Alan McLean

@signulll More of a cultural problem IMO. Hierarchy is a hindrance in this environment.

ai is exposing everyone right now & making legacy entities vulnerable af. even labs are having a tough time shipping features that feel really good end to end. most ppl fail to realize that the hard part of building ai stuff was never access to a good model, it's the orchestration layer, the data plumbing, the taste in knowing when ai should intervene vs shut up, how it should intervene, what it should say, how it should say it, how does human in the loop work.. among many other subtle things. copilot is a prime time example of this. most legacy players have none of these instincts cuz they built their orgs around shipping deterministic software. we are firmly in the non deterministic era now & that requires a very different skillset to build great tools.

Waiting for the web traffic graphs for recipe and health sites…

@kmccor2014 @matthewstoller @Jason Can you provide a little more detail? Are you referring to Medicaid? Or rebates from lily/novo?

@matthewstoller @Jason I've been able to get $35 insulin for my patients since 2020, insured or uninsured. That was before any politician intervened.

There is an easy way to beat companies that are price gouging: stop buying their products! McDonald’s and Starbucks raised their prices and broke the consumers.. who started brown bagging lunch and preparing/consuming coffee and meals at home! I stopped buying @bluebottleroast cold brew at $4.50 for a small carton and started making my own at home for 10% of the cost — with cafe du monde, chicory coffee Mine came out better and saved me $3,000+ a year / $10+ a day Consumers are smart, they opt out when abused

Arcs on arcs

Don’t miss @giorgialupi’s painterly guest essay on living with long Covid for 3+ years: nyti.ms/3tgcr2u Includes a visualization of what she’s experienced on every single day that — for those of us who have fully recovered from our bouts with Covid — feels staggering.

@AKoutnik Looks good. Is there a specific protocol you’ve adopted to define your IFF, carb ratio etc?

Type 1 Diabetes Pre-exercise factors that have required me to adjust my closed-loop settings: -Acute nutrition -Time of day -Form/duration exercise Today: lower body resistance exercise + 15min run 🏃‍♂️

@AKoutnik Impressive! You probably won’t be happy with the current insured solutions. Tandem will lock you to a target of 120. You can trick it a little but it’s not going to really allow full control. So far I’ve only been happy with Loop and old Medtronic pumps.

@alanmclean MDI but going to switch to using a closed-loop for basal and injections for meals (but I wait as it is an insurance game)

Type 1 Diabetes Resistance Exercise + Run -> Walk -> Meal -> Work -> Walk -> Meal -> Sleep -> Run -> Whole Food Smoothie

@AKoutnik Likewise. I set my Loop target to 80 but calculate TIR as 70-140. What setup are you using? Loop? Tandem? Or just fully self-manage?

@alanmclean I keep it lower. I find that if I were to keep it at 140 it can easily creep up to 130s and just sit there with me not being aware.

I recall at Fitbit we heard very similar exec comments when the Apple Watch came out. On the design team most of us knew it was just a matter of time.

@Alan_Couzens Isn’t that somewhat at odds with the often provided guidance for a far higher ratio of Zone 2?

The number 1 mistake that serious, advanced self-coached athletes make? Not understanding the negative effects of #TrainingMonotony If your day-to-day training load through the week looks pretty much the same, you're leaving a lot of improvement on the table.

Newsletter Drop💌 Last year, we made over one-hundred animations of the most frequently used emoji; however, I didn’t blog about it on the ole bloggy letter … so did it really happen? UH, YES. IT DID. And guess what? We never stopped making more! jenniferdaniel.substack.com/p/emoji-that-c…

@ryanattar @betacellpodcast @tx_jeeper Respectfully, I think you’re steering too far the other way. Loopers get sub 5 A1c with similar stdDev and MUCH less hypo time. You’re incurring damage that cant be reversed with that much low time.

@betacellpodcast @tx_jeeper Guidelines say 70-180 for BG range. This is already well within the range of established damage from hyperglycemia. also, within this only 70% of the time If a diabetic stays hyperglycemic all the time, sure you arent going to have lows, but will have long term complications

I’m an insulin dependent T1 diabetic and this is my latest A1c… 4.7%

@ryanattar @MdZilin Why not just call it a hypo? Dude. 20% hypo is a lot! To each their own I guess 🤷‍♂️

@alanmclean @MdZilin when a T1 diabetic has a low blood sugar, they have taken too much insulin... an insulin overdose

@ryanattar @lmareechampion I’d like to see the data to support “many”. I just don’t see that at all in the population data I have access to. FWIW, I have an A1c of 5.1 with low stdDev but I wouldn’t ever tell ppl 20% low is ok unless they’re deep keto which hinders accurate measurement of energy systems.

@alanmclean @lmareechampion This is during the holidays. But still, If i pop down in the high 60s, sometimes I won't even need to correct(many low carb non-Ds have fasting BG here),if I do its with 3-6g of glucose(like half a glucose tab).Low carb diet, & corresponding mild doses of insulin mean mild lows

@ryanattar @MdZilin I look at glucose traces all day for non-diabetics and they definitely do not avg 20% low. If you’re truly deep keto I can see measurable glucose lower, but that seems at odds with calling it an “insulin overdose”. In those cases it’s a low with all the associated implications.

@alanmclean @MdZilin Healthy, insulin sensitive non-diabetics have similar blood sugars to mine. So I wouldn't call this low at all. The brain runs great on ketones too

@ryanattar @MdZilin Is the negative long term impact of low glucose not present with an “insulin overdose”? My understanding is that it has the same net effect to long term cognitive function.

@MdZilin Hypos are insulin overdoses. My low carb, protein focused diet requires very mild doses of insulin (and I even use the milder R insulin for my protein meal). Lows are very rare and when occur are mild. Avg glucose is around 85mg/dL and standard deviation around 20

@ryanattar @lmareechampion But you’re at 20% low. Thats a lot. Have you defined low as higher than 3.6mmol?

@lmareechampion Once you hit around low 5s and under with a low carb diet hypos become less and less frequent and less severe. The occasions I get hypos I’m correcting with 3-6g of glucose only.

Among the best @nytgraphics for 2022, this one for #LongCovid really stands out nytimes.com/interactive/20… @joshkellerjosh