DIY APS, closed loop insulin delivery, Dr Thomas Crabtree ABCD, do it yourself artificial pancreas s

KITLIVING

"The fact that it is referred

to as DIY tells of its grass

roots growth. However,

the fact that these

specific set-ups are not

found via the usual routes means that

there are potential concerns about the

ethical and medico-legal implications

of their use. To be clear, DIY APS and

closed-loop systems are incredibly

similar, in some cases the same, but the

latter is commercial, right out of the box.

Whatever you call it, these systems

usually involve a pump (to put the insulin

in), a sensor (to check blood glucose) and

an algorithm (that decides less, more,

stop or same in terms of insulin delivery).

There may be an additional device, such

as a smartphone / other reader, or PDM

(personal diabetes manager). The fact

that there are so many interconnected

components is why it's called a system.

The NHS does support closed-loop

systems if they are available on the NHS.

Increasingly, however, we are finding that

HCP's in the diabetes sector are realising

that patients coming who have rigged up

their own DIY APS still need support. Data

from clinical trials is usually how systems

can be 'rubber-stamped', but these take

time. Subsequent steps are needed for

regulatory approval, a process we are all

likely more aware of in the era of Covid

vaccines. Once this has been achieved,

guidelines on the use of new devices are

issued to HCPs and eventually, once any continued over

funding issues are resolved, it will make

it into the hands of users. Further data

on safety continues to be collected and

any incidents are reported widely to raise

awareness and improve safety.

Taking control

We estimate potentially around 3000-5000

DIY APS users globally, so why would

they be doing this this if these systems are

becoming available commercially? This

routes back an online campaign that went

under the hashtag '#wearenotwaiting'.

Big companies can take a long time to get

devices and software platforms through

trials and to get passed by the FDA and

gain CE accreditation in Europe - with

just a few of the many steps highlighted

above. People who were really concerned

about either their own diabetes or - in

many instances - those who had children

with diabetes, and who also had software

and coding experience who realized that

they shouldn't/didn't have to wait to get

better control and peace of mind. The

idea that it was 'unsafe' was countered by

the fact that having diabetes and injecting

a potentially lethal drug was inherently

unsafe in some situations. There is always

some risk.

What we have been seeing is people

with diabetes directing their own care,

which is what we've been asking them

to do for decades: check your blood

glucose, count carbs, decide a dose

based on these factors plus anticipated

activity.

DIY APS users tend to have moderately

improved glycaemic outcomes, but more

than that, what they report is a significant

and, in some cases, drastically improved

quality of life. They were using algorithms

as a support for decision-making, not

spending all their time calculating carbs,

insulin ratios and so on - like any closedloop system, it automated some of

the endless calculations and decisionmaking.

What is involved with building a DIY

APS system? There are three commonly

encountered systems: Loop, Android

APS and OpenAPS. Which one is used

is often dictated by the availability of the

constituent parts. Put simply, you have to

'cherry-pick' parts of the system based

on what bits of the system you already

have. For an Android APS: a FreeStyle

Libre can be turned into a CGM to collect

data using a MiaoMiao attachment which

then feeds data into Nightscout. This

data can be entered into the algorithm,

held within the Android APS app (which

has to be built, but with readily available

codes). This algorithm will then bear the

brunt of decision making so long as it

knows your settings - you basal rates,

sensitivity factors and carbohydrate

ratios. Changes in insulin delivery rates will

be communicated to the pump - pump

availability also dictating which of the three

systems can be created. It can even deal

Index

  1. Free online Desang diabetes magazine diabetes information
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  11. Medtronic MiniMed 780G System – Automated for an easier way to stabilise glucose levels.
  12. Abbott Freestyle Libre 2, Flash Glucose Monitoring, FSL2
  13. Abbott Freestyle Libre 2, Flash Glucose Monitoring, FSL2
  14. Diabetes management equipment, my diabetes kit, desang diabetes magazine
  15. Diabetes management equipment, my diabetes kit, desang diabetes magazine
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  17. Air Liquide Healthcare UK Tandem t:slim insulin pump with Control IQ
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  19. Insulet Omnipod DASH insulin pump with insulin pods, podders, Omnipod DASH Personal Diabetes Manager
  20. Diabetes management equipment, my diabetes kit, desang diabetes magazine
  21. Ascensia Contour Next One Diabetes blood test meters
  22. DIY APS, closed loop insulin delivery, Dr Thomas Crabtree ABCD
  23. DIY APS, closed loop insulin delivery, Dr Thomas Crabtree ABCD, do it yourself artificial pancreas s
  24. DIY APS, closed loop insulin delivery, Dr Thomas Crabtree ABCD, do it yourself artificial pancreas s
  25. sulin pump, Dana RS system, artificial pancreas, Advanced Therapeutics UK, CamAPS FX, Dexcom G6
  26. Desang Diabetes Magazine, free diabetes magazine, living with diabetes
  27. Desang Diabetes Magazine, free diabetes magazine, living with diabetes
  28. Roche UK Accu-Chek Instant blood glucose system
  29. Roche UK Accu-Chek Instant blood glucose system
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  31. Desang diabetes, Inside Diabetes guides, guide to injecting insulin, guide to injecting for people w
  32. Page 0032
  33. Page 0033
  34. Diabeloop insulin delivery system, Diabeloop algorithm
  35. NHS Diabetes
  36. Diabeloop insulin delivery system, Diabeloop algorithm
  37. Page 0037
  38. Making Carbs Count, Carbohydrate counting for diabetes
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  40. Making Carbs Count, Carbohydrate counting for diabetes
  41. Desang diabetes kitbags, bag for diabetes kit
  42. Desang Diabetes Magazine, free diabetes magazine, living with diabetes

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