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data/overview/index.html

@@ -966,7 +966,7 @@ <h1 id="loop-data">Loop Data<a class="headerlink" href="#loop-data" title="Ancho
 <p>In order to assess your Loop's performance and more specifically your settings, having access to your historical data trends is invaluable. Seeing what your Loop was predicting, what actions were being taken, how blood glucose was reacting, and how insulin needs have been changing is critical when trying to assess any settings changes.</p>
 <h2 id="problem-with-traditional-methods">Problem with traditional methods<a class="headerlink" href="#problem-with-traditional-methods" title="Anchor link to this Header on this Page">&para;</a></h2>
 <p>As a person with diabetes, you’re probably carrying around a lot of different devices that are holding a lot of different data; a blood glucose meter for your finger sticks, a pump for insulin delivery, a continuous glucose monitor for real-time glucose measurements, phone app for tracking meals, etc. When you go to your endocrinology office, you probably start the process by dropping many of those devices at the front desk to be individually downloaded and then having to pack all of them away 20 minutes later.</p>
-<p>Then your clinic staff has the less-than-efficient process of trying to overlay all those different devices into some sort of cohesive strategy for how your diabetes may need some tweaks. Because of Loop use, a clinic currently has to look at separate reports from Medtronic pump, Contour Next Link BG meter, Dexcom <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr>/Clarity, and our iPhone Health app, as a typical example. There are also a couple of issues with Loop when using this separate downloads method:</p>
+<p>Then your clinic staff has the less-than-efficient process of trying to overlay all those different devices into some sort of cohesive strategy for how your diabetes may need some tweaks. Because of Loop use, a clinic currently has to look at separate reports from Medtronic pump, Contour Next Link BG meter, Dexcom <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr>/Clarity, and our iPhone Health app, as a typical example. There are also a couple of issues with Loop when using this separate download method:</p>
 <ul>
 <li>
 <p>Medtronic’s pump gets so clogged up by the numerous temporary basal rate records being recorded that the clinic can only pull about 7 days of data from the pump at most.</p>

