For many months I have been super jealous of Jeremy looping with his 1909 Medtronic pump and RileyLink. After he sent me his 100% time in range download just to mentally torment me, I finally got the RileyLink ($150 at https://getrileylink.org/product/rileylink433) for my Omnipod a few weeks ago. My friend from Stanford, Rayhan Lal, loaded the app on my iPhone for me when I was in Santa Clara for one of our TCOYD conferences, and Jeremy physically put my RileyLink together (it comes with a rechargeable battery that needs to be inserted) and got me up and running. I entered all of my settings (insulin to carb ratio, correction factor, duration of insulin, how long do carbohydrates take to be absorbed, etc.) and with two smart buddies who both have T1D helping me, it was super easy!
I can tell you I absolutely love it and my daily time in range after looping only two weeks has been in the upper 80 to low 90% range, when before it was in the 70s.
Below are some of my thoughts on the system:
- I do not have to carry my Omnipod controller around ANYMORE as all of the controls are on my iPhone and I can see it in the sunlight…wooo hoooo! Of note is that looping with the Omnipod does not work with the new Bluetooth pods that pair up with the DASH.
- You must be super honest when using Loop. You have to enter all of your carbs (fast acting, intermediate acting and longer acting), only bolus via your pump and tell it when you are going to exercise and for how long. The more data you put in, the better it works.
- Loop will take all of this information along with the data from your G6 and predict what your glucose level will be in the next few hours. When you give a correction bolus, you will see the predicted line adjust downward a few seconds after bolusing. I have found the predictions are pretty darn accurate when the settings are correct and I am honest.
- Loop is a basal rate modulator, also called a hybrid closed-loop system. It will adjust your basal rate upward when your glucose is above your target range and also if the software predicts your glucose will eventually get above your target range. It will lower or turn off your basal rate if it predicts you will get low as well. I have found that the system really works to keep you in range if your glucose is not too high (~200) or too low (~70). Above 200 I would give myself a correction bolus, and below 70 get some carbs depending on the trend arrow. It took me awhile, but you have to trust the system and be patient in that it will bring you into the target range eventually.
- My overnight glucose levels have NEVER been better. I do have gastroparesis and a bad case of the werewolf syndrome (after the sun goes down I eat anything that cannot move faster than me – watch our Edelman Report on werewolf syndrome here). That typically messes me up almost every night. I seem to cruise down slowly overnight and land between 115 and 125 without lows, night after night. Really amazing. My GF really appreciates it and my monthly Martinelli’s apple juice bills have really gone down and so has my weight!
- If I really eat a lowish carb diet, the system takes care of my glucose level without bolusing at all. The modulating basal rate feature keeps me in range. When Jeremy got his 100% time in range day after day, he was on a low carb diet. I now call him Jeremy Pettus, MD, LLC (Looping Low Carbs). You must bolus for meals if you are on a regular diet by entering the carbs. I do not carb count, but I add in the amount of carbs that would translate into my usual WAG (wild ass guess) method.
From the screen shot of the Loop app (below), from top left to top right you have the green circle indicating the system is active and connection to the G6 and Omnipod is good.
Then you have the glucose level and trend arrow, followed by the basal rate modulation (-0.45 U/hr). My normal basal rate is 0.8 U/hr so the system has lowered my basal rate as you can see from the insulin delivery view. Next to the basal rate are how much insulin is left in your pod and when your pod will expire. The first view below is the glucose both present (dark dots) and predicted (lighter dashed line). The next three views are the active insulin, insulin delivery and active carbohydrates. There is a ton more info but I do not want to overload you.
Looping can really make an improvement in your diabetes control, but there is a learning curve and problems that pop up here and there. For example, you will lose connection and your loop will not be active. You sometimes need to reboot things and move the RileyLink closer to your Omnipod for a few minutes. This happens to be when I wear my Pod on my upper back and keep the RileyLink in my pants pocket. You can also update your software from time to time online as well. Have a back up plan for sure if the system goes down or you lose your RileyLink, just as you should if you were not looping. Overall the occasional hassle is well worth it for me.
