Discussion; the Diabetic

[Guest jeffpeng]

5 hours ago, MarrowStone said:

It degrades hope. 

I didn't even touch on that - which is another important aspect. There are always people that argue that morals and hope aren't required to survive. But yes, from a group mechanic standpoint killing off one member for "the greater good" makes everyone ask when it's their turn.

[MueckE]

"ThePancakeLady" already said it, the way diabetes is displayed is, regarding your question, unrealistic. As a type 1 diabetic, you always have your insulin with you - on you and never in your luggage. If you don't have insulin it will take days or even weeks before you are in that situation - i mean, it's not like the survivor of the crash is eating all the time cakes and drinks coke you can actually regulate how fast your bloodsugar rises just by chosing what to eat (your body, liver, produces sugar by itself, therefore you will need to use insulin at some point - type 1) and you also can prolong it just by physical activity. Also, it'll take a very long time before someone wouldn't be able to walk - but after getting insulin just a few minutes to be fully recovered and ready to go.

 

So in that sense, the moral question wouldn't occure here in reality. Just with the insulin you hauled from the crash, the survivor will be fine for a very long time (weeks, months). Normally he just would save the insulin and stretch it so he would have a high bloodsugar, but that's only dangerous over years, not immedeatly. That means, here it really is not dangererous and no moral question involved. With the insulin you gave him, he will survive for months (disregarding the other threats in that situation). It's something completly diffrent from Hobbs situation. Also, the "survial situation" actually is perfect for a diabetic because you are forced to eat very little, mostly without any sugar (protein - deer) and you are constantly burning high amounts of energy while surviving like a marathon sprinter. It's the opposite of sitting on the couch, watching tv and drinking coke

So, there is no moral question here and absolutly no reason to ask the question of helping him or not.

 

It's displayed like in the movie "con air". That's not how it works with diabetes. It's a very slow process and the reason why diabetics always use insulin after every meal is to keep the level of bloodsugar at a "normal" level constantly - but you don't die or even recognise it if your bloodsugar would be 3 times as high as normal.

Edited November 6, 2019 by MueckE

[ThePancakeLady]

7 hours ago, MueckE said:

i mean, it's not like the survivor of the crash is eating all the time cakes and drinks coke you can actually regulate how fast your bloodsugar rises just by chosing what to eat (your body, liver, produces sugar by itself, therefore you will need to use insulin at some point - type 1

No, Type 1 cannot control their blood glucose levels by choosing what they eat, and just take insulin sometimes. That's not how it works. Type 2 can, to some degree, depending on how well controlled or how severe their condition is. 

But someone with type  Diabetes needs insulin every day to keep blood glucose levels in control.. If Dimitri were under good control prior to the crash, as long as he was not eating anything, and he was drinking lots of fluids to wash some of the ketones from his bloodstream (produced by his body digesting fat and muscle tissue to provide energy), to prevent full blown DKA, he would still have rising blood glucose levels, and he would still need insulin asap to lower those levels to normal again. The liver does not produce glucose. It stores glucose. the pancreas produces a hormone called glucagon, which when released, triggers the liver to  release glucose into the bloodstream. In people without Diabetes, this process works normally. In people with Diabetes, Type 1 or Type 2, it does not, to varying degrees, based on the individual themselves. Diabetes affect each person that has it in a unique and different way. It is not a one-size-fits-all disease. And Type 1 is a totally different monster than Type 2 is, totally different conditions, that share some similarities, and do not share others. They are not the same thing, even if they share the word "Diabetes" in their common names.

Diabetes mellitus is the disorder. It comes in a billion different flavors, each different for each person that has it. Type 1, Type 2, Gestational Diabetes, and the more controversial classification of Type 1.5 ( a theoretical blending of Type 2 and Type 1- someone who has both, and medical professionals do not agree on whether it is actually a separate Type or not... thus the controversy.)

But the idea that Dimitri, with Type 1, would be just fine eating only veggie airline meals is false. Many veggies have carbohydrates in them... the mashed potatoes for example... carbohydrate and fiber. Even the broccoli has a small amount of carbohydrate in it, though not much. Check for a list of "Free Foods" on a current American Diabetes Association menu. Free Foods can be eaten in certain amounts, with no impact on blood glucose levels, or very minimal impact on blood glucose levels.

