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Repository for [iAPS documentation (under development)](https://iaps.readthedocs.io/en/latest/) | ||
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Tips & Tricks: (please add!) | ||
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* Using the # sign makes a chapter show up on the menu/index. The amount of #'s determin the level. If you don't want a chapter to end up in the menu/index, use bold text by adding ** or using < b > before the text and < / b > after the text (without spaces). | ||
* When linking to other md files that are in another directory, the link must start with ../ - example: ../directoryname/filename.md |
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files: | ||
- source: /docs/EN/**/*.md | ||
translation: /docs/CROWDIN/%two_letters_code%/**/%original_file_name% | ||
- source: /docs/EN/**/*.rst | ||
translation: /docs/CROWDIN/%two_letters_code%/**/%original_file_name% | ||
- source: /docs/EN/images/**/* | ||
translation: /docs/CROWDIN/%two_letters_code%/images/**/%original_file_name% |
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## Evaluate Basal Tips | ||
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:::{note} | ||
- This is not medical advice. Please carefully understand the changes you are making and always exercise caution | ||
::: | ||
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<b>Nightscout</b> | ||
Nightscout (NS) is one tool that will provide more info for analysis. You will want to focus on the amount of IOB at the valleys. It should rise with negative IOB, and drop with positive. Adjust gradually to make that happen most of the time. Changing basal for the previous several hours by 0.05 U/h will typically change IOB by 0.2 - 0.3 units. This will depend on DIA. | ||
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<b>So, which Nightscout view is most helpful?</b> | ||
The normal default view when scrolling to the valleys is best for the last 24 hours (no IOB is displayed after that). | ||
Day to day reports if looking at older data (remember to check the IOB box, and optionally COB for meal related analysis). | ||
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<b>How to adjust basal rate?</b> | ||
All hours before the time you are looking at (within DIA hours) are adjusted. If you adjust only some of the previous hours, you can make smaller adjustments to the resulting IOB. You can also adjust every other hour one step up and down, so the average is in between available rates. |
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## Evaluate CR Tips | ||
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:::{note} | ||
- This is not medical advice. Please carefully understand the changes you are making and always exercise caution | ||
::: | ||
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<b>Background</b> | ||
Nightscout (NS) is one tool that will provide more info for analysis. With iAPS, there is a reduced requirement for precise carb entries, although some precision will still improve outcomes. Generally it is better to overestimate a little than underestimate carbs. But only if you let the algo take care of some of the dosing. If you overestimate and bolus for it all up front, there is little left for the algo to do. | ||
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<b>How to adjust CR</b> | ||
Some very important info to observe is looking at how fast the carbs decay. For the last 24 hours, you can scroll back and forth in Nightscout, and see when carbs from a meal decays to zero, or check if they don’t decay in a reasonable time. This gets a little complicated if meals are overlapping though, but still possible. You may want to utilize the Day to day report when that siutation occurs. | ||
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In the Day to day report, make sure to check the COB box (and alternatively IOB). You will see COB as orange “triangles”. If they decay too soon (in less than 2 hours or so, depending on the type and size of the meal), the carbs were either underestimated, CR could be too high a number, or ISF could be too low (carb decay is related to the fraction of CR/ISF) | ||
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If the carb absorption as observed by the algorithm is too slow, COB will eventually be cut down. You will see this as a vertical drop in COB in the Day to day report. This helps avoid overdosing on carbs that are overestimated or not eaten, or if there was physical activity that delayed digestion or muted the BG rise. |
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# Device Configuration | ||
This section covers the first two sections of iAPS settings: <b>Closed loop</b> and <b>Devices</b>. | ||
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## Closed loop | ||
Closed loop is disabled by default. This means iAPS is unable to make adjustments autonomously. The system relies on you approval of its actions until you enable Closed loop. | ||
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<b>Should I enable It?</b> | ||
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Closed loop allows the system to make insulin adjustments automatically. Your end goal for looping is to enable this setting to reduce the time spent managing your diabetes. However, entering closed loop too early can make it difficult for new loopers wanting to optimize their application settings. If this is your first time looping, it is recommended you keep this setting disabled initially, and ensure your profile settings (ICR, ISF, basal rates) are properly set. You should monitor iAPS's predictions and suggestions and see if they are appropriate for you. See the corresponding sections on ICR, ISF and basal rates for more information on their adjustment. | ||
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<b>I've been using Loop. Can I just copy my settings?</b> | ||
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<b>No.</b> Users coming from Loop usually have to make big changes to their ISF and ICR settings. Copying the settings you had in Loop will usually cause iAPS to give less insulin than you need. Please go through the steps of monitoring iAPS predictions and adjust your settings accordingly. You should also read the section on [transitioning from other closed loop solutions](transition-qa.md). | ||
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Remember that everyone's diabetes is different and there is no one size fits all, so take your time optimizing your settings. |
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# Devices | ||
Adding devices to iAPS is easy. Note that you can only have one pump and one CGM active at the same time. If you want to switch to another pump or CGM, you will have to delete the current device first. When you select a device, you will be guided through the setup of the device with an on-screen guide. | ||
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## Pump | ||
This section allows you to select your insulin delivery system. For more information on supported pumps, see the following [link](../Getting-Started/pump.md). Omnipod Eros and older Medtronic devices don't support Bluetooth. These devices require a Rileylink to translate communication between your phone's Bluetooth signals and the pump's radio communication signals. | ||
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During pump setup, you will be asked to choose your insulin type. This will determine your duration of insulin action and peak activity time. These settings can be changed later. | ||
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## CGM | ||
This section allows you to choose your glucose data source. Most options are self explanatory. For more information on compatible CGMs, please see the following [link](../settings/devices/cgm.md). | ||
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<b>Changing transmitter on Dexcom G5/G6</b> | ||
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If you are using a Dexcom G5 or G6 sensor, it is important that you remember to change your transmitter ID in the iAPS app whenever you change transmitter. | ||
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<b>xDrip as BG source</b> | ||
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xDrip is not recommended with newer versions of the iAPS app, as native connections to CGM are more stable. | ||
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## Watch | ||
This section allows you to add a watch to iAPS. Apple Watch and some Garmin watches are compatible. Using an Apple Watch will allow you to add carbs, bolus and set a temporary target from your watch, in addition to showing BG, IOB, COB, etc. Garmin watches will only display data, and will not let you interact by adding carbs or insulin. |
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# Transition from other closed loop solutions | ||
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## Introduction | ||
If you've been using other closed loop solutions, it's important to understand the differences between the one you're used to, and iAPS. | ||
In this section of the documentation we'll try to explain the differences from a user perspective. | ||
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-- | ||
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## Coming from AndroidAPS | ||
AndroidAPS (AAPS) and iAPS are both based on the same algoritm (Oref) and the same base system (Artificial Pancreas System, APS). While there are several differences between AndroidAPS and iAPS, the main algoritm is the same, | ||
meaning you can expect iAPS to behave the same way AndroidAPS does. iAPS has some additional features such as Dynamic ISF and Dynamic IC, which AndroidAPS does not have in main branch at the moment. These features are very handy | ||
once you get the settings right. | ||
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### What does AndroidAPS have that iAPS doesn't? | ||
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* Custom automations | ||
* Detailed reporting | ||
* Working remote bolus (for caregivers, not working at the moment in iAPS) | ||
* A built-in learning program | ||
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### What does iAPS have that AndroidAPS doesn't? | ||
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* iAPS works on your iPhone and Apple Watch | ||
* iAPS has dynamic ISF and dynamic IC support in main branch | ||
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### Why should I switch from AndroidAPS to iAPS? | ||
If you have been successfull with AndroidAPS but miss the Apple ecosystem, you can easily transition to iAPS. If you've been struggling to get stable BG with AndroidAPS, you will probably have the same issues with iAPS. | ||
Take some time to read the docs and fine-tune your settings. Join Discord or Facebook to get some help from other users. Once you've got your settings in order, you can consider making a switch to iAPS. | ||
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-- | ||
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## Coming from iOS Loop | ||
iOS Loop uses different algorithms, meaning it has a very different approach than iAPS. If you're coming from iOS Loop, you will have to change the way you think. Please read that statement again three times, as it is really important. | ||
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### What does Loop have that iAPS doesn't? | ||
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* A very clean, minimalistic user interface | ||
