diff --git a/docs/EN/Getting-Started/Introduction.md b/docs/EN/Getting-Started/Introduction.md index 6dc391acde96..7c711a4cc323 100644 --- a/docs/EN/Getting-Started/Introduction.md +++ b/docs/EN/Getting-Started/Introduction.md @@ -21,11 +21,11 @@ In an aircraft, an autopilot does not do the complete job of the human pilot, th (Introduction-what-does-hybrid-closed-loop-mean)= ## What does hybrid closed loop mean? -The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While we are waiting for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that doesn’t need any user input (like bolusing insulin for meals, or announcing exercise), with good regulation of blood glucose levels. At the moment, there are no widely available systems which are “full” closed loop, they all need some user input. The currently available systems are called “hybrid” closed loop, because they use a combination of automated technology and user input. +The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While we are waiting for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that requires a reduced need for user input (like suspending insulin for predicted lows or providing addtional insulin for fast rise in **BG**), with good regulation of blood glucose levels. At the moment, there are no widely available systems which are “full” closed loop, they all need some user input. The currently available systems are called “hybrid” closed loop, because they use a combination of automated technology and user input. ## How and why did looping start? -The development of commercial technology for people with type 1 diabetes (T1D) is very slow. In 2013 the T1D community founded the #WeAreNotWaiting movement. They developed systems themselves using existing approved technology (insulin pumps and sensors) to improve blood glucose control, safety, and quality of life. These are known as OS-AID (Open-Source Automated Insulin Dosing) systems (formerly DIY systems), because they are not formally approved by health bodies (FDA, NHS etc). There are four main DIY systems available: [OpenAPS](https://openaps.org/what-is-openaps/), **AAPS**, [Loop](https://loopkit.github.io/loopdocs/#what-is-loop) and [Trio](https://triodocs.org). +The development of commercial technology for people with type 1 diabetes (T1D) is very slow. In 2013 the T1D community founded the #WeAreNotWaiting movement. They developed an open source solution themselves using existing approved technology (insulin pumps and sensors) to improve blood glucose control, safety, and quality of life. These are known as OS-AID (Open-Source Automated Insulin Dosing) systems (formerly DIY systems), because they are not formally approved by health bodies (FDA, NHS etc). There are four main DIY systems available: [OpenAPS](https://openaps.org/what-is-openaps/), **AAPS**, [Loop](https://loopkit.github.io/loopdocs/#what-is-loop) and [Trio](https://triodocs.org). A great way to understand the fundamentals of DIY looping is to read Dana Lewis’s book “Automated Insulin Delivery”. You can access it [here](https://www.artificialpancreasbook.com/) for free (or buy a hardcopy of the book). If you want to understand more about [OpenAPS](https://openaps.org/what-is-openaps/), which **AAPS** has developed from, the [OpenAPS website](https://openaps.org/what-is-openaps/) is a great resource. @@ -45,15 +45,15 @@ Since OpenAPS is only compatible with certain older insulin pumps, **AAPS** (whi ## What are the basic components of AAPS? -The “brain” of AAPS is an **app** which you build yourself. There are detailed step-by-step instructions for this. You then install the **AAPS app** on a [compatible](../Getting-Started/Phones.md) **Android smartphone** (**1**). A number of users prefer their loop on a separate phone to their main phone. So, you don’t necessarily have to be using an Android phone for everything else in your life, just for running your AAPS loop. +The “brain” of **AAPS** is an **app** (or **apk**) which you build yourself with help from these notes. There are detailed step-by-step instructions for this. You then install the **AAPS apk** on a [compatible](../Getting-Started/Phones.md) **Android smartphone** (**1**). A number of users prefer their **AAPS** loop on a separate phone to their main phone to avoid battery drainge or bluetooth connection issues. So, you don’t necessarily have to be using an Android phone for everything else in your life, just for running your **AAPS**. -The **Android smartphone** will also need to have another app installed on it as well as **AAPS**. This [additional app](../Getting-Started/CompatiblesCgms.md) receives glucose data from a sensor (**2**) by bluetooth, and then sends the data internally on the phone to the **AAPS app**. +The **Android smartphone** will also need to have another **apk** installed on it as well as **AAPS**. This [additional app](../Getting-Started/CompatiblesCgms.md) receives glucose data from a sensor (**2**) by bluetooth, and then sends the data internally on the phone to the **AAPS app**. -The **AAPS app** uses a decision making process (**algorithm**) from OpenAPS. Beginners start out using the basic **oref0** algorithm, but it is possible to switch to using the newer **oref1** algorithm as you progress with AAPS. Which algorithm you use (oref0 or oref1), depends on which suits your specific situation best. In both cases, the algorithm takes into account multiple factors, and performs rapid calculations every time a new reading comes in from the sensor. The algorithm then sends instructions to the insulin pump (**3**) on how much insulin to deliver by bluetooth. All the information can be sent by mobile