diff --git a/docs/data/health.md b/docs/data/health.md index 3b8eacb..e01f220 100644 --- a/docs/data/health.md +++ b/docs/data/health.md @@ -18,7 +18,7 @@ There's often confusion over the terminology surrounding Apple's health data sto Loop version 3.x uses internal core storage of 7 days of data independent of *Apple* Health. -When you first install Loop onto your iPhone, you will be asked to setup Loop's access to the HealthKit database. It is recommended that you enable iPhone's HealthKit for these interfaces +When you first install Loop onto your iPhone, you will be asked to setup Loop's access to the HealthKit database. It is recommended that you enable iPhone's HealthKit for these interfaces *Loop* App @@ -43,7 +43,7 @@ Depending on the app, there may be other items you want to have the app read fro You can always check your HealthKit settings by opening the Health App, clicking on *Sharing* at the bottom bar, scroll down and tap on the row labeled **Apps** and then clicking on the app's name you are interested in, for example, Loop. -Potential conflicts can arise when third-party apps are granted access to HealthKit permissions that may interfere with Loop's specified data permissions. +Potential conflicts can arise when third-party apps are granted access to HealthKit permissions that may interfere with Loop's specified data permissions. With Loop 3, it is no longer the default that the *Loop* app reads carbohydrate from Apple Health. This prevents a problem that used to happen where third-party food apps were used to record meals. You can customize your *Loop* app to change this setting, but be aware that carbohydrate entries in HealthKit that were created by non-Loop apps will not be able to customize carbohydrate absorption times nor be edited later if needed. Refer to [LoopDocs: Carbohydrates and Apple HealthKit](https://loopkit.github.io/loopdocs/faqs/apple-health-faqs/#carbohydrates-and-apple-healthkit){: target="_blank"}. diff --git a/docs/data/nightscout.md b/docs/data/nightscout.md index 9dff6fe..5a71e96 100644 --- a/docs/data/nightscout.md +++ b/docs/data/nightscout.md @@ -1,6 +1,6 @@ # Nightscout {: translate="no" } -[Nightscout](https://nightscout.github.io/){: target="_blank" } (NS) is a cornerstone of the DIY type 1 community. It is an excellent tool to remotely view Loop's actions and access insulin and blood glucose data. It allows for easy remote monitoring of *Loop* activities, troubleshooting of *Loop* errors, history of CGM, carbs, boluses, & temporary basal rates, and reports to analyze data trends and patterns. There is a *Nightscout* app in your iPhone App Store, or you can use a web browser to view the data. [Setting up Nightscout for Loop](https://loopkit.github.io/loopdocs/nightscout/new_user/){: target="_blank" } is low cost and fairly quick. Once set up, the site can be accessed by anyone that you share your unique *Nightscout* URL with. +[Nightscout](https://nightscout.github.io/){: target="_blank" } (NS) is a cornerstone of the DIY type 1 community. It is an excellent tool to remotely view Loop's actions and access insulin and blood glucose data. It allows for easy remote monitoring of *Loop* activities, troubleshooting of *Loop* errors, history of CGM, carbs, boluses, & temporary basal rates, and reports to analyze data trends and patterns. There is a *Nightscout* app in your iPhone App Store, or you can use a web browser to view the data. [Setting up Nightscout for Loop](https://loopkit.github.io/loopdocs/nightscout/new_user/){: target="_blank" } is low-cost and fairly quick. Once set up, the site can be accessed by anyone that you share your unique *Nightscout* URL with. ## Nightscout Display *Nightscout* is highly recommended for *Loop* users, especially those using *Loop* as caregivers. *Nightscout* displays are often the easiest way to troubleshoot *Loop* settings if you are having problems and seeking input from others. Below is some discussion about the general *Nightscout* display, as well as some Loop-specific display information. @@ -41,7 +41,7 @@ The SAGE, BAGE, and CAGE pills are for sensor age, pump battery age, and cannula ## N​ightscout Reports -You can access the Reports tab from within your NS settings (the three horizontal lines in the upper right corner of your NS site). There are several types of reports which may be useful to you and/or your health care provider. The report types are listed in tabs at the top of the Reports section, and you can also select the range of dates you'd like any report to cover. +You can access the Reports tab from within your NS settings (the three horizontal lines in the upper right corner of your NS site). There are several types of reports which may be useful to you and/or your healthcare provider. The report types are listed in tabs at the top of the Reports section, and you can also select the range of dates you'd like any report to cover. ![Reports](img/reports.png){width="700"} @@ -81,7 +81,7 @@ For the graph above, for example, the blood glucose control around 4-6 am is ver ### Treatments -The treatments report will show a listing of all the temporary basal rates set by *Loop*, as well as boluses, carbohydrates, site changes, and any other "treatments" which have been entered into NS. +The treatments report will show a listing of all the temporary basal rates set by *Loop*, as well as boluses, carbohydrates, site changes, and any other "treatments" that have been entered into NS. ![Treatments](img/treatments.png){width="=700"} {align="center"} \ No newline at end of file diff --git a/docs/how-to/bolus.md b/docs/how-to/bolus.md index a88616b..ef27580 100644 --- a/docs/how-to/bolus.md +++ b/docs/how-to/bolus.md @@ -12,7 +12,7 @@ The transition to Loop use may be confusing at first for these meals since you c ### Example long absorption time bolus -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. +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. ![Pizza Bolus](img/pizza_bolus.jpg){width="400"} {align="center"} diff --git a/docs/how-to/endo.md b/docs/how-to/endo.md index d6cd6a3..1543e52 100644 --- a/docs/how-to/endo.md +++ b/docs/how-to/endo.md @@ -1,16 +1,14 @@ # Endocrinologist and Loop -There is a wide range of comfort within the health care profession for DIY projects and type 1 diabetes. Loop is no different; some health care providers are comfortable and some are distrusting. As with all things health care related, honesty with your health care provider is paramount so that the best decisions can be made. +There is a wide range of comfort within the healthcare profession for DIY projects and type 1 diabetes. *Loop* is no different; some healthcare providers are comfortable and some are distrusting. As with all things healthcare-related, honesty with your healthcare provider is paramount so that the best decisions can be made. -Since using Loop often requires people to secure access to pump supplies that they may not have otherwise have, often times the first conversation about Looping with an endocrinologist will be when trying to get prescriptions for Medtronic or Omnipod supplies. The best approach is to start with objective information. Find out if the clinic has other patients already Looping and whether or not they have concerns from what they have seen. Provide links to the [LoopDocs site](http://loopdocs.org){: target="_blank" } and this site so that your endocrinologist or health care provider can read about the system's algorithm and operations. +Since using *Loop* often requires people to secure access to pump supplies that they may not have otherwise had, oftentimes, the first conversation about Looping with an endocrinologist will be when trying to get prescriptions for *Medtronic* or *Omnipod* supplies. The best approach is to start with objective information. Find out if the clinic has other patients already Looping and whether or not they have concerns from what they have seen. Provide links to the [LoopDocs site](https://LoopKit.github.io/loopdocs){: target="_blank" } and this site so that your endocrinologist or healthcare provider can read about the system's algorithm and operations. Most often the important aspects that need discussion are: -* Loop will revert to normal pump use, within a maximum of 30 minutes, in the event of Loop failure. What happens during failure of the system is the most common concern your health care provider will likely have when initially learning about the system.
