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DIY Looping

Steve and I had the pleasure of going to Vienna, Austria together two weeks ago for the diabetes technology meeting, and while there definitely was some cool stuff presented in the artificial pancreas world, my update comes from my own AP world.

As I’ve mentioned before, I started on LOOP about 4 months ago, and I think I’m finally ready to give an update on it.  So first off, what is LOOP?  Basically, it’s an AP system that uses:

  1. An old Medtronic pump
  2. An Iphone
  3. Your CGM (dexcom or Medtronic)
  4. And a device called a “RileyLink” that connects them all together

The founder of Loop has a daughter with T1D named Riley, and thus, RileyLink!

So what does it do?  Basically, it uses an app to determine what basal rate adjustments should be made on your pump, and uses the RileyLink to hack the pump and tell it what to do.  You still have to bolus as you would for meals, and correct, and all that garbage, but the system does a great job of giving you more or less insulin as a basal rate.  Basically, it does what the 670g system does, but with a lot less hassle.  So what do I like about it?  Well here it is:


I could probably just drop the mike after this one and walk away and I would be fine with that.  I simply don’t get low at night anymore.  And I don’t really get high either.  Nighttime went from my most frustrating time, to my most consistent.  My wife told me the other day, “Hey you don’t sleep with apple juice by your bed anymore.”  And I was like- she’s right.  Now I’m just spending time thinking about what I’m going to do with all this juice money.  Seriously though, I don’t wake up to alarms, and I wake up every day with a really, really good blood sugar.  It took going on LOOP to realize how crappy I was sleeping before…  Low.  Eat.  High.  Insulin.  Repeat.


Yeah that’s right.  Loop lets me slack off a little, and I kinda like that.  I know if I don’t nail my bolus, the basal rate will kick in to help minimize the damage of me drastically underestimating my carbs…. again.  So I think I worry a little less about the fluctuations and my time in range is better.


Not a lot to add here.  I get low less.  Less at night, less during the day, and less with exercise.  Less lows means fewer texts from Steve telling me to get my shit together.  I really like that feature a great deal.


The pump is completely controlled from your phone through a pretty slick-looking app.  So if you don’t want to, you never really have to touch your pump.  You can adjust your target to whatever you want- including an exercise target.  It gives you a predicted glucose curve and its fun to see it shift when you enter carbs or insulin.  It’s not always right, but it looks cool.  You can tell the app if you’re eating a high carb meal (lolly pop), a mixed meal (taco), or high fat (pizza).  All well thought out stuff.


So what don’t I like about it?  Well it’s really when it just doesn’t work.  Sometimes it drops the Dexcom signal or isn’t picking up the pump for some reason.  So I do spend a fair amount of time looking at the app to make sure I’m still “looping”.  Carrying the RileyLink around is kinda annoying and I’ve broken 3 of them.  Yes 3.  All water related.  So more “fried” them then broke them.  But this is all minor stuff.


How do you or your patients get on the system?  To be honest it’s a little complicated to set up, but I actually did it myself (the second time) without any problems.  There are VERY good instructions here:


I didn’t mention before that this is a complete Do It Yourself (DIY) system so is NOT FDA APPROVED, you won’t find it in any CVS, and your doctor can’t prescribe it for you.  You have to do it your damn self (DIYDS).  And to do that you’ll need all those things I mentioned at the top, several hours to spend, and about 130 bucks to buy a RileyLink.

I didn’t realize how much LOOP had really been helping me until I was in Vienna, and I only packed one European electrical converter and ended up charging my phone more than my RileyLink.  So my LOOP would drop out when the RileyLink didn’t charge, and I was back to the dark ages.  Champagne problems for sure, but hey, it made me realize what a big advance this type of technology is.  So while we are waiting for systems to get better and better, for now, go out and DIYDS.


This post originally appeared on weareonediabetes.org. If you are a diabetes professional and also have type 1,  sign up for the WeAreOne online diabetes community here!

Apple just announced a major upgrade for Dexcom and Apple Watch

“An exciting nugget of information for Dexcom users was hidden among more eye-catching announcements during yesterday’s Keynote Address at Apple’s WWDC (Worldwide Developers Conference) in San Jose. Near the end of his preview of the upcoming watchOS 4 software update for Apple Watch, Kevin Lynch (VP of Technology at Apple) briefly showed a slide that included Dexcom’s CGM watchface. He stated (19:45 into the keynote address):

“We are also now supporting native core bluetooth on the watch, which is going to enable experiences for apps that work with small devices around you. So for example, continuous glucose monitoring directly from Dexcom’s sensor… to your watch.”

Similarly, Apple provided an information page which again specifically referenced continuous glucose monitoring as a beneficiary of the Watch’s upcoming software update (free for all Apple Watch owners, scheduled for this Fall).

What this means: iPhone no longer required!

As we predicted about 18 months ago when watchOS 2 was announced, the upcoming Watch OS4 software update will finally allow the Apple Watch to display CGM data without an iPhone nearby. Going for a run? You can leave your iPhone at home. Going on a flight? You can leave your iPhone in airplane mode.

