Discussion; the Diabetic

[sierra 117]

Just wondering what others feel about this part.

I'm saddened to realise that this is how I perceived the situation. (Maybe I'm too pessimistic)

But i couldnt help but think, should I even give him the insulin?

I mean I know this is really harsh ,but aren't we just delaying the inevitable?

Yes we get a dose of insulin, but after that, even if he makes it to somewhere that has more insulin, he's just living on borrowed time. And when that runs out there is nowhere that will be able to produce it.

All the while he will be consuming resources, that could help others survive longer.  Rather than keeping a dead man walking.

Therefore the final question I'd  like to ask the forum , is there anyway /anything we can find in nature to supplement insulin?

Because if not then I'm afraid as far as I'm concerned, it's pointless keeping the guy alive.

And believe me , I know how inhumane and disgusting this sounds. I've surprised myself with this one.but someone needs to /would have to ask the question.

However that's also what I love about this game it makes you really think about the inhumane decisions you would have to make in order to safeguard Humanity.( As contradictory as that sounds, we are a pretty paradoxical species)

Really interested to see what others think.

 

Edited October 28, 2019 by sierra 117

[Ice Hole]

Its similar to the Hobbs situation.  Except this time the person has a definitive chance of survival and just needs to find a sustainable source of insulin.  With Hobb's his death was imminent.  The choice to end his life or leave him to suffer was given to us.  This decision is based on emotions.   

With the diabetic decision logic cannot dictate and neither can emotion.  What needs to be considered is the morale of the group.  If a group sees a fellow survivor being chosen to be sacrificed for the "greater good" it will leave the group demoralized, they begin to think that their life can be forfeit at anytime as well.  For a group to survive all must be willing to sacrifice to save each other otherwise it turns into a desperate situation where every one is just looking out for themselves.

The point in treating everyone equal is to give everyone in the group a feeling that they will be treated well and not just "taking care of".  Consider a captain killing the weak crew members to save on rations to give another month of survival.  That type of action breaks morale and should be avoided.  Or there be talks of mutiny aboard thy ship.  

[Guest kristaok]

I would still help him to be honest, because doing so would give him and the others hope which really goes far. Also he is on the shot and not the pump which is better, meaning he can go a tad longer if and when the insulin runs out. Also I read type 1 diabetics that are newly diagnosed within so many years, they can live a few years without insulin. So if he was newly diagnosed he could have some life left in him still even when the insulin runs out, and hopefully by then things in the world would be better?  But if he wasn't newly diagnoseds or anything yea... that wouldn't be good, that would surely be one heck of a way to go.

Edited October 28, 2019 by kristaok

[sierra 117]

Dont get me wrong, I would give him the insulin. The choice would have to be his,  once he recovered, wether or not he wanted to struggle on.

I wouldn't just let him die.

That's why I ask about alternatives,  curious to know if it would be possible to keep him alive without insulin at all. In the long run.

I know it's a harsh way to think , however there area lot of things we take for granted, that without an operational infrastructure simply become unsustainable to manage.

And I'm not just being harsh to diabetics. In a situation like The Long Dark, where everything has ground to a halt, without manufactured medicine, people would die in huge numbers even from things as simple as the common cold

 

[MarrowStone]

No no, this is a good question! Morally grey things like these are what the world of The Long Dark bring to "Light". 

@Ice Hole did a terrific job enlightening me on why logical decisions aren't always good for the long run. We can min/max and use every resource to its fullest in survival mode, but in Wintermute everyone's actually human and this does not simply work anymore. 

From a character perspective, no one knows the true scope of this quiet apocalypse. Maybe if this individual makes it to the mainland there's a chance. Is it just the island? Why didn't all planes fall out of the sky at the same time then? Astrid seems to have crashed days before the airliner did, doesnt that seem odd if it was a global event?

Type 1 diabetes is hereditary, healthy individuals develop it simply from their genetics, so it's not the survivor's fault they have it either. 

Insulin was first used to treat diabetes in 1922, and for a while it was purified from animal pancreas. Now it can be made from vats of genetically modified bacteria. I don't know it how was harvested from pigs and purified but considering it was a hundered years ago there's a good chance it could be made without electronics. As long as someone with the knowledge survives....