-* Loop depends on your basal rate, ISF, and carbohydrate ratio settings, just like traditional pump therapy. The conversations will not need to change regarding the evaluation and adequacy of those settings.
-* Duration of insulin action is automatically set to 6-hours for the rapid-acting insulin models built into Loop, matching published data for those insulins. The settings in the pump for duration of insulin action are not used by Loop.
-* Reasonable values for the suspend threshold and maximum basal rate should be discussed. These two settings are not part of normal pump therapy and should be discussed with your endocrinologist. Typically to start Looping, setting the maximum basal rate not much above your highest scheduled basal rate is an excellent way to get used to Loop and safely double-check that your settings (ISF, carbohydrate ratio, and basal schedule) are reasonably accurate. As you gain experience and confirm your settings, raising the maximum basal rate can help Loop become more effective to correct rising blood glucose more quickly.
-* Develop a plan for how you will be providing Loop data to your health care provider in advance. Ask what information they would like to review so that you can have reports ready at each appointment. The usual downlaod of a Medtronic pump or Omnipod PDM will not be sufficient for many clinics once you start Loop. Instead, you may wish to discuss Nightscout or Tidepool data reports to provide the information those downloads would have otherwise provided.
-* Develop a plan for how you will deal with pump failure. Many health care professionals will cite the age and out-of-warranty aspects as concerns for Loop users. Having a clear plan, in advance, for how to deal with possible pump failure will help with that concern. The two most obvious steps would be to have a backup pump available and an active prescription for long-acting insulin. A gentle reminder to the clinic that even in-warranty pumps can fail also helps frame the conversation regarding the need to always be prepared, looping or not. - - +* *Loop* will revert to normal pump use, within a maximum of 30 minutes, in the event of Loop failure. What happens during the failure of the system is the most common concern your healthcare provider will likely have when initially learning about the system. +* Loop depends on your basal rate, ISF, and carbohydrate ratio settings, just like traditional pump therapy. The conversations will not need to change regarding the evaluation and adequacy of those settings. +* Duration of insulin action is automatically set to 6 hours for the rapid-acting insulin models built into Loop, matching published data for those insulins. The settings in the pump for the duration of insulin action are not used by Loop. +* Reasonable values for the suspend threshold and maximum basal rate should be discussed. These two settings are not part of normal pump therapy and should be discussed with your endocrinologist. Typically, to start Looping, setting the maximum basal rate not much above your highest scheduled basal rate is an excellent way to get used to *Loop* and safely double-check that your settings (ISF, carbohydrate ratio, and basal schedule) are reasonably accurate. As you gain experience and confirm your settings, raising the maximum basal rate can help *Loop* become more effective in correcting rising blood glucose more quickly. +* Develop a plan for how you will be providing Loop data to your healthcare provider in advance. Ask what information they would like to review so that you can have reports ready at each appointment. The usual download of a Medtronic pump or Omnipod PDM will not be sufficient for many clinics once you start Loop. Instead, you may wish to discuss Nightscout or Tidepool data reports to provide the information those downloads would have otherwise provided. +* Develop a plan for how you will deal with pump failure. Many healthcare professionals will cite the age and out-of-warranty aspects as concerns for *Medtronic* users. Having a clear plan in advance, for how to deal with possible pump failure will help with that concern. The two most obvious steps would be to have a backup pump available and an active prescription for long-acting insulin. A gentle reminder to the clinic that even in-warranty pumps can fail also helps frame the conversation regarding the need to always be prepared, looping or not. diff --git a/docs/how-to/high-bg.md b/docs/how-to/high-bg.md index 2344df2..3aacc4c 100644 --- a/docs/how-to/high-bg.md +++ b/docs/how-to/high-bg.md @@ -3,7 +3,7 @@ !!! info "Safety consideration" If the continued delivery of corrective insulin fails to bring down high blood glucose, remember to follow your doctor's recommendations for ketone testing, hydration, and/or more frequent blood glucose monitoring. Check for equipment failure (infected pump site? blocked cannula?). Try fresh insulin. Contact your doctor immediately if you are experiencing sustained high blood glucose despite continued insulin delivery and corrections. -*"How do I deal with high blood glucose that seems to be stuck?"* When you and your Loop are disagreeing about the effectiveness of high temporary basals to bring down blood glucoose, take a deep breath. Unfortunately, most of the time our disagreement is rooted in the impatience that the pump's insulin works so dang slow. We get tired of waiting another 4-6 hours until blood glucose will be back in range after a correction. So before we start overriding Loop's predictions with manual actions, it may be useful to ask yourself some questions first to help guide potential corrective actions: +*"How do I deal with high blood glucose that seems to be stuck?"