I'm T1D and currently working on something like this because diabetes healthcare in the UK is effectively non-existent past diagnosis.
Managing the condition isn't too difficult after 30 years of it, but dealing with the politics of NHS diabetes care is astronomically more difficult than it was in any decade previously. In my experience, if you are not pregnant, or you aren't at risk of passing out in the next 15 minutes, they don't care. Whatever long term consequences you experience are another department's responsibility.
A trend I've seen is that younger diabetes nurses and doctors are extremely dependant on tech (CGMs, insulin pumps), but don't comprehend how they work or what the data means. They don't know what patterns to look for beyond a 24hr window and generally seem to think everything is a bolus ratio or basal problem, overlooking other settings such as correction factor, duration, etc.
Because they are tech illiterate, vendor lock-in is becoming an issue, as no health tech companies want you using another tool except the one they get paid for. So I find myself being swapped from platform to platform as they change my devices every year or so, each one being less workable than the last. Glooko only allows 6 months of historic data to be viewed, and only through their web UI. Abbot refused to let me download my data after I was forced off their platform to Glooko. I was happy on Tidepool, but it doesn't work with my current set of devices.
No, more funding will not fix this. Threats of criminal punishments for lazy medical professionals and unlimited fines for anti-competitive behaviour from diabetes tech manufacturers will.
I feel your pain, but 'threats of criminal punishments for lazy medical professionals' isn't a great idea. There are already laws against medical malpractice, but it's pretty obvious why prosecuting doctors and nurses for 'laziness' would be incredibly counterproductive and result in a massive increase in bureaucratic ass covering rather than improved care. Ask yourself - what caused the NHS to get into this situation? Certainly reversing those causes would be a good first step to improving the service and fixing the issues they've caused. According to the doctors and nurses themselves, it's all about cost cutting, increases in hours and generally the financial starvation of the service. They're literally out there striking to be allowed to treat you better.
You were specifically criticising "younger diabetes nurses and doctors". Bear in mind also - part of the reason trainees and nurses have such poor pay (and far more importantly, awful suicide inducing hours and conditions cross nationally), is a rigidly hierarchical system where consultants who were themselves overworked and underpaid themselves see this as a right of passage.
You guys are decades deep into an ideologically propelled plan to "Starve the beast" by denying the NHS funding so that care quality declines, and use that as justification to privatize the NHS entirely.
The starting salary for a first-year doctor is below the national median income, and for a nurse significantly below. Their inability to requisition funds & time for care is something there is repeated labor action about. The NHS budget is 5.9% of GDP versus the 17.3% of GDP that the US economy spends on healthcare or the 11.3% of GDP that the UK economy spends on healthcare overall.
> The starting salary for a first-year doctor is below the national median income
Is it really that low?
In the USA an entry level doctor will make around $130,000 and the 'Average doctor' makes $200-$350,000/year depending on what website you want to believe.
And we're running like 13% of the population having diabetes.
Isn't one of the selling points of universal healthcare that it's overall cheaper in total cost than private insurance? If so, the UK should be celebrated for having such a low percentage of its GDP being spent on universal healthcare.
UK spends about 11% of GDP on healthcare
This is comparable to France, Germany, and Switzerland, which spend ~12%, and less than the USA at 16% of GDP.
Things get a little more interesting when you take the overall GDP of each country into account:
My diabetes consultant is on more than the national median income and only works part time in a low cost of living area of the UK. They are far from hard done by. Throwing money at them will not change what is effectively a systemic error in how they approach the disease.
The NHS is underfunded, but this isn't a problem of funding. The lack of a scientific approach to managing diabetes is strictly down to ineptitude.
> You guys are decades deep into an ideologically propelled plan to "Starve the beast" by denying the NHS funding so that care quality declines, and use that as justification to privatize the NHS entirely.