data or wifi to the internet (**4**). This data can also be shared with followers if desired, and/or collected for analysis. +The **AAPS app** uses a decision making process (**algorithm**) from OpenAPS. Beginners start out using the basic **oref0** algorithm, but it is possible to switch to using the newer **oref1** algorithm as you progress with **AAPS**. Which algorithm you use (oref0 or oref1), depends on which suits your specific situation best. In both cases, the algorithm takes into account multiple factors, and performs rapid calculations every time a new reading comes in from the sensor. The algorithm then sends instructions to the insulin pump (**3**) on how much insulin to deliver by bluetooth. All the information can be sent by mobile data or wifi to the internet (**4**). This data can also be shared with followers if desired, and/or collected for analysis. ## What are the advantages of the AAPS system? -The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data. Some of the reported advantages of using AAPS are extensive fine-tunable options, automations and increased transparency of the system for the patient/caregiver. This can result in better control over your (or your dependant’s) diabetes, which in turn may give improved quality of life and increased peace of mind. +The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data. Some of the reported advantages of using **AAPS** are perosnalised fine-tunable options, **Automations** and increased transparency and visibility of the system for the patient/caregiver. This can result in better control over your (or your dependant’s) diabetes, which in turn may give improved quality of life and increased peace of mind. ### **Specific advantages include:** @@ -62,7 +62,7 @@ To read about the safety features of the algorithms, known as oref0 and oref1, [ #### 2) **Hardware flexibility** -**AAPS** works with a wide range of insulin pumps and sensors. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. That offers flexibility as life changes. You don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. AAPS is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves. +**AAPS** works with a wide range of insulin pumps and sensors. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. That offers flexibility as life changes. You don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. **AAPS** is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves. #### 3) **Highly customisable, with wide parameters** @@ -70,21 +70,21 @@ Users can easily add or remove modules or functionality, and **AAPS** can be use a) The ability to set a lower glucose target 30 min before eating; you can set the target as low as 72 mg/dL (4.0 mmol/L). - b) If you are insulin-resistant resulting in high blood sugars, **AAPS** allows you to set an **automation** rule to activate when BG rises above 8 mmol/L (144 mg/dL), switching to (for example) a 120% profile (resulting in an 20% increase in basal and strengthening of other factors too, compared to your normal **profile** setting). The automation will last according to the scheduled time you set. Such an automation could be set to only be active on certain days of the week, at certain times of day, and even at certain locations. + b) If you are insulin-resistant resulting in high blood sugars, **AAPS** allows you to set an **Automation** rule to activate when **BG** rises above 8 mmol/L (144 mg/dL), switching to (for example) a 120% **Profile** (resulting in an 20% increase in basal and strengthening of other factors too, compared to your normal **Profile** setting). The **Automation** will last according to the scheduled time you set. Such an **Automation** could be set to only be active on certain days of the week, at certain times of day, and even at certain locations. - c) If your child is on a trampoline with no advance notice, **AAPS** allows insulin suspension for a set time period, directly via the phone. + d) After reconnecting a tubed pump which has been disconnected for swimming, **AAPS** will calculate the basal insulin you have missed while disconnected and deliver it carefully, according to your current **BG**. Any insulin not required can be overridden by just “cancelling” the missed basal. - d) After reconnecting a tubed pump which has been disconnected for swimming, **AAPS** will calculate the basal insulin you have missed while disconnected and deliver it carefully, according to your current BG. Any insulin not required can be overridden by just “cancelling” the missed basal. - - e) **AAPS** has the facility for you to set different profiles for different situations and easily switch between them. For example, features which make the algorithm quicker to bring down elevated BG (like supermicro boluses (“**SMB**”), unannounced meals, (“**UAM**”) can be set to only work during the daytime, if you are worried about night-time hypos. + e) **AAPS** has the facility for you to set different **Profiles** for different situations and easily switch between them. For example, features which make the algorithm quicker to bring down elevated **BG** (like supermicro boluses (“**SMB**”), unannounced meals, (“**UAM**”) can be set to only work during the daytime, if you are worried about night-time hypos. -These are all examples, the full range of features gives huge flexibility for daily life including sport, illness, hormone cycles _etc_. Ultimately, it is for the user to decide how to use this flexibility, and there is no one-size-fits-all automation for this. +These are all examples, the full range of features gives huge flexibility for daily life including sport, illness, hormone