I'm sorry, I am passionate about this, because the misinformation about the disease is rampant , still, globally. And Diabetes education is overlooked or bypassed at an alarming rate, when people are diagnosed with the disease. Doctors tell their patients "You have Diabetes" and sometimes don;t tell the patient  if it is Type 1, Type , Gestational, or otherwise. Which is why pencil-pushers at health insurance companies have no understanding how limiting coverage for medications, blood glucose testing supplies, and diagnostic tests affect some people who actually have the disease.

 

It's a disgusting failure of the healthcare industry, worldwide, but especially in the US, a First World Country, that has the funds and means to do better. If Big Pharma profit was taken out of the equation. 

 

And yes, if my blood glucose levels are 3 times over normal, I DO notice it. I have symptoms of it, very clear to me, and clear to any who know what to look for. In my case, I am asymptomatic when it comes to hypoglycemia. I do not get the "normal" headache, dizziness, confusion- until right before I fall down and have a Grand-Mal seizure. But if my glucose goes high? I get the furry white tongue from the dehydration it brings on, I get the Juicy-Fruit gum smelling breath, just before or as soon as my body begins producing ketones. I need to pee a lot. I will be sick to my stomach, and constantly thirsty. But it is different for each person. My symptoms are different than Joe's, or Jane's, or Morty's, or Pinky's. And over time, my symptoms, complications, and presentation of the disease has changed. And likely will continue to change as i age further. it is not a static disease. It is one that simply can be controlled, well, not so well, or not at all, depending on the patient,the doctors, the education, and the drive and willingness to do whatever it takes to control it. And even then, best efforts can still fail.

 

Diabetes is not a one-size-fits-all disease, and people need to stop seeing it as such, and treating it as such. 🤬

 

</RantOver>

Edited November 7, 2019 by ThePancakeLady
typo corrections and additional rant added...

[Ice Hole]

16 hours ago, ThePancakeLady said:

It's a disgusting failure of the healthcare industry, worldwide, but especially in the US, a First World Country, that has the funds and means to do better. If Big Pharma profit was taken out of the equation. 

 

Both my parents are type II diabetic.  Never been tested yet but I used to feel the symptoms regularly in the past.  Currently Cannabis has been federally legal here in Canada and more research should be carried out on the endocannabinoids system.  This study keys into the application of cannabis and maintaining insulin levels.

 

The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults

Elizabeth A. Penner, MD, MPHa,b, Hannah Buettner, BAc, Murray A. Mittleman, MD, DrPH

Results
Of the participants in our study sample, 579 were current marijuana users and 1975 were past users. In multivariable adjusted models, current marijuana use was associated with 16% lower fasting insulin levels (95% confidence interval [CI], −26, −6) and 17% lower HOMA-IR (95% CI, −27, −6). We found significant associations between marijuana use and smaller waist circumferences. Among current users, we found no significant dose-response.
 

Conclusions
We found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, and smaller waist circumference.

[ThePancakeLady]

@Ice Hole- That's a really interesting study! Possibly good news for people with Type 2 Diabetes. No news for people like me with Type 1.  
(Whether we partake or not... it literally saved my life when I was going through chemo though... my Diabetes was greatly affected by the vomiting, lack of appetite, and lack of food intake. A little pot helped to increase my appetite, calmed the nausea, and helped me keep the food f down. Plus my pain levels dropped significantly. Better control of my Diabetes meant better response to the chemo and better healing from any radiation burns fro the rad treatments.)

Sadly, testing like this under approved and tightly controlled situations, does not happen often, if at all. Insulin resistance exists in Type 1 as well, more so in the form that I have (Brittle Type 1), but the risks that patients would face would be more severe. But it's damned nice to see some more studies being done, for any form of Diabetes, to help people who have the disease get better control. Though, until it's legal at the Federal level, instead of at the State level, insurance here in the US will never consider paying for any form of cannabinoid treatments, and doctors will never be willing to risk legal implications of recommending it to patients, while it is not actually legal here. 

