1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.
  2. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  3. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2019 »
    Dismiss Notice
  4. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Closed Loop on the NHS

Discussion in 'Insulin Pump Forum' started by Steve3, Mar 8, 2017.

  1. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    Hi all,
    I'm after a bit of advice from people who are closed looping on the NHS. I've been using the Omnipod for four years and have recently started using a Dexcom G5 and have become increasingly interested in closed looping. I have used the HAPP app for around a month now, generally following its basal and bolus advice, and have run autotune to adjust my basal rates.

    This has resulted in rather fantastic blood sugars which I am keen to attempt to automate. I've managed to purchase two suitable pumps (one as backup) and have ordered a Rileylink from the USA to run Loop as the closed loop app.

    So my actual query! What support have others found from their consultants and nurses for closed looping? Ideally I'd like a supply of reservoirs and infusion sets made available whilst at the same time keeping the Omnipod as an option for when I potentially don't want to loop. If this isn't an option can the reservoirs and infusion sets be purchased from an online pharmacy?

    Thanks in advance
     
    • Like Like x 2
  2. Snapsy

    Snapsy Type 1 · Well-Known Member

    Messages:
    2,565
    Likes Received:
    2,753
    Trophy Points:
    198
    Hi @Steve3 I'm sure @tim2000s could well be of help to you here - perhaps he'll be along soon.

    :)
     
  3. BeccyB

    BeccyB Type 1 · Well-Known Member

    Messages:
    469
    Likes Received:
    538
    Trophy Points:
    153
    @tim2000s is definitely a good man to ask about closed looping - you will find loads of info on his blog too - http://www.diabettech.com/
     
  4. slip

    slip Type 1 · Well-Known Member

    Messages:
    3,260
    Likes Received:
    5,065
    Trophy Points:
    198
    LOl.....Steve meet Tim, Tim, Steve................!
     
  5. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    @tim2000s Thanks all, I've just received an email telling me that my Rileylink has been despatched so I'm hoping to start closed looping, once the Rileylink arrives and I am confident with the Loop settings. I have a small number of infusion sets and reservoirs which were supplied with the pumps but would like to find a European / English source of supplies I can purchase before my next consultant meeting in August. I'd love to be able to show what a change closed looping can make in the hope that the hospital will agree to supply future requirements.
     
  6. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    Hi @Steve3, nice to meet you. So here's the rub. My clinicians are happy for me to use hcl technologies, but will only support a single pump type per user due to contractual issues. So you'll need to determine hospital support for looping and then decide whether you're happy to give up on omnipod.

    If you want to buy supplies try diashop.de. They're in Germany and you can buy pump supplies yourself from Medtronic if the clinic signs off.

    Which hospital are you at?

    My only other comment is that loop's model for carb absorption is terrible and requires a ton of work to tune it. I wrote about a comparison here: http://www.diabettech.com/looping-a-guide/comparing-the-loop-and-openaps-algorithms/
     
  7. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    Hi @tim2000s many thanks for your response. I haven't checked with my clinic if they are happy with my decision to trial hcl so will purchase some supplies from Germany in the short term. My hospital is the Royal Sussex in Brighton.

    I did read your comparison (in fact I think I may have devoured most of your website!) but didn't get the impression from reading that loop was so terrible in comparison to openAPS. Are you using AndroidAPS? I am keen to trial loop and then move to Android if necessary.
     
  8. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    Thought I'd update on my progress after a week of closed looping. The Loop app is working well for me, with gradual adjustments to insulin sensitivity and carb ratios, together with running autotune to adjust basal rates. Here's my distribution chart for the past week. To compare, my HbA1c IFCC was 55 at my last clinic appointment :)
    [​IMG]
     
    • Like Like x 4
    #8 Steve3, Mar 30, 2017 at 3:56 PM
    Last edited: Mar 30, 2017
  9. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    Nice one @Steve3

    Here's my last week with closed loop and Fiasp (My low is set to 3.8 and my high to 9 for these stats). I'm using OpenAPS though as I found the Loop Carb Absorption model too painful to work with.

