A photon of bright news. Richard will be receiving a new insulin pump in the next few weeks that will increase his chances for staying alive and skirting the low and high sugars that damage organs in type 1 diabetics. This is an auto-immune disease, a chronic and incurable disease that afflicts 10% of diabetics. For unknown reasons the body attacks the beta cells in the pancreas that produce insulin, R and many like him produce no insulin at all and are entirely dependent on external insulin supplies. The new technology promises to turn off insulin doses when R is trending low, so he does not plunge into severe lows in the night when he is sleeping and cannot help himself get glucose. It also tracks highs and will add extra insulin without his intervention when he is trending too high. Severely low sugars lead to coma and then death if not treated. High sugars lead to nausea and ketoacidosis, which causes kidney damage and can be fatal as well. R will still use another device, his sensor–which is also installed in the body and changed every few days. The sensor sends information about the trends in R’s sugar levels to the pump on a bluetooth signal. The sensor measures trends, not precise blood sugar levels. For that he tests 8 or so times a day with a finger prick and glaucometer. So far his health care providers have made his life possible. R was diagnosed with Type 1 diabetes when he was 23, decades before insulin pumps, sensors, and even glaucometers existed. (He used to test with urine, and the strips were imprecise, with categories like “high,” or “very high,” rather than a precise number.) Fortunately for R, he has a tender relationship to his gizmos.