Looping is not FDA approved, but studies are currently being conducted with the folks who use open source software. This data will be used to obtain official sanction from the regulators. These rogue algorithm developers have accelerated the pace of diabetes technology for all of us!
I have ben so interested in looping. I was having trouble finding a compatible pump. How difficult is the set up? The directions look so intimidating. I do have a nephew who just completed his Phd in engineering who said he would help me, but I would prefer to do on my own. Thanks!
I started looping last week and it is AMAZING.
I really didn’t find it too challenging to set up everything. The loopdocs website has a great step-by-step procedure to setting it all up.
If you take your time and read each step carefully, you shouldn’t have any issues!
For me, I’m not a real techie, but I did find a friend who helped me so it was easy. I have many other patients who were able to set it up just fine by themselves, but if you have a friend or relative who can assist you, that’s always nice!
Very interesting information. I use a Tandem T2 pump and G6 CGM. Is there anything available for that system that could provide the looping benefits?
Unfortunately the answer right now is no. The Tandem pump cannot be hacked like older Medtronic pumps and now the Omnipod. However, Tandem is working on an update that is very similar to loop and hopefully will be available sometime this year.
I have been an Omnipod user for many years. I have not been consistent in wearing the Dexcom due to cost constraints. If I get a G6 CGM and a RileyLink, will it work with my Samsung Galaxy Note 3 phone or does it have to be an iPhone? My son has an iPhone 6s, I am wondering if that will work. Also, do I need an Apple computer to get everything set up?? I am so ready to not have super highs and the super lows that zap my energy for a day or two.
Here is a great website with a lot of helpful info and answers all of your questions!
I just ordered my Rileylink to go with my omnipods and discovered that I’m going to have to pay for the apple developer account for the year as well. sigh. I’m still really excited but didn’t notice the extra charge apple charges people.
Can’t wait to get going…
Wait, what?!? Why do you need an apple developer account?
In order to modify the App created for “Looping” with the OmniPod (Eros or first generation pod) to use on the Apple IPhone – the one creating it needs to have an Apple developer account – which is $99 per year that you get through Apple.
It took me two months to ponder if I could do this and all I can say, is I’m so glad I did – it’s Awesome. And the loop docs are so informative-I’m so grateful for everyone that worked together to “pave it forward”
hi there. Ive been a omnipod user for many years and a anodroid user for the same amount of years. Have you heard if this hack will come to android anytime soon ? ALSO i noticed you mentioned gastroparesis , how are you dealing with that? My endo thinks I may have the condition but Id like to speak to a T1D who has specific knowledge about the condition.
appreciate your feedback
We haven’t heard about a hack for Android users coming anytime soon unfortunately, but we’re hopeful it will. Regarding your question about gastroparesis, the key for me has been not stuffing myself at any one time, and also not eating too late.
Thank you for the information! Do you need to carry the RileyLink with you?
You do not, but then Loop will be inactive and you’ll need to do things manually.
There is no manual option. The Riley link translates the Bluetooth control signal coming from your phone to the RF signal going to the pod. If there is no Riley link with you, the phone cannot send any data to the pump.
I guess you are correct! The pump will still give you your basal rate which is a good thing!
Does this work during pregnancy with type 1? Using OmniPod G6
Yes but in all cases of pregnancy, any disruption in insulin long enough to cause DKA can lead to fetal heath issues. Anyone wearing a pump needs to be ultra cautious, and this is one situation where you need to check with your endo and ob docs.
Hi there, I’ve been using Omnipod for about a year now. about 2 months ago I was switched to the Dash system. From what I’ve read this isn’t good if I want to Loop. Should I try to go back to the old style?
Absolutely if you want to Loop. You cannot Loop with the DASH.
Dr. How can I get my loop set up? I’m in Silicon Valley and going to Stanford to see physicians. I use G6 and low carbs, I hand inject via pen. I’m working towards cure but this is the best we’ve created so far I can’t wait to get mine and I’m purchasing my Riley Link now and signed up for this group. I like to be in range always!