* A built-in onboarding guide | ||
* Few settings | ||
* A dedicated Follow app for caregivers | ||
* A large community of people ready to help | ||
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### What does iAPS have that Loop doesn't? | ||
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* Unannounced meals | ||
* Less user interaction / correction | ||
* Dynamic ISF and IC | ||
* Profile presets | ||
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### Why should I switch from Loop to iAPS? | ||
If Loop is working well for you, you should not switch to iAPS. If you're having difficulties building the Loop app, you will have issues building iAPS. If you find it hard to understand how Loop works, you will find that iAPS is even more complex. | ||
You should consider switching to iAPS if you've been using Loop for a while and you have issues that Loop can't solve even after tweaking and re-tweaking your settings and profile. Common issues include: | ||
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1. Incorrect or missing carb entries | ||
2. Lots of manual corrections and "fake carbs" | ||
3. Persistent highs because of variations in insulin sensitivity (ISF) and insulin:carb ratio (IC) | ||
4. Recurring/rebound lows | ||
5. Difficulties dealing with exercise | ||
6. Frequent, consistent variations in profile (basal, ISF, IC) | ||
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If any of those sound familiar, you should consider a switch. Again, note that you will have to read a lot, and change the way you think. | ||
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### How does iAPS deal with those common issues? | ||
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1. iAPS has a feature called Unannounced Meals (UAM). With this option enabled and properly configured, iAPS will react to rising BG by giving insulin (SMB - Super Micro Bolus) even if there are no carbs registered. UAM helps in two scenarios, one being that you forget to add carbs for a meal, and the other being that you enter carbs but not the correct amount. | ||
2. With UAM and SMB active and properly configured, iAPS will make any necessary corrections on its own. There is no need to add "fake carbs" to make iAPS give insulin, like many Loop users are used to. | ||
3. Many diabetics find that they need more insulin when BG is high. Loop uses constant ISF and IC ratios, based on time-of-day. Because of that constraint, it is hard for Loop to give enough insulin when BG is already high. There are some Loop Patches that attempt to fix this, but these patches don't work for everyone. With dynamic ISF and dynamic IC enabled and properly configured, iAPS will give enough insulin to get those highs down, without user interaction. More aggressive settings might lead to a low. With less aggressive settings, it will take iAPS some time to get BG back in range. The key is in getting these settings right. | ||
4. Properly configured, iAPS will not give you insulin if you don't need it. A typical issue with Loop is that it stops delivering insulin when BG is falling, and then gives insulin from the "negative IOB" once BG starts rising again. For some users, this is too much insulin and leads to recurring low. Properly configured, iAPS will not overcompensate for the rapid BG rise after a low. | ||
5. Exercise is good for everyone, including people with diabetes. People with insulin dependent diabetes often struggle with lows during exercise and highs after. iAPS has a built-in exercise mode that will reduce basal, ISF and IC whenever you set a higher temporary BG target. iAPS also has Profile Presets that can help get the right amount of insulin during exercise. | ||
6. Illness. Menstrual cycle. Lazy days. Active days. Home office days. These are situations where the overall insulin need is different from "normal". iAPS has Profile Presets that can be used to change basal rate, ISF, IC and target BG in a very easy way. Presets can also have a timer to switch back to the normal profile when the preset timer is done. | ||
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### What's all that talk about changing the way I think? | ||
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Loop is carb centric. Many Loop users have been instructed to enter carbs, including future carbs (fat, protein) to make sure Loop gives the right amount of insulin. Some users also enter "fake carbs" to make Loop give more insulin. | ||
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The iAPS algorithm does not consider future carbs. What does this mean? The algoritm does lots of considerations, adds guardrails, and then acts by setting a temporary basal and/or a bolus (SMB). Future carbs are not considered. The algorithm simply does not care about any future carbs you might have entered. | ||
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> Wait, what!? You have to consider carbs, right? Why else would I add them? | ||
iAPS does consider carbs, but not until they're actually absorbed and part of Carbs On Board (COB). But even then, iAPS will not give you any extra insulin automatically unless BG is rising. You could enter a million carbs in the future, and iAPS would not give you any SMB's unless it's needed. | ||
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> So what's the mealtime strategy then? | ||
### Mealtime strategy | ||
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Here's the recommendation: | ||
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1. Use the bolus calculator before you eat. Enter carbs (and fat and protein if you want). Look at the recommended bolus and tap the info button if you don't agree with the recommendation. | ||