[Muestereate]

Diet and excercise. If DiMitri stick s to airline vegetarian meals and walking 12 hours per day the wolves will get him first. Fish and dear should be good and Astrid may be able to  grind up some wolf Pancreas and make some homemade insulin.

Dimitri won't be able to eat by scavenging, All those candy bar and energy bars, canned fruits and beans will have to be traded to other for meat. No moldy crackers for you dude.

[DarkTreader]

This actually brings up a decent point - where are the remaining livestock? With this being a very rural area, cut off from the rest of the world and forced to be self-sufficient, I would've expected people to have chickens, pigs, etc..., which would be supported by the hay operation being run out of the PV Farmstead - you don't need hay if you don't have livestock.

Then again, most all of the bales have been left in the fields, which makes me think that either the demand was very low, or that anyone who should've been working the farm has already left...

[Muestereate]

They must have gone vegetarian long ago but why the hay bales and not even chickens, a lot of vegans eat eggs>

I wasn't being hard on Dimitri, rationing my insulin is something I do every month because of the state of US healthcare. Living off the land without a car would probably be the healthiest thing I coud do.... Cept for wolves.

[PlayerPawn]

19 hours ago, sierra 117 said:

Just wondering what others feel about this part.

I'm saddened to realise that this is how I perceived the situation. (Maybe I'm too pessimistic)

But i couldnt help but think, should I even give him the insulin?

I mean I know this is really harsh ,but aren't we just delaying the inevitable?

Yes we get a dose of insulin, but after that, even if he makes it to somewhere that has more insulin, he's just living on borrowed time. And when that runs out there is nowhere that will be able to produce it.

All the while he will be consuming resources, that could help others survive longer.  Rather than keeping a dead man walking.

Therefore the final question I'd  like to ask the forum , is there anyway /anything we can find in nature to supplement insulin?

Because if not then I'm afraid as far as I'm concerned, it's pointless keeping the guy alive.

And believe me , I know how inhumane and disgusting this sounds. I've surprised myself with this one.but someone needs to /would have to ask the question.

However that's also what I love about this game it makes you really think about the inhumane decisions you would have to make in order to safeguard Humanity.( As contradictory as that sounds, we are a pretty paradoxical species)

Really interested to see what others think.

 

The thing is, I don't know that they understand what is happening.  To them, it might have just been a nasty storm that took them down or maybe a malfunction of the plane itself, but they don't know it's the apocalypse, at least I don't believe they do.  Will and Astrid seem to be in the same boat on this.  While the people in Great Bear might have a different understanding of things, given the nature of the region depicted in the game, mainlanders like Astrid, Will, and likely all the crash survivors are probably unaware of what's really happening.  Given that context, they probably act more in line of "things will get better" rather than "this is the end".

[ThePancakeLady]

Not even going here. 

Okay, fine, I am going here.

I have had Type 1 brittle Diabetes for 48 years. They way the situation is in Wintermute is not true-to-life-realistic. But it is "realistic" enough to make for a compelling story, and some choices for the player to make. Because of my long list of other medical conditions, yes. I would likely die before Astrid ever found the community Hall. But Dimitri does not have any other known medical conditions, according to the story.

Go right away to get the insulin, and try to help Dimitri (who could survive for a few days without insulin, if his diabetes was well controlled prior to the crash, but he would be suffering, greatly), or let him lay there and suffer for days and days, getting sicker and sicker, closer to death and closer to the point of no return?

Astrid, as a physician, would have been trained in this, and would know more than the average layperson would, about the risks, the progression of hyperglycemia, and what Dimitri would be going through. Father Tom would not really have a clue how serious it is, other than knowing it was "bad". Astrid would want to go find the insulin ASAP,. She would follow the Hippocratic Oath she took as a physician (if you see her as a person who takes that oath seriously, which I do, or she would not have felt the need to contact her ex, to deliver whatever is in that case to the people in perseverance Mills... who are sick, as well). Your choice(s)- do you make the choice(s) that she would make, as  one dedicated to saving lives, or would you make the choice to play her as a doctor who forsakes the oath she took?