Keep in mind that owning an Apple Watch still requires owning an iPhone, so Android users can’t just go buy an Apple Watch for use with their Dexcom CGM. (Android support for Dexcom should be here any day now, though). But this new feature does allow users to be separated from their iPhone for periods of time without losing access to their CGM data.

This also (likely) means faster CGM data on Apple Watch

Although not explicitly stated, I predict that watchOS 4 will allow CGM data to be refreshed faster on the Apple Watch since it will be pulling data directly from the Dexcom transmitter. The way it currently works requires data to be sent from Dexcom -> iPhone -> Watch, so removing the middle man should make for faster synchronization.

All that being said, Dexcom owners with Apple Watches can look forward to a better CGM experience with the free watchOS 4 software update scheduled for this fall.

A promising innovation in insulin delivery: the OneTouch Via patch

The pain of insulin injections is well-documented, and the diabetes community is always searching for better alternatives. One such promising technology is the long-awaited OneTouch Via, an insulin patch pump from Johnson & Johnson subsidiary Calibra Medical.

Designed for both Type 1 and Type 2 diabetes, the OneTouch Via is a very small (2 x 1 x 0.25 inches) patch pump that stores up to 200 units of prandial (aka fast-acting) insulin, which can be delivered by discretely pressing two mechanical buttons on both sides of the pump. It can be worn for up to 3 days, and would be used in combination with basal (or long-acting) insulin.

OneTouch Via Insulin Patch Pump

A replacement for Multiple Daily Injections

Both doctors and patients dread starting multiple daily insulin injections (aka MDI). It means more painful pokes, more potential for public embarrassment, and more opportunities to forget a dose of insulin. Thanks to new classes of non-insulin therapies (eg Victoza, Trulicity, Invokana, etc), starting mealtime insulin can often be prevented or delayed, but millions of people with Type 2 diabetes (and all with Type 1) will still require MDI.

Mealtime insulin usually requires carrying around insulin injection supplies (insulin pens and needles or vials and syringes) and injecting before meals, which can be embarrassing and/or cumbersome. Traditional insulin pumps present their own challenges, as most have long tubing and complicated electronic interfaces that are not user-friendly.

Similar to the V-Go from Valeritas, the OneTouch Via is an entirely mechanical, tubeless, and disposable patch pump. There is no screen or complicated electronics, which keeps costs down, and makes for an easy-to-use interface. The user just presses two buttons down at the same time to deliver mealtime insulin, in 2 unit increments. This can be done through clothing, so a user could easily and discretely take 12 units (as an example) with six button presses done through their fabric.

Another advantage for both types of diabetes is that the OneTouch Via allows users to easily take additional boluses, for small snacks or hyperglycemic episodes that would otherwise require a new injection.

In study data shared at the 2016 American Diabetes Association Meeting, users wearing the OneTouch Via reported injecting mealtime insulin 50% more often than they had previously done with pen or vial, and 88% of them reported that they worried less about forgetting insulin injections.

Unlike the V-Go, the Via can be worn for 3 days and stores up to 200 units (the V-Go stores only 36units and must be changed every day). Also unlike the V-Go, the Via only replaces mealtime insulin and should be used in conjunction with basal (long-acting) insulin.

The Rocky Road Ahead

As the marketing efforts for inhaled insulin and the Valeritas V-Go have shown, replacing mealtime insulin injections in market and mindshare isn’t as easy as one would expect.

While 75% and 100% of providers in the previously mentioned study preferred the Via over insulin pens and insulin syringes respectively, providers in the community can be slower to adopt and more wary of newer technologies.

Also, adhesive patches and wearable devices are not the ideal solutions for all people. Patients can develop skin reactions to the adhesive or feel burdened when a device is stuck to their body, no matter how small.

Perhaps in light of these concerns, the OneTouch Via had been previously slated for release in early 2017, but now might face delays in light of JnJ’s recent intentions to explore the sale of their diabetes division.


Why the Medtronic 670G Artificial Pancreas is a huge deal for diabetes

So you’ve read all the headlines about an artificial pancreas and how it’s supposed to change the world for diabetes, but what does it really mean? We understand the skepticism… Remember: Medtronic previously claimed to have released an artificial pancreas system back in 2013.

But this time, the Medtronic 670G actually is a big deal. It’s a major step forward towards the artificial pancreas, and scientific studies back up its bold claims. (Note: it is NOT a true artificial pancreas, though)

But instead of repeatedly saying how important it is, we’re going to tell you exactly why it matters.

An “artificial pancreas” is like a “self-driving car”


The quest toward an “artificial pancreas” closely parallels that of the “self-driving car.” The names do a good job in describing their futuristic vision, so long as you understand that the pancreas is the body organ that produces insulin. (In Type 1 diabetes, the pancreas no longer functions properly and stops making insulin, causing blood sugar to go out of control.)

So continuing the comparison, having Type 1 diabetes is like owning a car with just an engine; no steering wheel or brake. Not good. Thanks to modern medicine, people with diabetes have the opportunity to “drive their car” by checking their blood sugar and injecting insulin appropriately.