* When you and your *Loop* are disagreeing about the effectiveness of high temporary basals to bring down blood glucose, take a deep breath. Unfortunately, most of the time our disagreement is rooted in the impatience that the pump's insulin works so dang slow. We get tired of waiting another 4-6 hours until blood glucose will be back in range after a correction. So before we start overriding Loop's predictions with manual actions, it may be useful to ask yourself some questions first to help guide potential corrective actions: * Is this temporary or has this been going on for a long time? * Is this consistently only after meals? @@ -25,48 +25,48 @@ Based on the answers to those questions, you may want to choose on of the potent ## Lower temporary targets -If you to believe the high blood glucose is a short-term issue, due to acute stress or anaerobic exercise for example, then using temporary lower override targets will help Loop be more aggressive at providing additional insulin. The pre-meal target would be a quick, easy implementation of this tool. +If you to believe the high blood glucose is a short-term issue, due to acute stress or anaerobic exercise for example, then using temporary lower override targets will help *Loop* be more aggressive at providing additional insulin. The pre-meal target would be a quick, easy implementation of this tool. This technique, and the delivery pending insulin as a bolus (described below), are good to help control the urge to "rage" bolusing which often yields an overcorrection and subsequent low blood glucose. These two techniques used in combination are often successful for most short-term situations or meals that are just taking a long time to "burn out". ## Pending insulin as bolus -To help correct a high blood glucose, Loop will apply a high temporary basal set to deliver over 30 minutes time. If you are stuck on a high blood glucose and want to speed up the correction, you can try to "hurry" along the correction by opening Loop's bolus tool. Within the information screen, you will see a "pending insulin" amount. That amount represents the amount of corrective insulin Loop plans on delivering with the currently running 30 minute temporary basal. You can choose to manually enter in that amount on the bolus deliver line as an upfront correction bolus, rather than waiting for it to be delivered over the next 30 minutes. This generally represents a pretty easy, safe way to help reasonably speed up a correction. +To help correct a high blood glucose, *Loop* will apply a high temporary basal set to deliver over 30 minutes time. If you are stuck on a high blood glucose and want to speed up the correction, you can try to "hurry" along the correction by opening Loop's bolus tool. Within the information screen, you will see a "pending insulin" amount. That amount represents the amount of corrective insulin *Loop* plans on delivering with the currently running 30-minute temporary basal. You can choose to manually enter in that amount on the bolus deliver line as an upfront correction bolus rather than waiting for it to be delivered over the next 30 minutes. This generally represents a pretty easy, safe way to help reasonably speed up a correction. The safety consideration for this is that you do not want to unintentionally stack insulin by using this technique repeatedly in a short period of time. Wait a reasonable amount of time, such as an hour or two, to give insulin a chance to start to affect blood glucose. If the correction still hasn't helped, you may want to consider another technique to help bring down blood glucose. ## Adjusting meal entries -Carbohydrate, fat, and protein estimations for bolusing is frequently a guessing game...and we've all guessed wrong before. If your blood glucose is remaining high due to a food guess gone wrong, you can definitely go back in time and adjust your meal's carbohydrate entry to more accurately reflect what you suspect it should have been. By adjusting the original entry, you'll help Loop know that the blood glucose effects it needs to control are greater (total carb entry increase) and/or longer (carbohydrate absorption time extension). Often you'll find Loop will offer an additional bolus immediately after you save your adjusted carbohydrate entry and/or the temporary basal adjustments will be more aggressive. +Carbohydrate, fat, and protein estimations for bolusing are frequently a guessing game...and we've all guessed wrong before. If your blood glucose is remaining high due to a food guess gone wrong, you can definitely go back in time and adjust your meal's carbohydrate entry to more accurately reflect what you suspect it should have been. By adjusting the original entry, you'll help *Loop* know that the blood glucose effects it needs to control are greater (total carb entry increase) and/or longer (carbohydrate absorption time extension). Often, you'll find *Loop* will offer an additional bolus immediately after you save your adjusted carbohydrate entry, and/or the temporary basal adjustments will be more aggressive. ## Fake Carbohydrates -Some people use "fake" carbohydrate entries to push Loop to be more aggressive with correcting a high blood glucose. This can be effective for hyperglycemia due to short term causes, but is not the recommended way of repeatedly dealing with high blood glucose. If you find yourself regularly using fake carbohydrates often, you may want to consider whether one of your underlying settings needs adjusting. +Some people use "fake" carbohydrate entries to push *Loop* to be more aggressive with correcting a high blood glucose. This can be effective for hyperglycemia due to short-term causes but is not the recommended way of repeatedly dealing with high blood glucose. If you find yourself regularly using fake carbohydrates often, you may want to consider whether one of your underlying settings needs adjusting. ## Prime insulin -If your Preferred Data Source is left on the default "Event History", Loop will not count insulin delivered from "prime" commands in the Medtronic pump. This means that any insulin you deliver through your infusion set while using the prime delivery will not count towards active insulin or insulin on board (IOB). +If your Preferred Data Source is left on the default "Event History", *Loop* will not count insulin delivered from "prime" commands in the Medtronic pump. This means that any insulin you deliver through your infusion set while using the prime delivery will not count towards active insulin or insulin on board (IOB). -If you think that you are being affected by a short term influence that will last for at least 4-6 hours, a conservative amount of primed insulin may help control high blood sugar more aggressively than Loop would have otherwise provided during the stressful event. +If you think that you are being affected by a short-term influence that will last for at least 4-6 hours, a conservative amount of primed insulin may help control high blood sugar more aggressively than *Loop* would have otherwise provided during the stressful event. -**If you choose to deliver insulin via prime command, remember that your active insulin or IOB will not be accurate for 6 hours after the delivery.