Libre 2 Changeover Time Trick

 The Libre 2 should last 2 weeks, at changeover time there is always the 'will it start, won't it start' question which could mean you're not getting readings for at least an hour, possibly longer if the sensors fail.

I had once bad day when 2 Libre's failed one after the other, which meant 3 hours without readings, and really impacted my DIY looping - here is how to get wound that problem.

Use a miaomiao 2 reader with xDrip - I have a couple of these from before xDrip fully supported the Libre 2, and there was a good period of time when I couldn't get anything working properly.

1. Put the miaomiao on the old sensor and change the 'Hardware Data Source' in xDrip to 'Libre Bluetooth' and connect to the the miaomiao in Bluetooth devices, without stopping the sensor
2. Once that's done the miaomiao will continue to use this sensor after its expiry time (it only expires in the LibreLink app rather than actually stopping working) and you're ok to carry on using the Libre 2 for a good few more hours (though accuracy starts to decline, its still ball-park ok)
3. Then start the new Libre 2 using the Librelink App (or patched Librelink app in my case) and wait for it to start. Once its starts ok, you can stop the sensor in xDrip and start the new sensor as normal, if it fails to start, carry on using the old Libre 2 and miaomiao until you have one started

Its a work-around but keeps your loop running until you get a good sensor signal with the new Libre 2

I'm currently looking at switching to Dexcom One - not sure if there is a similar way to avoid dead time with a Dexcom yet.

Insulin Pump Renewal Time (again)

 Since being put on pump therapy I've had 3 changes.

The first pump I chose was an Animas 2020, followed by and Animas Vibe - then when Animas withdrew from the pump market the only option at the time was to go for a Medtronic 640g

The Medtronic works more or less exactly the same way as the Animas pumps did - i.e. it was a long way behind the other pump companies developments and was 'old tech' before I got it - 4 years on its a bit like watching Star Wars on VHS - ok at the time but looks like you need an eye test now

Advances in pump therapy mean we can now use pumps integrated with CGM to create a 'Hybrid Closed Loop' system - the pump works as an artificial pancreas as long as we tell it a few basic things (like how much we've just eaten) and it does the rest based on our current BG readings, IOB, etc.

I'm under Derby CCG for my Diabetes Care, and in Nottingham for everything else (prescriptions etc)

At pump renewal time I've been offered the following pumps:

• Medtronic 780g
• Omnipod Dash
• Tandem t:slim (possibly later in 2022)
• DanaRS or maybe Dana i (possibly later in 2022)

The big hit here is looping - Imagine how life changing it would be to be able to have my pump altering insulin in the background if I go high or low? Now that's attractive - so how to achieve that given there are only 2 pumps available?

Self fund sensors on the Medtronic - that's a minimum of £1820 per year - taking into account Derby are usually 12 months ahead of Nottingham in approving things - that could be £3640 before I get the kit to use Medtronic looping and wouldn't give me the tech for BG on a watch etc. - as it's not available directly (though there may be some fudge loading data into xDrip+ I guess)

I'll admit I'm not a fan of Medtronic - the pumps are 'ok' but suffer from cases cracking, there customer service has been terrible (improved over the last 18 months, but things like Christmas come as a complete surprise every year and you cant get consumables for your pump) etc. They also tie you entirely to their equipment and sensors - no open API or freedom to integrate kit that they don't make so I prefer not to use them

So the options are the Artificial pancreas open source apps on the internet - More on those shortly as they drive pump choice for me, to integrate with my existing Libre2 sensors

NHS approval for CGM

 It looks like this week NICE will approve CGM (continuous glucose monitors) for addition to Health Authorities formularies so can be put on individuals repeat prescription in a more general manner.

Currently they have only been available for qualifying children who need the support of these specific devices.

That means that closed loop systems are within reach ok UK diabetics - for some time Medtronic have been trialing closed loop in some LHAs (local health authorities), recently some other pump manufacturers have announced the same capabilities tied to their own CGM censors.