how-to/bolus/index.html

@@ -989,25 +989,25 @@
 
 
 <h1 id="extended-or-combo-bolus-with-loop">Extended or Combo Bolus with Loop<a class="headerlink" href="#extended-or-combo-bolus-with-loop" title="Anchor link to this Header on this Page">&para;</a></h1>
-<p>The majority of meals have most of their blood glucose impact within 2-3 hours after eating.  Complex carbohydrates are slowed by their fat and protein content and can lead to extended time of blood glucose impacts. Many people with type 1 are familiar with the late blood glucose spikes from Chinese food, pasta, pizza or burritos. This extended blood glucose impact can be tricky to properly bolus for in traditional one-bolus insulin delivery.</p>
+<p>The majority of meals have most of their blood glucose impact within 2-3 hours after eating.  Complex carbohydrates are slowed by their fat and protein content and can lead to extended time of blood glucose impacts. Many people with type 1 are familiar with the late blood glucose spikes from Chinese food, pasta, pizza, or burritos. This extended blood glucose impact can be tricky to properly bolus for in traditional one-bolus insulin delivery.</p>
 <p>In traditional multiple daily injection therapy, these complex meals may require additional insulin boluses to help control long, slow absorption meals. The trick is to try to time the second bolus at a time when blood glucose is starting to rise and it can be tricky to estimate how much to give to control the tail end of those slow meals.</p>
-<p>If you're using traditional pump therapy, one technique is to use an extended bolus or dual wave bolus for your complex meal's insulin. In this method, a user give a portion of the insulin up front as an initial bolus and the remainder of the insulin is delivered as a psuedo high temp basal for a user-set duration of time. For example, you may give 5 units of bolus up-front and then "extend" 4 units of insulin over the next 60 minutes. In this way, you are providing a more complex bolus to help match the timing of the meal's blood glucose impacts; avoiding early low blood glucose and addressing later high blood glucose.</p>
+<p>If you're using traditional pump therapy, one technique is to use an extended bolus or dual wave bolus for your complex meal's insulin. In this method, a user give a portion of the insulin up front as an initial bolus and the remainder of the insulin is delivered as a pseudo high temp basal for a user-set duration of time. For example, you may give 5 units of bolus up-front and then "extend" 4 units of insulin over the next 60 minutes. In this way, you are providing a more complex bolus to help match the timing of the meal's blood glucose impacts; avoiding early low blood glucose and addressing later high blood glucose.</p>
 <p>The transition to Loop use may be confusing at first for these meals since you cannot use an extended/combo bolus and simultaneously have Loop set temporary basals automatically. The good news is that Loop has a bolus calculator that has the ability to emulate an extended bolus situation...and it's implemented with the pizza icon (or any custom carbohydrate absorption that is set longer than 4 hours).</p>
 <h2 id="pizza-icon">Pizza Icon<a class="headerlink" href="#pizza-icon" title="Anchor link to this Header on this Page">&para;</a></h2>
 <h3 id="example-long-absorption-time-bolus">Example long absorption time bolus<a class="headerlink" href="#example-long-absorption-time-bolus" title="Anchor link to this Header on this Page">&para;</a></h3>
 <p>For an example of Loop's bolus adjustments using carbohydrate absorption time, let's take a look at an example meal.  This is an example of a long absorption complex carbohydrate meal. This is a mushroom (arborio) risotto dish with heavy cream and cheese ingredients. While some white rice can be fairly quick acting, after several times eating this dish, the family has noticed that the meal tends to have a longer duration of impact on blood glucose. Using a "taco" icon (3 hours absorption) was causing slight low blood glucose soon after eating the meal. Therefore, they have been using the pizza icon to enter the meal's carbohydrate absorption time.</p>
 <p align="center"><img alt="Pizza Bolus" src="../img/pizza_bolus.jpg" width="400" /></p>
-<p>The initial meal entry was 70g at a "pizza" icon aborption time (4 hours). Based on carbohydrate ratio of 8 g/U, the initial bowl of risotto at 60g should have been a bolus of 7.5 units. Loop recommended 5.3 units, or about 70% of the total bolus that would be needed to cover the total carbohydrates. Loop recommended the lower upfront bolus because a full bolus would have overwhelmed the slow absorption of carbohydrates, and the likelihood would be a low blood glucose shortly after eating. </p>
-<p>As the meal was being absorped, Loop was tracking the carbohydrates still remaining to be absorped and expecting that blood glucose values would be rising soon (knowing that there was still insulin needing to be delivered once safely passed the near-meal low blood glucose potential). Loop would have provided the additional insulin via high temporary basals after seeing blood glucose impacts which indicated the potential for a low blood glucose had passed. </p>
