm + insulin pump combos like dexcom/tandem which offer some level insulin control?
I'm just curious. I run an xDrip set up and I've played around with a couple of the "DIY" closed loop setups.
I believe you are confusing Type I diabetes and Type II diabetes.
Type I diabetes your immune system destroys your insulin producing cells. You need to provided all of your insulin via injection/pump.
Type II diabetes is more akin to insulin resistance / inability to produce the correct amount of insulin. (It is more subtle then this in reality). Type II diabetes is tied to levels of activity and food (esp high sugar) intake.
In Type I diabetes, there is usually a genetic component as well as an environment event which causes the unfortunate autoimmune response. This article is talking specifically about a significant uptick in Type I diabetes cases.