We don't know that there is no way back to the Mainland, or that the production and supply of insulin is cut off in the rest of the world. Astrid and Will both seem to think there is something to go back to, to keep on trying to live for. The rest of the world may not be going through the same thing Great Bear Island is. A physician takes an oath to help and to "First, f do no harm". Leaving Dimitri there to suffer while she chases down local legends would be doing harm, because she was neglecting the known patient who needed help the most. Giving him the first dose of insulin and returning it to him gives him a chance to survive, and be saved. 

And no... there is no natural replacement for insulin, no plant or natural supplement that will keep a Type 1 Diabetic alive, Type 2, perhaps, diet and exercize can help control the disease, because in Type 2 Diabetes, the pancreas is still producing some insulin. Just not enough, or the body cannot use it efficiently, so insulin or medications that improve the body's ability to use what insulin it has can make help to control the disease, and give a good quality of life. Type 1- the body produces no insulin. None. Which is why those of us who have it need insulin injections, for the rest of our lives. Pancreatic transplants are being tried, with limited success. Transplants of just the Islets of Langerhans (the clusters of cells in the pancreas that are responsible for insulin production and release) are being tested, with limited success. Someday these may be a viable option to cure Type 1, right now they are still experimental. 

But... insulin has been around for some time now, and has evolved and been improved significantly. If there are cattle and hogs left in the world, the ability to produce beef and pork insulin would still be there, to a degree, and would be the most likely option pursued after an apocalyptic situation like this. Diabetes knows no boundaries anyone can develop the disease if they have the "right" genetic and physical make-up, Even if every living person who had the disease died in the apocalypse, more would be born with it as humanity recovers, and begins trying to repopulate. Insulin was developed in 1921, and put into use treating humans with Type 1 Diabetes in early 1922. So it can be produced in much more "primitive" societies, using the old ways it was produced with in the 20's. It would not be as effective as what we have now, but it would give every person with Type 1 Diabetes a chance to live, and possibly even to thrive. And yes, there are many, many Type 1 Diabetics, particularly here in the US, and in third world countries where insulin is in short supply, who ration their insulin, due to cost or unavailability. It happens daily, all over the world. It just doesn't make the news like cancer, or ebola, or black plague outbreaks do. Those who have o to ration insulin live, they are not generally healthy, or "thriving", but they are alive, hoping things will get better, and trying to be as productive as they can be, while they wait for Big Pharma to stop trying to make a fortune off of life-sustaining medications like insulin (among others, I might add, like cancer medications, heart and breathing medications).

 

So yeah, I played Asrid's choices as I feel she would have, as a physician, and as a person who wants to help people get well, survive, and thrive, if she can, and who believes that the world is not completely dead, away from Great Bear. I feel she and Will, and the other survivors believe there is hope that they can get back to the Mainland, and be saved.

 

What choices did you make? Would you make different ones after reading this?

[ThePancakeLady]

15 hours ago, MarrowStone said:

Type 1 diabetes is hereditary, healthy individuals develop it simply from their genetics, so it's not the survivor's fault they have it either. 

And quickly... this is not entirely true. It was believed to be hereditary, and it may have some validity being seem as such. More recent research has revealed tat Type 1 diabetes is an autoimmune disorder. Possibly passed down, possibly not. No one else in my family has ever been diagnosed with Diabetes, Type 1 or Type 2. Just me. About 6 months after I had a serious Influenza infection as a child. That actual Flu (not a stomach bug, but the actual Flu) may have triggered my immune system to over respond, and attack my pancreas, damaging and destroying the Islets of Langerhans. 

So, it may be *sometimes* hereditary, in that autoimmune diseases can be hereditary, but it does not always occur in multiple generations of a family. But agreed, it is not the fault of the patient, in any way shape or form. 

[sierra 117]

36 minutes ago, ThePancakeLady said:

What choices did you make? Would you make different ones after reading this?

 

16 hours ago, sierra 117 said:

The choice would have to be his,  once he recovered, wether or not he wanted to struggle on.

I wouldn't just let him die

Like I said in second post, i would help him.

39 minutes ago, ThePancakeLady said:

So it can be produced in much more "primitive" societies, using the old ways it was produced with in the 20's. It would not be as effective as what we have now, but it would give every person with Type 1 Diabetes a chance to live,

Well that's hopeful. Maybe there would be a chance for him to fight on then.