-<p>The Loop user then had a second, smaller bowl of risotto about 90 minutes later, and entered 30g at 4 hours absorption again. Notice this bowl of risotto had a bolus recommendation much different than the original bowl. The second bowl had a recommendation of 5 units, much greater amount of bolus relative to the amount of carbs entered than the first bowl had received, and more than the carbohydrate ratio alone would provide (3.75 units). Why the "extra" 1.25 units? Because Loop was including <em>some</em> extra bolus amount to cover what it predicted could safely be provided from the amount <em>not</em> given in the original bowl's bolus (the original bolus was approximately 2.2 units short of carbohydrate ratio alone recommendation). If the user had not had the second bowl, Loop would have been providing high temporary basals as soon as blood glucose had exceeded the correction range. And in fact, you can see that Loop still provided the remaining insulin via high temporary basals as blood glucose rose after the second bowl, in effect making up the small remaining difference.</p>
+<p>The initial meal entry was 70g at a "pizza" icon absorption time (4 hours). Based on a carbohydrate ratio of 8 g/U, the initial bowl of risotto at 60g should have been a bolus of 7.5 units. Loop recommended 5.3 units or about 70% of the total bolus that would be needed to cover the total carbohydrates. Loop recommended the lower upfront bolus because a full bolus would have overwhelmed the slow absorption of carbohydrates, and the likelihood would be a low blood glucose shortly after eating. </p>
+<p>As the meal was being absorbed, Loop was tracking the carbohydrates still remaining to be absorbed and expecting that blood glucose values would be rising soon (knowing that there was still insulin needing to be delivered once safely passed the near-meal low blood glucose potential). Loop would have provided the additional insulin via high temporary basals after seeing blood glucose impacts which indicated the potential for a low blood glucose had passed. </p>
+<p>The Loop user then had a second, smaller bowl of risotto about 90 minutes later, and entered 30g at 4 hours absorption again. Notice this bowl of risotto had a bolus recommendation much different than the original bowl. The second bowl had a recommendation of 5 units, much greater amount of bolus relative to the amount of carbs entered than the first bowl had received, and more than the carbohydrate ratio alone would provide (3.75 units). Why the "extra" 1.25 units? Because Loop was including <em>some</em> extra bolus amount to cover what it predicted could safely be provided from the amount <em>not</em> given in the original bowl's bolus (the original bolus was approximately 2.2 units short of the carbohydrate ratio alone recommendation). If the user had not had the second bowl, Loop would have been providing high temporary basals as soon as blood glucose had exceeded the correction range. And in fact, you can see that Loop still provided the remaining insulin via high temporary basals as blood glucose rose after the second bowl, in effect making up the small remaining difference.</p>
 <h2 id="low-carbhigh-fat-or-keto-diets">Low carb/High Fat or Keto diets<a class="headerlink" href="#low-carbhigh-fat-or-keto-diets" title="Anchor link to this Header on this Page">&para;</a></h2>
-<p>The example meal above, while relatively high carbohydrate, also helps illustrate how Loop can be used to bolus effectively for low carb/high fat (LC/HF) or Keto diets.  Those diets tend to have low glycemic index food with a relatively long blood glucose impact.  Said another way, they don't spike blood sugar as much, but often need additional insulin after the meal was eaten to account for the slow conversion of protein to glucose.</p>
+<p>The example meal above, while relatively high carbohydrate, also helps illustrate how Loop can be used to bolus effectively for low carb/high fat (LC/HF) or Keto diets.  Those diets tend to have low glycemic index food with a relatively long blood glucose impact.  Said another way, they don't spike blood sugar as much but often need additional insulin after the meal was eaten to account for the slow conversion of protein to glucose.</p>
 <p>To account for those dietary differences, there are two useful strategies:</p>
 <ul>
 <li>convert some of the protein and fat to "equivalent carbohydrates" and</li>
 <li>extend the duration of those carbohydrates using a pizza icon or even longer, depending on the person/food.</li>
 </ul>
-<p>Most LC/HF or Keto users will convert a portion of their fat and protein content into an equivent carbohydrate content.  So while an example meal might only have 5g of carbohydrates based on nutritional labels, they may convert 25% of the 20g fat and 50% of the 20g protein grams into an additional 15g of "equivalent carbs" for bolusing purposes. The percentages that people use to convert fat and protein will usually be a bit of trial-and-error, but there are some published articles (<a href="https://www.practicaldiabetes.com/article/fat-protein-counting-type-1-diabetes/">here</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/21949219/">here</a>, <a href="https://youngandt1.com/how-to-bolus-for-fat-and-protein/">here</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609492/">here</a>) that may be helpful starting points, if you are interested.</p>
+<p>Most LC/HF or Keto users will convert a portion of their fat and protein content into an equivalent carbohydrate content.  So while an example meal might only have 5g of carbohydrates based on nutritional labels, they may convert 25% of the 20g fat and 50% of the 20g protein grams into an additional 15g of "equivalent carbs" for bolusing purposes. The percentages that people use to convert fat and protein will usually be a bit of trial-and-error, but there are some published articles (<a href="https://www.practicaldiabetes.com/article/fat-protein-counting-type-1-diabetes/">here</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/21949219/">here</a>, <a href="https://youngandt1.com/how-to-bolus-for-fat-and-protein/">here</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609492/">here</a>) that may be helpful starting points if you are interested.</p>
 
