Automated insulin delivery (AID) systems have come a long way in the last few years. Variable blood glucose (BG) targets, exercise modes, custom profiles and automatic corrections are all features that make a meaningful difference to helping us pumpers manage our BG targets on a daily basis. What many people are unaware of though, is that for pretty much all of those features we have to thank the amazing people from the #WeAreNotWaiting community who created DIY looping systems over ten years ago, and continue to improve them today. These systems put the pressure on insulin pump manufacturers to up their game, in an industry that had not changed much in the preceding twenty years.
And in the last few years especially, we've gone from relatively weak algorithms that could only adjust basal rates or suspend insulin delivery, to systems like Control IQ, CamAPS and Medtronic's 780G SmartGuard - some of which are delivering correction boluses every 5 minutes, and adjusting background insulin based on previous patterns with no user input! These features are making a massive difference to the day-to-day burden of type 1... and the amount of sleep we're getting!
With this exponential up-tick in features, one has to wonder if there is still a place for the DIY looping algorithms and, if so, who is a good fit for them. The short answer is: they're a good fit for the same people as before - those that want finer control over their insulin dosing, or want more advanced features that aren't yet available in the commercial systems.
On the bell curve of diabetes knowledge, these are the people on the far right. Because to use these systems safely and effectively, you need to have a really firm grasp on how insulins work, how carbohydrates, proteins and fats are absorbed, how to adjust insulin sensitivity factors, carb ratios and basal rates, and how the algorithm is making decisions about how much insulin to give you and when. To that, you then have to add the technical knowledge (and/or sheer force of will) to work your way through the documentation to build one of these systems.
So it's quite a small percentage of the type 1 population for whom this is the right path, but these systems do have some super-useful features, so here's a few reasons why you might be in the group that should give it a try:
Advantages of DIY looping
You can bolus from your phone, and some will even let you bolus or make other adjustments from your watch - much more discreet than pulling out an insulin pump.
It gives you more fine-grain control over how your insulin dosing is managed - there's a lever for pretty much every factor you can think of.
You can set your blood-glucose target at pretty much any level - not limited to the 2 or options that the commercial systems do.
Parents can send remote bolus commands to their kids' pumps, allowing them to bolus for meals or correct high BG levels when they're at school or at a friend's house. (The safety measures here obviously need to be considered very carefully, but for working parents this can be a game-changer!).
Without the limitations placed on it by the Therapeutic Goods Administration (TGA), these algorithms can be much more aggressive in correcting high blood glucose levels than some of the commercial systems.
With the Omnipod DASH now being one of the pump options for these systems, you have the potential to have the best of both worlds: a tubeless pump AND an algorithm.
Dynamic insulin sensitivity factors: this feature detects when you’re more or less insulin resistant and will automatically adjust (to an extent) your correction factors to try and compensate.
Alongside these pro features, you have to consider the risks and potential drawbacks.
Drawbacks and Risks of DIY Looping
Although there is fantastic documentation available online, and a large community of people to help you, setting up a DIY looping system is quite a technical process, and can take anywhere from one to several days.
Although the community working on the software for these systems are very thorough, the software isn't checked or regulated by the Therapeutic Goods Administration (TGA).
Because you've got more things you can control, it means there's also more things you have to check in on and adjust. So you might end up with BG levels that are more in range, but it might require more brain space to do so.
There's no technical assistance phone number to call when something goes wrong (but there is a a good online community).
If you start using the system without properly understanding how it calculates doses, there is the potential for dosing errors, which can be very dangerous. Interestingly, the AndroidAPS system does have a series of modules that it makes you work through to ensure that you understand how a feature works before it will let you enable that feature.
DIY Looping Workshop
If you've been thinking about giving DIY looping a try, now might be the time. Australia's king of DIY looping, David Burren, is coming to Perth and will be running a one-day workshop where he'll explain the different looping options available and how they differ. There'll also be ample opportunities to ask questions. In the afternoon, we'll then get into actually building a loop, and David will
be on hand to help when you get stuck.
Workshop Details
Date: 24 August Time: 10am – 3:30pm Location: Type 1 Diabetes Family Centre, Stirling
Registration: $25 (lunch included)
Some additional resources that you might find helpful:
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