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I've automated almost all of my diabetes management into a level I basically can look into graphs and decide the level I want my glucose to go. For glucose mon

by pimeys 8y ago

I've automated almost all of my diabetes management into a level I basically can look into graphs and decide the level I want my glucose to go. For glucose monitoring I use Dexcom G5 sensors[0] and xDrip[1] open source monitoring application for Android. Insulin delivery is handled by a Accu-Chek Spirit Combo[2] pump, that is one of the rare pumps with a Bluetooth connection. The entity deciding the basal rates and corrections is an open source Android app called AndroidAPS[3]. As an insulin I use the fastest available analog Fiasp from Novo Nordisk, that works 10-15 minutes after injection. All of these combined together has dropped my A1c results from 7.5% to 5.5%, being 90% of the time between 4.0 mmol/l and 8.5 mmol/l, and having no severe hypoglycemias. Basically I got myself some more years to live without any complications and in general I feel much better when I can sleep my nights without worrying and can eat whatever I want whenever I want. Oh, and a warning to everybody who tries this: Accu-Chek will not cover any damage, there is nobody taking any responsibility of the results from the treatment you get out of the software. For me this works much better than any other treatment, but for others it might be even dangerous. [0] https://www.dexcom.com/g5-mobile-cgm https://www.dexcom.com/g5-mobile-cgm [1] https://github.com/NightscoutFoundation/xDrip/ https://github.com/NightscoutFoundation/xDrip/ [2] https://www.accu-chek.com/insulin-pumps-integrated-systems/combo-system/support https://www.accu-chek.com/insulin-pumps-integrated-systems/c... [3] https://github.com/MilosKozak/AndroidAPS/ https://github.com/MilosKozak/AndroidAPS/

