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Nightscout Overview

Overview

Nightscout  is an excellent tool for remotely viewing  Loop  actions.  Nightscout  can act as a stand-alone tool or be integrated with  Loop. (Nightscout  also integrates with other open-source hybrid closed loop systems such as OpenAPS, AndroidAPS and iAPS.  LoopDocs  focuses on  Loop.)

When integrated with  Loop,  Nightscout  provides monitoring of  Loop  activities such as viewing history of glucose, carbs, boluses, temp basals and overrides; troubleshooting  Loop  errors; and provides extensive reports for analyzing data trends and patterns. These reports assist when  Loop Therapy Settings  need to be adjusted.

For caregivers,  Nightscout  enables remote monitoring and even the ability to issue remote commands through  Nightscout  when both  Loop  and  Nightscout  are properly configured. There are several pages starting at  LoopDocs: Remote Overview that provide documentation on this feature. If you are a caregiver, this summary of remote capabilities may encourage you to look into  Nightscout.

Remote Commands

  • Loop  2.2.x
    • Overrides can be enabled and disabled
  • Loop  3
    • Overrides can be enabled and disabled
    • Carbs can be entered
    • Boluses can be commanded
    • Loop Caregiver  app (under development, iOS only) enables the following from the caregiver's phone
      • monitor  Loop
      • issue remote commands for carbs, bolus and overrides

Nightscout  is useful for many who use  Loop. Adults who take care of themselves find the reports and analysis methods from the  Nightscout  site provide effective tools to monitor their settings and provide reports for their health care provider. It also stores  Loop  configurations so they can be reviewed. With  Loop  3, the saved  Nightscout  profiles can be downloaded to a new app for quick onboarding, should you ever need to start fresh.

Setting up a  Nightscout  site is described in a separate web site:  Nightscout: Documentation.

There are  Nightscout  apps in your iPhone App Store that allow you to view the  Nightscout  site after you've configured it, or you can use a web browser to view the data. The app alone is not enough - you need to follow the steps to configure your own  Nightscout  site and obtain your specific  Nightscout  URL.

  • Nightscout  is highly recommended for  Loop  users, especially those using  Loop  as caregivers
  • Nightscout  displays are often the easiest way to troubleshoot  Loop  settings if you are having problems and seeking input from others
  • Nightscout  provides reporting features for longer-term review and preparing information for your physician

Nightscout  Documentation

There used to be a lot of  Nightscout  information found only in  LoopDocs, but that was transferred and subsequently updated in  Nightscout: Documentation. The information that remains in  LoopDocs  is  Loop  specific. So you may be jumping back and forth between the two sets of documents.

  • If you see the  Nightscout  Owl logo in upper left you are in the  Nightscout  website
  • If you see the  LoopDocs  green-loop logo in upper left you are in the  LoopDocs  website
  • While in the  Nightscout  tab of  LoopDocs, most links have a  Nightscout  or  LoopDocs  in the link name
  • Suggestion: open the  Nightscout: Documentation in a separate tab or window of your browser for easy access to both websites

Nightscout  with  Loop

This page provides general discussion about the  Nightscout  display, as well as some  Loop -specific display information. Over time, interactions between  Loop  and  Nightscout  were improved. The information on this page has been updated for  Loop  3 and  Nightscout  version 14.2.6 (or later). Older versions may exhibit some differences in display of  Loop  information on the  Nightscout  site.

Loop  Uploads to  Nightscout

The  Nightscout  display updates when the  Loop  phone is connected to the internet via WiFi or cellular service. When the uploads stop, the  Loop  pill becomes "stale" (cannot open it) after 15 minutes.

"Pills" are the little information boxes. They are Nightscout: Plugins that must be enabled with configuration variables and then the display for each pill can be turned on or off within your  Nightscout  site.

If upload to  Nightscout  is interrupted,  Loop  stores up to 7 days of  Nightscout  information in a local buffer on the phone, and will attempt to upload later when access is restored. Once access is restored, a stale  Loop  Pill may require 15 minutes before it will open to display additional  Loop  information.

The Carb pill on the  Nightscout  site is populated by  Loop  when  Loop  is actively uploading to  Nightscout  - but it may lag the value displayed in the  Loop  pill by one loop cycle and it will display 0 COB within 5 to 10 minutes if upload is interrupted. In other words, if the COB pill shows 0 unexpectedly and  Loop  pill is active, you can believe the value shown in the  Loop  pill.

Loop  2  Red Loop  Warning

With  Loop  2.2.9 and earlier versions, when  Loop  has a  Nightscout  site added in  Loop  Services AND is unable to upload messages to that site, it can fill up a buffer of stored upload messages. This may lead to sluggish behavior in  Loop  or even cause a  Red Loop. This can happen if the  Nightscout  site is "down" or if the database is full so it is not accepting messages.

Step 1: Remove  Nightscout  URL from  Loop  Services

Step 2: Figure out why the  Nightscout  site is not accepting uploads from  Loop  and fix that problem.

Step 3: Add  Nightscout  URL to  Loop  Services

Do you want to know more? (Click to open)

For those who want to know more:

There is a big architectural change between  Loop  2 and  Loop  3 for remote data services like  Nightscout.

It used to be that Loop would keep trying to upload data to  Nightscout. If a site could not be reached or would not accept data, that could cause large backlogs.  Loop  2 could slow down by trying to keep uploading the backlog. The new system does not allow for this. Uploaders individually keep track of where they are in the upload stream via a lightweight “query handle”, and if the data in  Loop  data store expires before upload, that data will be missing in  Nightscout.

 Loop  3 saves 7 days of information in the data store.

Nightscout  Dashboard

img/example.jpg

Blood Glucose

Glucose readings from the CGM are shown in green, yellow, or red in the main Dashboard of  Nightscout. (The graphic above was generated with Colors enabled in  Nightscout; there are other display options.) You can adjust your high and low glucose alarm thresholds in  Nightscout  by modifying configuration variables. This is optional - defaults are provided if you do not set them. The alarm thresholds affect the color of the displayed CGM data points and, if enabled, determine when an audible and visible alarm sounds. The  Nightscout  alarm thresholds will not affect  Loop  performance.  Loop  only uses the glucose correction ranges in the  Loop  app settings.

The main dashboard (upper section) for  Nightscout  displays the time duration you have selected (in the example above, 12 hours). The bottom of the screen shows the last 48-hours of glucose trends. You can scan backward by dragging the bottom timeline to the left, if you want to review specific  Loop  actions or data in the last two days.

SAGE, CAGE, BAGE pills

The SAGE, CAGE, and BAGE pills are for Sensor Age, Cannula Age, and (pump) Battery Age. These optional pills track the time since your CGM sensor, Pump site, and Pump battery were last changed. You can set up custom alerts to remind you when it is time to change the devices, or simply use the visuals to keep track of your particular timing for site/sensor changes. These fields will not auto-update from pump or CGM devices, instead you will have to update them using  Nightscout  Careportal so that the pill information is accurate.

Carbs

Carbs are automatically uploaded to  Nightscout  by the  Loop  app. The amount of carbs on board (active carbs or COB) can be seen by clicking the  Loop  pill. The size of a white carb dot on the graph is proportional to the amount of carbs entered...bigger meals get bigger dots.  Loop  does not read carbs from  Nightscout  for use in looping calculations, it only uploads carbs to  Nightscout  that have been entered in the  Loop  app.

Boluses

Insulin boluses are automatically uploaded to  Nightscout  by the  Loop  app. The bolus is shown as a filled-in blue lower-half of the dot, and the specific amount of the bolus is also shown. There may be a separation between the bolus and the carb entry, especially if the user preboluses a meal.

The bolus is uploaded to  Nightscout  as soon as it starts and Insulin on board (active insulin or IOB) is updated in the  Loop  pill. Should the bolus be interrupted, the  Nightscout  information is updated when the  Loop  information updates (assuming internet access is active).

Temp Basals

Your current basal profile is automatically updated to  Nightscout  whenever it is changed by  Loop. The dashed blue line represents the scheduled basal profile. The solid blue lines indicate the actual basal amounts set for a given time...so as  Loop  sets temp basals higher or lower than your scheduled basal rate. If the graph and  Loop  pill do not agree, you should believe the  Loop  pill.

Predicted BG

The purple line to the right of the BG is  Loop  predicted BG. Watching the behavior of that purple line can help you understand why  Loop  is making decisions regarding high or low temps. You can read more on that topic in the  LoopDocs: Algorithm section of these docs. If you don't see the prediction (and all other  Nightscout  and  Loop  settings are configured), tap on the 3 dots to the right of the 24 to reveal the choice to display AR2 prediction or  Loop  prediction. Adjust the check boxes to show just the  Loop  prediction.

Loop  pill

The  Loop  pill is the little display box which, when hovered over or clicked, will provide additional information about recent  Loop  activities and status. Information included is the last time  Loop  ran, the temp basal set, IOB, and COB. Looking at the  Loop  pill is a quick method for assessing if your loop is currently active, as well.

 Loop  Pill status indicator symbols

X Error in  Loop

ϕ Recommending basal, but not enacting (open loop or pump suspended)

Enacted a new temp basal

 Loop  is continuing with last temp basal, no change

Warning indicating  Loop  is either red or has failed to upload to  Nightscout  for a longer period of time.

Mouse over or Touch the  Loop  pill to view a tool tip containing one or more of the latest status messages. The most up-to-date  Nightscout  also includes information in the  Loop  pill for the minimum and maximum predicted BG, eventual and predicted BG.

img/loop_pill_message.png