Pump Advice Sought for Closed Looping

[declan88]

Hi di hi Campers

I'm thinking of trying a closed loop system. My dsn told me i might get freestyle libre if i'd had sufficient hypos- what a world.

Could anyone tell me of (tubeless preferably) pumps which work with the Freestyle Libre and a closed loop app? I understand not all pumos can be accessed by bluetooth for control of dosing.

And also what app/ system they used to make the link. I have an android phone.

Thanks

 

[MrDaibetes]

The only one I know of that is tubeless is Omnipod, you would also need a Riley link, apple phone and mac to set it up.

 

[everydayupsanddowns]

Probably the easiest way to explore your options is to read some of Tim Street's blog posts on the subject:
https://www.diabettech.com/looping-a-guide/

For Android APS I think your best pump options are Combo or Dana RS or possibly Insight. I'm not sure Omnipod works 'closed loop' yet, but you could run 'open loop' with any of the tubeless or semi-tubeless options.

You'll also need a way of getting the CGM data available to the algorithm which with Libre1 might mean MiaoMiao and then x-drip into Nightscout.

I would also recommend you (and especially your nurse!!) consults the mandatory national criteria for Libre on prescription, because frequency of hypos really isn't something that defines access. If anything frequent hypos are an indication that full rtCGM should be 'considered', but local healthcare beancounters usually resist funding applications for full CGM unless there are extraordinary circumstances.

The national criteria for Libre can be found here:

https://www.england.nhs.uk/publicat...ts-for-funding-of-relevant-diabetes-patients/

Annex A: Criteria for NHS England Flash Glucose Monitoring Reimbursement

1. People with Type 1 diabetes
   OR
   with any form of diabetes on hemodialysis and on insulin treatment
   who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months
   OR
   with diabetes associated with cystic fibrosis on insulin treatment
2. Pregnant women with Type 1 Diabetes -12 months in total inclusive of post-delivery period.
3. People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
   
4. People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
   
5. Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of thesecriteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding.
6. For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation.However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.

 

[declan88]

Probably the easiest way to explore your options is to read some of Tim Street's blog posts on the subject:
https://www.diabettech.com/looping-a-guide/

For Android APS I think your best pump options are Combo or Dana RS or possibly Insight. I'm not sure Omnipod works 'closed loop' yet, but you could run 'open loop' with any of the tubeless or semi-tubeless options.

You'll also need a way of getting the CGM data available to the algorithm which with Libre1 might mean MiaoMiao and then x-drip into Nightscout.

I would also recommend you (and especially your nurse!!) consults the mandatory national criteria for Libre on prescription, because frequency of hypos really isn't something that defines access. If anything frequent hypos are an indication that full rtCGM should be 'considered', but local healthcare beancounters usually resist funding applications for full CGM unless there are extraordinary circumstances.

The national criteria for Libre can be found here:

https://www.england.nhs.uk/publicat...ts-for-funding-of-relevant-diabetes-patients/

Annex A: Criteria for NHS England Flash Glucose Monitoring Reimbursement

1. People with Type 1 diabetes
   OR
   with any form of diabetes on hemodialysis and on insulin treatment
   who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months
   OR
   with diabetes associated with cystic fibrosis on insulin treatment
2. Pregnant women with Type 1 Diabetes -12 months in total inclusive of post-delivery period.
3. People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
   
4. People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
   
5. Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of thesecriteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding.
6. For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation.However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.

Thanks Mike 🙂

I assumed the dsn wanted the meter download to get a hypo count ( condition 6 on the Libre justification list) to see if a cgm was justified, but i now see that there are other potential justifications too.
There are a lot of techno/ acronym spaghetti in all that. l'll try it out.

The only one I know of that is tubeless is Omnipod, you would also need a Riley link, apple phone and mac to set it up.

Thanks David 🙂