2. Change the recommendation if you want to, and then bolus. If the recommendation is way off, you should probably check your settings. Remeber that the recommendation is based on your settings, including the "Recommended bolus percentage". | ||
3. Depending on type of insulin and your sensitivity, you should consider doing this some minutes before eating. You do not need to adjust carb timestamp to the actual time you plan on eating, you can just keep it at the time you announced the meal and pre-bolused. | ||
4. Enjoy your meal. iAPS will in most cases set a temporary low/zero basal. | ||
5. If iAPS detects BG rising faster or more than expected, it will give more insulin (SMB) depending on settings. | ||
6. If iAPS detects BG falling it will keep the low/zero temporary basal. | ||
7. If you think iAPS is not giving enough or giving too much insulin, you should take a look at your settings - including MAX IOB, and all SMB related settings. | ||
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> Does everyone do it like that? | ||
No. | ||
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> What are the alternatives? | ||
* Some iAPS users don't bolus for meals. They wait for iAPS to detect rising BG and let iAPS handle it. This usually leads to a temporary high BG, but with the right settings iAPS will get you back to target. If you're OK with a temporary high, then go ahead and try to skip bolus. Start with small meals and tune your settings. You will need aggressive settings to let iAPS give enough insulin. | ||
* Some iAPS users do a manual pre-bolus and skip entering carbs. iAPS will predict a low BG until the meal kicks in and BG starts to rise. iAPS will give more insulin, based on settings, if the pre-bolus was not enough. Yes, even without entering any carbs. This approach will probably also give a temporary high, but smaller than the completely un-attended approach. | ||
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> What do most people do? | ||
Most iAPS users do a bit of all these approaches. Have an apple without entering anything into the app. Then pre-bolus for lunch, because it was high carb. Then use the calculator for dinner. This is all OK, and it comes down to the level of variation you accept for your BG. | ||
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## Coming from commercial closed loop systems | ||
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Are you using a commercial closed loop system like Omnipod 5, Tandem Tslim, Medtronic, etc? If you're happy, stay. If you're not getting the results you want, read through the chapter on "Coming from iOS Loop" to see the main issues that iAPS solves. | ||
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## I want to try iAPS. How do I proceed? | ||
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Read the documentation. | ||
Build the app. | ||
Go through all the settings, tap the setting name to get an explanation on what each setting does. | ||
Start with CGM and a virtual pump if you want to see how iAPS would react. | ||
If you have any questions, reach out on Discord or Facebook. But please read the docs first :) | ||
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### Watch the Loop N Learn Videos on iAPS: | ||
* [Open Mic: iAPS with Magnus Reintz & Theresa Hastings, 8.3.2023](https://youtu.be/Jubfy-s9URI?si=cKOMb2mcHzBJdPIb) | ||
* [iAPS with Magnus Reintz & Theresa Hastings: Starting iAPS, 8.17.2023](https://youtu.be/9I1nuHbcUHo?si=wlRurW3Qh_60ss2d) | ||
* [iAPS Q&A with Magnus Reintz, Tom Barrows, Jonas Hummelstrand & Theresa Hastings, 30 August 2023](https://youtu.be/Li3AKjSrdPw?si=WwLctkAGjVsbDLNs) | ||
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# Overview | ||
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## What is iAPS? | ||
iAPS is an open source artifical pancrease system based on the OpenAPS algorithm. Using your inputted settings, carbohydrates and historical data, it aims to automate insulin delivery to reduce the time spend managing your diabetes. Before starting with iAPS, you should consider alternative commercial options such as the Tandem IQ and Omnipod 5, or other open source applications like Loop and AndroidAPS. iAPS is not approved by any health care authority. You are building and running this system at your own risk. | ||
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## Getting Started | ||
Before starting with iAPS, you should have a basic understanding of what ICR, ISF and basal rates are. If you do not have a clear understanding, or require some help identifying your settings, please read the appropriate documentation. | ||
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To use iAPS, you are required to build the application from the source code. This does not require substantial technical know-how but is a time consuming process. You may need to carry this out through several sessions on your first attempt. | ||
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Upon installation, you will need to configure your settings appropriately. By default iAPS acts no different than that of your pump, with the exception that it may recommend temporary basals from time to time. The magic happens by turning on "Closed Loop", enabling automatic bolus features, and turning on autotune. In general, these are the first three settings you will want to configure as you gain confidence in the app and your settings: | ||
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- Enable Closed Loop for automation | ||
- Increase Max IOB via "average mealbolus + 3x max daily basal" | ||
- Enable SMB and UAM for automatic bolusing (ensure your ISF is optimized before enabling this) | ||
See Configure for more information on iAPS configuration. |
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