Much like a self-driving car, a true artificial pancreas would be an autopilot for navigating the highs and lows of blood sugar. With an artificial pancreas, the user would not have to devote any effort to controlling their blood sugar. It would take care of itself, just as a self-driving car would get you from point A to point B on its own.

But now the next question…

Is the Medtronic 670G an artificial pancreas?

No, but it’s halfway there. If a true artificial pancreas is like an autopilot for self-driving cars, the Medtronic 670G is similar to “adaptive cruise control.” (If you don’t know what that is, adaptive cruise control allows a car to automatically accelerate and decelerate to maintain a safe distance from the car in front of it). If you want to drive on a straight stretch of road without making any lane changes, adaptive cruise control requires virtually no user interaction.


Similarly, the Medtronic 670G’s breakthrough feature adjusts basal insulin delivery (by speeding it up or slowing it down) to maintain a normal blood sugar of 120 mg/dL. It might not be as obvious during the day with meals and periods of exercise, just as adaptive cruise control plays a more subtle role when making many turns during city-driving.

But overnight and between meals is when the 670G’s adaptive cruise control truly shines, when circumstances are relatively stable, without the need to “change lanes” for meals or exercise. And keep in mind, unlike a car that you only use for trips, people with diabetes live with their disease 24 hours a day, 7 days a week. So a significant portion of their day is spent during those in-between and overnight periods.

Medtronic 670G’s “Adaptive Cruise Control” Works

Studies have clearly shown that wearing the 670G improves sugar control by reducing time spent in both high and low blood sugar range and lowered average A1c from 7.4% to 6.9%.

People who have worn insulin pumps with “dynamic cruise control” features particularly rave about its benefits on improved sleep overnight. Restful sleep is a big deal (and why mattress/pillow companies make a killing!), and it’s even more elusive with Type 1 diabetes due to the fear of overnight hypoglycemia or hyperglycemia. It’s not uncommon to be woken up several times a week in the middle of the night to check blood sugar or to have to eat a snack to avoid hypoglycemia. And even when sleep is not interrupted, waking up with higher or lower sugars than desired can start the day off with a thud.

Medtronic 670G Artificial Pancreas

As you can see in the graph above, adults using the 670G algorithm (highlighted in red) had a much narrower range of blood sugars, especially at night, when compared to standard pump users (the shaded grey area). They also headed into their mornings closer to target, and with a more stable glucose trend.

Medtronic 670G is just the beginning…

The top reason we’re excited for April 2017 (when the Medtronic 670G becomes available) is that it is just the first of a wave in the movement towards a true artificial pancreas.

While Medtronic has the advantage of manufacturing both its CGM and insulin pump, many future competing artificial pancreas systems are partnering with Dexcom’s highly rated, iPhone-compatible continuous glucose monitors.


The long list of such artificial pancreas systems includes a variety of approaches such as Bigfoot’s iPhone-based user interface, the more altrustic public benefit company BetaBionics’ iLet, and collaborations between Tandem and TypeZero.

bigfoot-artificial-pancreasThese projects are in various stages of advanced development, most of which are being currently worn and tested in clinical trials and research labs. The initial feedback of test subjects has been exceedingly optimistic, and the future of the “self-driving” artificial pancreas is just around the corner.

No matter which company (or companies) win, the type 1 diabetes community is the biggest winner.

Stay tuned for more coverage of the Medtronic 670G and other artificial pancreas devices…



Life Is Sweet

2016 TCOYD National Conference Schedule


You aren’t alone. TCOYD Understands

Take control of your diabetes and join us for a day that will ignite motivation for change, offer hope, provide invaluable education, and change the life of anyone who has diabetes.

What makes a TCOYD conference special?

Dr. Steve Edelman, Founder and Director of the not-for-profit TCOYD was diagnosed with type 1 diabetes at the age of 15 and has lived well with the disease for over four decades.

Dr. Edelman’s mission is to educate, empower and inspire people just like him. Dr. Edelman has never allowed diabetes to define his life. Instead, he spends his life defining a new way to teach individuals how to live healthy and happy lives with diabetes.

2016 TCOYD Conference  Schedule

[alert type=white ]Memphis, Tennessee

April 16, 2016

Memphis Cook Convention Center

More Info[/alert] [alert type=white ]Honolulu, Hawaii

April 30, 2016

Hawaii Convention Center

More Info[/alert] [alert type=white ]Washington DC

May 21, 2016

Walter E. Washington Convention Center

More Info[/alert] [alert type=white ]San Antonio, Texas

June 18, 2016

Henry B. Gonzalez Convention Center

More Info[/alert] [alert type=white ]Native American Conference – Corning, California

August 27, 2016

Rolling Hills Casino Event Center

More Info[/alert] [alert type=white ]San Diego, California

October 1, 2016

San Diego Convention Center

More Info[/alert] [alert type=white ]Orlando, Florida

November 19, 2016

Orange County Convention Center

More Info[/alert]