 
 

how-to/cgm/index.html

@@ -1036,13 +1036,10 @@ <h2 id="sensor-noise">Sensor noise<a class="headerlink" href="#sensor-noise" tit
 <p>As you can see on the left, the red dot was a finger stick blood glucose check and it nicely aligned with the <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> value when the session first started to provide live data.  However, between that first value and approximately noon the next day, there was a considerable amount of jumpiness to the data (as well as some suspected compression lows or extreme sensor jumpiness in the first 6 hours). The <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> noise immediately decreased after the first calibration was provided at the noon-time meal bolus. (Personally, we give the G6 one calibration point about 8-12 hours after a session starts because we have noticed that it helps settle down the noise quickly. This is not a part of the standard Dexcom protocols.)</p>
 <p>We similarly see an increase in sensor noise at the end of a sensor's useful life. The figure below is a G6 sensor at 9.5 days, but your end of sensor symptoms may occur differently and at longer/shorter days. Much of the specifics regarding useful sensor life seems to depend on the user's body chemistry and sensor insertion. </p>
 <p><img alt="noisy old G6 sensor" src="../img/end_of_sensor.jpeg" /></p>
-<p>There is a marked increase in sensor noise and scatter, as well as several periods of sensor error that lead to lost <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data. We opted to pull this sensor just shy of the 10 days due to this noise. However, as you can see, the Loop was still doing an aequate job controling overall blood glucose fluctuations despite the erratic <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data.</p>
+<p>There is a marked increase in sensor noise and scatter, as well as several periods of sensor error that lead to lost <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data. We opted to pull this sensor just shy of the 10 days due to this noise. However, as you can see, the Loop was still doing an adequate job controlling overall blood glucose fluctuations despite the erratic <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data.</p>
 <h2 id="compression-lows">Compression lows<a class="headerlink" href="#compression-lows" title="Anchor link to this Header on this Page">&para;</a></h2>
-<p>A frequent question from people before starting Loop is "<em>How does Loop deal with compression lows?</em>"  If you aren't familiar with compression lows, they are false low blood glucose alarms caused by sustained pressure on the sensor area. In effect, the phenomenom is much like resting on an arm for too long and causing it to fall asleep from poor blood flow.</p>
-<p align="center">
-<img src="../img/compression-low.jpg" width="300">
-</p>
-
+<p>A frequent question from people before starting Loop is "<em>How does Loop deal with compression lows?</em>"  If you aren't familiar with compression lows, they are false low blood glucose alarms caused by sustained pressure on the sensor area. In effect, the phenomenon is much like resting on an arm for too long and causing it to fall asleep from poor blood flow.</p>
+<p align="center"><img alt="compression low" src="../img/compression-low.jpg" width="300" /></p>
 <p>The figure above showing an example of a compression low. <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data shows blood glucose dropping low, but finger checks on a meter would confirm that the <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> data is falsely low. Often, Dexcom G5 and G6 will stop providing <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> values for awhile when their algorithm detects a suspected compression low. Once the person rolls off the sensor area and blood starts flowing well again, the <abbr title="continuous glucose monitor, wearable medical device that measures and reports glucose in interstitial fluid">CGM</abbr> values come back online to a more reasonable tracking again. </p>
 <p>Generally speaking, Loop will deal with compression lows just fine. Loop will suspend for a short time during the low blood glucose values, and then recover with temporary high temporary basals to make up for the active insulin it had missed as result of the compression low. No special actions need to be taken for compression lows.</p>
 <h2 id="calibration-jumps">Calibration jumps<a class="headerlink" href="#calibration-jumps" title="Anchor link to this Header on this Page">&para;</a></h2>