Taking into account the time it takes for LHAs to gain funding and approve products for prescription, and the current funding crisis caused by Covid, it may be some time before we see those products available in Nottingham (for example) and it may be triaged on a case by case basis until the LHAs can see benefit from cost savings and life quality to those taking up the opportunity for CGM and the Closed looping.

I have a pump renewal coming up in May 2022 - I'll take advice from the Derby Diabetes specialists to see what its likely to happen, however I'm currently planning on using my Libre2s linked to xDrip and Nightscout, a new DANA RS pump (open API) and AndroidAPS to perform the looping. That should buy me 4 years for it all to settle down, and I can review what's happened next time when its all sorted out.

Interestingly there is a new 'Libre 3' device that seems to be CGM rather than flash - more on that when I work out what that might mean

Its not easy being a Diabetic - you need one foot in the medical camp (I have spent most of my life being 'an organ' - in this case a pancreas) and one foot in the technology camp - I have no idea how this will work out when I hit 70 and still need to be switched on to compiling Android apps and whatever the new version of Bluetooth protocol stack is doing.....

Diabetes Tech and how it hangs together for me

 As some background, I have the following bits of kit helping me manage my T1D:

• Medtronic 640g Insulin Pump
• Contour Next Link USB Blood Glucose reader
• Tidepool
• 600 Series Uploader
• Nightscout
• Freestyle Libre 1 and Freestyle Reader
• 2 x MaioMaio 2
• Google Pixel 2 XL (Android 10) Phone
• xDrip+ Nightly build
• Pebble Smartwatch

Medtronic 640g Pump

This replaced my Animas pump, when Roche pulled out of supplying Insulin pumps in the uk.

Not a great gadget - it does everything fine, and has all required settings / programs, however the level of support is not as good as Animas, and the essential products that were supplied as standard with Animas are not available.

The Canula design was changed a few years back, so they shatter when removing them from the reservoirs (to prevent re-use) which can be annoying when parts of the cannula fail and you're stick int he middle of no-where and just need to do a quick fix.

Battery life is approx 10-15 days

Belt clips wear out quickly, and although replacements are available (as long as its within 1 year of supply) they don't last well. In addition to this, after 3 years of wearing a pump, the pump itself is work on the belt clip, so new clips do not stay on well. Roll on the 4 year renewal!

Contour Next Link Blood Glucose Meter

Works well, although the lance isn't to my personal comfort. Accuracy of the blood strips was questioned in the UK - although never noticed a problem myself. I tend to use this only to upload data to Tidepool and into xDrip+ / Nightscout

Tidepool

On-line application that gathers data from Nightscout and xDrip+ along with readings from your pump and Libre scanner, and displays it in graphs and detail to help you plan your changes and review 'what went wrong' and then give you the info to go fix it.

Data can be loaded directly from your devices (pump and blood test machines), or by sending it all directly from xDrip+

600 Series uploader

Pulls the info directly from your Medtronic pump (basal/bolus settings, CP amounts, insulin delivered etc) and sends it to xDrip+

Once installed on your phone, you plug a OTG USB cable (On-The-Go is a special USB cable type, but widely available) between your phone and the reader, and it sucks the data off the pump and into xDrip+

Nightscout

This allows you to create your own website that shows your current Blood Glucose and the events (boluses, food intake etc) that constantly updates in a graph form. Great if family need to keep an eye on you and check you're safe

Freestyle Libre 1 and Freestyle Reader

One of the great steps forward -  A flash glucose monitoring system (from Abbott) which measures interstitial fluid glucose levels. The system comprises a sensor and a reader. ... At each scan, the reader displays current glucose levels, levels over the previous 8 hours, and whether glucose levels are trending upwards or downwards (and how fast).

Works really well with the following things to be aware of:

• BGs displayed are approx 20 minutes behind real time. You may need to check using a Blood test if you need a 'whats happening now' test
• When inserted it takes 1 hour to activate after you first swipe it with your reader. This is supposed to git it time to settle down with your interstitial fluid and calibrate itself. If you can do it, insert it a day or maybe 2 days before activating - the readings are more accurate
• They tent to come off in hot weather - I use 3M Tagaderm film to stop that happening (also means when you walk into a door frame they stay put (that happens more than you realise, till you start wearing one of these things
• From time to time they don't start up - usually due to blood getting in the sensor when you insert them. If this happens they are replaced by Abbot, usually take 1 week to get the replacement, so worth keeping a couple in stock if you can

MaioMaio 2

 Another great leap forward - AS bluetooth transmitter for the Libre - sends the data to xDrip+ on your phone, is rechargeable (mine lasts about a week between charges) and can be held on by simply sticking it to your arm on-top of the libre using a larger 3M Tagaderm. You don't need the self adhesive strips they send with the MaioMaio that way - and you can remove it for charging

Google Pixel 2 XL

Seems to work ok with the above kit - Google don't put additional software enhancements in the way of the basic Android O/S (like Samsung can do) and this one seems to work ok for me. Battery life is impacted by xDrip+ (lots of bluetooth activity) so you'll end up charging it up more than usual.

I can't get xDrip Vehicle mode working any more (google updates stopped that) so maybe another phone would be needed to get that working

xDrip+ Nightly build

Awesome - pulls all your tech together and give a detailed way of gathering the data in one place. Graphs whats going on with your Blood Sugar, and allows you to set alarms for highs and lows, and predict when they might hit you. If you've not seen it - go have a look, it can be challenging to set up first time, but its incredible.

I use the Nightly build to keep up to date with new features - usually wait a couple of days after its published in case there are issues

Pebble Smartwatch

Best I've found as an all rounder, but getting older now - means you always know your blood sugar levels and are warned when they drop.

Doesn't work as an xDRip collector (where the watch talks directly to your MaioMaio when out of reach of your phone, but I'm not sure what watches do work - the info out of the xDrip community is a bit 'scattered' and I'm not sure what works or doesn't at the moment

XDrip+ and Watches

If any of you work in IT, you know that developers very seldom write documentation for the rest of us.

The xDrip team write some incredible software, that gives my diabetic life a massive leap forward in manageability, sometimes its hard to find up to date info on how parts of the system work (thats up to date at least).

The official info is here and has some great reference info: Nightscout cgm-watchfaces

Its possible using xDrip to get the display and high/low warnings etc on a bluetooth enabled watch, there are several types supported:

• Android Wear OS
• Pebble (all types)
• Amazfit
• Bip
• GTR
• BlueJay
• Lefun band
• MiBand

I initially bought an old Pebble Time (ebay £10) as these are now legacy, but after wearing it while fixing the car (it got covered in brake fluid) it fell to bits and I had to superglue it back together as a temporary fix.

I then started looking at the Android alternatives, as this is mainstream tech and seemed to be the easiest to get running, plus should have support going forward.

The watch I picked was a 2018 Ticwatch Pro - again from eBay (about £110 I think) which has been fine for the last 18 months or so. Then Google started changing the way Apps can be loaded onto a WearOS watch - they look to be forcing developers through the Playstore, which is difficult for an open source app and development team.

So for the moment there is a question on whether we will be able to load xDrip onto Android for updates etc without jumping through (IT) hoops, which lots of us find difficult to do.

I started to look back at the old Pebble watches and see if there was something I could pick up cheaply that would do the job, as Pebble was bought out by Fitbit in 2017 (and then shut down) the watches are getting old, and batteries in them starting to fail.

To get a Pebble to work, you need to load the Pebble app from the Playstore, then patch it using http://rebble.io (google 'pebble rebble' to find them)

Once thats done, you have the Pebble app with the associated store of watch apps/watch faces etc.