cycles _etc_. Ultimately, it is for the user to decide how to use this flexibility, and there is no one-size-fits-all **Automation** for this. #### 4) **Remote monitoring** There are multiple possible monitoring channels (Sugarmate, Dexcom Follow, xDrip+, Android Auto _etc._) which are useful for parents/carers and adults in certain scenarios (sleeping/driving) who need customisable alerts. In some apps (xDrip+) you can also turn alarms off totally, which is great if you have a new sensor “soaking” or settling down that you don’t want to loop with yet. #### 5) **Remote control** -A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or AAPSClient) to send a wide range of commands back to the **AAPS** system. This is used extensively by parents of kids with type 1 diabetes who use AAPS. It is very useful: for example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is possible to monitor the system (_e.g._ Fitbit), send basic commands (_e.g._ Samsung Galaxy watch 4), or even run the entire AAPS system from a high-spec smartwatch (**5**) (_e.g._ LEMFO). In this last scenario, you don’t need to use a phone to run AAPS. As battery life on watches improves and technology becomes more stable, this last option is likely to become increasingly attractive. +A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or **AAPSClient**) to send a wide range of commands back to the **AAPS** system. This feature is used extensively by parents of type 1 kids diabetes who use **AAPS**. + +The remote control features can very useful. For example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is possible to monitor **AAPS** (_e.g._ Fitbit), send basic commands (_e.g._ Samsung Galaxy watch 4), or even run the entire **AAPS** system from a high-spec smartwatch (**5**) (_e.g._ LEMFO). In this last scenario, you don’t need to use a phone to run **AAPS**. As battery life on watches improves and technology becomes more stable, this last option is likely to become increasingly attractive. #### 6) **No commercial constraints, due to open application interfaces** Beyond the use of an open-source approach, which allows the source code of **AAPS** to be viewed at any time, the general principle of providing open programming interfaces gives other developers the opportunity to contribute new ideas too. **AAPS** is closely integrated with Nightscout. This accelerates development and allows users to add on features to make life with diabetes even more convenient. Good examples for such integrations are [Nightscout](https://nightscout.github.io/), [Nightscout Reporter](https://nightscout-reporter.zreptil.de/), xDrip+, [M5 stack](https://github.com/mlukasek/M5_NightscoutMon/wiki) etc. There is ongoing dialogue between open-source developers and those developing commercial systems. Many of the DIY innovations are gradually adopted by commercial systems, where developments are understandably slower, partly because interfaces between systems from different companies (pumps, apps, sensors _etc_) need to be carefully negotiated and licenced. This can also slow innovations which are convenient for the patient (or a small sub-population of patients, who have a very specific requirement) but do not generate any sizable profit. @@ -93,13 +93,13 @@ Beyond the use of an open-source approach, which allows the source code of **AAP With **AAPS** it is easy to keep track of things like: pump insulin levels, cannula age, sensor age, pump battery age, insulin-on-board _etc_. Many actions can be done through the **AAPS** app (priming the pump, disconnecting the pump _etc_.), instead of on the pump itself, which means the pump can stay in your (or your dependant's) pocket or belt. #### 8) **Accessibility and affordability** -**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a world-class hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) [Android phones](https://docs.google.com/spreadsheets/u/1/d/e/2PACX-1vScCNaIguEZVTVFAgpv1kXHdsHl3fs6xT6RB2Z1CeVJ561AvvqGwxMhlmSHk4J056gMCAQE02sAWJvT/pubhtml?gid=683363241&single=true). Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](#accessibility-for-users-aaps-who-are-partially-or-completely-blind). +**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) [Android phones](https://docs.google.com/spreadsheets/u/1/d/e/2PACX-1vScCNaIguEZVTVFAgpv1kXHdsHl3fs6xT6RB2Z1CeVJ561AvvqGwxMhlmSHk4J056gMCAQE02sAWJvT/pubhtml?gid=683363241&single=true). Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](#accessibility-for-users-aaps-who-are-partially-or-completely-blind). #### 9) **Support** -No automated insulin delivery system is perfect. Commercial and open-source systems share many common glitches in both communications and temporary hardware failure. There is support available from community of AAPS users on Facebook, Discord and GitHub who designed, developed and are currently using **AAPS**, all over the world. There are also Facebook support groups and help from clinic/commercial companies for the commercial APS systems - it is worth speaking to the users, or former users of these systems to get feedback on the common glitches, the quality of the education programme and the level of ongoing support provided. +No automated insulin delivery system is perfect. Commercial and open-source systems share many common glitches in both communications and temporary hardware failure. There is support available from community of **AAPS** users on Facebook, Discord and GitHub who designed, developed and are currently using **AAPS**, all over the world. There are also Facebook support groups and help from clinic/commercial companies for the commercial APS systems - it is worth speaking