** Caution should be taken using this method because if the short term stress suddenly ends and blood glucose begins to drop again, the drop may be more pronounced than Loop predicts due to the untracked primed insulin. +**If you choose to deliver insulin via prime command, remember that your active insulin or IOB will not be accurate for 6 hours after the delivery.** Caution should be taken using this method because if the short-term stress suddenly ends and blood glucose begins to drop again, the drop may be more pronounced than *Loop* predicts due to the untracked primed insulin. -Note: For Omnipod users, Loop does not allow you to prime insulin in. +Note: For Omnipod users, *Loop* does not allow you to prime insulin in. ## Open loop and correct manually -Don't forget that you can always go old-school and open your Loop until the cause of the high blood glucose is sorted out and you can get back to normal operations. Site failures are an especially good example of when open looping plus manual correction may be a less frustrating way of dealing with Loop during times when prediction just isn't meeting reality. Give IOB a chance to get back to reality by letting open loop run for 4-6 hours and you'll come back after site failure with a more functional Loop prediction. +Don't forget that you can always go old-school and open your Loop until the cause of the high blood glucose is sorted out and you can get back to normal operations. Site failures are an especially good example of when open looping plus manual correction may be a less frustrating way of dealing with *Loop* during times when prediction just isn't meeting reality. Give IOB a chance to get back to reality by letting open loop run for 4-6 hours and you'll come back after site failure with a more functional *Loop* prediction. ## Adjust settings -Finally, if your underlying cause doesn't appear to be short term (no site failures, no stressful event, no illness) or food related (no recent meals, happens even overnight), then you may need to adjust your underlying settings to help Loop get a more accurate prediction curve working for you. +Finally, if your underlying cause doesn't appear to be short-term (no site failures, no stressful event, no illness) or food-related (no recent meals, happens even overnight), then you may need to adjust your underlying settings to help *Loop* get a more accurate prediction curve working for you. -Long duration "stuck" high blood glucose most often means you'll need to increase your underlying basal rate(s). If Loop's high temporary basals aren't making meaningful progress towards your correction range within 4-6 hours, and you don't suspect food, stress, or site failure, then a basal increase is likely a good place to start. Many people start with a 10% basal adjustment to begin with and wait to see the effectiveness before making any additional adjustments. +Long duration "stuck" high blood glucose most often means you'll need to increase your underlying basal rate(s). If Loop's high temporary basals aren't making meaningful progress towards your correction range within 4-6 hours, and you don't suspect food, stress, or site failure, then a basal increase is likely a good place to start. Many people start with a 10% basal adjustment to begin with and wait to see the effectiveness before making any additional adjustments. What kind of situations are most likely to need this adjustment? Monthly hormonal cycles and steroids are good examples of when underlying basal rate adjustments for a few days could help tremendously until things return to normal. -Consult your health care provider if you are at all uncomfortable self-adjusting basal rates. +Consult your healthcare provider if you are at all uncomfortable self-adjusting basal rates. ## Maximum basal rate -It is worth mentioning one adjustment that will *not* be helpful in these situations. Increasing your maximum basal rate is very unlikely to resolve a stuck high blood glucose. Stuck high blood glucose is the result of Loop predicting that the insulin on board is sufficient to cover the needed correction. The issue is almost never that Loop is being limited by a maximum basal rate, but rather that Loop is predicting that the insulin it has been delivering for awhile is adequate. In other words, Loop doesn't even think that it needs to reach that maximum basal rate. The better adjustment would be to increase your scheduled basal rates, and not the maximum basal rate listed in Delivery Limits. +It is worth mentioning one adjustment that will *not* be helpful in these situations. Increasing your maximum basal rate is very unlikely to resolve a stuck high blood glucose. Stuck high blood glucose is the result of Loop predicting that the insulin on board is sufficient to cover the needed correction. The issue is almost never that *Loop* is being limited by a maximum basal rate but rather that *Loop* is predicting that the insulin it has been delivering for awhile is adequate. In other words, *Loop* doesn't even think that it needs to reach that maximum basal rate. The better adjustment would be to increase your scheduled basal rates and not the maximum basal rate listed in Delivery Limits. diff --git a/docs/how-to/low-treat.md b/docs/how-to/low-treat.md index c93c04e..35242e1 100644 --- a/docs/how-to/low-treat.md +++ b/docs/how-to/low-treat.md @@ -15,13 +15,13 @@ For the most part, you do not *have* to enter low treatments. Not logging low tr ## Roller Coaster after Low Treatment -If you are roller coastering blood glucose after treating lows (going low, quick rise from the treatment carbs, then drop again from Loop's high temps during the rise, and then repeating pattern), here are some tips:

+If you are roller coastering blood glucose after treating lows (going low, quick rise from the treatment carbs, then drop again from Loop's high temporary basals during the rise, and then repeating pattern), here are some tips: -* While treating the low, try setting a temporary workout target of an hour to help keep Loop from aggressively treating a rebound.

-* Consider lowering your maximum basal rate in Loop (within the Delivery Limits setting). This will limit Loop's ability to aggressively treat the rebound rise and allow you to work on getting your settings adjusted, if needed.

-* Consider raising your ISF value (for example, if your ISF is set to 50, consider raising value to 55) to help Loop understand that a smaller magnitude of insulin adjustment is needed. In other words, tell Loop that insulin is packing a bigger punch than you'd previously thought.

+* While treating the low blood sugar, try setting a temporary workout target of an hour to help keep Loop from aggressively treating a rebound. +* Consider lowering your maximum basal rate in Loop (within the Delivery Limits setting). This will limit Loop's ability to aggressively treat the rebound rise and allow you to work on getting your settings adjusted if needed. +* Consider raising your ISF value (for example, if your ISF is set to 50, consider raising the value to 55) to help Loop understand that a smaller magnitude of insulin adjustment is needed. In other words, tell Loop that insulin is packing a bigger punch than you'd previously thought. -If your ISF is set to a value that is too low compared to what it really should be, one of the most common symptoms you'll see is a roller coaster of blood glucose where the temporary basals are cycling between zero and strong high temporary rates. Here are some example graphs from Looped group. These are examples where too low of ISF is more than likely a large factor in the roller coaster (doesn't mean it is the only culprit, and is more difficult to ferret out when food is involved like the second graph).  But, lightning bolt high temporary basals followed by very quick blood glucose drops and zero temps is usually too low of ISF value...raise the ISF value (e.g., go from 50 to 55) to help Loop know that each unit of insulin is actually having more impact than you'd previously thought. +If your ISF is set to a value that is too low compared to what it really should be, one of the most common symptoms you'll see is a roller coaster of blood glucose where the temporary basals are cycling between zero and strong high temporary rates. Here are some example graphs from *Looped* group. These are examples where too low of ISF is more than likely a large factor in the roller coaster (doesn't mean it is the only culprit and is more difficult to ferret out when food is involved like the second graph).  But, lightning bolt high temporary basals followed by very quick blood glucose drops and zero temps is usually too low of ISF value...raise the ISF value (e.g., go from 50 to 55) to help Loop know that each unit of insulin is actually having more impact than you'd previously thought. ![ISF 1](img/isf1.jpg){width="650"} diff --git a/docs/how-to/overrides.md b/docs/how-to/overrides.md index 9bb4893..45d8345 100644 --- a/docs/how-to/overrides.md +++ b/docs/how-to/overrides.md @@ -1,16 +1,17 @@ # Override Targets -Your Loop has two override targets that you can set; Pre-meal and Workout. When activated, these targets will "override" or take the place of your usual correction range and therefore will affect Loop's decisions about insulin delivery. +Your Loop has two override targets that you can set; *Pre-meal* and *Workout*. When activated, these targets will "override" or take the place of your usual correction range and therefore will affect Loop's decisions about insulin delivery. -You can set the value for these override targets from the Correction Range area of Loop settings. Generally speaking, pre-meal targets are set to value(s) lower than your correction range and workout targets are set to value(s) greater than your correction range. Loop will indicate that an override target is active by showing a darker blue bar on the blood glucose chart showing the duration and loation of the target. +You can set the value for these override targets from the Correction Range area of Loop settings. Generally speaking, pre-meal targets are set to value(s) lower than your correction range, and workout targets are set to value(s) greater than your correction range. *Loop* will indicate that an override target is active by showing a darker blue bar on the blood glucose chart showing the duration and location of the target. ## Pre-Meal Targets -The pre-meal target, when activated by pressing on the icon, will stay active for:
+The pre-meal target is also known as the **pre-meal preset**. +When activated by pressing the icon that looks like a timer :material-camera-timer: between a f​ork and a knife :fontawesome-solid-utensils:) it will stay active for: -* one hour, or
-* until carbs are entered, or
-* until pre-meal target is manually cancelled by pressing the icon again. +* one hour, or +* until carbs are entered, or +* until the pre-meal target is manually cancelled by pressing the icon again. Pre-meal target will automatically end when one of those three things happens, whichever comes first will end the pre-meal target. @@ -25,10 +26,10 @@ Pre-meal target won't replace the utility of a true pre-bolus in most situations ## Workout Targets -The workout target, when activated, will give a duration choice of 1 hour, 2 hours, or indefinitely. The workout target, set greater than your usual correction range, is useful to help in situations where Loop needs to be *less* aggressive with insulin delivery. The most common use of the workout target is to set it in advance and during exercise to help minimize IOB going into a workout. While the name is a hint to the most common timing of this override's use, there are other times where it can be helpful such as:
+The workout target, when activated, will give a duration choice of 1 hour, 2 hours, or indefinitely. The workout target set greater than your usual correction range is useful to help in situations where Loop needs to be *less* aggressive with insulin delivery. The most common use of the workout target is to set it in advance and during exercise to help minimize IOB going into a workout. While the name is a hint to the most common timing of this override's use, there are other times when it can be helpful, such as: * Helping to recover from low blood glucose treatment * Helping after workouts when still experiencing increased insulin sensitivity -* Helping during illness which is tending to lower blood glucose or increase insulin sensitivity +* Helping during illness which tends to lower blood glucose or increase insulin sensitivity -You can read more about the timing and use of workut targets before/during/after exercise in the Exercise page of these tips. +You can read more about the timing and use of workout targets before/during/after exercise on the [Exercise](exercise.md) page of these tips. diff --git a/docs/index.md b/docs/index.md index 12dc0af..737ef92 100644 --- a/docs/index.md +++ b/docs/index.md @@ -1,6 +1,6 @@ # Introduction -Welcome to LoopTips! The purpose of these pages is to help you make the most of your DIY closed-looping experience. In particular, these pages support users of the [Loop app](https://loopkit.github.io/loopdocs/){: target="_blank" }. These documents have been a long time in the making and as always, your feedback is welcome. If you have comments, please feel free to provide input at the [Looped Facebook Group](https://www.facebook.com/groups/TheLoopedGroup){: target="_blank" }, [Loop and Learn Facebook Group](https://www.facebook.com/groups/LoopandLearn){: target="_blank" } or in [Loop's Zulipchat](https://loop.zulipchat.com/#narrow/channel/270362-documentation/topic/LoopTips){: target="_blank" }. +Welcome to LoopTips! The purpose of these pages is to help you make the most of your DIY closed-looping experience. In particular, these pages support users of the [Loop app](https://loopkit.github.io/loopdocs/){: target="_blank" }. These documents have been a long time in the making and as always, your feedback is welcome. If you have comments, please feel free to provide input at the [Looped Facebook Group](https://www.facebook.com/groups/TheLoopedGroup){: target="_blank" }, [Loop and Learn Facebook Group](https://www.facebook.com/groups/LoopandLearn){: target="_blank" } or in [ Loop's Zulipchat](https://loop.zulipchat.com/#narrow/channel/270362-documentation/topic/LoopTips){: target="_blank" }. LoopTips is a companion to LoopDocs. LoopTips does not cover the build or installation of Loop app. If you have problems with building your Loop app or troubleshooting the technical aspects of Loop operations, please head over to [LoopDocs](https://loopkit.github.io/loopdocs/){: target="_blank" } for help. The LoopTips pages are specifically related to understanding how your loop is recommending the actions being taken, and how you can improve your blood glucose outcomes on Loop. Some of the pages that originated in LoopTips are now included in LoopDocs. Don't be surprised when you find links between the sites. (The color bar is deliberately a different shade to help you know where you are.) @@ -25,5 +25,5 @@ As exciting as this sounds...we should first get the caveats out of the way. Th ## Disclaimer -While it may seem obvious, please consult with your health care professional regarding your diabetes management. The suggestions and discussion in LoopTips are not a one-size-fits-all nor intended to replace the input from your doctor. You take full responsibility for building and running this system and do so at your own risk. +While it may seem obvious, please consult with your healthcare professional regarding your diabetes management. The suggestions and discussion in LoopTips are not a one-size-fits-all nor intended to replace the input from your doctor. You take full responsibility for building and running this system and do so at your own risk. diff --git a/docs/settings/adjust.md b/docs/settings/adjust.md index 14078e9..4e78aee 100644 --- a/docs/settings/adjust.md +++ b/docs/settings/adjust.md @@ -1,6 +1,6 @@ # Adjusting Your Settings -There will be times when you need to adjust your settings in order to keep your blood glucose within your correction range. The degree to which you adjust your settings will depend on a variety of personal decisions about how active you engage with your diabetes, how comfortable your endocrinologist may feel with patient-adjusted settings and the underlying reason for the change. +There will be times when you need to adjust your settings in order to keep your blood glucose within your correction range. The degree to which you adjust your settings will depend on a variety of personal decisions about how active you engage with your diabetes, how comfortable your endocrinologist may feel with patient-adjusted settings, and the underlying reason for the change. ## Troubleshooting before a change @@ -10,7 +10,7 @@ Before considering a change to your settings, the usual laundry list of possible * Bad infusion site (kinked cannula, blood in cannula, infected site?) * Bad insulin (cloudy? insulin exposed to heat/freezing?) -* Unexpected food impacts (that diet coke wasn't diet, kid sneaking food?) +* Unexpected food impacts (that diet Coke wasn't diet, kid sneaking food?) * CGM damaged (poor calibration, damaged sensor site?) Some signs that the issue is actually the result of equipment failure include the failure of blood glucose to decrease despite repeated bolus corrections. Often during equipment failure troubleshooting, you've blamed the food (and adjusted a carbohydrate count), given corrections, checked for hidden food wrappers, and maybe even open-looped rage bolused. Breathe deep, it is super frustrating to have equipment failure. One of the benefits of Loop can be that equipment failures can become a little easier to identify over time because blood glucose control becomes more predictable and reliable. @@ -22,7 +22,7 @@ Before considering a change to your settings, you should assess if you expect th ### Short-term factors - There's a long list of short-term factors that may temporarily affect how well Loop can automatically keep your blood glucose at your correction goal. Of course, the definition of "temporarily" is also subjective. Some people grow impatient with blood glucose excursions within hours and other people don't consider the need to correct excursions for days. That difference in tolerance will affect a user's assessment of how quickly they will consider adjusting settings. For these discussions, short-term is referring to less than a day. + There's a long list of short-term factors that may temporarily affect how well Loop can automatically keep your blood glucose at your correction goal. Of course, the definition of "temporarily" is also subjective. Some people grow impatient with blood glucose excursions within hours, and other people don't consider the need to correct excursions for days. That difference in tolerance will affect a user's assessment of how quickly they will consider adjusting settings. For these discussions, short-term is referring to less than a day. For the most part, it is not a good idea to adjust settings for very short-term underlying causes such as: @@ -33,7 +33,7 @@ Before considering a change to your settings, you should assess if you expect th * "Baggage claim" lows from pressure changes causing unexpected insulin delivery * Weather - Those are very short term factors and if you change your underlying settings too quickly from just one or two observed blood glucose excursions, you'll likely end up needing to undo the changes just as quickly. For these short-term factors, the best tools involve using temporary target overrides and a measure of patience. In some medium-duration cases (factors that last for at least several hours), people also use "fake" carbohydrate entries to mimic the extra insulin needed during temporary stress on the system which causes high blood glucose. + Those are very short-term factors and if you change your underlying settings too quickly from just one or two observed