Looping

So its been a while since i've started looping...figured its time for a new blog. Over the past week i've been getting quite a bit of questions about looping so I figured i'd do two different blog posts. 

Looping in short is a DIY closed loop system.
So what looping does is it connects my medtronic pump and my CGM to a mobile app called loop. In that app the pump and CGM are able to communicate and adjust basal rates by decreasing or lowering them depending on the algorithms BG predictions attempting to keep you in range more often.

Setting up the loop wasn't too bad, you definitely don't need to be a tech genius. The coding is all done for you and you can access it all on the loop docs, a great document, very easily designed with instructions and pictures of a step by step set up and all the trouble shootings possible.
To set up loop you need a Riley link an old Medtronic paradigm pump, a CGM (either a dexcom or a libre with a transmitter...I totally recommend the miaomiao).

Once you have the app all set up it should look something like this.



As you can see at the top tool bar there are 5 icons. The first is the green circle which means you are currently closed looping. If an error occurs the green circle will become red. Also, if the circle is a semi circle that means you are open looping which I will discuss later on.

Next you can see you blood sugar reading. This information is derived from the spike app. Which reads my miaomiao transmitter every 5 minutes.

The third icon shows the current basal changes happening at this current time. As shown in the picture my predicted blood sugar is 6.2 therefore loop has chosen to keep the basal set on my pump. Any basal changes done with your current pump basals as a starting point therefore, its vital in my opinion to have an accurate basal set before you start looping...maybe some basal testing too!

Lastly the 3rd and 4th icon is your pump reservoir and battery. Which is super cool because I get an alert to both my phone and apple watch when either of them go low!

The bottom tool bar has another 5 icons which are pretty handy! The first green one on the left is where I bolus for meals from. Simply inputting my carbs and loop calculates the amount of insulin needed based on your I:C ratio and once i confirm my pump starts bolusing. Pretty cool because I don't even need to touch my pump...just straight off my phone. And my apple watch too!

The following green on and the blur heart are pre set targets. The green on is for pre meals...if I want to be at 4.5 before a meal I will press that icon about an hour or two before my meal so loop can target my blood sugars to my desired setting. The blue heart is a similar idea but for exercise.

The orange double triangles in between them is a bolus option that doesn't include carbohydrates. So if I am correcting or over riding my pump by giving additional insulin.















So how does loop help exactly? the picture above you can see under insulin delivery...each block is a basal increase or decrease that loop adjusted my pump too throughout the day as it aims to keep me in my set target range. Loop adjusts basals in U/H (units per hour) rather than percentages

The picture on the left at the top tool bar you can see that there was a current basal decrease of -0.0625u per hour to prevent me from dipping too low. Loop adjusts if needed as it gets a new blood sugar reading every 5 minutes from my transmitter.


While being closed loop is awesome, a few situations seem to work better when i'm not looping.


When the circle is no longer fully closed that means you are in open looping mode. As you can see that while on open loop the app won't change your pump basal setting however, it will still show you its recommendation 

I go to open loop when I override my pump which probably happens more times than i'd like to admit. The reason for this is because loop starts calculating I will be very low so it starts suspending my basal which defeats the purpose to my rage bolus.

Another reason, however I haven't experienced it often is when loop causes my blood sugars to become a yo-yo, going high than low than high than low...you get the point. Not Fun! This happens because the pump suspension causes the spike than a correction causes you to crash back down which makes loop suspend basal again and so on.
Going off closed loop allows you to break the cycle so you can fall into range and than go back to closed loop.

I've been looping for about a month and I think its been great! so here is my take on it with some pictures to back me up.

Definitely been in much better range over all with great over all stats! Now loop might've worked against me over the fact that i get even more anxious than before when I go high...just because since I started looping how high I go has decreased quite a bit. It also definitely reduced the amount of lows I have, although if I stop myself from overriding it would be better for sure

A Week Of Looping Stats

A Day Of Looping
Targets: 4-7.5

That Time I was Vulnerable

Writing things out is one of the ways I deal with any bitterness, emotions, and anger towards my diabetes. I've always had a journal I write in about it all...and every now and then I'd blog about it, it sure does help me. And I always have hope it helps another diabetic out there or helps me connect with others.