Mind providing some sources for this? Rather tired of hearing this unfounded conspiracy theory from people
This is counter to my experience - my daughter has received fantastic care. We have regular time with the endocrinologist and get phoned up inbetween clinics. They have provided a closed loop system and all the backup we could have asked for.
I agree about Glooko, it's not as good as diasend was.
This was my experience when I was first diagnosed, too (minus closed loop - it was the early 90's). They put more effort in with children, as it's a dedicated team. Same as gestational diabetes care.
Expect to start having appointments cancelled and to go years without hearing from them once she is passed to the adult diabetes team.
> Abbot refused to let me download my data after I was forced off their platform to Glooko
So I've been using Abbot (LibreLink) since 2019 and if you log into LibreView (https://www.libreview.com/) there's a 'Download glucose data' link in the top right of the screen.
There's also a handy PDF report that I send to my diabetic nurse before my annual meeting, I think I'm the only one of her patients who knows how to do this because she's always thrilled and spends half the appointment going through it in amazement at the data/trends.
Abbot have been quite good overall despite the fact I reported a bug to them in their Android app in 2022 and they still haven't fixed it. If you add LibreLink to the whitelist of apps that can interrupt DND, then enabled DND, LibreLink alerts you saying "Alarms unavailable."
'...diabetes healthcare in the UK is effectively non-existent past diagnosis.'
I was referred to a dedicated team with a specialist nurse who checks in with me regularly. Maybe I am fortunate not to live in a big city where most NHS facilities seem to have descended into third world standards?
I think it depends where in the UK you are, as I believe different areas healthcare is run differently. This has not been my experience, I've found the care to be good, as long as I'm willing to put in the work on my side and be proactive on occasion about looking for help. In my local area the diabetic team is stretched thinly (that's what the staff said to me themselves) and I am relatively proactive with reaching out, research and asking questions. With that said they really want me to succeed in keeping in a healthy range and have been a massive support as much as they can. Also the fact I don't have to pay for Insulin or my CGM is something I am really thankful for. Threats of criminal punishments for lazy medical professionals doesn't sound like a good fix to be honest.
This is a surprising view given that I'm T1D in the UK and the healthcare I've received, along with the tech, support and collaboration with diabetic consultants has been first class. You are making an assumption that every doctor is like the one you have (I guess), but its simply not the case.
Good luck with your programming, but the agenda you're pushing for it is remarkably short-sighted.
I've had 4 consultants over the past 10 years. The first, who was forward thinking and kept up with the latest in the field, helped me acquire an insulin pump. Sadly, I had to transfer clinics when I moved across the country and have never had another consultant that helpful.
But how did they get people into the ecosystem to begin with? iOS has ALWAYS been this locked down. Heck it didn't even have an app store to begin with. The apps you got were what Apple decided you could have and that was it. Cell phones before the iPhone (Palm, Blackberry and even dumb phones) had some form of software market capabilities, and certainly phones after and their larger competitor (Windows Mobile, Palm again and Android respectively) have had far more open platforms. So how did Apple manage to get all the developers and users locked in when the better options were – perhaps with the brief exception of June 2007 - Sept 2008 (if you don't count Palm and Blackberry) – always there?
Additionally, how has Apple designed their ecosystem to make it "as painful as possible" to switch to a competitor? It's on the app developers whether they would charge for a replacement copy of their app on Android. Apple does nothing to prevent them from offering a "switcher" discount. All of your first party app data is syncable to your computer, and Google even offers a tool that says it can do contacts, photos, calendars, messages, apps and music. And if that's not enough, Apple will provide you with a copy of all your iCloud stored account data in the original format (for things like photos) and in standard format (for things like calendars and emails) https://support.apple.com/en-us/102208. So other than Apple themselves providing a first party tool to migrate your data directly to your new Android phone, what are they doing or not doing that qualifies as "[making] it as painful as can be to switch"
I just did that switch having been on iphone since the 6s. It is amazing how much choice there is on the Android platform. Having switched to Samsung immediately I get two software stores for a start. I'm not beholden to a single file service; Apps will integrate with multiple different options not just iCloud. I can download multiple browsers, with adblockers. I can download torrent clients without having to jailbreak.
Meanwhile I can't receive text chat integrated video above about 240p from iphone friends because Apple won't integrate with them. They're a shit company and I'll never buy their products again.
They've been at it for years. I'd genuinely be surprised if this cracked the top 10 worst things Microsoft have done to Windows users.
I think there would need to be a concerted effort at a grass-roots level, say from r/buildapc, to get new PC gamers onto an alternative for there to be a considerable shift away from Windows.
> ...to get new PC gamers onto an alternative for there to be a considerable shift away from Windows.
Have you tried Steam on Linux? It works amazingly well, either with native Linux support in games or through Proton support (their Windows emulation layer). Quite a few people I know have gone that route and are shocked at just how well it works in practice.
I recently purchased a Steam Deck and I've been blown away by how games just work. I used to use Wine a lot for applications in the early 2010s and it was always hit and miss (and Codeweaver for Office support). Proton is amazing.
> I used to use Wine a lot for applications in the early 2010s and it was always hit and miss
IME Wine is still hit and miss for applications in general, even old ones. Games are just a particularly good fit here—they rarely care how well your COM marshalling or shell namespace or transactional NTFS or weird SQL-like inside Windows Installer is implemented. Not to imply that getting games to work is a simple task, just that the API surface is much less spread out, and any emulation improvements for a single game are more likely to improve support for a wider range of other games.
I think the discussion is tainted actually by technical people who used Wine in the bad old days, haha. I fought Wine a decade ago and it was pretty bad. If anyone had asked, I’d probably give the “dual boot, may as well keep Windows around as a glorified console” spiel.
A non-technical friend got a steam deck, when I asked what OS he’d used I got a response along the lines of “oh, I guess it must be Linux.” It the thought about what OS hadn’t even occurred.
I just wish Proton supported macOS. It being Linux-only always felt like their goal was never actually cross-platform gaming, but specifically SteamOS being able to run everything.
The Nvidia experience on the beta channel is shockingly good now, too. The big sore spot for gaming on Linux was trying to convince Nvidia users the experience was worth their time. Using 555-series drivers on GNOME Wayland right now is pretty much flawless.
Proton has been huge for Linux gaming, especially since the Steam Deck launched. Apple’s Game Port Toolkit is also quite promising on Mac side. Unix based OSs are seeing something of a vg renaissance.
YMMV there depending on the specific game, both of those anti-cheats can work on Linux but the developer of the game has to opt-in to allow it since their Linux implementations are much easier to bypass than their Windows ones. There's games like Rust which use EAC but have refused to enable its Linux support for that reason.
Offer to install it to people who experience difficulties with Windows, and never lie about it being much simpler or N times faster; don't forget to ask first if they use any special software/hardware that requires Windows or has only Windows drivers. Offer alternatives, but always be clear that they're not the same thing. 99.9% of non professional Office users wouldn't even notice the differences with LibreOffice, but that's not a good reason to tell them that the two products are identical: they're not, but one is open and free, both in price and in how it respect the user, which for many people could count a lot more than the extra features MS Office has over LibreOffice.
One thing that worked for me many times is that I always offered full support for any problems the user would encounter, and to install Windows back and for free if after a given period of time they didn't find Linux usable for them. One has to understand that the common non tech user trying Linux can't easily phone their friends, coworkers, kids, nephews, etc. not even the PC repair shop down the street and magically find a Linux expert, so they must be given something that works and is well supported.
Word of mouth will do the rest: most users don't care about pervasive advertising or spyware, Closed vs Open Source etc, but others do, and they're the ones telling about Linux and bringing other users in.
This is actually an interesting point. There's a tendency to assume that the core of a story is the same, even if the way it's told is different. I wonder how many generations of retellings it takes for us to notice significant differences.
I think stories about King Arthur would be a good comparison. They fit a similar cultural niche, but we have lots of different versions that were written down over the centuries.