blood glucose excursions, you'll likely end up needing to undo the changes just as quickly. For these short-term factors, the best tools involve using temporary target overrides and a measure of patience. In some medium-duration cases (factors that last for at least several hours), people also use "fake" carbohydrate entries to mimic the extra insulin needed during temporary stress on the system which causes high blood glucose. ### Long-term factors @@ -46,12 +46,12 @@ The list of long-term factors is just as long, but the most common are probably: * Travel * Beginning new consistent exercise routine (or suddenly becoming more sedentary) -For long(er) term factors, you may benefit from adjusting your underlying settings to reflect the insulin-need changes that have happened as a result of the factors. By adjusting your underlying settings, you will help Loop to better predict your insulin needs and therefore you'll be more likely to achieve blood glucose in correction range. +For long(er) term factors, you may benefit from adjusting your underlying settings to reflect the insulin-need changes that have happened as a result of the factors. By adjusting your underlying settings, you will help Loop to better predict your insulin needs and therefore you'll be more likely to achieve blood glucose in the correction range. ## Assess the data Once you have assessed that there's a need for a settings adjustment, the next step is to decide *which* setting(s) to change and *how* to adjust them. -Whether you undertake the adjustments by yourself and/or with your health care provider's input is at your own discretion. Ideally, you would have your health care provider's input and support to discuss the observations and concerns you have and develop an adjusted setting profile based on those discussions. Many endocrinologists are still becoming familiar with Loop and its algorithm, so providing them links to the various sites would be a good starting point for discussion. This can help the endocrinologist understand where Loop is similar/different than traditional pump therapy. If you and your health care provider are comfortable with your self-adjustments and Loop's algorithm, then proceed ahead. +Whether you undertake the adjustments by yourself and/or with your healthcare provider's input is at your own discretion. Ideally, you would have your healthcare provider's input and support to discuss the observations and concerns you have and develop an adjusted setting profile based on those discussions. Many endocrinologists are still becoming familiar with Loop and its algorithm, so providing them links to the various sites would be a good starting point for discussion. This can help the endocrinologist understand where Loop is similar/different than traditional pump therapy. If you and your healthcare provider are comfortable with your self-adjustments and Loop's algorithm, then proceed ahead. To begin the process of settings adjustment, visualizing your data trends is important. You need to be able to piece together what was eaten, how it was bolused, what temporary basals were applied, and how your blood glucose was reacting. The Data section of LoopTips covers the various places you can find your diabetes-related data to help you during adjustments. diff --git a/docs/settings/overview.md b/docs/settings/overview.md index 9154460..05db45b 100644 --- a/docs/settings/overview.md +++ b/docs/settings/overview.md @@ -18,7 +18,7 @@ Let's start by thinking about basal rates. A well-adjusted basal schedule is de That is how Loop's math starts, and it's an important point to remember as you use and learn your Loop app. Loop's math is based on the assumption that the basal schedule you have provided in your settings are capable of keeping your blood glucose steady in the absence of other stressors. So as your blood glucose goes higher than your correction range for an unusual short-term influence like stress or unannounced carbs, you've been accustomed to delivering a "correction bolus" to get back to range. Or if blood glucose goes below your correction range, you may need to eat recovery carbohydrates. -With all the excitement about automated insulin delivery, some people mistakenly assume that the user's settings don't matter anymore....that **everything** is automated. However, settings do still matter as they provide the basis for Loop's math. Diabetes is not a static math equation. Loop does not adjust your settings for you, that responsibility still falls to the Loop user when needed. +With all the excitement about automated insulin delivery, some people mistakenly assume that the user's settings don't matter anymore....that **_everything_** is automated. However, settings do still matter as they provide the basis for Loop's math. Diabetes is not a static math equation. Loop does not adjust your settings for you, that responsibility still falls to the Loop user when needed. Let's give some examples to help. When you calculate a meal bolus, your math probably looks similar to this: @@ -37,17 +37,17 @@ Some of those factors you are already used to making allowances for, such as: * Hormones...monthly hormone cycles have many women adjusting their basal rates and/or insulin sensitivity schedules for a week or so each month. * Exercise...always a tough one because some exercise may make your blood glucose rise (lifting weights) and other exercise may make your blood glucose drop (running). Through repetition, most people have learned how to adjust for exercise by using temporary basal rates or timing of meals/boluses. -The degree to which Loop can deal with those stresses/factors is largely dependent on the duration of the "factor" itself and how well we can communicate to Loop that those factors are at play. For things we know are coming, we can tell Loop in advance, and Loop has ways of dealing with them mathematically. In the pizza example, Loop lets us mark the meal as long, slow digestion, and therefore better react to a potential late blood glucose rise. For exercise, we can use temporary override blood glucose targets before/after exercise to help Loop administer less insulin for awhile. +The degree to which *Loop* can deal with those stresses/factors largely depends on the duration of the "factor" itself and how well we can communicate to *Loop* that those factors are at play. For things we know are coming, we can tell Loop in advance, and *Loop* has ways of dealing with them mathematically. In the pizza example, Loop lets us mark the meal as long, slow digestion, and therefore better react to a potential late blood glucose rise. For exercise, we can use temporary override blood glucose targets before/after exercise to help Loop administer less insulin for awhile. -If, however, your insulin needs are impacted by something more long term such as hormone cycles, medications, or illness then sometimes your Loop may not be able to consistently hold you at your desired blood glucose. You may end up holding steady