Last week Saturday, of what seemed like a normal morning, where the sun was shining and the wind was blowing, a beautiful breeze it was. I was contemplating if I should go out running or go to the YMCA.

It was the first time in a few days in which I had no lows all night, the previous days I would have up to three lows a day and it sure was EXHAUSTING! Anyways, I woke up at a beautiful blood sugar of around 6. Perfect for a workout! I usually avoid breakfast till after my workout so I don't have any insulin on board...nothing new!

I went to a step cardio workout at the gym, the room was HUMID! Like really humid! I felt my blood sugar crash (and that rarely happens). I felt dizzy and nauseous, I scanned my libre and it was 3.8! No biggie had some skittles and decided to push through the workout but that didn't go as planned. I felt my blood sugar drop more and more, I was out of skittles so I had 2 dates...tested again and it was 3.7.

I decided to leave the room, firstly it was cooler outside, much cooler and secondly, I hate having to sit aside and wait for my blood sugar to rise so I might as well leave. I went and sat on the floor near the couch. For some reason when I'm low I like sitting on the floor, not too sure why? Anyone else?

I sat with my head into my knees trying to keep my composure because I was getting mad at myself for going low. Trying to understand why I all of a sudden felt my low. I tested again and I was at 3.7, why isn't it rising? Am I crashing fast and just don't know it? 
My friend finished the workout and came around to make sure I was alright and keep me company, It was maybe 15mins later and my blood sugar was still at 3.7, but for some reason, I felt like I was 1.3.

I felt light-headed, very low in energy, I was sweaty but also shivering. I could barely form words to say and when I did I had very little energy to say it. I was getting drowsy and wanting to fall asleep but I knew I shouldn't so I kept my mind focused on the rhythm of the sound of a basketball bouncing in the court below me, eventually, that sound was too loud for me. In fact, the sound of a normal voice felt like yelling! Tested again and I was STILL 3.7! No freaking way, blood test and I was 3.8. My libre died out, perfect timings, right?

My friend grabbed another juice box from the first aid kit in hopes it will help! I was so mad at myself, I was furious, I wanted to help myself, I was feeling crap, my body felt so weak but I kept telling myself just hold yourself till you get home, just get to the car, just get to the car. But I had no energy to get up...and when I did I felt dizzy and sat back down. I broke into tears (and trust me I'll only cry in front of people if I trust them or I'm at a breaking point). Just imagine a 19-year-old crying in public? That never looks good. So for me to break down into tears just said how bad I felt...maybe its because it was my first time in a long time to feel low so I've forgotten how bad it felt? But I felt so weak and vulnerable. I just wanted diabetes to be gone and for me to feel better quickly. Maybe a hug too? Hugs are MAGICAL! 

They eventually called my mum and she came by to pick me up. And while my bg finally came up an hour later, my body took half of the remaining of the day to recover and feel better. But through my awful feeling of me being low, despite not a very low blood sugar ... I saw the love of a community and the love of people. From my friend to those working at the gym, to my mum. Each are special to me. While I hated feeling weak and not being able to brush it off and keep going like I often try to do, I did appreciate every part of their help offered.

BluCon Review

I'm a total fan of searching, trying and knowing every possible thing about diabetes and all the technology that's out there!

About a month ago, I came across the blucon. Blucon is a small device that works with the libre to transmit to your phone. Ultimately, I was super interested in the device to get alerts for night time lows and why the heck not try it out...seems like something cool.

The blucon is a small circular device that fits on top of the libre sensor. It is slightly bulky upwards. It's the size of 3 libre sensors on top of each other.

The device costs $110 Dollars. However, it's a onetime purchase, unlike the Dexcom transmitter. The blucon lasts much longer as the battery in it is interchangeable. A little downfall is that the device is not waterproof. (so don't be forgetful like me and jump in the shower with it)

There are a few ways in which people attach the blucon on top of the libre, my favourite is using velcro dots. Other options are tegaderm on top of them to keep them in place or a blucon armband.

The following apps that I will mention, in which the blucon transmits reading too are all still "apps in progress". None are perfect but, I definitely prefer some over others.