jrowley 8y ago
Wow this is incredibly impressive. This is so impressive. I love seeing someone take responsibility for their healthcare and being empowered to control it. This is great.
- pimeys 8y ago
  Of course a big thanks goes to the European health insurance, who're willing to pay the expensive parts, and to my doctor, who pushes me to do research about my possibilities, having a circle of connections who've helped me out to build my own rig. P.S. Today I built a new widget to my i3 setup, displaying the current glucose and the trend. https://i.imgur.com/VnZ23vO.png https://i.imgur.com/VnZ23vO.png
  - aloisamae 8y ago
    My younger brother has type 1 diabetes and he really liked your setup! Do you happen to have written about it somewhere?
    - pimeys 8y ago
      Not yet, but I'm planning to. For him there's some good reading, starting with OpenAPS. AndroidAPS is implementing the research from OpenAPS and the site has lots of papers and documentation to read. https://openaps.org/ https://openaps.org/ AndroidAPS and OpenAPS do not work with all the same hardware, So you choose your rig based on your CGM and Pump model. If I'd be him, I'd start by trying to get my hands into Dexcom G5 system or if he doesn't have a good insurance, the Freestyle Libre has some unofficial bluetooth readers available that work with Xdrip. First you get your continuous glucose monitoring working and then start thinking about automating the insulin delivery. These projects started because we're not waiting. The organization behind is called Nightscout and their website has information how to build the needed hardware: http://www.nightscout.info/ http://www.nightscout.info/ Now the pump manufacturers are seriously planning to bring closed loop systems like I have here to the market. The only model right now that has some of the features is Medtronic 670g, but in comparison, if you know what you're doing, building an open source rig will give you much more control and features than the commercial offerings. This might change in a couple of years though.
toomuchtodo 8y ago
Have you seen the recent development of using two TB BCG vaccine doses as a protocol for Type 1 diabetes? https://www.nature.com/articles/s41541-018-0062-8 https://www.nature.com/articles/s41541-018-0062-8
liamzebedee 8y ago
A question from a fellow diabetic hacker - what prompted your switch to the faster acting insulin and how does it compare wrt basal rates? I became aware of it not too long ago, currently using Novorapid on my pump. Have brought it up once and the endocrinologists were apprehensive of switching. Forgetting to bolus and accounting for the dawn phenoemenon are pretty challenging in a backpackers routine. :-)
- pimeys 8y ago
  It's definitely much faster. I'll try everything new I get my hands into with diabetes and my treatment at the time was not that great, so it was pretty easy choice. First I did Fiasp when still with MDI and it's not that great to be honest. Even half a unit can be too much and it's very hard to dose if you don't use a proper bolus calculator. Of course using it in pump is a different story, especially if you have a CGM with the pump. Right now I'm using the SMB algorithm in AAPS, that can help with unannounced meals by giving small boluses if it thinks you ate something. The same mechanism pretty much evens out my dawn phenomenon. One thing you should know before trying Fiasp is the molecule size is much larger and might cause stinging feeling when the pump gives you dosage. Try to get a pump that goes slow with the dosing, otherwise the first couple of months might be a bit unpleasant. You'll get used to it though and I don't really notice it anymore.
anderspitman 8y ago
For those interested in personal T1D data management, Tidepool[0] is a fantastic (and open source) nonprofit in this space. [0] https://tidepool.org https://tidepool.org
- liamzebedee 8y ago
  Can also vouch. Their uploaded is super fantastic and works with many types of meters/pumps. Data stored their is also openly accessible using their API. Chris (the founder) seems like a good guy.
- pimeys 8y ago
  The problem with this software is that you don't get uploads automatically. I use Nightscout and InfluxDB with Grafana, and just set xDrip and AAPS to upload every new value automatically. Now I can have a browser tab open showing the glucose graph and medication and see changes happening real time.
Herodotus38 8y ago
Assuming you are type I, I found this paper today which you might find interesting. https://www.nature.com/articles/s41541-018-0062-8 https://www.nature.com/articles/s41541-018-0062-8 My little sister is type I and using the BCG vaccine in this way blows my mind.
radiKal07 8y ago
Hey man, look into the keto diet.
- mjaniczek 8y ago
  For type 1 diabetes? Really?
- robbiep 8y ago
  That is radically dangerous advice, do you have any qualifications in this matter or are you just trying to kill someone?
  - tugberkk 8y ago
    No it is not. He just stated that he/she "look into it".
- pimeys 8y ago
  I've been doing research about keto diet and tried it out a couple of times. I think it's not worth it, food being more expensive and so on. I'm in a good shape, eating normal food and sometimes stuff like pizza. My glucose is excellent, I'm in a very tight control now with the current system. It's much nicer this way than I need to worry about every time I go to a restaurant (in Berlin) what kind of food they serve.
catamorphismic 8y ago
The Dexcom G5 website says you should recalibrate with a meter every 12 hours to ensure accurate readings. Do you really have to recalibrate that often?
- pimeys 8y ago
  Not really, but you should really know how the calibrations work and understand when they might be off. It takes time to learn and understanding the basic math behind doesn't hurt. Always calibrate when you are not sure. G6 promises a no-calibration mode, but has a hard stop for sensors after 10 days. With G5 and calibrations you can double or triple the sensor lifetime (with xDrip).
terrie_coach-me 8y ago
This is fantastic. In a reply, you mentioned that you were interested in writing more about your setup and findings. I would love to pay you for a full article from you on this for Better Humans. See our "Write for Us" page here with instructions on submitting a proposal, or drop me a note via email - I'm terrie at coach.me. https://betterhumans.coach.me/write-for-better-humans-4c6c9884fc08 https://betterhumans.coach.me/write-for-better-humans-4c6c98... I have been looking for someone with experience monitoring and using their blood sugar data to manage diabetes, so I hope to hear from you!

by pimeys 8y ago

jrowley 8y ago

Wow this is incredibly impressive. This is so impressive. I love seeing someone take responsibility for their healthcare and being empowered to control it. This is great.

pimeys 8y ago
Of course a big thanks goes to the European health insurance, who're willing to pay the expensive parts, and to my doctor, who pushes me to do research about my possibilities, having a circle of connections who've helped me out to build my own rig. P.S. Today I built a new widget to my i3 setup, displaying the current glucose and the trend. https://i.imgur.com/VnZ23vO.png https://i.imgur.com/VnZ23vO.png
- aloisamae 8y ago
  My younger brother has type 1 diabetes and he really liked your setup! Do you happen to have written about it somewhere?
  - pimeys 8y ago
    Not yet, but I'm planning to. For him there's some good reading, starting with OpenAPS. AndroidAPS is implementing the research from OpenAPS and the site has lots of papers and documentation to read. https://openaps.org/ https://openaps.org/ AndroidAPS and OpenAPS do not work with all the same hardware, So you choose your rig based on your CGM and Pump model. If I'd be him, I'd start by trying to get my hands into Dexcom G5 system or if he doesn't have a good insurance, the Freestyle Libre has some unofficial bluetooth readers available that work with Xdrip. First you get your continuous glucose monitoring working and then start thinking about automating the insulin delivery. These projects started because we're not waiting. The organization behind is called Nightscout and their website has information how to build the needed hardware: http://www.nightscout.info/ http://www.nightscout.info/ Now the pump manufacturers are seriously planning to bring closed loop systems like I have here to the market. The only model right now that has some of the features is Medtronic 670g, but in comparison, if you know what you're doing, building an open source rig will give you much more control and features than the commercial offerings. This might change in a couple of years though.

