The Family Centre's Looping Info Night on 20 February provided a window into the world of looping, offering information on the set-up, equipment and user experiences of both commercially available loop systems and 'do-it-yourself' systems.
Gabby Lane, the Family Centre's Adults' Community Coordinator, presented on the history of looping and the equipment, know-how and software needed for different loop systems. Following that, we heard user experiences from guest speakers Maddy Baxter, Spike Beecroft, Beth Wright and her partner Adam, and Kyle Masterman who wowed the audience with their ingenuity and presented both the benefits and challenges of looping.
For people who couldn't attend, here's a wrap of the key information presented on the night:
Looping is an automated insulin delivery system that takes Continuous Glucose Monitor (CGM) values, runs them through an algorithm, and automatically adjusts basal insulin delivery through an insulin pump. Commercial closed-loop systems have been a research priority for a number of years, while do-it-yourself (DIY) looping emerged from the #wearenotwaiting movement. You may have heard looping referred to as a closed-loop system or the 'artificial pancreas' - although all systems are a long way off a true artificial pancreas.
Whether you choose to use a commercial system or build a DIY system, looping may improve your time-in-range (especially overnight), reduce high and low blood sugars, reduce time spent on diabetes, and free up mental space.
Currently in Australia, there is one commercial loop system, the Medtronic MiniMed 670G which is approved for ages 7+. Smart Guard Auto Mode is installed as approved software on the 670G insulin pump and is the system that automatically adjusts basal insulin rates. This system can be accessed via your private health insurance, or you can purchase it outright through Medtronic.
Although not currently available in Australia, the Tandem Control-IQ software is another commercial loop system which is in use in the United States. This system will most likely be available in Australia once the Dexcom G6 (which received TGA approval in March 2020) starts distribution in Australia, and when the automatic basal adjustment algorithms 'Basal-IQ' and 'Control-IQ' get TGA approval and are made available. It may be a little while before we see the Tandem Control-IQ loop system up and running in Australia, but the recent Dexcom G6 TGA approval is an important step towards it.
Do-It-Yourself (DIY) systems
Do-It-Yourself (DIY) loop systems were born from the #wearenotwaiting movement and type 1 software engineer Dana Lewis's Open APS technology (watch her Ted Talk here). The overall aim of DIY systems is similar to commercial systems: they automate basal insulin delivery for people with type 1 diabetes. The DIY movement, however, had different beginnings - they started with type 1 community members taking matters into their own hands and developing their own loop solution.
There are three different types of DIY systems available: Loop, AndroidAPS, and OpenAPS. All of these DIY systems must be made by the person who wears the technology. DIY systems are more customisable and potentially have more features than commercial systems, but all our speakers agreed that they require a lot of work to set up. We suggest reading Diabetes Australia's position statement on DIY loop technology. If you choose to run a DIY system, our speakers suggested that you read the DIY documentation linked above carefully first and that you join Facebook groups to engage with the community for extra support (Aussie, Aussie, Aussie, Loop, Loop, Loop is a recommended Facebook group).
All loop systems work off the same basic premise: an insulin pump is connected to a Continuous Glucose Monitor (CGM) and insulin delivery is automated through a control algorithm.
Commercial loop systems simply require an insulin pump that has the control software installed and a compatible CGM. For any support in the requirements of these systems, chat to your local distributor for more information.
DIY systems typically reverse-engineer older devices to work within a loop system and this generally requires an extra device (a 'bridging' device) to connect up the older insulin pump with current CGMs. This bridging device may be a small computer that you need to build from scratch, or some systems work with a device called a RileyLink that you can purchase pre-built online. For support with requirements and building this system, check out the documentation and Facebook groups linked above.
It's important to think hard about whether loop is the right tool for you. Our guest speakers, who use either a commercial or DIY loop system, presented balanced perspectives of the benefits (diabetes management and quality of life) and challenges (time-consuming set up and potential failure points). Looping is a new and exciting area of type 1 technology that may be the next addition to your type 1 toolbox.
Thank you to everyone who attended and contributed to the Family Centre's Looping Info Night. We're excited to see where the future of 'loop' takes the type 1 community.
Read what the attendees loved most about the Looping Info Night:
“Attending the Family Centre for the first time and being made to feel like I have been coming there for years! An amazing resource for the community, and a credit to all involved. Meeting many awesome new peers and their support people who bravely shared their lived experience of T1D. Seeing the interest in the Looping movement and the hope people hold for a brighter future.”
“The thought put into it was amazing. Food choices, speakers, info and set up were great.”
“It was very informative, and I got a lot out of it. It’s been something that I have been interested in for a while.
“Being able to speak with people who understand what you are going through and being able to assist them with receiving support.”