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.