<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>gumby</author><text>&amp;gt; my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes&lt;p&gt;&amp;gt; Also, they prefer to try medications like glucophage before they resort to insulin.&lt;p&gt;A couple of points: 1- the targets set by associations like the ADA actually assume the patients &lt;i&gt;won&amp;#x27;t&lt;/i&gt; be able to make significant lifestyle changes; for example the ADA A1C targets are higher than for healthy patients.  The diet changes they preach are not that radical, e.g. cake is bad for you but you can have a really tiny slice and offset it by not eating bread.  This belief isn&amp;#x27;t that unreasonable; FDA requires that medical labeling be targeted at a 5th grade reading level.&lt;p&gt;2 - And glucophage is &lt;i&gt;much&lt;/i&gt; easier for patients to manage than insulin both in dosing regime and simply caring for the drug.&lt;p&gt;3 - Finally the insurance companies&amp;#x27; actuaries have figured out that maintenance therapy of this nature has the best cost&amp;#x2F;outcome ratio.&lt;p&gt;To that last point: I had &amp;quot;adult onset type 1&amp;quot; due to an autoimmune condition.  The endocrinologist I was sent to was only interested in maintenance therapy and not at all in looking for root cause, even though I presented with a body fat of about 14%.  She finally admitted that even if she did look into it the insurance companies would hassle her for going off the reservation without a good excuse.&lt;p&gt;But my no-insurance primary doctor and I and a rheumatologist were able to dig into root cause and now I am &amp;quot;cured&amp;quot; (of diabetes at least) thanks to treating the underlying condition (note: this is glossing over a lengthy period of unpleasant work).  Which is actually cheaper for the insurance companies, but honestly how many patients have the training to be able to be involved in their care to this degree?</text><parent_chain><item><author>ThJ</author><text>Why don&amp;#x27;t doctors recommend them for type 2 diabetes? Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Also, they prefer to try medications like glucophage before they resort to insulin. There just seems to be less eagerness to finely manage type 2 diabetics, maybe because it is felt that the patient is partly to blame for the disease, whereas type 1 diabetics are innocent victims of their own immune systems. I honestly don&amp;#x27;t know what they&amp;#x27;re thinking. An artifical pancreas would vastly improve the situation for type 2 diabetics too.</text></item><item><author>ThJ</author><text>I have type 2 diabetes and I&amp;#x27;ve always been a bit envious of insulin pumps, not because I love having a machine plugged into my body (I don&amp;#x27;t), but because they offer better control of blood glucose peaks, since they use fast-acting insulin exclusively. The pancreas secretes insulin in pulses and pumps can mimic that. What has turned me off from pumps (apart from doctors generally not recommending them for type 2 diabetes) is the lack of a sensing mechanism. This DIY system sounds absolutely perfect. It could keep my blood glucose perfect at all times. At the moment, I&amp;#x27;m injecting in the mornings and the evenings and have little control over my peaks apart from adhering to a strict diet (and we all know how hard that can be), and every peak does a little bit of damage to my eyes, nerves, etc. I&amp;#x27;ve always wanted to have a more sophisticated treatment option, and this may be it.</text></item></parent_chain></comment><story><title>A $250 Biohack That’s Revolutionizing Life with Diabetes</title><url>https://www.bloomberg.com/news/features/2018-08-08/the-250-biohack-that-s-revolutionizing-life-with-diabetes</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>morganherlocker</author><text>Along with what others have noted, there is also risk associated with insulin therapy from hypoglycemia (low blood sugars). Low blood sugars can be deadly for type I diabetics, killing as many as 1 in 10[1]. This is at least one of the factors leading to insulin being a tool of last resort, and in fact, insulin &lt;i&gt;is&lt;/i&gt; prescribed to type II diabetics with especially strong insulin resistance.&lt;p&gt;&lt;a href=&quot;http:&amp;#x2F;&amp;#x2F;care.diabetesjournals.org&amp;#x2F;content&amp;#x2F;35&amp;#x2F;9&amp;#x2F;1814&quot; rel=&quot;nofollow&quot;&gt;http:&amp;#x2F;&amp;#x2F;care.diabetesjournals.org&amp;#x2F;content&amp;#x2F;35&amp;#x2F;9&amp;#x2F;1814&lt;/a&gt;</text><parent_chain><item><author>ThJ</author><text>Why don&amp;#x27;t doctors recommend them for type 2 diabetes? Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Also, they prefer to try medications like glucophage before they resort to insulin. There just seems to be less eagerness to finely manage type 2 diabetics, maybe because it is felt that the patient is partly to blame for the disease, whereas type 1 diabetics are innocent victims of their own immune systems. I honestly don&amp;#x27;t know what they&amp;#x27;re thinking. An artifical pancreas would vastly improve the situation for type 2 diabetics too.</text></item><item><author>ThJ</author><text>I have type 2 diabetes and I&amp;#x27;ve always been a bit envious of insulin pumps, not because I love having a machine plugged into my body (I don&amp;#x27;t), but because they offer better control of blood glucose peaks, since they use fast-acting insulin exclusively. The pancreas secretes insulin in pulses and pumps can mimic that. What has turned me off from pumps (apart from doctors generally not recommending them for type 2 diabetes) is the lack of a sensing mechanism. This DIY system sounds absolutely perfect. It could keep my blood glucose perfect at all times. At the moment, I&amp;#x27;m injecting in the mornings and the evenings and have little control over my peaks apart from adhering to a strict diet (and we all know how hard that can be), and every peak does a little bit of damage to my eyes, nerves, etc. I&amp;#x27;ve always wanted to have a more sophisticated treatment option, and this may be it.</text></item></parent_chain></comment><story><title>A $250 Biohack That’s Revolutionizing Life with Diabetes</title><url>https://www.bloomberg.com/news/features/2018-08-08/the-250-biohack-that-s-revolutionizing-life-with-diabetes</url></story>