    Fiasp stats.JPG
     
    • Winner Winner x 2
    • Like Like x 1
  10. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    Thanks @tim2000s, that chart is helpful to see where I can go with this. As I haven't used OpenAPS I can't compare Carb Absorption models but I do appreciate that Loop is currently limited in areas. What sold it to me initially is having the required iOS hardware and the simplicity of purchasing and setting up the Rileylink (link device between Pump and iOS).
     
  11. slip

    slip Type 1 · Well-Known Member

    Messages:
    3,260
    Likes Received:
    5,065
    Trophy Points:
    198
    I know this site doesn't condone swearing so I'm not going to type it! :wideyed::woot:

    82% in target for Steve and I think his range is probably tighter then Tims 3.8-9 and Tims 94% in target just wow!

    Well done guys.

    Now when can we expect to get this sort of thing off the shelf ready to run for mere mortals not in to coding and soldering and at a reasonable cost!?!?!
     
    • Agree Agree x 3
    • Like Like x 2
    • Funny Funny x 1
  12. Engineer88

    Engineer88 Type 1 · Well-Known Member

    Messages:
    2,141
    Likes Received:
    1,446
    Trophy Points:
    198
    dear *** I cant wait to get off this trial (rock and hard place!)
     
    • Like Like x 1
  13. Julian_Hands

    Julian_Hands Type 1 · Well-Known Member

    Messages:
    69
    Likes Received:
    56
    Trophy Points:
    58
    WOW.

    I never knew this existed till I read this and have just googled RileyLink.
    Was amazed at your control ranges and I'm along way from that control on MDI.
    Problem still exists with not having the NHS support the CGM technology where I live.
     
  14. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    @Julian_Hands They don't where I live either. PAying myself.
     
    • Like Like x 1
  15. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    It's an cash investment both in CGM and a compatible pump. In time the pump selection may become easier as there is work being carried out to enable the use of Omnipods and the Accu Chek Spirit. The only 'new' pump currently running as closed loop is the Dana R.
    It's then a time investment in working on the software, assessing the results and acting upon them.

    I know a lot of work is being carried out on closed loop systems but 'off the shelf' will be limited by the need to get regulatory approval. The joy of the systems running at the moment is that they are open source and so can work to the end users' needs and requirements.
     
    • Like Like x 1
  16. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    And if I'm honest, given the work going on on the algorithms, with Fiasp I reckon we'll have bolus free APS this year via the open source route.
     
    • Like Like x 1
  17. Steve3

    Steve3 Type 1 · Member

    Messages:
    16
    Likes Received:
    9
    Trophy Points:
    43
    That's fantastic, and I believe far ahead of anything coming to market soon. I did find a mention of Bigfoot on Facebook today for an 'off the shelf' solution. It appears that they're selling a service rather than a product.
     
    • Like Like x 1
  18. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    In the UK? Not in 2017 as far as I am aware. In the US? Next month the roll out starts.

    If we're honest, you don't need to be into coding and soldering to do this anymore. Both Loop and OpenAPS have very detailed set-up guides that make life a lot easier.

    At a reasonable cost? Hummm. I think that's a long way off.... Or to put it another way, my "rig" cost a total of about £600 to put together. The commercial versions are around £3,000. And I'd have to pay for CGM in either case....
     
    • Like Like x 1
  19. Julian_Hands

    Julian_Hands Type 1 · Well-Known Member

    Messages:
    69
    Likes Received:
    56
    Trophy Points:
    58
    After reading about this last night and also exploring the great OpenAPS website, i'm assuming that this solution is only available in the UK if your using the Medtronic VEO as I cant find any detail about anyone with a 640g that has this running and the openAPS website doesn't list this pump?
     
  20. tim2000s

    tim2000s Type 1 · Expert
    Retired Moderator

    Messages:
    8,924
    Likes Received:
    11,804
    Trophy Points:
    198
    That's right. There's work underway to try and crack the 640 but it's going to require a different set-up from the current openAPS hardware rigs. Most of us have had to "source" an older pump.
     
    • Like Like x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook