[semenko]

Hey Graham -- great post! The Medtronic / Guardian sensor combo is generally disliked by patients, though (in the US) the Medtronic 770G is FDA approved for ages 2+.

Most prefer the t:slim X2 with "Control-IQ" (their hybrid closed-loop: https://www.tandemdiabetes.com/products/t-slim-x2-insulin-pu...), which is FDA approved for ages 6+, and works great.

The bleeding edge is the Beta Bionics (https://www.betabionics.com/) bi-hormonal system (insulin + glucagon), currently in clinical trials for ages 6+.

[bleair]

There's also two "open source" systems - https://loopkit.github.io/loopdocs/ - https://openaps.org/

Tidepool is also trying to take the loop project and get a version of it FDA approved.

Both of the open source projects require you to do the work and actively take control of your setup (a cgm plus pump plus phone). They have really nice support communities. I would never go back to not using Loop.

[vallard]

Our 15 y/o son was diagnosed T1D Jan 2020. Finally got him on loop Sept 2021 and feel the same way. These developers are saints for doing this work. They've given us countless hours of sleep. We had another T1D family come visit us and I set them up on loop. I was in tears when I got text message from them telling us how they their kid is 85% in range and they are actually sleeping through the night. These are truly life changing projects.

[pimeys]

I'll be adding one more, I've been using this for some years now:

https://github.com/nightscout/androidaps

It's awesome.

[kakoni]

Indeed! AndroidAPS with omnipod dash+G6 (+Android phone) is the latest and greatest setup that you can do

[kakoni]

+ the funny thing is that both openaps/androids + loopkit are more advanced than the commercial offerings that we are starting to see now.

Medtronic licensed their artificial pancreas system MD-Logic from Israeli company DreaMed in 2015. Dexcom bought TypeZero (who have system called inControl) back in 2018.

[jacquesm]

That's to be expected though, self experimentation goes a lot quicker than a regulated track. Even so they are doing great work, and I'm sure the industry is watching this development like a hawk to see what they can pick up.

[zaroth]

Bi-hormonal was always something I thought they should do but didn't know anyone was actually trying it! Thanks for the link.

Although in theory you've screwed up if you need to bolus glucagon. Also, I can't imagine it feels all that great to be getting exogenous glucagon....

But from a safety perspective, having the device have a reserve tap of glucagon ready to deploy allows the algorithm to deploy full insulin dosages and true corrections boluses, versus just tip-toeing around a HIGH with a temp basal.

[jnsie]

> Although in theory you've screwed up if you need to bolus glucagon.

Not at all. There are myriad reasons why one might go low despite doing everything right. For instance, unanticipated cardiovascular activity. T1D is a 24/7/365 PITA and one cannot anticipate everything, even with the best will in the world.

[pimeys]

Or the classic: have lunch with your colleagues and then walk back to the office. I hope you didn't take all the insulin in the restaurant, just half and half back in the office. It's a nasty drop otherwise...

[jamiek88]

Jesus Christ I’m exhausted just reading these stories.

That’s fucking ridiculous.

My aunty was T1D and that was back in the 30’s until 90’s when she died, I never realized what a hero she was. Never once heard her complain thus assumed it was easily dealt with. She used to just disappear after meals for a while. It was like some dark family secret.

[pimeys]

A loop helps a lot here. You get used to it. It is easier if you're anyhow watching grafana daily...

50% insulin for the lunch. When sitting in front of your computer the carbs are working and just press a button to dose the last 50%. Or let the automation do it.

[zaroth]

Oh I 100% agree. I have two kids with T1D.

I think the words “in theory” are probably doing too much lifting in my original sentence.

[grahar64]

Yeah, the tslim X2 would be the preferred pump at the moment, but by the time he gets old enough for a pump I hope the technology will have improved a lot.

[jawngee]

Our T1D kid has been pumping since 18 months. He was diagnosed at 12 months old. He's six now and has been pumping nearly the entire time.

We're in Vietnam but we do all his endo related medical stuff in Singapore.

Counting carbs in kids is a nearly pointless endeavor. Picky eating habits, nutrition mis-labeling (good luck finding accurate nutrition information in Vietnam), etc. And you'll also need to consider that their bodies are moving targets with hormones, growth spurts, etc. It's going to be really hard to manage just by math alone.

Being five years into it now, because the math seems to be changing daily, we are doing it almost by feeling backed by CGM evidence. In our case, the only CGM available here is the Freestyle Libre which is mildly inaccurate except for informing us on the general direction his blood sugar is taking. It's enough info that we've gotten his hb1ac into near normal range and the miaomiao3 turns into a full fledged CGM that we can use with nightscout and xdrip4ios for realtime monitoring.

I'd also advise you to think about joining a group of parents of T1Ds because there's a lot of things to learn and I've personally found it helpful when working through edge case scenarios that will eventually happen.