Let's start off with the actual blucon app LinkBluCon. The application is definitely still a work in progress. I personally wasn't a fan of it due to connectivity issues, however, many have said it works well for them. While the libre and the blucon read differently due to different algorithms the app reads super accurate. The blucon has both a share app and links up to the apple watch. While the blucon is accurate without the need of calibrations both the main and share app are super basic. The alarms are loud, so you're sure to hear them, however, super annoying and repeat every 5 minutes with every update until you're back into range. The app does not have a solid graph, the graph creates itself using your highest and lowest blood-sugars during the selected hours of graph preview. Personally, I wasn't the greatest fan of that. I would rather have a graph showing my range targets. With the blucon app, I am a fan with how it is displayed on the Apple watch. It has the target zones you set and is even colour coded. The blucon app seems to convert the blood sugars from mg/dl and display them in mmol/l and hence it shows blood sugars in 2 decimal places.

The second application I tried is spike, I would    say this app seems to suit my needs better and has a much better set up. While once again its a work in progress and infect in order to download it, you need to download it through test flight as it isn't available in the App Store yet. 

The application, similar to the blucon doesn't have a set graph, it creates it as your numbers fluctuate. Something I really like about the app is the ability to colour code the graph depending on blood sugar ranges. ex.  I colour coded anything below 4.5 is in red, anything above 7.5 in yellow and anything above 10 to be in orange. That way at a glance I have an idea of how my blood sugars are doing, big picture. Also, at the bottom, there is a pie chart which is a neat way to present the data. You are able to customize your alarms and determine the snooze timing of it. Another thing I like about the app is that it shows you the difference in your blood sugars to 2 decimal places. This gives me a good idea of how fast or steady I am climbing or dropping. Having an idea using numbers helps me think ahead and avoid overriding a pump I can see I am not drastically climbing. This app needs a calibration every 12 hours and 2 calibrations once a sensor is started, similar to Dexcom. For the people in the US who need to change their libre out every 10 days, the blucon will continue reading numbers up to 14 days using the app. So while you can not use your libre meter the past 10 days the blucon will work the full 2 weeks.

Unlike linkblucon, at this current moment spike does not have a share app.

Other apps that people use that I have not tried are night scout, night guard, and xdrip. Some are better features on the android phones than iPhones due to security reason on the iPhone. However, as the apps keep developing they will function better and better with fewer bugs. And eventually be available in the app store

Ketones?

Earlier in the morning, my pod fell off in my sleep without me realizing and I ended up waking with moderate-large ketones. According to google ... "Glucose is the body's main energy source. But when the body can't use glucose for energy, it uses fat instead. When fats are broken down for energy, chemicals called ketones appear in the blood and urine." The amount of ketones I woke up with was the most I've had to deal with. As I tried to stay calm and stay awake I decided to write out how I was feeling. 


You wake up at 5 am, body completely aching, mouth tasting gross and completely dry, and the sudden urge to pee. While you contemplate if you can hold it in until the morning or not, you can feel your heartbeat in your head. Your head feels heavy and about to explode as every heartbeat echoes. BOOMBOOM BOOMBOOM BOOMBOOM. The symptoms finally click in as you reach for your meter, very slowly as you feel your muscles ache. Muscles that you never even knew existed. As you reach for your meter you feel a lump under you, which you later discover was your insulin pump. But for now...you focus on your mission. Get a hold of that meter. And finally, with every achy muscle, your fingertips get a hold of that meter and you check your blood sugar. 27.3! THATS NOT GOOD...you tell yourself. You throw out a few curse words towards the pod and diabetes as you force yourself to get up and head to the washroom. Afterall if you aren't on that toilet in 3 secs...you're gonna pee your pants. Test ketones! Moderate-high! AHH, CRAP...thats the darkest colour you've had to experience. For the first time, you can smell the "sweet" pee everyone has mentioned (TMI?...oops sorry) Your head is still pounding but you try to clear out the fog inside and focus on getting these blood sugars to come down because after all the last place you want to end up is at the ER.

As you sway side to side, slowly twaddling back to bed, leaning on everything to support you because you feel like you're about to pass out...you finally make is back into bed. Slowly change out the pod, praying and hoping that this pod behaves and stays on. Firstly because you hate and avoid site changes and don't want to do anymore. And also because you don't want to end up with more ketones and high blood sugars! 