> I wonder how many generations of retellings it takes for us to notice significant differences.
That's not really a sensible question. Compare the 17th-century European story of Cinderella to the 9th-century Chinese story of Ye Xian: https://en.wikipedia.org/wiki/Ye_Xian
The story stayed nearly identical for a period of many centuries. Significant differences could have been introduced at any point, but they weren't.
I think a lot of people aren't necessarily happy because they're highly skilled at it, but because its a default state of being. If it was purely a skill then environmental or biological factors wouldn't play any role.
If anything, we learn to be unhappy. It's no secret how toxic academia can be - I would say the original commenter's personal observation that only 1% of people are happy is probably because many people around them are deeply unhappy.
I know I felt this way when I was in a different career. Once I moved out of that field, I was astounded to find out that people are actually not depressed most of the time. I won't lie, the improved financial situation that followed was a big factor - it's definitely easier to be happy when you're not poor!
So, I agree, a recalibration is in order. But that might involve removing yourself from certain social groups as much as it requires a thought pattern adjustment.
Probably not as absurd as you think. I reckon if you dropped an American in a random town in Scotland (or even a northern English town, for that matter), they would also need to use very broken English and hand gestures to communicate as well. Glaswegian or Geordie is near incomprehensible to RP speaking Brits, yet alone to an American who's only exposure to Scottish is Mel Gibson as William Wallace.
This is a good assessment. 1 and 2 are why the system won't change, but I don't think they were intentionally designed with that in mind. I think it's a hang over from academia, bearing in mind how many of the top engineers at FAANG are PhDs.
Well, that and how almost nobody who successfully finds employment after "grinding" leetcodes wants to remove the barriers for entry.
I think Leetcoders can't envisage a better way to assess someone than by subjecting them to the same kind of hoop-jumping you get made to do in university. They're not interviewing you for a job as there's no module on interviewing candidates on the CS curriculum, and don't have much professional experience outside of academics or software engineering. They're simulating a dissertation defence, because that's how they were assessed for their competence.
That's my charitable interpretation. If I'm being cynical, it's elitism - a way of making sure you're "one of us" (read: obnoxiously academic, Type-A personality, "logic over feelings").
> how many of the top engineers at FAANG are PhDs.
Not that many, but its interesting how many are from "elite" universities. I'm in a research org for a FAANG and we often get to see all the handwringing about how we can't recruit more of people type x.
Well, if you only hire from MIT, Stanford, Oxford etc, then they are all going to look the same.
For those outside the research org, its a bit better, but its still the most uneven place I've worked.
Lets not get into a debate over how legal abstractions cover up the reality of rape and sexual abuse, but keep in mind that rape is staggeringly underreported.
Managing the condition isn't too difficult after 30 years of it, but dealing with the politics of NHS diabetes care is astronomically more difficult than it was in any decade previously. In my experience, if you are not pregnant, or you aren't at risk of passing out in the next 15 minutes, they don't care. Whatever long term consequences you experience are another department's responsibility.
A trend I've seen is that younger diabetes nurses and doctors are extremely dependant on tech (CGMs, insulin pumps), but don't comprehend how they work or what the data means. They don't know what patterns to look for beyond a 24hr window and generally seem to think everything is a bolus ratio or basal problem, overlooking other settings such as correction factor, duration, etc.
Because they are tech illiterate, vendor lock-in is becoming an issue, as no health tech companies want you using another tool except the one they get paid for. So I find myself being swapped from platform to platform as they change my devices every year or so, each one being less workable than the last. Glooko only allows 6 months of historic data to be viewed, and only through their web UI. Abbot refused to let me download my data after I was forced off their platform to Glooko. I was happy on Tidepool, but it doesn't work with my current set of devices.
No, more funding will not fix this. Threats of criminal punishments for lazy medical professionals and unlimited fines for anti-competitive behaviour from diabetes tech manufacturers will.