Loop & pump

I have been using a pump for 40 years. I am finding that CIQ doesn’t work for me What pumps can currently work with loop. My goal is to find a pump where I can control the algorithm. (Used to write algorithms for a living). I need to have suspend insulin when low but not manage highs. Loop might work but where would I get a comparable pump?(prefer a tubed pump) :vulcan_salute:

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If you must use a tubed pump, @Terry is the guy to ask about that. He knows the specs for the MiniMed pumps that are compatible.

I think it has to be a pretty old MiniMed to work with the DIY Loop, and I also think you need to use a RileyLink.

The RileyLinks are easy to get. But finding an old MiniMed is tough. @Terry might know some tricks there.

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Assuming you mean “loop” to include all the forks, i.e. the ones that run on mobiles rather than a PC, the “FDA approved” list seems to be just twiist running a modified and possibly restricted, version of TidePool Loop internally. I.e. loop runs inside the twiist pump; not hard, I’m sure loop could be ported to Arduino and maybe even an ESP32 :slight_smile: Wouldn’t surprise me if that was what was inside the twiist!

If you are willing and able to do the work AAPS (“Android APS”, “Android [Artificial Pancreas System]”) supports a variety of pumps:

Android APS compatible pump list

A lot of that work crosses over with TidePool Loop but it seems difficult at present to find a single, “Supported Pump” list for TidePool Loop. TidePool Loop is the only FDA approved program to run with an “acePump”, but there are, at present, no such things; there are lots of controllable pumps (though the number is decreasing rapidly), but the control is not FDA approved so they are not FDA “acePumps”.

TidePool Loop explain it from a much more marketing oriented viewpoint. There are useful definitions and good historical perspectives but to find them you have to know they are there.

Their sad list of device partners is here:

The core part of Loop is to manage both the highs and the lows. It is true that all the Loop variants seem to be biased against low vs high and that does seem to reflect a very strongly held doctor viewpoint, possibly motivated by liability insurance.

It is also possible to run Loop, I believe all variants, in, “Low Glucose Suspend” [LGS] mode, but I thought CiQ could do that as well. It’s regarded as “safe”, though I do not think so; it can easily result in DKA.

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Thanks for the feedback. The caveats I’m not concerned with. 60 years t1d - never had CKD never had a trip to ER for BS reasons. Infections yes. With basal iq circa 2020 and very low carb I was achieving an A1c of 5.1-5.4. I won’t measure that low next time around but I’ll figure out how to adjust diet to using x2 as a dumb pump.

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@jbowler posted the list…Sequel twiist is the only commercial pump running Tidepool loop. I have been using twiist pump with loop for about 2 months. ( I never tried DIY loop so can not provide a comparison). Twiist pump does suspend insulin based on predicted lows, and seems to do it quite well. There is also a manual suspend.

That said, I am going back to Omnipod 5 for a few months. My trial of twiist was plagued by an initial lengthy period of tweaking the settings. I finally got the settings to behave adequately a few weeks ago. I had two extreme high BGs, heading towards DKA territory, caused by infusion set problems. Both times the cannula was bent when I removed it. The last straw was a mechanical pump failure today. They are sending me a replacement but I am concerned about reliability of the hardware.

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I apologize that I did not include the Tidepool pumps in my initial reply.

Since you said that your goal is to find a pump where you can control the algorithm, I did not think you wanted any of the Tidepool stuff.

There is a little bit of a gray area with Tidepool.

The basic algorithm is like DIY Loop, but there are several safety “guardrails”, and the official Tidepool version implements hard limits.

I think you can get the code, fork it, and make your own. But then it is no longer the official Tidepool app.

My version of Loop only supports omnipods and medtronic, but there may have been updates to it that allow other pumps now. So my reference to either omnipod or medtronic is based on the older Loop code. Not 100% sure if there aren’t other options now with DIY Loop.

@TomH might know about that, he follows all the Loop stuff very closely.

My understanding, Tidepool Loop is a version of Loop that has had additional coding work done by both Tidepool and Twisst for use with the Twisst pump since Twisst’s announcement. I’m not familiar with all the changes committed by them, nor do I expect Twisst will be forthcoming regarding them.

As to pumps compatible with Loop, here’s a link to the docs section stating current pumps supported: Compatible Pump - LoopDocs
There’s also work being done and expected to be completed soon on a couple of other pumps (Omnipod 5 is one). I think all the pumps being written for are available for experienced Loop pumpers in various dev versions of the program. Anyone using them is highly encouraged to monitor https://loop.zulipchat.com/ for updates because those versions are experimental and updates can drop at any time. Most if not all of these pumps are also compatible or being worked on to be compatible with Trio.

Hope this helpful!

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@Penn – For sourcing compatible Loop DIY pumps, @TomH provided the best link. I use the Minimed 722 and have two of them, one for backup. These tubed pumps were manufactured circa 2006-2010 so they are getting a bit old but were sturdily built. There are other tubed pumps that work with alterable algorithms like AndroidAPS and OpenAPS. Again, carefully read the LoopDocs linked above for details.

I have been using Loop DIY since late 2016 with a tubed pump and have enjoyed very good results, most A1c’s since then < 5.7%. My results are not just attributed to the hardware & software but also to my eating style and personal glucose management philosophy. Good luck!

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I have a tslim xz & run it in manual mode. I use temp rate both to increase insulin rate and go to 0% x … to prevent lows.

Wow! @Terry, an A1c below 5.7 is impressive, particularly if you’ve achieved it regularly, whether it’s the algorithm or your eating style! I normally look at GMI, SD, and COV (Loop, Trio, and LoopFollow do the math for you thank goodness), but A1c is a useful tool/reference and still used by most docs. I try to stay below 7, usually come in between 5.9 and 6.4 on both GMI and A1c. I’ve read the history of the ADA recommendation of <7. Apparently there was quite the “kerfufle” of what A1c should be establish as a goal, particularly regarding older follks and a few other factors. There were two primary camps advocating for <7 and <8, depending on age and other factors, but the <7 won when ADA announced it in 1994. Some folks shoot for as low as possible; I’ve read of those shooting for <5, and a few or even <4, but there’s even more controversy about doing so. Anyway, congrats!

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I consider the coefficient of variation percentage (CV%) to be the best representation of glycemia, yet also see the % time in normal range (65-120 mg/dL) to be a fair measure. CV% = SD/Average BG, but make sure to be consistent with mg/dL or mmol/L units. But since the less aware world, including most physicians, think in terms of A1c, I default to that less representative measure.

When I talk to medicos who are concerned about my glycemia, I will quickly add that my % time below 54 mg/dL (3.0) is < 1% after I indicate my A1c. Thanks for the encouragement, @TomH!

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@Terry is an impressive guy in many ways :slight_smile: Terry, I think our relationship goes back to 2016?

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The admiration is mutual, @Michel! You’ve accomplished much for this community.

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Most of that is for the data logging project; it’s not clear to me how much of the TidePool loop fork is there but a quick perusal by me suggests that it all is, somewhere:

  1. The Algo: GitHub - tidepool-org/LoopAlgorithm: Swift Package implementation of the Loop Algorithm · GitHub
  2. The Apple [specific] implementation: GitHub - tidepool-org/Loop: An automated insulin delivery app template for iOS, built on LoopKit · GitHub

Those links are from the list presented to me by github but I was not signed in. There are a massive 223 repos; no structure, just a list. I do appreciate they are keeping them public but there’s such a thing as too much dirty laundry.

At times there seem to have been suggestions of a Google-specific implementation too, that may be lower down in the list.

Marketing BS: Tidepool Loop | Tidepool

The Important Part (hidden as a link):

Bookmark that link (so I won’t have to) :wink:

“The TidePool app” is not supported by any pump for the simple reason that the approved “app” (the iAGC if you read the previous link) requires an “acePump” (a separately controllable insulin pump) and there is no such thing. Well, of course there is; I use a Dash pump (a non-approved acePump) and AAPS (a non-approved iAGC) along with an approved iCGM but not approved in the way I use it to control my diabetes.

I don’t boast about my HbA1c for the simple reason that it sucks. I boast about the freedom I get from doing this. I eat, I go high, the iAGC handles it. If it doesn’t handle it I kick it, with a manual bolus to the acePump and it, somewhat dog-like, acknowledges that I just rage bloused (ooh, I love that word; we should all use it) 2IU and said dog deals with it.

For me this is what counts.

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I’ve been using the Beta Bionic Ilet pump for about a month now. I switched from T-slim 2x because I had a stroke, and my husband has to assume a lot of my care. I’m liking it, but I’m not sure it does or doesn’t do what you’re needing. It truly takers over one’s care, He just has to let it know when I’m having a meal and whether it’s “usual”, more, or less than “usual”, then swipe to deliver. No math. The pump learns” your basal rate

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Yes, I’ve been tempted and, indeed, my endo asked if I’d seen it a couple of years ago. I don’t want to have to care about my diabetes and if I were to start hacking my own system meals would be “small”, “medium”, “large” and “insane”; maybe slightly more than the isLet but that’s easy.

This works because the pump learns everything, not just basal but bolus and even how big the meals are that we eat.

This isn’t any more difficult than learning one thing correctly because bolus, basal and eyeball all interact; get them all right or get nothing right.

I did mention it again to my endo more recently but he didn’t want me to change; apparently I’m doing good enough with my current system and, if it aint broke dont fix it. (Hum, I have made the same observation to him over the last couple of years…)

If my wife gets into the same situation with me I would certainly want to swap.

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That ‘rage boloused’ line is pure gold :joy: Gotta love a system that just handles it when life happens. Also nice to see earthling back on the forum!

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