These are chat archives for nightscout/intend-to-bolus

9th
Oct 2015
diabeticgonewild
@diabeticgonewild
Oct 09 2015 00:09
Weird, I just got a UPS mail packet from Animas demanding that I return my old Animas 2020 pump to them...
diabeticgonewild
@diabeticgonewild
Oct 09 2015 00:26
Also had a terrible day. Diarrhea galore courtesy of autoimmune autonomic ganglionopathy/neuropathy and tincture of opium isn't helping enough for it. Also low blood pressure problem is so bad that I am almost bedbound, so I had to take medicine to raise my blood pressure. This is very concerning, especially since I am on 3 forms of immunomodulatory treatment, and extremely frustrating. I will be lucky to be able to work on this project this weekend.
Also haven't ate in over 24 hours. Go me.
Dana Lewis
@danamlewis
Oct 09 2015 00:36
Yuck. Sounds like self care time
diabeticgonewild
@diabeticgonewild
Oct 09 2015 00:36
Yeah, true.
Thanks.
Ben West
@bewest
Oct 09 2015 00:56
hmmm
blob
I get a lot of graphs like this
probably need to reduce basal for afternoon?
openaps has been running whole time, can't do enough to back off
Scott Leibrand
@scottleibrand
Oct 09 2015 00:57
Has it been zero-temping you in the afternoon?
Ben West
@bewest
Oct 09 2015 00:59
yeah, it'll see the trend, and try untemping or zero-temping, but it's too late already
usually 0 temps me at 90-ish
maybe high 90s
guess limit is 105, so not that far off
but it's that steady down trend... I had some gummy bear to spike it back up and it happened same exact way, same exact rate again
so that graph shows twice in a row
interesting, the decline after is identical to decline before
kenstack
@kenstack
Oct 09 2015 01:21
If you look at the 640 algo it temps to zero when the predictor says you will be 20 points above your threshold in the next hour - you've got to be super aggressive with zero basals to stop anything but a very slow drop - the 640 algo I think blends 4 predictors btw - been playing with my own stuff and noticing that unless Ryan is really dropping slowly you have to be an hour out at least - which also means you end up zero basaling too often and you end up with a higher average bg ...
Ben West
@bewest
Oct 09 2015 01:21
yeah
need to layer other techniques to get aggressive with that
in this case though
I've got perfect data to say "you should lower your basal from T0 .. T1 by x%"
kenstack
@kenstack
Oct 09 2015 01:22
the mdt guys wee smart to buy that Israeli company - I think they have the best predictors - lots of heuristics
Matthias Granberry
@mgranberry
Oct 09 2015 01:24
@holgi13 can you send me the android apk? It should be pretty easy to deompile and document it.
I'm tempted to get one and start looping
kenstack
@kenstack
Oct 09 2015 01:29
So if your threshold is 80, they temp to zero when your bg is predicted to go below 100 an hour from now to achieve their results, which are pretty decent in low prevention but at the expense of average bg - which may be ok btw depending on the situation
Chris Hannemann
@channemann
Oct 09 2015 01:32
@jasoncalabrese do you know what flavor of raspbian you're running? Run uname -aand let me know the version; think it may be related to the bcm2708_usb issue, trying to collect some data.
(same for anyone else who can verify that their fix-stick script does or doesn't power-cycle their USB stack)
Ben West
@bewest
Oct 09 2015 01:36
it definitely does not on my laptop, it seems to be some "RPI" kernel module.... for some reason I can't find any documentation on that module
but the mm-stick has a usb-reset command
yeah mm-stick reset-usb most definitely resets whole usb stack
but for me does not influence stick at all
Chris Hannemann
@channemann
Oct 09 2015 01:37
on your laptop?
Ben West
@bewest
Oct 09 2015 01:37
yeah, even on my laptop... any linux computer
it doesn't rely on knowing about particular kernel module
on my laptop, it resets all the keyboard bindings because it's a usb device...
internally
Chris Hannemann
@channemann
Oct 09 2015 01:38
when you say it doesn't influence the stick, what do you mean? does it not do the same as unplugging/plugging?
Ben West
@bewest
Oct 09 2015 01:38
right, it did not restore working status to the stick
Chris Hannemann
@channemann
Oct 09 2015 01:38
weird
does it not power cycle?
Ben West
@bewest
Oct 09 2015 01:39
oh.... might have tainted that test
should try it again
Scott Leibrand
@scottleibrand
Oct 09 2015 01:47
@kenstack I think if we get basals tuned right, and know about IOB, we can generally do quite a bit better than those BG-only algorithms.
Will be interesting to see how Ben does once he gets his basal adjusted.
Chris Hannemann
@channemann
Oct 09 2015 01:48
@scottleibrand agree, a blended approach is best
Scott Leibrand
@scottleibrand
Oct 09 2015 01:50
Main thing we can't handle is exogenous drops, like from exercise.
Chris Hannemann
@channemann
Oct 09 2015 01:51
... yet ...
Dana Lewis
@danamlewis
Oct 09 2015 01:51
Depends on if you activity mode it ahead of time :)
Scott Leibrand
@scottleibrand
Oct 09 2015 01:52
Well, we don't have an OpenAPS activity mode yet... :-)
Ben West
@bewest
Oct 09 2015 01:53
the computer/openaps should be able to suggest to me that my basal should be changed
or some app should
Dana Lewis
@danamlewis
Oct 09 2015 01:54
yea, that's one of the things we were talking about pre-loop, given the retro predictions in NS, how to turn that into automated alerts/reco's for changing things
Chris Hannemann
@channemann
Oct 09 2015 01:54
we have the groundwork laid for activity mode, just haven't executed on it
Dana Lewis
@danamlewis
Oct 09 2015 01:54
we= how? I've got activity mode in #DIYPS...
Chris Hannemann
@channemann
Oct 09 2015 01:54
it's in decocare and openaps now as records for x23s, all the way through mmhistorytools
gotta do it another way, though
through dex or something
It takes advantage of the exercise marker in the x23, hence not widely useable
Dana Lewis
@danamlewis
Oct 09 2015 01:55
yea
wondering about markers from dex
also wanting to take sensor start and generate alarms 36 hours out from end of snesor
Ben West
@bewest
Oct 09 2015 01:56
maybe pebble/fitbit/calendar is enough somehow
gps confirms en route to gym... matches calendar gym schedule...
or pebble -> NS careportal
use rileylink to insert exercise marker ;-)
Chris Hannemann
@channemann
Oct 09 2015 02:00
I like the concept of it being automatic (fitbit, etc), but I wonder about its practicality at the moment. I'd like some way of indicating that I'm going to exercise, preferably enterable on something that will be one me (pump and cgm work, third interface would have to be pretty compelling)
kenstack
@kenstack
Oct 09 2015 02:00
@scottleibrand yeah it's tough - it really depends on the size of the "excursion" from normal - I see exercise drops a lot, but also post exercise rises (from non absorbed carbs taken during exercise) and post exercise drops (when he's blown through glucose stores) that are just huge - also from teenage sensitivity shifts (ugh) - on the rises the software can chase them, but on the drops Im trying some alarms where I calc what a temp basal will do and when there is no way the temp can handle it alarm and eat now - the 640h heuristics are I think just really really good - better then our simple predictors - so they have an advantage but again trade low prevention for a higher avg bg
Scott Leibrand
@scottleibrand
Oct 09 2015 02:04
Yeah. When you get the post-exercise drops, is that with or without iob?
Chris Oattes
@cjo20
Oct 09 2015 02:04
I think the best long-term solution to that is actually faster acting insulin. When a dose has it's effect spread over 4-5 hours, it's hard to catch a drop in 30 minutes time
Scott Leibrand
@scottleibrand
Oct 09 2015 02:04
How many of you have tried Afrezza?
Ben West
@bewest
Oct 09 2015 02:04
not yet, just chatted with someone who tried it instead of pump on FB
would be curious about layered/hybrid approach... just using it to cut spikes along with normal bolus/basal
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:06
Hovorka's paper that I sent you guys tells you how to account for exercise using basic calculus, based on Rate of Perceived Exertion (which closely related to heart rate), so you could use a Bluetooth enabled HR monitor.
It was published like in February.
I intend on adding that feature eventually.
Ben West
@bewest
Oct 09 2015 02:07
yeah, heart rate would be interesting to layer on as well
kenstack
@kenstack
Oct 09 2015 02:08
Without - it seems like after some hard cardio and when all the carbs he took during are absorbed his liver starts absorbing glucose and whatever basal I have on is now way too much - problem is I never really know when that happens - I can guess sometimes knowing the workout and his bg during and what and when he ate, but that's a lot of variables ...
Chris Hannemann
@channemann
Oct 09 2015 02:08
How do you account for type of activity?
Matthias Granberry
@mgranberry
Oct 09 2015 02:08
Delayed hypos 7-12h out are what I have the biggest problem with
Chris Hannemann
@channemann
Oct 09 2015 02:08
For example, I go high when I play soccer but low when I run distance
kenstack
@kenstack
Oct 09 2015 02:09
Game day versus practice is a crap shoot as well
Chris Hannemann
@channemann
Oct 09 2015 02:09
Yeah, for sure
Ben West
@bewest
Oct 09 2015 02:09
:-)
Dana Lewis
@danamlewis
Oct 09 2015 02:09
@mgranberry ditto, which is where loop is amazing
Chris Hannemann
@channemann
Oct 09 2015 02:09
Is there a "fuck it, just guess" mode that we should put into OpenAPS?
Ben West
@bewest
Oct 09 2015 02:10
like "ludicrous mode" in tesla?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:10
=losing credibility
kenstack
@kenstack
Oct 09 2015 02:10
@channemann yeah I call that default :)
Chris Hannemann
@channemann
Oct 09 2015 02:10
More like the biohazard air filtration thing in the Model X
HA!
Ben West
@bewest
Oct 09 2015 02:11
hehe
ah, we talked about idea of "cruise control" a lot last night
that seemed to connect with people
Chris Hannemann
@channemann
Oct 09 2015 02:11
yes, that was a good metaphor I feel
Ben West
@bewest
Oct 09 2015 02:11
I got that from @ianjorgensen also
self driving car vs "lane control" + "cruise control" etc
most of industry is going for segmented feature by feature approach
Dana Lewis
@danamlewis
Oct 09 2015 02:12
@scottleibrand likes the concept of driving with only gas, no breaks. speed up or slow down the insulin.
Matthias Granberry
@mgranberry
Oct 09 2015 02:12
That's a good analogy
Ben West
@bewest
Oct 09 2015 02:12
which is what regulatory/FDA types like to see
Chris Hannemann
@channemann
Oct 09 2015 02:12
yes, @danamlewis, also a very good one
Matthias Granberry
@mgranberry
Oct 09 2015 02:13
That's how cruise control works.
Chris Hannemann
@channemann
Oct 09 2015 02:13
car analogies seem to work well, what with @bewest 's favorite regarding opening the hood
Dana Lewis
@danamlewis
Oct 09 2015 02:13
FDA likes that one ;p
Chris Hannemann
@channemann
Oct 09 2015 02:13
yeah, well
Ben West
@bewest
Oct 09 2015 02:13
yeah, FDA is also using the car analogy
Chris Oattes
@cjo20
Oct 09 2015 02:13
@scottleibrand I've not seen a lot about it, but I have seen a lot of people basically 'promoting it' on forums etc.
Chris Hannemann
@channemann
Oct 09 2015 02:13
they like their version of it
@bewest did you have a chance to redo that test?
Ben West
@bewest
Oct 09 2015 02:14
no
Chris Oattes
@cjo20
Oct 09 2015 02:14
I think the mods at /r/diabetes got a lot of Afrezza spam
Ben West
@bewest
Oct 09 2015 02:14
in fact, I've had a beer and may have forgotten which test
Chris Hannemann
@channemann
Oct 09 2015 02:14
(on mm-stick reset usb)
Ben West
@bewest
Oct 09 2015 02:14
ha
Matthias Granberry
@mgranberry
Oct 09 2015 02:14
I'm excited about the glucagon-bolusing pumps too. I'd love to have brakes.
Ben West
@bewest
Oct 09 2015 02:14
no, my stick is working
Chris Hannemann
@channemann
Oct 09 2015 02:14
a beer, that may reset the stick
Ben West
@bewest
Oct 09 2015 02:14
unfortunately I'm going to wait until it breaks ;-)
Dana Lewis
@danamlewis
Oct 09 2015 02:14
Yea. Be careful if you tweet about it, be ready for the trolls (on afrezza). I'm happy to share my experience privately if anyone is interested.
Chris Oattes
@cjo20
Oct 09 2015 02:14
beer would certainly do something to it :P
Chris Hannemann
@channemann
Oct 09 2015 02:15
so you're saying your stick wasn't working, then you drank a beer, and now it's working?
Ben West
@bewest
Oct 09 2015 02:15
the person I chatted on FB said the vomitting stopped when they stopped alfrezza
Chris Hannemann
@channemann
Oct 09 2015 02:15
conclusive test! I will carry a 6-pack around to help reset my stick
Ben West
@bewest
Oct 09 2015 02:15
hahaha
it'll reset something
just add it to the low supplies
Chris Oattes
@cjo20
Oct 09 2015 02:15
I'd be interested in hearing about it, but probably best not to at 0315
Ben West
@bewest
Oct 09 2015 02:15
don't mind this... medical device...
Chris Hannemann
@channemann
Oct 09 2015 02:15
:-)
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:16
Had a blood clot in my lung, so probably not a good candidate for afrezza
Matthias Granberry
@mgranberry
Oct 09 2015 02:17
I talked to my endo about it today. She said that it seems to work for people in bad control, but if you've figured it out, it probably isn't worth it.
Ben West
@bewest
Oct 09 2015 02:17
oh wow, the person I talked to today said no way for "poor control"
the report I've heard from dana would lead me to think same thing
seems like the messaging/expecations around it are off
Matthias Granberry
@mgranberry
Oct 09 2015 02:18
The endo said "it's better than nothing. I only consider it for people that aren't interested in fine-tuning and are potentially skipping meal-time insulin. It works well for corrections, but not precise ones."
Ben West
@bewest
Oct 09 2015 02:20
right so was thinking anytime over 180, puf puf, then dial it precise with pump/basal
still bolus as usual
doesn't it act within short time?
Matthias Granberry
@mgranberry
Oct 09 2015 02:20
and I think that might work alright.
Dana Lewis
@danamlewis
Oct 09 2015 02:20
yes supposedly short time
Ben West
@bewest
Oct 09 2015 02:20
under hour?
yeah, so anytime over 180-ish, puf puf?, otherwise still bolus normal
Dana Lewis
@danamlewis
Oct 09 2015 02:21
yes
Matthias Granberry
@mgranberry
Oct 09 2015 02:21
The activity graphs look slightly quicker than humalog, but without the long tail
Dana Lewis
@danamlewis
Oct 09 2015 02:21
scott wanted me to try the other day when I had a bad pump site, but finallys tarted coming down about the time I had gotten it to room temp
I had previously only tried it for meals, because otherwise I wasn't ever that high...
Ben West
@bewest
Oct 09 2015 02:21
ah, needs to be chilled?
yeah, would be interesting...
Dana Lewis
@danamlewis
Oct 09 2015 02:22
Yea, most of it. you can have a pack out, but I hadn't used in a while so was in fridge
Ben West
@bewest
Oct 09 2015 02:22
I run into a lot of times where the pump has my attention "now" but it's not right time to do main bolus
Matthias Granberry
@mgranberry
Oct 09 2015 02:23
@bewest what do you mean by that?
Dana Lewis
@danamlewis
Oct 09 2015 02:23
?
Ben West
@bewest
Oct 09 2015 02:23
so I'm on low side
and carbs from dinner will take while due to fat/protein/alcohol/unwell
Matthias Granberry
@mgranberry
Oct 09 2015 02:23
ah, makes sense.
Ben West
@bewest
Oct 09 2015 02:23
pump has my attention at beginning of meal
but it's not really right time to bolus
Matthias Granberry
@mgranberry
Oct 09 2015 02:24
I usually do a 30-minute square bolus or something in that situation, but YDMV.
Ben West
@bewest
Oct 09 2015 02:24
maybe puf of afrezza is less hassle a bit later
Matthias Granberry
@mgranberry
Oct 09 2015 02:24
or I eat a roll.
Ben West
@bewest
Oct 09 2015 02:24
hmm might play with squares... I do lot of dual waves
Matthias Granberry
@mgranberry
Oct 09 2015 02:24
Rolls seem to power through any amount of insulin
Ben West
@bewest
Oct 09 2015 02:24
lol
Dana Lewis
@danamlewis
Oct 09 2015 02:25
(This is where I fell in love with #DIYPS for reminding me when I need my next half once I started coming up BG wise and was ready for insulin, square and dual waves were always too imprecise for me to like.)
Ben West
@bewest
Oct 09 2015 02:25
yeah, I eat the rolls etc, but then I "foget to bolus"
right, I really just want to see +2 or something
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:25
I never do square or dual waves even with severe gastroparesis. Never.
Ben West
@bewest
Oct 09 2015 02:25
and then on first one go ahead
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:25
I take Novolog too.
Ben West
@bewest
Oct 09 2015 02:26
usually I arrive after nice long walk, so I'm low and going lower still
so I just want to see it inflect before bolusing... I also want to be sure I'm going to eat all the food
lot of times I get some food and for some reason can't eat all of what expected
Matthias Granberry
@mgranberry
Oct 09 2015 02:27
@danamlewis I like my Android Wear watch for that "ok google, wake me up in 45 minutes" and then it buzzes like mad when I need to bolus
Ben West
@bewest
Oct 09 2015 02:27
haha, so ask siri to bother me?
hehe
Dana Lewis
@danamlewis
Oct 09 2015 02:27
nice @mgranberry .
Paul Andrel
@stavlor
Oct 09 2015 02:28
@danamlewis heh yeah the army of afrezza trolls on twitter can be a handful sometimes
Dana Lewis
@danamlewis
Oct 09 2015 02:30
@stavlor always from what I've seen, so I won't publicly post about what I've experienced, which is bad because then only the people who it works for perfectly are out there sharing, and the cycle continues :/
Chris Hannemann
@channemann
Oct 09 2015 02:34
Switching topics .... Infusion set question: what do people use? I'm on a 9 mm quick-set, but wondering if others have strong preferences? I've never tried anything else and wondering if I'm missing something better.
Matthias Granberry
@mgranberry
Oct 09 2015 02:35
Too many people bet too much money on a novel meal-time insulin for T2s with a needle phobia, who only go on meal-time insulin when a GLP-1 agonist and basal insulin aren't cutting it...
Ben West
@bewest
Oct 09 2015 02:35
where do you insert?
Matthias Granberry
@mgranberry
Oct 09 2015 02:35
I use a 6mm steel cannula because teflon does bad things to me.
Ben West
@bewest
Oct 09 2015 02:35
I use 6mm when I can
90 degree
Dana Lewis
@danamlewis
Oct 09 2015 02:35
@channemann used to use silhouette for (10?!) years. ick over time for me, switched to the smallest Mios and like them.
Chris Hannemann
@channemann
Oct 09 2015 02:35
mostly stomach and side
Ben West
@bewest
Oct 09 2015 02:35
currently using lower back
Chris Hannemann
@channemann
Oct 09 2015 02:36
@danamlewis is there a difference between mio and quick-set other than inserter and color?
Ben West
@bewest
Oct 09 2015 02:36
the mio's are kind of hard to plug/unplug from the site, aren't they?
quick-set and mio differ in two ways
Dana Lewis
@danamlewis
Oct 09 2015 02:36
@bewest I don't have any trouble with them. @channemann I'd have to look it up vs make up an answer for you.
cjo20 @cjo20 uses the long-tubing 6mm quickset
Ben West
@bewest
Oct 09 2015 02:36
mio has the "inserter" device built into the set casing/wrapping itself
so each mio "set" has an inserter with it
Chris Hannemann
@channemann
Oct 09 2015 02:37
right
Ben West
@bewest
Oct 09 2015 02:37
the unwrapping process for that drives me crazy
the other way is the connector to the site itself
when you unhook/hook yoursel
Dana Lewis
@danamlewis
Oct 09 2015 02:37
@bewest yes. but after years of having a separate inserter to lug with the silhouette (plus fixing my infection issues and kinks), mios definitely worth the unwrapping
Ben West
@bewest
Oct 09 2015 02:37
the quick-set squeezes and rotates
it's a round button type thing
it rotates off
Chris Hannemann
@channemann
Oct 09 2015 02:37
Yeah, I like that part
Ben West
@bewest
Oct 09 2015 02:37
the mio you squeeze and pull off
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:38
Mios, all the way
Ben West
@bewest
Oct 09 2015 02:38
it's like a lateral action
Chris Hannemann
@channemann
Oct 09 2015 02:38
I can see that on the images now
Ben West
@bewest
Oct 09 2015 02:38
and it's flat/square, not round
Chris Hannemann
@channemann
Oct 09 2015 02:38
But in terms of performance, are they essentially the same piece of kit?
Ben West
@bewest
Oct 09 2015 02:38
I find it catches on clothing and stuff more easily
yeah, same thing
the round vs square latching is different
but I use any 6mm I can get ahold of
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:39
Better packages. Easier to travel with. The mios.
Chris Hannemann
@channemann
Oct 09 2015 02:39
What's the 6 mm vs 9 mm preference?
Matthias Granberry
@mgranberry
Oct 09 2015 02:39
@channemann BD has a new set design coming to market soon that is supposed to have fewer occlusions.
Ben West
@bewest
Oct 09 2015 02:39
I don't like unwrapping/opening it
Dana Lewis
@danamlewis
Oct 09 2015 02:39
6mm. would go smaller if I could
Chris Hannemann
@channemann
Oct 09 2015 02:39
Yeah, @mgranberry, looking forward to that
Ben West
@bewest
Oct 09 2015 02:39
peeling off the needle cover and getting the tubing out is frustrating
Matthias Granberry
@mgranberry
Oct 09 2015 02:39
6mm does 3mm less damage and works just as well
Ben West
@bewest
Oct 09 2015 02:39
yeah, would love 4mm
Chris Hannemann
@channemann
Oct 09 2015 02:39
@danamlewis for comfort or performance?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:39
Aaron Kowalski says Medtronic is the distributor and it's coming out in January
Chris Hannemann
@channemann
Oct 09 2015 02:40
thanks, @diabeticgonewild
Ben West
@bewest
Oct 09 2015 02:40
I find the longer one cathers kink easier
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:40
Both Medtronic proprietary and luer lock
Dana Lewis
@danamlewis
Oct 09 2015 02:40
@channemann comfort…not a lot of body fat to deal with for sites, which is why I originally used silhouette (angle insertion)
Ben West
@bewest
Oct 09 2015 02:40
ah, I have a few "shorter" angled ones
is there a way to insert them by hand, or do you need the inserter?
Chris Hannemann
@channemann
Oct 09 2015 02:41
angle insertion seems so much more painful to me
Dana Lewis
@danamlewis
Oct 09 2015 02:41
@bewest you could do by hand, but I could never bring myself to do that.
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:41
I always inserted the silhouette by hand
Matthias Granberry
@mgranberry
Oct 09 2015 02:41
Angles sets insert just fine by hand
Ben West
@bewest
Oct 09 2015 02:41
is there a technique?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:41
You get used to the pain.
Dana Lewis
@danamlewis
Oct 09 2015 02:41
I also had a lot of site infections with silhouettes. very easy to get dirt in vs the 90degree inserted ones
Matthias Granberry
@mgranberry
Oct 09 2015 02:41
just pinch or stretch the skin and it helps to go in fast.
Ben West
@bewest
Oct 09 2015 02:41
those seem like opposite things ;-)
Matthias Granberry
@mgranberry
Oct 09 2015 02:42
they are. Depending on how fat you are you want one vs. the other. You probably want to pinch
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:42
Silhouettes leave more scar tissue
Ben West
@bewest
Oct 09 2015 02:42
maybe we can organize campaigns to lobby vendors same way we've done for FDA and congress, etc...
get people to email/call vendor to ask for xyz
Chris Hannemann
@channemann
Oct 09 2015 02:42
Think I'll give the 6 mm quick set a try on my next round of orders then, for comparison
Chris Oattes
@cjo20
Oct 09 2015 02:43
I think I've only had a couple of bad sites a year with 6mm quicksets
maybe 3 or 4
Chris Hannemann
@channemann
Oct 09 2015 02:43
@cjo20 somehow that's impressive and depressing at the same time
Matthias Granberry
@mgranberry
Oct 09 2015 02:43
I haven't noticed much scarring from the 6mm 29-gauge contact detach steel infusion sets that I use, and they are quite reliable and fairly comfortable.
Ben West
@bewest
Oct 09 2015 02:44
where do you put the sites, @mgranberry ?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:44
I get a bad site once a year at most
Chris Oattes
@cjo20
Oct 09 2015 02:44
@channemann I think I've only ever had 1 or 2 "no delivery" site failures (in 5 or 6 years of pumping) and I've always used quickset.
Matthias Granberry
@mgranberry
Oct 09 2015 02:45
Upper thigh/abdomen depending on the rotation schedule. I like to give lots of room to heal
Ben West
@bewest
Oct 09 2015 02:45
I discovered the "no delivery" "feature" will not work like 90% of the time
if your basal is only around 1U it'll basically never go off
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:45
With the BD infusion sets that are coming out, they discovered that micro kinks happen a lot
That don't set off any alarms
Chris Oattes
@cjo20
Oct 09 2015 02:45
the rest that I'd call "bad" weren't 'emergencies', I just noticed that my insulin didn't seem to be working properly
Ben West
@bewest
Oct 09 2015 02:45
right, most sites I pull out are only slightly kinked
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:45
The BD sets are the ones coming out in January
Ben West
@bewest
Oct 09 2015 02:46
took me long long time to recognize it as a kink
Chris Hannemann
@channemann
Oct 09 2015 02:46
I always thought it got mangled on the way out, but yeah, they're visible
Chris Oattes
@cjo20
Oct 09 2015 02:46
I've only had "no delivery" as the result of a bolus
Dana Lewis
@danamlewis
Oct 09 2015 02:46
@cjo20 ditto
Chris Oattes
@cjo20
Oct 09 2015 02:46
but then again, my highest basal rate is 0.95u/hr, my lowest is 0.35u/hr
Dana Lewis
@danamlewis
Oct 09 2015 02:47
@cjo20 usually when I needed/was doing a big bolus too, of course
Chris Hannemann
@channemann
Oct 09 2015 02:47
yeah, same
Ben West
@bewest
Oct 09 2015 02:47
yeah, you would never see "no delivery" basically
Matthias Granberry
@mgranberry
Oct 09 2015 02:47
@cjo20 kinks/micro-occlusions are quite common. If you see an unexplained night-time rise followed by a drop back to near where you ought to be, it's likely the cause
Chris Hannemann
@channemann
Oct 09 2015 02:48
unless it's openaps just doing what it does, @mgranberry :-)
Chris Oattes
@cjo20
Oct 09 2015 02:48
@mgranberry I think my main issue is that I have a bad habit of using the same site for 4 days, instead of 3
Matthias Granberry
@mgranberry
Oct 09 2015 02:48
and it isn't just kinking that does it. Sometimes insulin crystallization in the line can do it to after a delivery suspension etc.
@channemann or that.
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:49
I can only get infusion sets sent to me on 85 day intervals because I have Medicare. And my record already gets audited by them so I don't ask for more than 3 boxes of sets. Therefore I wear them longer than 3 days.
Request at 84 days=can't be shipped
Chris Oattes
@cjo20
Oct 09 2015 02:50
10 per box = 30 sets * 3 days = 90 days?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:50
Yeah but if they fall out sometimes you're screwed. It's hot where I live.
Chris Oattes
@cjo20
Oct 09 2015 02:51
O.o I've never had a set 'fall out'
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:51
I've had countless fall out. Plus I swim but I have been too sick to lately.
Dana Lewis
@danamlewis
Oct 09 2015 02:51
@cjo20 it's easy when you live where it's humid. Sweat = whoosh goes the site
Matthias Granberry
@mgranberry
Oct 09 2015 02:51
Do you live in TX? It happens to me.
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:51
Yep, I live in Houston.
Chris Oattes
@cjo20
Oct 09 2015 02:52
I've never managed to properly pull one out either. My tubing got caught in someones jacket while getting off the tube, and that pulled it hard enough to kink the cannula, but the sticky part was still attached
Ben West
@bewest
Oct 09 2015 02:52
never had one wrapped around a seat belt?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:52
I have pulled out several, even just changing out of my swimsuit...
Matthias Granberry
@mgranberry
Oct 09 2015 02:52
Another advantage to steel. If I'm out and it starts to come loose, I plug it back in, throw some flexfix from a cut strip in my wallet on it, and hope it doesn't get infected until I can do a more permanent fix
Chris Oattes
@cjo20
Oct 09 2015 02:52
@bewest nope
although part of the reason I use the 110cm tubing is that it gives me extra time / space to react to it being caught on something
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:53
Yeah true.
Ben West
@bewest
Oct 09 2015 02:53
lol @mgranberry "and in you go"
Matthias Granberry
@mgranberry
Oct 09 2015 02:54
@cjo20 but the doorknobs
Ben West
@bewest
Oct 09 2015 02:54
yes... it's double edged... more warning time but also extra surface area to be caught
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:54
I use 32" tubing not 40"/110 cm cause the pump will fall on the floor even though I am tall.
Ben West
@bewest
Oct 09 2015 02:54
lots of hardware at my folks house has lots of prongs off them
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:54
That can damage the pump.
Ben West
@bewest
Oct 09 2015 02:54
a fall?
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:54
The fall from dropping the pump with long tubing.
Matthias Granberry
@mgranberry
Oct 09 2015 02:54
@diabeticgonewild I never really worry about pump damage. Warranties usually cover that.
Ben West
@bewest
Oct 09 2015 02:54
it should be able to withstand being dropped quite well :-)
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:54
Not when you have a 522
Ben West
@bewest
Oct 09 2015 02:55
my 522 has survived many many many falls
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:55
I went through 7 Medtronic pumps in 3 years, 2003-2006.
Matthias Granberry
@mgranberry
Oct 09 2015 02:55
@bewest says Mr. Motor Error.
Chris Oattes
@cjo20
Oct 09 2015 02:55
@mgranberry I'm very good at stopping very quickly :P
Chris Hannemann
@channemann
Oct 09 2015 02:55
@cjo20 taken out of context, I would assume you work at an artisanal pitchfork manufacturer
Ben West
@bewest
Oct 09 2015 02:55
lol
Chris Oattes
@cjo20
Oct 09 2015 02:56
@channemann taken in context, you might think that bewest lives at one :P
Chris Hannemann
@channemann
Oct 09 2015 02:56
fact!
Ben West
@bewest
Oct 09 2015 02:56
lol
motor errors are after years of having garbage shoved in it's serial port and many many drops ;)
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:57
I was sick of my Medtronic pump and I was relieved to change brands. Plus I had a near DKA incident skiing cause their shitty BD meter does not operate below 59 Fahrenheit and it would even warm up indoors.
Ben West
@bewest
Oct 09 2015 02:57
I did start minding it a littlemore carefully after I realized leaning against sink/edge of things was damaging pump display
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:57
  • would not
Chris Oattes
@cjo20
Oct 09 2015 02:58
with my tubing, I let it dangle. There isn't that much at thigh-height to get it caught on that the shorter tubing wouldn't catch, and if you tuck the tubing in, it'll get tangled in your pocket etc. and then if a short loop gets caught on a handle, it will start pulling sites out
Ben West
@bewest
Oct 09 2015 02:58
yeah
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:58
I always keep my pump in my pocket. It's nobody's business but my own.
I don't care who knows about / sees my pump. That's where it is most convenient for me
diabeticgonewild
@diabeticgonewild
Oct 09 2015 02:59
Yeah...
Matthias Granberry
@mgranberry
Oct 09 2015 02:59
@cjo20 adhesive never worked well enough for me. I used to go with 40" tubing so it would bang against the ground and not rip out if I drop it after a shower.
Chris Oattes
@cjo20
Oct 09 2015 03:00
I found the shorter tubing was too short to put anywhere when I was getting changed / dressed, so I had to juggle the pump with clothing :P
Ben West
@bewest
Oct 09 2015 03:00
yeah, that's the trick
extra surface area vs having to juggle
you wear pump in the shower?
Dana Lewis
@danamlewis
Oct 09 2015 03:01
At least ya'll have boy pockets…
Chris Oattes
@cjo20
Oct 09 2015 03:01
as I said, Ithink the shorter tubing gets caught on just as much, it just gives you less time to react :P
Ben West
@bewest
Oct 09 2015 03:01
yeah, with dresses etc... dunno, specially with the quality of the clips
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:01
If you are female...TMI...but you need to have long enough tubing to use the restroom. Hahahaha!
Chris Oattes
@cjo20
Oct 09 2015 03:02
@danamlewis yeah, I can fit my rpi + carelink + battery in the pocket at the very bottom of that picture
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:02
Sorry for the craziness
Matthias Granberry
@mgranberry
Oct 09 2015 03:02
nah, but I used to connect it first thing after. I figure women are going to be the first big market for a phone-controlled pump.
Dana Lewis
@danamlewis
Oct 09 2015 03:02
@cjo20 jealous, as always. @bewest I bust a clip about once a year or so, but surprisingly not bad otherwise
Chris Hannemann
@channemann
Oct 09 2015 03:02
I also use the clip
Chris Oattes
@cjo20
Oct 09 2015 03:02
eugh, the medtronic plastic pump clips are terrible. I break several a year
Chris Hannemann
@channemann
Oct 09 2015 03:02
Don't like it in my pocket
But yeah, new clip once a year is standard
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:03
I mean the FlipBelt is good enough...
Chris Oattes
@cjo20
Oct 09 2015 03:03
usually I'll misjudge sitting down, and the pump will hit the arm of the chair, and then I need to get a new clip :P
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:03
Plus if you get a minimalistic case (search lasergoodies on Amazon) you're good
Ben West
@bewest
Oct 09 2015 03:03
yeah, although the last one literally disintegrated in my hands while latching it on/off my pants
Matthias Granberry
@mgranberry
Oct 09 2015 03:04
The t:slim fits great in the coin pocket of jeans. Best feature ever.
Ben West
@bewest
Oct 09 2015 03:04
I like the slim sports one they have
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:04
Diabetes hazards are awkward
Chris Oattes
@cjo20
Oct 09 2015 03:04
they need to make them so that the clip part comes away from the case when there is a significant amount of force, so that it can just be clipped back on
I mean if there is enough force to snap the plastic in the current design
Chris Oattes
@cjo20
Oct 09 2015 03:11
eugh, after 4am. Need to at least attempt sleep. Night.
diabeticgonewild
@diabeticgonewild
Oct 09 2015 03:11
Night.
kenstack
@kenstack
Oct 09 2015 03:17
Have to say the mios are working great here - almost fool proof for about a month - order of magnitude fewer issues then we were having with silhouettes and kinks etc
Chris Hannemann
@channemann
Oct 09 2015 03:18
@kenstack did you try the quick-sets?
Dana Lewis
@danamlewis
Oct 09 2015 03:19
@kenstack :)
kenstack
@kenstack
Oct 09 2015 03:27
@channemann used them for years but struggled as he got older with what I think was tunneling - then switched to silhouettes - been horrible - now on mios - not sure if there is much difference between the quick sets and mios but so far rock solid
Chris Hannemann
@channemann
Oct 09 2015 03:29
Good to hear
Pete Schwamb
@ps2
Oct 09 2015 03:45
Maybe this is how all tubing is (I’ve only used mios), but if you take the tubing apart, you’ll see there is actually a ridged insert running the lenght of the tubing, providing protection against kinking. I thought that was really cool, as it’s not obvious from looking at it externally.
Jason Calabrese
@jasoncalabrese
Oct 09 2015 04:23
@channemann my pi:
$ uname -a
Linux raspberrypi 4.1.7-v7+ #817 SMP PREEMPT Sat Sep 19 15:32:00 BST 2015 armv7l GNU/Linux
eszcloud
@eszcloud
Oct 09 2015 04:24
I'm a fan of the 6 mm mio. The built in inserter means one less thing to forget.
Jason Calabrese
@jasoncalabrese
Oct 09 2015 06:17

thanks @bewest with the new --extra option I don't need an private repo anymore

GITHUB REFUND RECEIPT - October 09, 2015 06:15

User: jasoncalabrese
Refund: USD $4.67*

Scott Leibrand
@scottleibrand
Oct 09 2015 06:22
Heh
Jason Calabrese
@jasoncalabrese
Oct 09 2015 06:40
Screen Shot 2015-10-08 at 11.39.59 PM.png
auto pushing from the loop really effects my github stats
going to shoot up really fast
Ben West
@bewest
Oct 09 2015 07:08
'-nk
Matthias Granberry
@mgranberry
Oct 09 2015 13:20
@jasoncalabrese lol. Ancillary benefits.
@bewest So I was thinking about the open-source pump development thing. It sounds like something that might be able to get some Helmsley money behind it. Especially if it automatically uploaded data to nightscout/tidepool/diasend/whatnot and generated weekly summaries. Given the low percentage of people who actually review pump/cgm data and the value that reviewing it provides, making that part easier even without an APS development aspect would benefit people quite a lot.
Chris Oattes
@cjo20
Oct 09 2015 14:27
developing pump hardware seems like it's asking for trouble
timomer
@timomer
Oct 09 2015 15:35
This message was deleted
"open-source pump development" - I am very much in favour of this (fyi I am not up to date on this convo )
Pete Schwamb
@ps2
Oct 09 2015 15:41
I think it’s an interesting idea. In the same way that security can be improved with more eyes on it, I’d guess there would be benefits to implementing and documenting a piece of hardware with stringent safety requirements in the open.
I’m wondering if the design of the motor progression feedback mechanism on the omnipod would’ve stood up to any amount of outside scrutiny.
JamOrHam
@jamorham
Oct 09 2015 15:44
Wouldn't it make more sense to approach existing pump manufacturers with the objective of having a secure open standard interface which could be used for this type of research.
Matthias Granberry
@mgranberry
Oct 09 2015 15:45
I don't think the manufacturers really want it.
Pete Schwamb
@ps2
Oct 09 2015 15:45
I’d view that not as a contrary approach, but a complementary approach to open design.
JamOrHam
@jamorham
Oct 09 2015 15:46
@mgranberry Probably not in EU and USA but I wonder about Asian manufacturers perhaps.
Matthias Granberry
@mgranberry
Oct 09 2015 15:48
you're right. Shenzen would be all over something like that.
it could really advance the state of the art for knockoffs.
JamOrHam
@jamorham
Oct 09 2015 15:49
Also I had heard of CellNovo having cloud system and I remember reading about a Korean pump which I thought was bluetooth enabled. I don't know much about either pump manufacturer though.
Chris Oattes
@cjo20
Oct 09 2015 15:49
i doubt it. If any part of the pump is manufactured in china, they'll have access to the actual pumps anyway
the problem with pump development is that it will take far more time/effort/money than software development will. And the cost of "failure" is so incredibly high
Matthias Granberry
@mgranberry
Oct 09 2015 15:51
@jamorham The Korean Sooil Dana Diabecare R is bluetooth-controllable.
Chris Oattes
@cjo20
Oct 09 2015 15:52
and as soon as someone decides to make their own, screws it up and then it empties a reservoir into them because a cat looked at the pump in the wrong way, the project is completely dead
JamOrHam
@jamorham
Oct 09 2015 15:52
@mgranberry thats the one
LadyViktoria
@LadyViktoria
Oct 09 2015 15:52
here is a german article about a research team which uses a freestyl navigator the dana r and a smartfon to bulid a closed loop ;)
Dana Lewis
@danamlewis
Oct 09 2015 15:55
::pines for my freestyle navigator:: (although the G4 is probably better, navigator was the equivalent of where the G4 is over Medtronic from 10 years ago)
Pete Schwamb
@ps2
Oct 09 2015 15:55
@cjo20 then it just needs builtin cat-glance protection features. ;)
Chris Oattes
@cjo20
Oct 09 2015 15:57
actually making hardware that is fault tolerant, and testing it to make sure that it was assembled correctly, and mkaing sure it is resilliant to most common radio emissions is hard
JamOrHam
@jamorham
Oct 09 2015 15:57
@LadyViktoria nice one, I have no idea how open the bluetooth standard might be on that pump. I'm really just advocating getting an interested pump manufacturer involved in opening up the control so their pump can be used in closed loop research without having to reinvent the wheel with each brand of pump.
Pete Schwamb
@ps2
Oct 09 2015 15:57
@cjo20 yes, most certainly
Chris Oattes
@cjo20
Oct 09 2015 15:57
and expensive
JamOrHam
@jamorham
Oct 09 2015 15:59
@cjo20 any attempt at manufacturing a pump seems insane considering the absolute precision that I assume must be required.
timomer
@timomer
Oct 09 2015 15:59
@cjo20 true, but that can be said about any project
Chris Oattes
@cjo20
Oct 09 2015 15:59
timomer: I disagree
there are plenty of projects that don't have the same requirements for correctness that an insulin pump has
timomer
@timomer
Oct 09 2015 16:00
the piston in the pump I would imagine is a common part that can be purchased
LadyViktoria
@LadyViktoria
Oct 09 2015 16:00
@jamorham the pump has an android app too it is called anydana
Chris Oattes
@cjo20
Oct 09 2015 16:00
you still have to drive the piston correctly
JamOrHam
@jamorham
Oct 09 2015 16:01
@LadyViktoria let's ask them for a tasker plugin for it :)
timomer
@timomer
Oct 09 2015 16:01
@cjo20 correct, but there are still some projects with that requirement - ie: openaps
Chris Oattes
@cjo20
Oct 09 2015 16:01
timomer: not to the same extent, using an off-the-shelf pump takes some of the risk out of the system, because you can put delivery limits in the pump, like maximum bolus and maximum basal rate
LadyViktoria
@LadyViktoria
Oct 09 2015 16:02
@jamorham i think the big problem on that pump is that special 1/2aa battery which has + and - on the top. and the fact that the battry runs out f power very fast if you connect bluetooth every 5 min
Chris Oattes
@cjo20
Oct 09 2015 16:02
using a homebrew pump you don't have those safety nets
timomer
@timomer
Oct 09 2015 16:02
but if my cat looks at wrongly,,,
:)
agree and disagree with you
Pete Schwamb
@ps2
Oct 09 2015 16:03
@jamorham the precision required by the motor is not very high, and well within the limits of even cheap motors. You’d obviously want to use reliable, accurate motors, but the required limit isn’t extreme at all.
Matthias Granberry
@mgranberry
Oct 09 2015 16:03
@LadyViktoria It looked like a fairly standard shape/size except for the contacts. I'd just make a shim to run the contacts where they need to be.
Chris Oattes
@cjo20
Oct 09 2015 16:03
pumps from medtronic etc. will have undergone far more testing / validation than an opensource project could hope to carry out
timomer
@timomer
Oct 09 2015 16:03
building a open-source pump is a great idea, but does not mean you avoid the testing process and use cheap parts
there are education institutions also interested in a open source pump - it came up in a recent conversation I had
Chris Oattes
@cjo20
Oct 09 2015 16:04
timomer: how much does it cost to rent a faraday cage to test how the pump responds to EM radiation?
for each version of the pump hardware
Pete Schwamb
@ps2
Oct 09 2015 16:04
I would want to have a pump that gave me even more feedback about how well or poorly it was working than the medtronic ones do.
Matthias Granberry
@mgranberry
Oct 09 2015 16:04
@cjo20 It isn't something that I think should be done w/o testing. I just think it could be done with a grant from a charitable organization if it looks like there is a business model to keep the organization going.
timomer
@timomer
Oct 09 2015 16:05
sure, I do not have answers to this - but, I would not dismiss the project
/ idea
Matthias Granberry
@mgranberry
Oct 09 2015 16:05
@cjo20 ~3-10k depending on what you want tested
Chris Oattes
@cjo20
Oct 09 2015 16:06
I'm not dismissing the project, I just think without actually being set up as a proper company (for liability reasons) and actually going as far as getting it properly certified, something will go wrong and it will have serious consequences
Pete Schwamb
@ps2
Oct 09 2015 16:06
Medtronic’s pump has to be crude enough to have a hard line for ‘non-delivery’ vs ok. But in reality, with a good feedback system, you’d have a much richer idea of how well infusion was going.
omnipod doesn’t even detect non-delivery very well at all.
Matthias Granberry
@mgranberry
Oct 09 2015 16:07
@cjo20 which is why I think it's important to have a proper company. And it's a big task that would take a bit of full-time work.
Chris Oattes
@cjo20
Oct 09 2015 16:07
more than a bit
JamOrHam
@jamorham
Oct 09 2015 16:08
@mgranberry and a LOT of money imho and I think there are easier ways to achieve the same goals
timomer
@timomer
Oct 09 2015 16:08
I know someone who has produces a piston delivery system for medical use - ill get more info...
Chris Oattes
@cjo20
Oct 09 2015 16:08
to be clear, an open-source pump is so much more than a piston hooked up to an arduino
timomer
@timomer
Oct 09 2015 16:09
true, but the project may have some useful info
JamOrHam
@jamorham
Oct 09 2015 16:09
@cjo20 In my head I am imagining a lego mindstorm robot with an insulin pen chasing after me
dinner time here
Matthias Granberry
@mgranberry
Oct 09 2015 16:09
@cjo20 clearly, but there are electronic insulin pens that are manufactured for a reasonable amount of money. The mechanics are not wildly different.
Chris Oattes
@cjo20
Oct 09 2015 16:10
there is a vast difference between having a piston wired in to a uC giving mostly correct doses when being issued with carefully crafted commands when it is sitting on your desk and something you can actually use as a pump
Pete Schwamb
@ps2
Oct 09 2015 16:10
@cjo20 when you talk about external RF affecting pump behavior, are you talking effecting the digitial signalling part of the circuitry, or motor control electronics?
Chris Oattes
@cjo20
Oct 09 2015 16:12
@ps2 any of it
timomer
@timomer
Oct 09 2015 16:13
just to be clear, I never said that the system should use a piston, just that I know someone who has built such a system and the info they may have maybe interesting
Chris Oattes
@cjo20
Oct 09 2015 16:15
@timomer piston, lego robot with an insulin pen, a Portal turret firing insulin-filled darts, it doesn't really matter what the delivery mechanism is. The point was that getting $delivery_system functional doesn't mean you've got an open source pump that is suitable for usage
Paul Andrel
@stavlor
Oct 09 2015 16:16
lol
Toby Canning
@TC2013
Oct 09 2015 16:16
Sure it does, that'd be awesome!
Paul Andrel
@stavlor
Oct 09 2015 16:17
@cjo20 Great that image will be stuck in my head the rest of the day lol
timomer
@timomer
Oct 09 2015 16:17
ha
well, this piston based system is being used and passed all the required tests for medical use, ill get details and share
Matthias Granberry
@mgranberry
Oct 09 2015 16:18
It's a shame I'm at work. I have a mindstorms scorpion robot build and ready to go at home...
Toby Canning
@TC2013
Oct 09 2015 16:18
I think this is too ambitious of a project to take on with out some dedicated full-time people
Matthias Granberry
@mgranberry
Oct 09 2015 16:19
I don't think it should be without full-time people. But I suspect there is some money lying around for such a project.
Toby Canning
@TC2013
Oct 09 2015 16:19
Not that it shouldn't be tried ;)
If the community is able to come up with a robust delivery "detection" system that @ps2 described, I'd be very interested
Matthias Granberry
@mgranberry
Oct 09 2015 16:22
PCB design/layout is going to require someone with professional experience to get the RF/static electricity protection down for a consumer device, drop/mechanical testing is going to be an issue, but developing an infusion pump isn't rocket science. Simple, isolated safety systems work best, so I would isolate the motor controller from the rest of the system and require multiple ICs to agree on state to deliver insulin. That solves some of the corrupt state issues.
and prevents the squirt-all-the-things parade of horribles
Chris Oattes
@cjo20
Oct 09 2015 16:23
yes, it is possible to design an insulin pump with safety features. Hence the fact that we have insulin pumps
the practicalities of going through that process as an open source community...
Toby Canning
@TC2013
Oct 09 2015 16:24
Even Medtronic safeties have failed and killed people
Chris Oattes
@cjo20
Oct 09 2015 16:25
however, they are a proper company, with liability protection and $28 billion in revenue to spend
Toby Canning
@TC2013
Oct 09 2015 16:25
agreed
I was meaning to support your earlier argument with my comment
Chris Oattes
@cjo20
Oct 09 2015 16:26
:)
Matthias Granberry
@mgranberry
Oct 09 2015 16:29
and the only insulin pump manufacturer that is actually turning a profit on their devices and they have locked down access as tightly as possible. I see this is a market with great potential for disruption. But it will take more money than a kickstarter project benefiting the early adopters among 0.25% of the population. Which is why I said It sounds like something that might be able to get some Helmsley money behind it.
I don't think it's something that should be done without some bigger cash reserves than the nightscout foundation has, but it might be possible in the $1-4M range, which isn't too far from what the HCT has done for other APS work or even CGM-pump-integration
Toby Canning
@TC2013
Oct 09 2015 16:30
HCT?
Matthias Granberry
@mgranberry
Oct 09 2015 16:30
Helmsley Charitable Trust
Toby Canning
@TC2013
Oct 09 2015 16:31
I'll go look it up.
It is too bad NS couldn't have bought Snap, instead of Big Foot
Matthias Granberry
@mgranberry
Oct 09 2015 16:32
Leona Helmsley left billions of money that is being controlled by a man with a T1 daughter. They have to spend 5% per annum, which comes out to 200+ million. Mostly on diabetes devices and things they think will have immediate quality of life/care benefits.
Matthias Granberry
@mgranberry
Oct 09 2015 16:38
http://helmsleytrust.org/our-grants FY 2015 shows $85m to T1D so far. I don't think it's impossible to make it happen, but it will take a real business case etc. I think the real opportunity might be to make care more affordable/safe in Asia and the third world as the CGM/APS market matures by having an open base platform.
It wouldn't shock me if Google was willing to talk too.
Some services around getting a device built upon the platform through the regional approval processes etc and firmware maintenance, app integration, etc might be a place to extract enough money to make a foundation sustainable
Matthias Granberry
@mgranberry
Oct 09 2015 16:45
As the situation currently stands the biggest difference between MDI and a pump for most users is that they don't have to worry about markings wearing off on syringes when they throw them in a pocket and doctors might have more data to look at because only 10% of users do. And it's a whole lot more expensive. That needs to change.
Lori
@LoriLori
Oct 09 2015 17:07
This message was deleted
This message was deleted
Ben West
@bewest
Oct 09 2015 17:29
wow
Chris Oattes
@cjo20
Oct 09 2015 17:30
what are you wow-ing at?
Ben West
@bewest
Oct 09 2015 17:32
blob
Chris Oattes
@cjo20
Oct 09 2015 17:33
that's some rollercoaster
Ben West
@bewest
Oct 09 2015 17:34
so last night I lost my dinner
actually some stomach problem or something
went to 40 immediately after dinner
Chris Oattes
@cjo20
Oct 09 2015 17:34
:/ you ok now?
Ben West
@bewest
Oct 09 2015 17:34
hung in there for awhile
threw up, lost entire meal at 3am
took a handful of gummy bears and went to sleep
this is the cool part though
openaps brought me back to ~120
woke up at 106
cause I just had to throw back gummy's... nothing was absorbing properly
and it was 3am... so ... sleep
that shot me up to 250+, but openaps brought me back down very nicely
that's cool
Scott Leibrand
@scottleibrand
Oct 09 2015 17:36
nice
Matthias Granberry
@mgranberry
Oct 09 2015 18:25
That's pretty rough. I feel like I've been constantly sick the last year or so since putting my daughter in daycare. It would be nice to have some assistance.
it's nights like those that make me want glucagon micro-dosing. Sometimes food just doesn't cut it.
Matthias Granberry
@mgranberry
Oct 09 2015 19:11
@scottleibrand @danamlewis is there an annotated view of the Pebble watch face for DIYPS somewhere? I'm curious what all the numbers are.
Dana Lewis
@danamlewis
Oct 09 2015 19:11
Heh, no, but I can make one
Scott Leibrand
@scottleibrand
Oct 09 2015 19:17
there is also an openaps watch face, whose data is generated by pebble.sh, if you want to walk through that
Matthias Granberry
@mgranberry
Oct 09 2015 19:21
@scottleibrand Thanks. It looks to be pretty clear.
Dana Lewis
@danamlewis
Oct 09 2015 19:29
@mgranberry And here's a markup of the #DIYPS one. https://twitter.com/danamlewis/status/652566409537433600
@scottleibrand is annoyed because there's 0 iob and 0 carbs and the predictions are all 103, but that's what my BG is currently and it was easier than digging up a picture with lots of stuff happening to mark up.
Will be more interesting after I eat lunch
Scott Leibrand
@scottleibrand
Oct 09 2015 19:33
heh
not at all annoyed. just might be interesting to show what actually happens when IOB is non-zero. :)
Matthias Granberry
@mgranberry
Oct 09 2015 19:35
That's a pretty information-dense display there. I wonder if some analog bars would end up being integrated better by the brain.
I guess it's probably easy enough to read once you're used to it.
Dana Lewis
@danamlewis
Oct 09 2015 19:36
Totally customizable. I like the number view as it's subtle. Anyone who sees my watch can't tell its BG data, and I can easily interpret
Yup
Matthias Granberry
@mgranberry
Oct 09 2015 19:40
Yep. I was thinking about knocking off the enigma watch face with BG above and raw and/or iob down below. The error bands are large enough that I'm comfortable with a trendline+instantaneous with a rate indicator somewhere. If the G5 ditches raw that's unfortunate because a 3-point raw average delta gives a very good indicator of how quickly BG is rising.
I like it better than the difference-from-previous number
Dana Lewis
@danamlewis
Oct 09 2015 19:42
Delta was huge for me, especially since the receiver is so hard to see what it was.
Matthias Granberry
@mgranberry
Oct 09 2015 19:44
Have you compared it to a smarter trend arrow? I suspect an indicator more like an aircraft rate of climb indicator would be more useful than just the delta, but I've never bothered to make one. I find that the delta is often dominated by noise, especially if I have a noisy box of sensors.
Ben West
@bewest
Oct 09 2015 19:44
really want to post this somewher
blob
shows what openaps does well and what it does not, simultaneously
Dana Lewis
@danamlewis
Oct 09 2015 19:46
@mgranberry Haven't done so myself, mostly because I always want to see the #s versus the arrow. (Why I have the previous BGs at the bottom, for more context after I look at current, delta, and predicted)
Matthias Granberry
@mgranberry
Oct 09 2015 19:46
it also shows what a pain in the ass this "invisible" disease is, even with "future technology"
Dana Lewis
@danamlewis
Oct 09 2015 19:46
+1
Still have diabetes
Ben West
@bewest
Oct 09 2015 19:46
any reason I shouldn't post it to twitter?
Dana Lewis
@danamlewis
Oct 09 2015 19:46
even with an APS or any kind of diabetes tech. still diabetes.
@bewest no, think it's a great idea
Dana Lewis
@danamlewis
Oct 09 2015 19:49
Nice. I love context :)
Ben West
@bewest
Oct 09 2015 19:49
yeah, lot of information in this one
openaps was temp basaling me zero
but if you've fundamentally got too much insulin, that's a problem
and that's not "diabetes" that's a side effect of bad therapy, etc...
Dana Lewis
@danamlewis
Oct 09 2015 19:50
Yep. Most of the lows I've seen after bed with openaps is going to bed with too much IOB.
it can't completely fix human choices, although it can help somewhat blunt impact
Ben West
@bewest
Oct 09 2015 19:51
so that's a different kind of problem... different kind of solution
what this does remarkably well is regulating you back into zone when it can...
I would have woken up near DKA
instead I woke up feeling much much better than I had expected
Dana Lewis
@danamlewis
Oct 09 2015 19:51
that is so awesome
Ben West
@bewest
Oct 09 2015 19:51
there's a pretty visceral difference waking up at 100 vs waking up 300
Matthias Granberry
@mgranberry
Oct 09 2015 19:52
@bewest when you say "bad therapy" you mean inadequate insulin speed etc with subcutaneous delivery?
Ben West
@bewest
Oct 09 2015 19:52
yes... going low is not part of diabetes
I hate it when people say "that's diabetes"
Dana Lewis
@danamlewis
Oct 09 2015 19:52
Honestly, even there's a difference between 120 and 150-180, once you get used to riding <120 all night.
But for sure 300 to 100, and esp w/ you being that sick too
Ben West
@bewest
Oct 09 2015 19:52
if you got perfect amount of insulin you'd never go low
Matthias Granberry
@mgranberry
Oct 09 2015 19:52
Right. But "that's subcu insulin delivery" doesn't have the same ring.
Ben West
@bewest
Oct 09 2015 19:52
insulin is an intervention
so it's only an incorrect intervention that yields los
this is why drs have people ride high... avoid hypo/death/liability
Matthias Granberry
@mgranberry
Oct 09 2015 19:54
right. It drives me crazy that there are several ways of speeding up insulin delivery and they aren't being promoted. I think part of it is that we're such a small market vs. T2s and automated insulin delivery isn't on the market yet.
BD's micro-needle array delivery mechanism sounds promising. By delivering insulin directly into skin the peak is 15 minutes out with 1-2h DIA
too short for manual control, but close to being enough for automatic control
Dana Lewis
@danamlewis
Oct 09 2015 19:56
that will be a game changer (peak 15 vs 60-90)
we do a pretty amazing job with openaps and peak 60-90. peak 15 will be crazy awesome to blunt rises from meals
Ben West
@bewest
Oct 09 2015 19:57
feels like cheating almost
JamOrHam
@jamorham
Oct 09 2015 19:59
@bewest very informative graph, well worth posting
Dana Lewis
@danamlewis
Oct 09 2015 19:59
@mgranberry here's more interesting numbers now for better context (https://twitter.com/danamlewis/status/652574130395418624)
Matthias Granberry
@mgranberry
Oct 09 2015 20:01
It would still be slower than a "real" pancreas because of the 5-9-minute delay from interstitial fluid, but it would be good enough that you would be better off than now on an "eat and don't worry" plan.
Thanks for the pics. I think that's most of the useful information.
Peter Miller
@ochenmiller
Oct 09 2015 20:12
Among many other fun projects, I'll be working on making "Hank" (hank the pank!) portable this weekend. Have a 10000mah 5V battery. Will use a UART connected wixel to pull glucose data. Need to devise a good method to disable wifi when I don't need it. Any other sage advice from those who've already "taken the show on the road"?
Dana Lewis
@danamlewis
Oct 09 2015 20:12
woo!
Matthias Granberry
@mgranberry
Oct 09 2015 20:12
Would a tape "pull tab" to yank the dongle work? :)
Peter Miller
@ochenmiller
Oct 09 2015 20:13
I like it! Simple is good.
Dana Lewis
@danamlewis
Oct 09 2015 20:13
Or you just turn off your hotspot?
Holger Sanft
@holgi13
Oct 09 2015 20:15
@mgranberry email with app is on the way :+1:
Holger Sanft
@holgi13
Oct 09 2015 20:23
Unbenannt-2.jpg
@scottleibrand last night looping perfect ...
Unbenannt-2.jpg
Dana Lewis
@danamlewis
Oct 09 2015 20:24
@holgi13 excellent
Holger Sanft
@holgi13
Oct 09 2015 20:25
red dots = pump stop ; blue dots = aps insulin
Dana Lewis
@danamlewis
Oct 09 2015 20:25
pump stop as in zero temp, or also includes lower temp?
Holger Sanft
@holgi13
Oct 09 2015 20:25
zero temp
Matthias Granberry
@mgranberry
Oct 09 2015 20:30
@holgi13 it looks like they obfuscated it, but there's still paydirt. https://gist.github.com/mgranberry/20a8e1e6ed7c16524ff3
Ben West
@bewest
Oct 09 2015 20:31
lol, "hank the pank"
Matthias Granberry
@mgranberry
Oct 09 2015 20:32
I wonder what the story behind CMD_MSGSEND_CALL_TO_ME_MOM is
Ben West
@bewest
Oct 09 2015 20:33
so I'm starting to head down my afternoon descent again
if I set a 4 hour temp basal to experiment with a new basal, will openaps still nudge that or go hands off
if I do it now, it should be enough to alleviate the excessive insulin pressure later in afternoon
3 hours from now
Dana Lewis
@danamlewis
Oct 09 2015 20:35
if you set a 4hr temp, and openaps is on and needs to set a temp, it'll cancel and set the new one for 30
otherwise, use a pattern if you want to drastically change your base for the day
Ben West
@bewest
Oct 09 2015 20:35
yeah, need to swap patterns
need a tool to program patterns ;-)
copy pattern A to pattern B
modify pattern B
switch to pattern B
Dana Lewis
@danamlewis
Oct 09 2015 20:35
OH MY GOD YES. Tuesdays switch to b, thursdays to a, saturday/sun back to standard.
Ben West
@bewest
Oct 09 2015 20:36
yeah
I mean the technology is there..
fidelity is low
Pete Schwamb
@ps2
Oct 09 2015 20:36
gymnastics days need low basal at night. :)
Lori
@LoriLori
Oct 09 2015 20:36
can't programsa basals with carelink?
Ben West
@bewest
Oct 09 2015 20:36
patterns done well with being able to modify from great UI and with openaps could create high fidelity therapy
Lori
@LoriLori
Oct 09 2015 20:36
a little script to swith on each day?
Ben West
@bewest
Oct 09 2015 20:36
you can with carelink
and MM22's :-)
not exactly sure how, but found several hints
Lori
@LoriLori
Oct 09 2015 20:37
or phone and dana :)
Matthias Granberry
@mgranberry
Oct 09 2015 20:37
cron+script
Dana Lewis
@danamlewis
Oct 09 2015 20:37
@LorelaiL you mean DanaR? the pump?
confusing for me ;)
Lori
@LoriLori
Oct 09 2015 20:37
sory :)
Peter Miller
@ochenmiller
Oct 09 2015 20:37
I can't take any credit for "hank the pank". All out of the - wonderfully demented - mind of my 16 year old T1 son.
Matthias Granberry
@mgranberry
Oct 09 2015 20:37
Has anyone documented the Dana R protocol?
Lori
@LoriLori
Oct 09 2015 20:38
not documented, but have something working
Matthias Granberry
@mgranberry
Oct 09 2015 20:39
Is there a URL? I'm trying to decide if it's worth ordering one and searching for a suitable source of replacement batteries
Lori
@LoriLori
Oct 09 2015 20:39
anyway it is surprising pumps have multilple basal options, but not copy 1 to 2
Matthias Granberry
@mgranberry
Oct 09 2015 20:40
the t:slim has pretty good support for coping profiles
they got a lot right and a few things terribly, terribly wrong
Lori
@LoriLori
Oct 09 2015 20:40
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Matthias Granberry
@mgranberry
Oct 09 2015 20:41
ah, the desktop tool?
Lori
@LoriLori
Oct 09 2015 20:42
yes, link sent
Peter Miller
@ochenmiller
Oct 09 2015 20:43
@mgranberry agree with your observation about t:slim. Sooooo close in so many ways. And yet we inadvertently programmed a bolus of 16U rather than 1.6U a few weeks back. Sometimes the keypad is not your friend. After that we set the max bolus to 9U.
Ben West
@bewest
Oct 09 2015 20:53
MM512/ CMD_SET_STD_PROFILE 111 0x6f 111 ??
most commands use a parameter payload format that is similar to whatever shows up in the history records...
in this case it's confusing because it's a large, but variable payload
also, the payload in the history records is double the size, it's a "changed" record with both the old and the new values...
and I haven't completely understood all the bytes in the payload, either....
but, I've been analyzing an app with @ps2 that used to actually use these commands ;-)
Matthias Granberry
@mgranberry
Oct 09 2015 20:58
How are the new pumps secured? AES crypto or somesuch?
Ben West
@bewest
Oct 09 2015 20:58
oh, new pumps, have no idea
the general pattern seems to be to customize their vendor's toolchain enough to be custom/proprietary and then use that
Matthias Granberry
@mgranberry
Oct 09 2015 20:59
I'm just surprised that I haven't really heard anything about an attempt to RE them beyond "they're secure"
Ben West
@bewest
Oct 09 2015 20:59
it's part of their "security" claim... the fact that no one knows how to operate it
so they are saying it's necessary for security to keep documentation out of public/patient hands
Matthias Granberry
@mgranberry
Oct 09 2015 21:00
but that sounds like a dare. :) It seems like it should be even more likely that people would talk about it.
Ben West
@bewest
Oct 09 2015 21:01
welcome to 2015 :-)
Paul Andrel
@stavlor
Oct 09 2015 21:01
Security through obfuscation are we going back in time again lol
Matthias Granberry
@mgranberry
Oct 09 2015 21:02
it's better than security through security when I want to get the keys.
Ben West
@bewest
Oct 09 2015 21:02
it should be completely secure to the point where I can revoke the vendor's access
we actually did that at meraki
customers could disable our access if they wanted to
should be completely secure with us in control
Matthias Granberry
@mgranberry
Oct 09 2015 21:03
They'd never allow that. The data now appears to be worth something.
Paul Andrel
@stavlor
Oct 09 2015 21:04
in a perfect world but whos willing to call MedT Perfect
Ben West
@bewest
Oct 09 2015 21:04
I'm actually more worried about dexcom than medtronic
Dana Lewis
@danamlewis
Oct 09 2015 21:05
I am hoping Google/Dex partnership becomes a game changer to be honest. Medtronic and Dexcom are not data companies, and they admit it. Would be nice to shake that up and have some players to add to the mix for algorithms, data analysis, etc
Paul Andrel
@stavlor
Oct 09 2015 21:05
@danamlewis Same hoping to see some useful stuff out of the Alphabet/Dexcom Partnership
Dana Lewis
@danamlewis
Oct 09 2015 21:06
@stavlor Yup. I met someone at Stanford who's going to work at Google Life Sciences in December, he was interested in having some follow up conversations which would be great
Ben West
@bewest
Oct 09 2015 21:06
hmm that's annnoying
I was told by google recruiter life sciences positions were available to internal googlers first
Dana Lewis
@danamlewis
Oct 09 2015 21:07
@bewest we weren't talking about jobs, though
Ben West
@bewest
Oct 09 2015 21:08
:-)
maybe not frontend software per se either
google would want me for js buttons of all kinds
Paul Andrel
@stavlor
Oct 09 2015 21:09
heh i remeber that discussion lol
Ben West
@bewest
Oct 09 2015 21:47
also mine's mobile now on occassion
I don't have as neat a kit as others, I just toss it loosely in my bag
last night it temp basaled me appropriately on walk to restaurant :-)
heard the pump beeping and double checked, was pretty nifty
kind of liberating
Dana Lewis
@danamlewis
Oct 09 2015 21:49
:) :)
Ben West
@bewest
Oct 09 2015 21:54
so it seems variety of people have some hacks to display what openaps is doing
some are in NS, some are PowerBI
would it be possible to assemble/survey them?
it'll help to get a nice list and review it as a group to help point everyone for how to integrate, what to combine, etc
Dana Lewis
@danamlewis
Oct 09 2015 21:55
That would be great.
Would love something beyond dumping screenshots to gitter though so it's easier to compare. So not sure if we can do an issue and track there, or best tool to use?
Ben West
@bewest
Oct 09 2015 22:09
hmmmm
well, that's why I back up to github
to show raw data
as well as the changes made to the data
hard to do much better fidelity
but need a second tool specifically for visualization
not just "tracking"
hmmm looking at logs
looks like openaps was off all night
pfff
gah
oh wrong again
ah, was totally legit after all
Ben West
@bewest
Oct 09 2015 22:18
or not
no dosing during that timeframe
Ben West
@bewest
Oct 09 2015 22:27
oh bother
Ben West
@bewest
Oct 09 2015 23:12
my git repo is corrupted ;-)
good news is I think I see what caused it
Ali Mazaheri
@amazaheri
Oct 09 2015 23:13
do share!
Ben West
@bewest
Oct 09 2015 23:18
blob
Ali Mazaheri
@amazaheri
Oct 09 2015 23:18
lol
Ben West
@bewest
Oct 09 2015 23:19
with the git thing
Dana Lewis
@danamlewis
Oct 09 2015 23:19
Haha
Ali Mazaheri
@amazaheri
Oct 09 2015 23:19
some angry unicorn
Ben West
@bewest
Oct 09 2015 23:19
historically in mythology unicorns are not nice creatures, really
they're generally to be avoided
Ali Mazaheri
@amazaheri
Oct 09 2015 23:19
oh oh
Chris Oattes
@cjo20
Oct 09 2015 23:21
You wouldn't want to get your pump tubing caught on one of those :P
Ali Mazaheri
@amazaheri
Oct 09 2015 23:21
522f58ad7914c.jpg