[zaroth]

You can read about the “We Are Not Waiting” movement and the ethical considerations of doing this research, writing the software, and documenting and even to an extent productizing the software for mass consumption.

It is not a zero sum game. Not having this control over the pump can also kill you, because the systems that were available before this movement got started were so poor.

When the hacker community started putting together remote monitoring systems for the CGMs that allowed, e.g. parents to watch their kids at school, or through the night from the next room, that improved quality of life and maybe even saved lives.

Hackers have already tapped into the Medtronic pump to build the world’s first closed loop system. The OnniPod is just another pump in line to be reverse engineered.

If you saw first hand the quality of software being put out by Dexcom and Insulet, this work is serving as an important check&balance as well as pushing them to invest in R&D versus sitting back and milking their patents.

It’s also worth noting that the pod has important hardware safeguards that mitigate the impact of a software error on the remote control side. You can’t just send a message asking for 100 units of insulin because the hardware won’t dose it. You can also hear (and somewhat feel) each 0.05 unit of insulin being delivered as a click about once every 1.5 seconds.

And again I’ll reiterate that it’s not a zero sum game. The software and UI is so bad on the Insulet/Omnipod side that it’s easy to screw up a basal program, or when applying a temp basal on top of an extended bolus, or when changing a pod while an extended bolus is active. All these events can result in low blood sugar events that are potentially dangerous.

Efforts like Nightscout have actually saved lives and while they are not without risk (what thing worth doing is?), the T1D world has been measurably improved because of their efforts.

Finally I’ll says that the reverse engineering effort already uncovered one significant bug in the protocol that we know of. They didn’t delve into the details of the “nonce” but I’m willing to bet that imaging the chip was not actually necessary and that the “encryption” is some homebrew POS which is highly insecure. We deserve to know the protocol which is protecting the communication between the pod and the controller, for example is there a secure DH key exchange happening when a new pod is paired and initialized? Can a third-party controller potentially spoof commands to my kids’ pods? OmniPod would never disclose how this works, so I’m supppsed to just trust them.

[arafa]

I know folks that work on Nightscout and I agree with everything in this post. I find them to be very thoughtful and circumspect about the work (the contributors often have T1D or family with T1D). Besides that, a closed loop system (which as yet is only partially implemented or is still somewhat inconsistent) is a holy grail for a lot of these folks.

Most of them are already well acquainted with manually managing insulin and the existing products and can handle any mishaps for the most part.

[gh02t]

I don't really understand in detail how insulin pumps work, so I want to ask why are there not commercial closed-loop systems available? It seems like an obvious development that pump makers should have implemented a long time ago. Is there a complication that makes it harder than it sounds, or is it something like regulatory concerns or just plain laziness?

[GiorgioG]

Few competitors, no reason to innovate. And they're charging $8-12,000 for a new pump setup. That was our experience 5 years ago with Medtronic. Not a single update in 4 years with our son's 530g pump. With his new pump (from Tandem) we're expecting a pretty big software patch/upgrade later this year. Beta Bionics is working on their artificial pancreas (dual hormone) that should be out next year. So newer/more-nimble players are forcing the bigger companies to start innovating. Having said that, it never comes soon enough ;)

[ZucchiniZe]

I got a chance to try out the beta bionics artificial pancreas in a research trial and it is a truly new innovation in this field, it lifted about 90% of the constant thinking about bolus and blood sugar from me and allowed me to live my life. It truly deserves all the hype that it is getting.

[GiorgioG]

Wow that's great to hear! Was it insulin-only or did it also have glucagon onboard? I know they're working towards releasing the insulin-only version first. I can't wait for the dual-hormone version to become available. It'll allow my wife and I to sleep through the night without worrying that our son won't wake up when he drops too low.

[thecosas]

Sidebar: Tandem's Q1 2019 results came out today and they're doing pretty dang well. http://investor.tandemdiabetes.com/news-releases/news-releas...

Operating margin is still negative, but it's improved tremendously year over year.

[bleair]

In short, real humans and these medical devices are inexact. The device must choose “How much insulin should be dosed?”. Lawsuits argue medical devices should be flawless, so no company will bring out a device that could be pointed out as causing an incorrect amount of drugs being delivered The open source insulin pump and continuous-glucose-monitors as a feedback systems are just incredible BUT they require the user to be very aware of what is easy and reliable and what can be flaky (see all the details about pod screamers - e.g. the pod can’t continue, or drift in cgm data)

[emiliobumachar]

Every time a self-driving car kills one person, it's national headlines for a week, with no shortage of people calling for the people responsible to be jailed. It will be like that the first few times that a commercial closed-loop system kills a person.

[ron0c]

> this work is serving as an important check&balance as well as pushing them to invest in R&D versus sitting back and milking their patents.

Thank you for your reply. This is what angers me the most. They drug companies have a solution. Keep buying insulin, keep buying needles, keep buying new pods, sensors, and apps. No, this can be fixed, it can be better.

[Odenwaelder]

Thank you for your reply, very interesting! I have no doubt that this project is great help to many people, and it's a shame that any medical device of this kind is closed source. Being involved in the development of medical software, I know how important testing is, and given the chaos that reigns in some open source projects, I'd be wary of hacking a medical device. I see both sides and surely it's a balancing act.