Here is what I've learned from looking at the watches themselves:

• Original Pebble Model 301BL (BL is black)
• Old and batteries usually failed by now, unless replaced.
• Essentially 2 types
• original kickstarter one, thats glued together
• the newer one, that has 4 screws on the back (screws are T3 torx)
• Batteries can be replaced (£15 quid on ebay) but its a reasonable bit of work to strip them down and solder the very small connections - not for the faint hearted.
• Monochrome screen
• Pebble Steel Model 401B
• Some working ones about on ebay if you keep looking (£15-£20)
• Lots suffer from Screen Tearing - the connector in the watch goes loose, so you have to take it to bits and jam something (toilet paper works fine) in the back over the connector and screw the back on again (T4 torx screws), lots of Youtubes on how to do this
• Monochome screen
• Strap is a stepped connector on the watch - special for the Pebble steel, so if you need one expect to pay £12 on Amazon or £20 on ebay
• The strap pins are screw in - not sure what the sizes are, but if you buy a working watch without them (I did) its probably easiest to buy a broken one an use the pins for spares
• Battery life 3-4 days using xDip
• Pebble Time Model 501
• Colour Screen (yay!)
• Battery life is usually 'ok' but mine lasts about 1.5-2 days before needing charging as its getting older
• Case is glued together so if you need to get into it - its a 'warm up with a hair dryer' job
• Pebble 2 Model 1002
• Newest (the last of the line) of watches before being shut down
• Heartrate monitor
• Colour screen
• Buttons on the side wear out (you can buy these 3D printed if a replacement is needed)

Pebble sold best in America - so lots more on ebay.com if you can stomach the postage costs to the UK

Philips Diamondclean toothbrush hard reset

The Philips Diamondclean sonic toothbrushes stimulate blood vessels - so are recommended for T1s

Mrs Cheeseseeker has a pink one of these and every now and again it locks up and wont do anything - it charges ok but the button does nothing.

If you google for sonicare reset - you get instructions for other types of Philips tooth brushes that have more than one button to press, which say:

1. Place your handle on the charger.
2. Press and hold the power button together with the intensity button (intensity up) and the mode button for at least 2 seconds
3. You will hear 3 beeps and see the battery light flashing green

That doesn't work as there is only the one button.

To fix this problem you need to do the following:

1. Make sure its charged (at least partially)
2. Take it off the charger
3. Hold the button down for about 30 seconds - keep holding it and it should then light up and start cleaning

Brush fixed and a happy Mrs Cheeseseeker

MiaoMiao 2 charging problems

 I've been fighting a bit with my MiaoMiao recently

Over the last few months its been harder and harder to get it to charge, the usual routine is simply connect the cable (attached with a couple of magnets that hold two small sprung pin connectors on the 2 round gold coloured contacts on the MiaoMiao itself). Once connected the blue LED flashes (once every 5 seconds or so) until it charges and then goes green

I started connecting it for extended periods without any sign it was doing anything, before it started to flash (maybe an hour or more before the blue light).

Did hard resets, pressed the connector on, cleaned contacts, tried different charger cables etc, but nothing worked.

Last week I ordered a new one from miaomiao.cool (cheaper than miaomiao.com) - originally it took 2 weeks to arrive (over 15 months ago now), but things have improved - 5 days this time so much better.

The new one works perfectly and was simple to switch the sensors in Xdrip, so I was up and running again.

I wanted to work out why the MiaoMiao had stopped working, and did a fair bit of googling and found very little other 'do a reset' then I found this Youtube: MiaoMiao 2 not charging

Nothing to lose, so I carefully levered apart my MiaoMiao with a pen knife blade (so as to minimise damage to the plastic case) - the two parts of the case are held together with silicone sealer so its possible, just ease it slowly and try not to slip.

So the case comes apart and the internal boards are exposed - one is the brains of the gadget with the battery on (in the fat rectangular bit) that will lift out, and there are connections to the charging points under this (shown in the Youtube), as well as a separate board that does the sensor part.

On mine it wasn't that the two connectors from the brains to the charging points needed bending (as in the Youtube) but the contacts had corroded up (damp got in as some of the silicone sealant had given up).

I cleaned those up gently by scraping the corrosion off (a dull grey-green colour) to get back to the gold coloured contacts, re-assembled the board (watch out as the magnets tend to flip out from the brains board as the glue on one of my magnets had failed) and gave it a charge test with the cable.

All working fine and light flashing blue until it goes green.

Now all I need to do is test it on a new sensor in another week or so, then seal it up with a bit of silicone (I use RTV automotive sealer) and I have a spare one just in case.