This website has a lot of helpful info for starting loop- https://loopkit.github.io/loopdocs/
How is everything going since setting this up? I just received my RileyLink in the mail today. I’m both nervous but so excited to get it set up.
Do you know if it’s possible to do the initial setup, but not use it for a day or two?
Just go for it! You will have your Dexcom on with alerts and alarms to ease your fear…you will love it!
great article!! I am a type 1 diabetic w/two type 1 diabetic kids. we are building our loop now, lol or should I say my type 1 diabetic son Riley is! I will be the guinea pig getting used to looping, then my daughter will follow shortly after. our riley links are here and ready to loop! my son is a little reluctant so I think he will likely change his mind once he sees us looping. (lol took >6 months to get him to open mind about pumping which he now LOVES. he has been pumping for 4 years) anyhow very excited to try looping and love reading your story of success! now if we can just get the build done lololol
Hi Lisa, I am not a techie at all and I got help. Lots of my patients literally did it themselves…you will love it!
Do you know if the Horizon will be any better than the Loop. I have been on the Loop for a year and my control is great
I really have no clue, and I think no one knows until people outside of a clinical trial start to use it. I will try it for sure.
Is there any indicator of how long Eros will be available for purchase and whether similar setups will be available moving forward?
You may want to speak with an Insulet/Omnipod rep directly. Their 27/7 customer care number is: 1-800-591-3455, and they will also have a booth at our next virtual conference on 12/12. Registration for the conference is free here: https://tcoyd.org/tcoyd-dec-2020/ and you can chat with reps live during the event.
Can anyone share general comments on their experience with Tandem’s control IQ feature and contrast that with Omnipod + Looping?
I’m considering getting the Tandem pump, just for the Control IQ feature, but realized that I TRULY do not want tubing. I have the old (non-Dash) Omnipod.
I’m a bit scared to try setup with Loop on my own, but have a Mac, old Omnipod, Dexcom G6, and iphone, so…. I think I’ve got the needed tech.
Still need to read the Looping documentation.
Hopefully others will respond with their experiences but you may also want to post your question in our T1D facebook group here: https://www.facebook.com/TCOYD/groups
hey Dr. E,
are you still using medtronic, g6, Riley, iPhone?
are you switching to Horizon or any other more efficient device in future that just uses phone, sensor and pump?
are you using any faster insulin like lyumjev or fiasp over Humalog as Im trying to find most efficient system for my 13 year old son.
I am looping with the Omnipod (never used the Medtronic system). I will check out Horizon for sure. Fiasp and Lyumjev are a little faster on and faster off, but not too different from Humalog.
Thanks for replying.
1. So you are using Omnipod Aeros, what pump, Riley Kind, G6, Iphone?
2. Where do you buy the pump and pods and avg total cost?
3. Does yours have similar for predictive IQ like TSlim?
1. I am using the G6, Omnipod and RileyLink to Loop, and I have been for a few years.
2. I have health insurance so I pay a copay, but everyone’s copay is different. Cash would be super expensive.
3. Yes…Loop has all that like the Basal-IQ. Check out the lecture by Gary Scheiner on our video vault here for more info: https://tcoyd.org/video-vault/
Thanks for sharing your experience. What type of insulin are you using with your loop set up?
Humalog or Novolog
I literally hade to fight tooth and nail with my Insurer to get the Omnipod Dash.!
When I asked about the compatibility of the Omnipod Dash, I was told that it only works for the Eros pods! Surely there should be some solution to be able use Loop with the Dash! Does anyone know of one?
I have been asking the same question, since I loop also. I do not believe they have any plans of allowing the dash pod to sync up with the RileyLink, and that it will only continue to work with older pod.
Was referring to RILEY Link.
Is there a solution to loop th dash to Dexcom g6?
I heard that the software developers for loop recently figured out a way to loop with the DASH Omnipods, which is great news because you won’t need a RileyLink anymore since the DASH has Bluetooth.
I believe it’s for androids right
Haven’t heard of an iPhone solution