toomuchtodo 8y ago

Have you seen the recent development of using two TB BCG vaccine doses as a protocol for Type 1 diabetes? https://www.nature.com/articles/s41541-018-0062-8 https://www.nature.com/articles/s41541-018-0062-8

liamzebedee 8y ago

A question from a fellow diabetic hacker - what prompted your switch to the faster acting insulin and how does it compare wrt basal rates? I became aware of it not too long ago, currently using Novorapid on my pump. Have brought it up once and the endocrinologists were apprehensive of switching. Forgetting to bolus and accounting for the dawn phenoemenon are pretty challenging in a backpackers routine. :-)

pimeys 8y ago
It's definitely much faster. I'll try everything new I get my hands into with diabetes and my treatment at the time was not that great, so it was pretty easy choice. First I did Fiasp when still with MDI and it's not that great to be honest. Even half a unit can be too much and it's very hard to dose if you don't use a proper bolus calculator. Of course using it in pump is a different story, especially if you have a CGM with the pump. Right now I'm using the SMB algorithm in AAPS, that can help with unannounced meals by giving small boluses if it thinks you ate something. The same mechanism pretty much evens out my dawn phenomenon. One thing you should know before trying Fiasp is the molecule size is much larger and might cause stinging feeling when the pump gives you dosage. Try to get a pump that goes slow with the dosing, otherwise the first couple of months might be a bit unpleasant. You'll get used to it though and I don't really notice it anymore.

anderspitman 8y ago

For those interested in personal T1D data management, Tidepool[0] is a fantastic (and open source) nonprofit in this space. [0] https://tidepool.org https://tidepool.org

liamzebedee 8y ago
Can also vouch. Their uploaded is super fantastic and works with many types of meters/pumps. Data stored their is also openly accessible using their API. Chris (the founder) seems like a good guy.
pimeys 8y ago
The problem with this software is that you don't get uploads automatically. I use Nightscout and InfluxDB with Grafana, and just set xDrip and AAPS to upload every new value automatically. Now I can have a browser tab open showing the glucose graph and medication and see changes happening real time.

Herodotus38 8y ago

Assuming you are type I, I found this paper today which you might find interesting. https://www.nature.com/articles/s41541-018-0062-8 https://www.nature.com/articles/s41541-018-0062-8 My little sister is type I and using the BCG vaccine in this way blows my mind.

radiKal07 8y ago

Hey man, look into the keto diet.

mjaniczek 8y ago
For type 1 diabetes? Really?
robbiep 8y ago
That is radically dangerous advice, do you have any qualifications in this matter or are you just trying to kill someone?
- tugberkk 8y ago
  No it is not. He just stated that he/she "look into it".
pimeys 8y ago
I've been doing research about keto diet and tried it out a couple of times. I think it's not worth it, food being more expensive and so on. I'm in a good shape, eating normal food and sometimes stuff like pizza. My glucose is excellent, I'm in a very tight control now with the current system. It's much nicer this way than I need to worry about every time I go to a restaurant (in Berlin) what kind of food they serve.

catamorphismic 8y ago

The Dexcom G5 website says you should recalibrate with a meter every 12 hours to ensure accurate readings. Do you really have to recalibrate that often?

pimeys 8y ago
Not really, but you should really know how the calibrations work and understand when they might be off. It takes time to learn and understanding the basic math behind doesn't hurt. Always calibrate when you are not sure. G6 promises a no-calibration mode, but has a hard stop for sensors after 10 days. With G5 and calibrations you can double or triple the sensor lifetime (with xDrip).

terrie_coach-me 8y ago

This is fantastic. In a reply, you mentioned that you were interested in writing more about your setup and findings. I would love to pay you for a full article from you on this for Better Humans. See our "Write for Us" page here with instructions on submitting a proposal, or drop me a note via email - I'm terrie at coach.me. https://betterhumans.coach.me/write-for-better-humans-4c6c9884fc08 https://betterhumans.coach.me/write-for-better-humans-4c6c98... I have been looking for someone with experience monitoring and using their blood sugar data to manage diabetes, so I hope to hear from you!