Ketones

You turn up some Ed Sheeran, curl up into a ball, inject some insulin through a syringe...hoping it works fast! Meet your new best friend, water. And your other best friend, the washroom (in which you've probably thought so many times so far "why can't I have a surgically attached toilet so I wouldn't have to leave my bed every 3 secs) 
You chug on water, go pee it out, curl back into a ball, snooze off for a bit, test blood sugars, test ketones. You're full of emotions, tears, frustrations. You feel weak, with every muscle ache. You don't like being out of control of your body. It's only 5 am...but you're all ready for this day to end. You planned on going to the gym with friends...but hey, diabetes had other plans and you can barely move. So you cancel your plans as you dedicate this day to spending it in bed.


All you need right now is LOTS OF INSULIN, water, and the washroom.

Omnipod thoughts

Happy New Year! Its been a while since I've done a blog post...so here's to hoping I'm productive enough and write more blog posts this year!

I'm a Medtronic pumper, however, over the past two months I've been using Omnipod for a clinical trial I'm participating in.  Through my experience of using the Omnipod I've noticed some disadvantages and advantages about it....so thought I'd share it.


The Omnipod consist of a PDM (personal diabetes management) and a pod.

The PDM is both a blood-sugar meter and your "remote control". All communication to the pod is done through the PDM....boluses, temp basal, carb ratios, ...pretty much everything.

The pod is basically the pump. Unlike Medtronic, the Omnipod is tubeless, which is something I've personally love about it. The pod holds up to 200 units, with a minimum requirement of 80 units. In my personal opinion....it is slightly bulky but is a relatively small size and you can easily be discrete if you want to hide the pod

The biggest disadvantage I'd say about the Omnipod is the PDM. I'm not the biggest fan it. It's large, bulky and pretty old school. The buttons are annoying to press and make a squeaky sound. If I want to just carry the meter on me without my diabetes bag (which I do often) it barely fit in my jeans pocket and make the pocket so bulky. However, Insulet is working on a new touchscreen PDM...which I think will look super cool once its out.

Comparing it to the Medtronic pump, I like that you can bolus from the pump...which stays on my 24/7. Unlike with Omnipod, you can't bolus from the pod. This may not be a disadvantage for many...but for a forgetful person like myself who always leaves her PDM in the car, at work, or at home it might be a slight disadvantage. While the pod still administers basal insulin if the PDM isn't nearby, you can not bolus or put a temp basal without the PDM.

Changing out the pod has to be every 72 hours (+ 8-hour window) ... now, this is definitely a good thing for insulin sensitivity and skin integrity. With the Medtronic pump, the pump continues working after the 72 hours (3 days), therefore many change their site every 4 days rather than 3. However, with Omnipod...the pod alarms at 72 hours and gives you another 8 hours before the pod expires and stops working. 

Now while this hasn't been an issue for me, many of my fellow ponders have complained of having issues with their pod due to static. During the winter weather, the static electricity results in pod failures. This often happens when wearing wooly fabrics over cotton. Hearing about pod failures taught me it is really important to carry a syringe or a spare pod with you at all times because if a pod fails (which doesn't happen often) ... then you can extract the insulin in the pod using a syringe or change out your pod. 

Inserting the pod is super straightforward and easy. The pod self-primes. Requires no inserting of needles or pokes. All is done automatically by the pod. My only comment in this area is, while the pod inserts the cannula it makes a "loud-ish" sound. 

While the pod is recommended on certain areas of the body...compared to Medtronic, you can be very creative in which areas you apply the pod. While the back of my arm is my favourite, I've used my calf, love handles, upper and lower back upper ribcage and abdomen. Be creative! To add on, being able to rotate my pod to so many areas has kept me insulin sensitive and avoided a buildup of scar tissue. This results in better blood sugars!

Comparing the Omnipod to Medtronic, I love the tubeless feature. It has brought so much ease not having to worry about any tubes.  The Omnipod is also waterproof....and while the new 640G Medtronic is also waterproof, I'm not too sure if I would want to swim or shower with a tubed pump, but, with the Omnipod its no hassle at all! 

Lastly, and probably the top reason I like the pod is I get to design it and make it look fancy. I always say, if I have to wear it, it better look good! Overall, I'm a total fan of the pod and enjoy the features it provides! I would totally stick to the Omnipod.