Looping: 2 months-in

 I'm pretty excited about the open source software (Loop) that I'm currently using. The algorithm  is working well for me, and I don't spend much time outside of non-diabetic range. My last A1C was the lowest I've gotten at 6.0. Since I had only been looping for about 5 weeks when I did my blood draw, I believe that it can get lower. 

How I got Loop Started: I had been hearing about it through podcasts and discussion boards, but I didn't really know how to get started with it. I ended up reading a lot on a website called Loop and Learn which is provided by the volunteer developers. Even after reading it quite a lot, I still felt unsure of how to proceed. The weekend my winter break started I decided to watch a video and see if I could follow the steps to build the app. It took me a few hours, and a few missteps, but I got it built and installed on my phone. It was kind of amazing. I set up the therapy settings based on my previous pump numbers and the "safe" recommendations from the DIY Loop community. I connected it to a Omnipod DASH pod, and tested it in the kitchen attached to a glass so I could see it dripping insulin, both basal and bolus. It seemed to work well, as planned. The interface for setting up the pod was very similar to the native Omnipod app.

I wanted to test it out in a controlled situation, so I waited until I was at home post-holidays to give it a go. Honestly, I don't recall any real hiccups... it just worked. Once I put it into closed loop mode it started making adjustments and kept me in range very well. I wondered if I needed to optimize my settings, but it really was pretty good from the start. I was surprised that it worked so well. I loved that it also had an Apple Watch app that allows you to monitor your BG on your watch, and you can even bolus from it. 

Another thing I like about using the Omnipod DASH with the Dexcom G7 is that they both connect via the iPhone, so I don't have to keep the CGM and pump within line of sight, like I did with the Omnipod 5. However, you do have to keep your phone with you for everything to keep working correctly. It's not a big deal to leave your phone in the other room for a bit, but if I try to keep it with me if I'm going to settle in for a bit.

What would happen if my phone was lost or destroyed? The pump would stop receiving CGM data and it would just start delivering my manual basal. I'm thinking about buying a used iPhone that I could install my app on, and it could be used as a backup controller for the system, in case of an emergency. 

Revelations: I have been able to observe my diabetes more closely. With tighter control, I'm finding that stable blood sugars begets lower insulin use. My insulin use has gone down, and I'm finding that my basal may be much lower than I ever thought. I have my current basal settings at 7-10 units of insulin, depending on where I am in my GLP-1 cycle. For some time, 20-24 units of basal was my norm. 

I've included a screenshot of my phone screen for LOOP. It shows the control panel and the data that it shows you all the time. I like how it gives you info about the carbohydrates that are being digested, and the insulin action as well. It has predictive forecasting to show where you will end up, and you can even enter carbs without bolusing to include it in your overall picture. When I eat glucose tablets for a potential low, I enter them and I can see the predicted impact. It's pretty smart.

What's next? I'm investigating another iteration of DIY Loop called Trio. It's made by the same open-source community, but the algorithm is different and is meant to be better for people eating low-carb and/or using GLP-1. It is not as carb-based, and allows for dynamic insulin sensitivity.  This is something that I think might help me navigate the half-life of GLP-1 across the week, between doses. I notice that have 4-5 days of higher insulin sensitivity, and 2-3 days that it wanes slightly. I would imagine this would also be helpful for hormonal cycles that impact insulin sensitivity/resistance. Some of the current users of Trio say that it has allowed them to think about diabetes a lot less and stay in range 80-90% of the time. I have the app built and can deploy it whenever I decide to give it a try.

Re-starting dia-blogging 2026

 Ok, I'm going to start by giving a status update on my diabetes, and the tools and technologies I'm currently using. I might also give a chronology of where I have been since 2012. I should also note that, since I'm turning 53 this year, I've been T1 diabetic for over 40 years. I'm grateful for diabetes which as taught me to be curious, disciplined, and flexible. 

Note: I'm re-posting this on blogspot from Tumblr. I didn't realize that this was my most current blog, and it's actually a better place to write and interact. 

Insulin: I'm taking Fiasp as my main insulin these days. It's a newer fast acting insulin with an action time starting within 15 minutes and lasting roughly 2-3 hours. It's been a good insulin to use with a pump because it can make corrections faster. I don't have to give lead time before meals. When I first started using it, I noticed that sometimes it noticeably stung at the infusion site. Lately, I haven't had that issue. It seemed like it also used to create inflammation at the infusion site, and absorption would be impacted, but that is also no longer an issue. I don't know if the insulin has changed, or if I've changed... but in the end, it's good.

CGM: I switched to Dexcom a few years ago (probably when I stopped using the Medtronic pump), and it has been great. I waited to go from G6 to G7 till the kinks were worked out, and that was maybe 6 months ago. I'm getting good results with it. One thing I didn't like about the G7 was the requirement that it be in line-of-sight with my Omnipod 5 pump to maintain connection. The G6 maintained a connection wherever it was on my body, but... with G7, I started having to keep the pump and sensor on the same side of my body. I ended up just placing them side-by-side for optimal results. However, I'm no longer using Omnipod 5, so that's no longer a limitation.

Pump: I'm currently using Omnipod DASH (older model) tubless pump pods as my delivery device. I started using Omnipods within the past year or so. They are fully disposable, and can be purchased via pharmacy benefits. Because of this, I was able to try them without a warranty/ contract situation. My endo mentioned that it's easy to give it a try, despite still having my previous pump under warranty. When I did, I was surprised how much I loved being tubeless. I had gotten so used to threading my tubing through my pants pockets, but it was surprisingly very freeing to be tubeless after many, many years (15?) being tethered. I first started with Omnipod 5, which allowed me to manage the pod from my phone and take insulin from my phone. I switched to DASH pods so I could start using LOOP, an open source algorithm that gets data from the sensor and controls the pump.

Automated Insulin Delivery Algorithm: I'm currently using DIY Loop to control the pump. It was developed by a cadre of open-source developers that wanted to "close the loop" and make an artificial pancreas available without waiting for the slow process of FDA approval, etc. It has been available, and constantly under improvement, for several years. They have been staying way ahead of the commercial offerings and have made some the most advanced algorithms available. The catch... is that, you have to build the app yourself using the resources they make available, so you are totally responsible for the settings and education about what you are doing. I built the app on December 20th, tested it with a DASH pod off-body, and then started using it on January 1st.

One of the reasons that I felt the need to start using a non-commercial algorithm was because I noticed my Omnipod 5 not being able to control my BG after I started using a GLP-1. My insulin needs went down dramatically and the pump no longer delivered the appropriate corrections when my glucose drifted up. I found that my BG was hanging out around 150 mg/dL all the time, while I was very sensitive to insulin and using a lot less.The reason this was happening is because the Omnipod 5 uses your Total Daily Dose (TDD) to decide how sensitive you are, and it downgrades how aggressive your corrections are. With some searching online, I found a lot of people who were frustrated with this, and many of them were tricking the pump into being more aggressive or they were just using manual mode to override this issue. I found that a lot of people were getting better control with Loop, so I planned to try it if I could get the DASH pods, which are hack-able.

Non-insulin Meds: I started taking Metformin a few years ago in an attempt to push back on insulin-resistance. At one time I was taking the max dose, and when I would take less or stop taking it, I would notice a difference. In the online communities for T1 diabetics I had heard that Type 1s were using Metformin and it was helping to stabilize blood sugars by slowing down the glucose being released by the liver. It also has been shown to provide some longevity benefits in cardio and kidney health overall. Sidenote: my T1 dad (60+ years T1) started to notice some brain fog that he associated with metformin, and discontinued it. I haven't noticed anything like that for myself, so far.

This past August I saw my endo and I told her that I'd been a bit frustrated because I'd been noticing insulin resistance that I couldn't seem to counter with eating differently or exercising more. I had spent a summer walking a ton and eating low-carb, and I found my blood sugars hovering high for periods of 6 hours or more. As soon as I ate again, I'd be chasing a 200 for a while. At night my BG wasn't coming down with the help of auto-mode on the pump. It didn't make sense, and in the past I had good results from my interventions. I also noticed that I was using more insulin and slowly gaining weight despite increased physical activity. I had decided to start taking Metformin again to see if it would help with insulin sensitivity.

My endo offered the idea of using a GLP-1. She said that it is like metformin on steroids. I didn't really know what GLP-1s were, but after looking into it I recalled a lot of coverage of a class of weight-loss drugs (Wegovy, Ozempic, etc) that had been adapted from Type 2 diabeles to clinical weight-loss for obesity. I was nervous about taking something that seemed quite powerful and unkown. As I looked into other Type1 diabetics that had been using GLP-1s, I realized that it addressed some issues that are often unaddressed in T1 care (constant hunger, rapid stomach emptying, liver glucose release, insulin resistance). *I had previously used injected Symilin at mealtimes for similar purported benefits, but the hassles outweighed the benefits. I was seeing many T1s talk about their insulin use going down, and blood sugars stabilizing. Many T1s were only using the lowest doses for these benefits. I decided to give it a try.

My endo said that insurance might not approve it since I wasn't obese, but said there were different channels for getting it (compounded, self-pay). Since I have a sleep apnea diagnosis it was approved on 2nd try, otherwise I might not have pursued it. It's an expensive drug.

In early-September, I started Zepbound. Normally, you up your dose every month as long as you can tolerate the side-effects. Your body has to adapt to it. I noticed lots of benefits on the first dose, with blood sugar stabilizing and my insulin use going down to about 50-60% of my previous dose. At the time, I was using the Omnipod 5 in auto-mode and it beautifully adapted to my changing insulin needs. I didn't have lows and just observed that my daily insulin use was going down, along with very flat blood sugar graphs. When month 2 came, my insurance balked at keeping me at the introductory dose, I guess no one is supposed to stay there... but, many T1s do, with good results. I acquiesced and went up to 5mg, which is still considered a introductory dose. I have stayed on that amount for 4 months and plan to stay there till further notice. I'll write up another post with more granular detail about how it works and the nuances of using it.

This post has already gotten long. I will close it out now. I will make a separate post with the results I'm getting with my current interventions. I would say that, at this moment, I have possibly the best blood sugar control I've ever had. Maybe that's why I've been inspired to start writing about it again.