at a higher/lower blood glucose than you'd prefer. This is because Loop's math is still using the inputs that were from before you got sick/stressed/hormone'd (new word). Then the decision becomes "Do you adjust your settings now or just wait it out until the stressor goes away?" +If, however, your insulin needs are impacted by something more long-term such as hormone cycles, medications, or illness then sometimes your Loop may not be able to consistently hold you at your desired blood glucose. You may end up holding steady at a higher/lower blood glucose than you'd prefer. This is because Loop's math is still using the inputs that were from before you got sick/stressed/hormone'd (new word). Then the decision becomes "Do you adjust your settings now or just wait it out until the stressor goes away?" ## When do you need to change settings? -If the inputs to those math equations (i.e., your settings) are not accurate, your results for blood glucose control may also not be optimal. +If the inputs to those math equations (i.e., your settings) are not accurate, your blood glucose control results may also not be optimal. Your basic insulin settings are what keeps your blood glucose steady *without stressors* present. For much of the time, the stressors in type 1 are short-lived and temporary (we just ride them out)...carbohydrate count is a little off, math test in algebra class, public speaking engagement, etc. Loop does well helping with the short-term stressors. They don't represent a prolonged need to change settings and the blood glucose impacts are short-lived as Loop corrects for them. -However, the longer term stressors are often helped by settings adjustments. Examples of longer term stressors are medications, illness, hormones, travel, or altitude. By letting Loop know that the status quo has changed (more/less insulin is needed overall) will help BGs get and stay in range. If you have told Loop that your insulin need is 1 unit/hour, but in reality, you're needing 1.3 units/hour because you've traveled to a colder place and will be sedentary for days...you will likely find yourself steady but higher than your target range while Looping. The high temporary basals that Loop will be providing in an attempt to bring you back to target will simply be going to fill the lack of adequate basal scheduled. If you update your basal schedule to reflect 1.3 units/hour of basal needs, Loop would be better positioned to provide needed insulin delivery to keep you in the target range. +However, the longer-term stressors are often helped by settings adjustments. Examples of longer term stressors are medications, illness, hormones, travel, or altitude. By letting Loop know that the status quo has changed (more/less insulin is needed overall) will help BGs get and stay in range. If you have told Loop that your insulin need is 1 unit/hour, but in reality, you're needing 1.3 units/hour because you've traveled to a colder place and will be sedentary for days...you will likely find yourself steady but higher than your target range while Looping. The high temporary basals that Loop will be providing in an attempt to bring you back to target will simply be going to fill the lack of adequate basal scheduled. If you update your basal schedule to reflect 1.3 units/hour of basal needs, Loop would be better positioned to provide needed insulin delivery to keep you in the target range. ## Automated settings adjustments @@ -57,6 +57,6 @@ What the user is actually implying is that the user thinks Loop should be doing There is a short-term retrospective analysis built into Loop which will apply a weighted-correction based on the past 60 minutes of blood glucose changes. While this does help some, larger-scale "learning" is not currently a part of Loop's algorithm. -Perhaps in subsequent versions of Loop, auto-adjustment of settings or machine learning could be incorporated. Until then, you will need to tell Loop if your underlying settings need updating or make temporary adjustments for short term issues. These pages in LoopTips are written to help you identify when settings may need adjustment or when other techniques may be useful in given situations. +Perhaps in subsequent versions of Loop, auto-adjustment of settings or machine learning could be incorporated. Until then, you will need to tell Loop if your underlying settings need updating or make temporary adjustments for short-term issues. These pages in LoopTips are written to help you identify when settings may need adjustment or when other techniques may be useful in given situations. diff --git a/docs/settings/settings.md b/docs/settings/settings.md index 2f882c1..5f10a7e 100644 --- a/docs/settings/settings.md +++ b/docs/settings/settings.md @@ -63,7 +63,7 @@ Many people, especially little kids, are not enthusiastic about fasting basal te ### Insulin Sensitivity Factor -Insulin sensitivity factor (ISF) is the next logical setting to test. If you've just done the basal test and gotten steady blood glucose with an open loop, try taking a glucose tab or two. Wait for your blood glucose to be steady at the higher value, and give a safe correction that you think will get you close to target. Watch the resulting blood glucose drop over the next 3-4 hours. You should see blood glucose come to a steady level again. How much did the blood glucose drop? How many units of insulin did you use? Divide the two numbers and you will have your ISF.  If your BG dropped 15 mg/dL with half unit of insulin, your ISF is approximately 30 mg/dL per unit. +Insulin sensitivity factor (ISF) is the next logical setting to test. If you've just done the basal test and gotten steady blood glucose with an open loop, try taking a glucose tab or two. Wait for your blood glucose to be steady at the higher value, and give a safe correction that you think will get you close to target. Watch the resulting blood glucose drop over the next 3-4 hours. You should see blood glucose come to a steady level again. How much did the blood glucose drop? How many units of insulin did you use? Divide the two numbers and you will have your ISF.  If your BG dropped 15 mg/dL with half a unit of insulin, your ISF is approximately 30 mg/dL per unit. Testing ISF is an important step in successful closed Loop use. ISF is used in every Loop calculation and plays an important part in Loop's prediction curve. Most users find that they have to adjust ISF; most often increasing the value. If you are experiencing roller coastering blood glucose, as described below, that is often a sign that ISF needs to be weaker (higher value). diff --git a/mkdocs.yml b/mkdocs.yml index efcb2d3..238b0be 100644 --- a/mkdocs.yml +++ b/mkdocs.yml @@ -36,6 +36,9 @@ markdown_extensions: - attr_list - pymdownx.arithmatex: generic: true + - pymdownx.emoji: + emoji_index: !!python/name:material.extensions.emoji.twemoji + emoji_generator: !!python/name:material.extensions.emoji.to_svg - pymdownx.highlight - pymdownx.inlinehilite - pymdownx.superfences