to the users, or former users of these systems to get feedback on the common glitches, the quality of the education programme and the level of ongoing support provided. #### 10) **Predictability, transparency and safety** -**AAPS** is totally transparent, logical and predictable, which may make it easier to know when a setting is wrong, and to adjust it accordingly. You can see exactly what the system is doing, why it is doing it, and set its operational limits, which puts the control (and responsibility) in your hands. This can provide the user with confidence, and a sounder sleep. +**AAPS** is transparent, logical and predictable, which may make it easier to know when a setting is wrong, and to adjust it accordingly. You can see exactly what the system is doing, why it is doing it, and set its operational limits, which puts the control (and responsibility) in your hands. This can provide the user with confidence, and a sounder sleep. #### 11) **Access to advanced features through development (dev) modes including full closed loop** This **AAPS** documentation focuses on the mainstream **“master”** branch of **AAPS**. However, research and development is going on all the time. More experienced users may wish to explore the experimental features in the **development** branch. The development innovations focus on strategies for full closed looping (not having to bolus for meals _etc._), and generally trying to make life with type 1 diabetes as convenient as possible. @@ -190,7 +190,7 @@ If a malicious attack was made on your insulin pump, these strategies would sign #### Safety considerations around improving blood glucose control too fast -A rapid reduction in HbA1c and improved blood glucose control sounds appealing. However, reducing average blood glucose levels _too fast_ by starting any closed loop system can cause permanent damage, including to the eyes, and painful neuropathy that never goes away. This damage can be avoided simply by reducing levels more slowly. If you currently have an elevated HbA1c and are moving to AAPS (or any other closed loop system), please discuss this potential risk with your clinical team before starting, and agree a time plan with them. More general information on how to reduce your glucose levels safely, including links to medical literature is given in the safety section [here](#preparing-safety-first). +A rapid reduction in HbA1c and improved blood glucose control sounds appealing. However, reducing average blood glucose levels _too fast_ by starting any closed loop system can cause permanent damage, including to the eyes, and painful neuropathy that never goes away. This damage can be avoided simply by reducing levels more slowly. If you currently have an elevated HbA1c and are moving to **AAPS** (or any other closed loop system), please discuss this potential risk with your clinical team before starting, and agree a time plan with them. More general information on how to reduce your glucose levels safely, including links to medical literature is given in the safety section [here](#preparing-safety-first). #### Medical safety around devices, consumable supplies and other medications @@ -282,7 +282,7 @@ Setting up the system requires patience, determination and the gradual developme The developers of **AAPS** take safety incredibly seriously, and want others to have a good experience of using **AAPS**. That is why it is essential that every user (or carer, if the user is a child): -- builds the AAPS system themself and works through the **objectives** so that they have reasonably good personalised settings and understand the basics of how **AAPS** works by the time they “close the loop”; +- builds the **AAPS** system themself and works through the **objectives** so that they have reasonably good personalised settings and understand the basics of how **AAPS** works by the time they “close the loop”; - backs up their system by exporting and saving important files (like keystore and settings .json file) somewhere safe, so you can setup again quickly if needed; @@ -331,10 +331,10 @@ The above table assumes that the user has access to both continuous gluocse moni ### Accessibility for users AAPS who are partially or completely blind #### Day to day AAPS use: -AAPS can be used by blind people. On Android devices, the operating system has a program called TalkBack. This allows screen orientation via voice output as part of the operating system. By using TalkBack you can operate both your smartphone and AAPS without needing to be able to see. +**AAPS** can be used by blind people. On Android devices, the operating system has a program called TalkBack. This allows screen orientation via voice output as part of the operating system. By using TalkBack you can operate both your smartphone and AAPS without needing to be able to see. #### Building the AAPS app: -As a user you will build the AAPS app in Android Studio. Many people use Microsoft Windows for this purpose, where there is the screen reader analogous to TalkBack. Since Android Studio is a Java application, the “Java Access Bridge” component must be enabled in the Control Panel. Otherwise, the screen reader of the PC will not speak in Android Studio. +As a user you will build the **AAPS** app in Android Studio. Many people use Microsoft Windows for this purpose, where there is the screen reader analogous to TalkBack. Since Android Studio is a Java application, the “Java Access Bridge” component must be enabled in the Control Panel. Otherwise, the screen reader of the PC will not speak in Android Studio. How you do this depends on your operating system, two methods are outlined below: