Peter van Rijt

Read this blog translated automatically to Dutch here. View all related articles using this link.

Service Management is all about delivering value. As a professional Service (Delivery) Manager – and volunteer on the AndroidAPS project – I hope to inspire you.

The idea of the diabetic patient as a crisis manager is outdated. By using an (open source) closed loop system you can archieve a higher quality of life for yourself as well for all others. When configured properly, it is quite possible that the diabetic person has a healthy HbA1c value. A life changing journey. Welcome to the future! #WeAreNotWaiting

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The last decade a huge amount of technical possibilities came available to all of us. For example the internet, IoT, Bluetooth, smartphones, smaller batteries, sensors, cloud computing, open source software and 3D printing. These technologies give us the power to use and/or create the automation of diabetes management instead of waiting for it to happen. We – like literally you and me – can contribute to a global solution without having to wait on the expensive, slow commercial companies.

Diabetes care

When you are diagnosed with diabetes it is impossible to imagine what effect it will have. For everyday life you need to purchase equipment, use needles + insulin multiple times a day (for example before each meal, once a day for 24 hour insuline, few times a day for checking bloog glucose), visit the pharmacy and hospital regularly, educate yourself on diabetes in general – specific on your own body – and 24 hour a day you need to be alert on a low blood sugar level to prevent a life-thretening hypoglycaemia in which case you quickly need to eat some glucose (like three Dextro Energy tablets).

Looking back on improvements

100 years ago there was a small chance you would still be alive. Nowadays there isn’t a commercial solution available (yet) but there are technical Do It Yourself (DIY) possibilities which combine different (open source) projects and components to check your blood sugar levels, calculating and automatically adjust your insulin pump on body needs. Each 5 minutes, 288 times a day! Also you can configure a password to view historic and live data (for example for your kids, partner or endo) using the open source Nightscout project. You can even co-manage an insulin pump using SMS commands to help someone very ‘close’ to you!

• 1869

  The German Paul Langerhans discovers cells that make insulin in the pancreas (source).

• 1889

  Joseph von Mehring and Oskar Minkowski discover that dogs whose pancreas they have removed get diabetes (source).

• 1921

  Frederick Banting and Charles Best succeed in using insulin from the pancreas of dogs and calves for humans (source).

• 1950 – 1980

  Development of synthetic insulin (source).

• 1980 and beyond

  Diabetic patients can now test their blood sugar levels with tests and instruments. That gives more control and flexibility. Insulin types and the methods of injecting them are also greatly improved. Researchers continue to look for ways to treat and possibly cure diabetes (source).

• 2013 and beyond

  Start of closed loop movement using programs like AndroidAPS, OpenAPS, or Loop (source).

Roadmap technical possibilities

In the beginning of 2019 the Dutch JDRF (Juvenile Diabetes Research Foundation) launched a series of Dutch blog posts to inform on loop systems. Use your browser to translate the blogs from Dutch to English:

• Part 1. What is ‘loop’
• Part 2. Closed loop: which options are there?
• Part 3. Closed loop: what does the industry do?

When choosing to explore technical possibilities it’s important not to rush. Please take your time, try to see the whole picture, learn as much as you can and help others around you with the knowledge you will build.

I’ve validated the list below in this Facebook group, please use the knowledge. It’s a step-by-step plan to slowly move towards a closed loop system see some other (technical) options (steps 12-14):

1. Pen therapy (contact your endo).
2. Check you health insurance for compensation to start with sensor.
3. Start using sensor measurements & mobile alerts on low and high values (for example FreeStyle Libre with MiaoMiao and Android app xDrip+).
4. Monitor in the cloud (Nightscout).
5. Share Nightscout data with your endo.
6. Self Education on basic diabetes math like Insulin Sensitivity Factor (ISF), Carb Ratio (CR), basal testing, Duration Insulin Activity (DIA).
7. Check you health insurance for compensation to start with insulin pump. Find a compatible pump for later use in programs like AndroidAPS, OpenAPS, or Loop.
8. Start using an insulin pump.
9. Replace the remote control of your insulin pump by your smartphone (see this link, part ‘pumpcontrol’)
10. Use Nightscout for co-management (for example your kids or your partner)
11. Start looping
    1. AndroidAPS – start with open loop
    2. AndroidAPS – closed loop for lows (automatic pause of insulin pump to prevent low)
    3. AndroidAPS – closed loop for high (automatic distribution using insulin pump to prevent high)
    4. AndroidAPS – full closed loop (automatic response to prevent lows and highs)
12. Full Artificial Pancreas Systems (works with insulin as well with glucagen, no need to enter carbs anymore. For example equipment of Robin Koops TEDx, Building my own pancreas. Status: clinical trials, CE certification requested)
13. Smart insulin (by science, research ongoing)
14. Healing of diabetes (by science, research ongoing)

From the basics to a solution

View all related articles using this link.

Need some help?

Most effort in the online DIY APS community is done by volunteers through a pay-it-forward mechanism. Each participant/volunteer has severe perseverance and the will to contribute to the community in their own field of knowledge. Please feel free to contact me on whatever question you may have and request a membership in Facebook groups AndroidAPSUsers / TheLoopedGroup. Happy to help!

About the author

I am Peter, a millennial born in 1984, living in The Netherlands and hope someone will find a cure for type 1 diabetes (T1D). Since my girlfriend was diagnosed as T1D both of our lives rapidly have changed. I became involved as a volunteer on the AndroidAPS project. In this blog series I commit my IT Service Delivery Management passion to a more comfortable and healthier diabetes-life because of all automation possible since 2013. As a professional I feel comfortable to deliver value, overseeing all components while managing staff and costs.

Disclaimer

I am not a healthcare professional. Always consult your doctor before making changes to your diabetes treatment plan. For this blog series I do not have and do not want any sponsorship deals or whatsoever. I pay for all equipment just like anybody else. I publish the articles out of enthusiasm to inform the world on current technical possibilities.

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