33 minutes ago, ThePancakeLady said:

But agreed, it is not the fault of the patient, in any way shape or form.

I never implied it was his fault, I'm not looking down on someone for having a medical condition.

 I also have a medical condition which, left without medication in a survival situation like this , then I would be more of a detriment to any group than a help. Therefore I would not want anyone potentially risking there own survival to help me.

[McThulu]

22 hours ago, sierra 117 said:

Rather than keeping a dead man walking.

That's the basic principle of life, right? I mean we're all dead man. There is no such thing like eternal life. Even your sandbox character is dying sometime. That's for sure! The only difference with Dimitri is that his remaining time seems to be known. Let him die only because of that feels wrong. We are all "wasting" rescources in order to "delaying the inevitable". We all eat food and drink water even though it's absolutly sure we die. And we should continue with that

[ThePancakeLady]

@sierra 117- my response was to a general audience, not to you in particular. 

My only direct response was to MarrowStone, about Type 1 Diabetes being hereditary. 

1 hour ago, sierra 117 said:

I never implied it was his fault, I'm not looking down on someone for having a medical condition.

And I never said you did. Neither did MarrowStone, from the way I read their post.

1 hour ago, sierra 117 said:

I also have a medical condition which, left without medication in a survival situation like this , then I would be more of a detriment to any group than a help. Therefore I would not want anyone potentially risking there own survival to help me.

That's your choice. I have said something similar many times. But, I have also been in a situation where I was stuck underground in a cave for 2 days, when we had a cave in. I was lucky to have my insulin and other medical supplies. I did not have to make that choice. And to be honest, if that moment comes, the will to live and desire to stick around may very well overpower my feelings of not wanting to be a burden to anyone else. Because death by hyperglycemia and DKA for a Type 1 Diabetic is not quick. It's slow, painful, days of puking and other messy digestive disorders, pain, and waiting for the Cheyne–Stokes and/or Kussmaul breathing to kick in, and slowly smother me as I gasp for breath. I may very well beg for anyone and everyone to make it stop, or to make it better, and let me live. Won't know for sure unless or until I am in that situation.

 And yes, Dimitri would have a chance, as long as he can get back to civilization, and find more insulin. How good of a chance? Depends on what the Mainland is like when he got there. People will loot pharmacies if TSHTF, but most of those looters are going for narcs, not insulin. How much insulin is there to be found? Depends on where you are, and how many Diabetics are out looking for it. 1 vial won't hold out forever, you can only ration so much, It will eventually run out if there is no more to be found. Syringes will be another issue as well. But there would still be a chance.

Edited October 29, 2019 by ThePancakeLady
typo correction and added information

[ajb1978]

Most of the good points have been made already, but I have one more to contribute: Type 1 diabetics can and have been able to survive without insulin by eating a diet primarily of fats and protein.  Prior to the discovery of insulin as a treatment for hyperglycemia in diabetics, this is how the disease was controlled.  Now obviously it's not ideal, as patients did need to essentially push themselves to the brink of starvation in order to survive.  But they did survive.  So likewise Dimitri could survive by eating basically standard Interloper fare until they were able to raid a pharmacy or find someone with the knowledge of how to extract insulin from an animal pancreas.

[RaukGorth]

2 hours ago, ajb1978 said:

Most of the good points have been made already, but I have one more to contribute: Type 1 diabetics can and have been able to survive without insulin by eating a diet primarily of fats and protein.  Prior to the discovery of insulin as a treatment for hyperglycemia in diabetics, this is how the disease was controlled.  Now obviously it's not ideal, as patients did need to essentially push themselves to the brink of starvation in order to survive.  But they did survive.  So likewise Dimitri could survive by eating basically standard Interloper fare until they were able to raid a pharmacy or find someone with the knowledge of how to extract insulin from an animal pancreas.

This is what I wanted to add to the discussion.

Type one is not a death sentence. It also depends on how much your insulin production is compromised. In the situation of the plane crash survivor in the quiet apocalypse we would need to restore his insulin sensitivity and switch to protein/fat based diet. Which would come naturally in a world with never-ending winter.

So in terms of the moral problem raised here it much much less severe - you are not prolonging his death sentence. He needed the insulin here and now. After he survives the few initial days and all processed carbohydrates are eaten, he would be able to survive. 

Edited October 29, 2019 by RaukGorth

[devamadhu]

On 10/28/2019 at 10:26 AM, MarrowStone said:

No no, this is a good question! Morally grey things like these are what the world of The Long Dark bring to "Light". 

@Ice Hole did a terrific job enlightening me on why logical decisions aren't always good for the long run. We can min/max and use every resource to its fullest in survival mode, but in Wintermute everyone's actually human and this does not simply work anymore. 

From a character perspective, no one knows the true scope of this quiet apocalypse. Maybe if this individual makes it to the mainland there's a chance. Is it just the island? Why didn't all planes fall out of the sky at the same time then? Astrid seems to have crashed days before the airliner did, doesnt that seem odd if it was a global event?

Type 1 diabetes is hereditary, healthy individuals develop it simply from their genetics, so it's not the survivor's fault they have it either. 

Insulin was first used to treat diabetes in 1922, and for a while it was purified from animal pancreas. Now it can be made from vats of genetically modified bacteria. I don't know it how was harvested from pigs and purified but considering it was a hundered years ago there's a good chance it could be made without electronics. As long as someone with the knowledge survives....

This got me googling the early insulin extraction process, and I found this: https://hackaday.com/2015/07/30/the-biohacking-movement-and-open-source-insulin/

Super interesting! I'm sure with the bajillion deer we're able to kill in the game, the cold temperatures for pancreas preservation, and Astrid's lab skills, she could figure out DIY insulin for the survivors.  

[ThePancakeLady]

Did you know the gentlemen who invented (or created) insulin for human use back in 1921, sold the patents for it for $1 each, so everyone could have access to it?

And they were Canadian.

I love Canada. I kinda owe my life to them, and their country.

'Nuff said.

And yeah, I love biohackers, too. If they succeed, Americans with IDDM, and people all over the world with the disease, could someday have affordable sources for our life-sustaining medicine, instead of being milked for profits by Big American Pharma. (Yes, I am passionate about it... and I donate to this project. )

https://openinsulin.org/

 

(a And yeah, not sure if deer would be a source for insulin for us, but if water buffalo can be, who knows.)((Great link @devamadhu! Thanks for sharing it. Love Hackaday, great site.))

[sierra 117]

4 hours ago, ThePancakeLady said:

Did you know the gentlemen who invented (or created) insulin for human use back in 1921, sold the patents for it for $1 each, so everyone could have access to it?

And they were Canadian.

Wow Canadians are just too damn nice. 

This is why they don't need a nuclear deterrent program. Because if anyone messed with Canada, half the world would jump to thier aid immediately.lol

I love hearing about things like this, cheap or free patents/open source networks etc. Kinda restores a bit faith in humanity. Makes you realise not everyone is out for themselves.

[BESt]

7 hours ago, ThePancakeLady said:

Did you know the gentlemen who invented (or created) insulin for human use back in 1921, sold the patents for it for $1 each, so everyone could have access to it?

And they were Canadian.

I love Canada. I kinda owe my life to them, and their country.

'Nuff said.

And yeah, I love biohackers, too. If they succeed, Americans with IDDM, and people all over the world with the disease, could someday have affordable sources for our life-sustaining medicine, instead of being milked for profits by Big American Pharma. (Yes, I am passionate about it... and I donate to this project. )

https://openinsulin.org/

 

(a And yeah, not sure if deer would be a source for insulin for us, but if water buffalo can be, who knows.)((Great link @devamadhu! Thanks for sharing it. Love Hackaday, great site.))

The part about the discovery of the insuline is controversial. You can find out more in the link below.

https://www.diabetes.co.uk/pioneers/nicolae-paulescu.html

His discovery was neglected by the scientific world during that period, mainly because of the lack of money and resources to publish and continue his research, now being neglected by scientific community.

Edited October 30, 2019 by BESt
Adding more information

[devamadhu]

9 hours ago, ThePancakeLady said:

(a And yeah, not sure if deer would be a source for insulin for us, but if water buffalo can be, who knows.)((Great link @devamadhu! Thanks for sharing it. Love Hackaday, great site.))

There's always the Moose! Or maybe the Bear? The whole $1 patent thing is awesome - I love when scientific discoveries are shared like that, for the benefit of everyone.  

[ThePancakeLady]

Just now, devamadhu said:

There's always the Moose! Or maybe the Bear? The whole $1 patent thing is awesome - I love when scientific discoveries are shared like that, for the benefit of everyone.  

Yeah. It isn't perhaps 100% IRL realistic, but it is 100% plausible.  And if we are killing wildlife to eat and stay alive, on the Island, at least, harvesting the animals' pancreases to extract the insulin, just like in Victor & Eva's true life story, would be a possible solution, until production on a grander scale is possible. Especially if you play the game with the belief that return to the Mainland and "civilization" is possible someday, somehow. Though I also get the feeling that the residents on Great Bear would do all they could to remain independent, and self-sufficient.

[ThePancakeLady]

5 hours ago, BESt said:

The part about the discovery of the insuline is controversial. You can find out more in the link below.

https://www.diabetes.co.uk/pioneers/nicolae-paulescu.html

His discovery was neglected by the scientific world during that period, mainly because of the lack of money and resources to publish and continue his research, now being neglected by scientific community.

Edited 5 hours ago by BESt
Adding more information

I never said anything about the Nobel Prize, btw. I posted about the discovery and creation of insulin the at was proven to work on humans, for the treatment of diabetic hyperglycemia. And the Canadians were the firs to do this, and patent it.

Your article points out that Nicolae Paulescu may have discovered how to extract insulin, but his tests were on dogs, and only proved that his discovery was effective on canids, no mention of humans other than theory speculation. Would he have been first with proving effectiveness on humans if he had not stopped his research  because he went to the military, due to the Big War? No one will ever know. We can only speculate. I do feel that the Nobel should have been shared, perhaps, but the Canadians are the ones I thank because they were able to make insulin that worked on humans, and basically gave the patents away for  almost nothing in terms of money. They could have been greedy, and held the patent themselves, to try to profit hugely from it, or they could have demanded a much, much higher price for the patent. They did not.  Only Big Pharma in countries with no socialized prescription medication coverage for all citizens seeks to make huge profits off of medications people need to actually stay alive.

[Guest jeffpeng]

On 10/28/2019 at 6:26 PM, MarrowStone said:

From a character perspective, no one knows the true scope of this quiet apocalypse.

Which is probably the best argument made that there isn't really a feasible reason to just start letting people go because they would possibly pose a strain on the group. As far as we know this all is a temporary glitch, winter will end and the Aurora situation will resolve soon.

But....

There's also another element to the OP, which is basically ethics. The point is: once I am willing to let a person go not for the person's sake, but for the sake of the group, where do I draw the line who is let go, and who is not? Maybe letting a Type1 diabetic with a small chance of survival go seems like the "hard but right" choice to make in a situation where food and medical supplies are short, and survival of the entire group is in danger due to that fact - but it isn't.

Here we go down the rabbit hole: Isn't the same also true for the woman that suffers from frostbite, is prone to infection or possibly even necrosis? Do I expend my already scarce stack of antibiotics on her? Or do I save them for the guy that suffers from pneumonia? Do I even treat the guy that suffers from pneumonia? I mean he's also relatively far gone, and I have 7 other people, that have better chances. Well except that old guy ...... and so on and so forth.

This is different from Triage. When doing Triage you help those you can help, and not those you cannot help, prioritising the ones you can save and need the help the most. That's already an ethical dilemma, but it's just one question: is saving this patient plausible - or not. Not: is saving this patient despite being plausible worth the effort, and doesn't one more mouth to feed reduce the chances of the entire group.

Once we start valueing human life based on fitness for survival - or really any other factor than being human life - we've lost our humanity. And while situations exist in which such a choice must be made, such situations have to present themselves with imminence, not in hypothetical projections. Meaning: when I can only pull 3 of 5 people out of a fire I have to make that choice, and I probably will try to pull those out with the best chances of survival. But if I can pull all 5 people out I don't leave 2 people in there all the same just because the ambulance would get crowded.

 

[MarrowStone]

@jeffpeng, yeah, I totally agree. When you take one person out of the picture due to complications, it means everybody is up for debate if something were to happen to them. It degrades hope.