 

Total aside... do you know how many forms of Diabetes there are? It's a bit astounding to some people to learn that there are so many different forms...

Best website I can link to that gives "easier to understand" information (for laypeople, not just scientists and doctors) is here:

https://beyondtype1.org/other-forms-of-diabetes/

[Jimmy]

Kudos to @ThePancakeLady for giving a good summary of the truth of Type I Diabetes. Many people are only familiar with the far more common Type II, due to the rapid growth of the disease thanks to our modern diet and lifestyle. It's valuable to recognize that Type I means zero insulin produced by the body, zero cures available for the disease, and zero chance of survival without treatment.

As to the original question of the topic, in my mind there's no question about it. If Astrid has the insulin, she should use it on Dmitri.

First and foremost, the insulin is absolutely useless to someone without diabetes. Also, it has a limited shelf life, which is quite likely drastically worsened by the storage in sub-zero temperatures for who knows how long. Insulin should be stored between 2-8 degrees Celsius, or at room temperature for typically up to a month. If it freezes, it's likely useless, since the large delicate peptide structure of insulin is damaged by the conversion of the water suspension medium converting from liquid to solid form, bending and breaking the amino acid chain out of alignment. I'd wager this scenario would see Dmitri's insulin dosage double or triple from normal as much of the vial's potency would have been lost.

A case could be made that this one vial of insulin, if rationed, could control the insulin levels of dozens of Type II patients, compared to a single Type I patient. However, this vial is Dmitri's property. Denying it to him is a death sentence.

Is the situation hopeless? Possibly. Should Dmitri be allowed to die for the good of the group? There's only one person who should make that choice, and it's not Astrid.

Only Dmitri should be the one to decide how long he wishes to prolong the inevitable. Perhaps he has the strength of will to survive by whatever means possible. Perhaps he will choose to weigh his odds, and decide to follow the example of Captain Lawrence Edward Grace "Titus" Oates, saying to his companions, "I am just going outside and may be some time", making the sacrifice of the one for the many.

[ThePancakeLady]

Well said @Jimmy. And yeah, the insulin not freezing while at the crash site is not IRL realistic, but then again, neither are bottles or water laying out in the snow not freezing, or cans of soda not freezing and rupturing the can.

Sadly, many with Type 1 Diabetes here in the US do ration their insulin, to make it last longer. Dimitri could do that as well, but it only gives him more quantity of life (he lives a little longer) while decreasing quality of life (he's going to have more long and short term complications...). 

But Father Tom, and it seems most everyone in Wintermute, all episodes, seems to believe there is a future for the world, still. So, even if they are wrong, they believe they will be rescued, or things will get better. And Astrid as a doctor is likely to believe the same thing, religious or not.

 

And yeah... I am so tired of people, when they learn I have Type 1 Diabetes, feeling sorry for me and saying "Oh, you poor thing. You can't eat sugar at all! That must be terrible!"
Ummm... carbohydrates, simple or complex are sugars. One acts more quickly on blood glucose levels, one acts more slowly. But it irks me that baby carrots are chock full of carbohydrates, and have a high glycemic index. I love baby carrots.  And I follow a carb-counting/glycemic index diet, taking my short acting insulin dosage based on carbs taken in. Long acting taken in a split dose (2x daily instead of the usual 1x daily.) And I still have issues keeping my HbA1c at or below 6.0. But it's way better than the HbA1c levels of 11.0-13.0 I had as a child, on the old old old Regular and NPH insulins and a strict 1500 kcal/day diet. What works for me may not work for another. More education, and customized care and treatment is so important. And so lacking for many here.

 

But as far as the game goes... the idea of deer or other animals harvested for meat, having their pancreas harvested to "milk" them for insulin is plausible, even if it may not be practical.

[Ape88]

On 10/28/2019 at 4:13 PM, Muestereate said:

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.

A lot of VEGETARIANS still eat eggs and dairy products. VEGANS strive to use only plant matter in all parts of their lives. No honey, no dairy, no eggs, no leather, etc.