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Endocrinologist and Loop

There is a wide range of comfort within the health care profession for DIY projects and type 1 diabetes. Loop is no different; some health care providers are comfortable and some are distrusting. As with all things health care related, honesty with your health care provider is paramount so that the best decisions can be made.

Since using Loop often requires people to secure access to pump supplies that they may not have otherwise have, often times the first conversation about Looping with an endocrinologist will be when trying to get prescriptions for Medtronic or Omnipod supplies. The best approach is to start with objective information. Find out if the clinic has other patients already Looping and whether or not they have concerns from what they have seen. Provide links to the LoopDocs site and this site so that your endocrinologist or health care provider can read about the system's algorithm and operations.

Most often the important aspects that need discussion are:

  • Loop will revert to normal pump use, within a maximum of 30 minutes, in the event of Loop failure. What happens during failure of the system is the most common concern your health care provider will likely have when initially learning about the system.
  • Loop depends on your basal rate, ISF, and carbohydrate ratio settings, just like traditional pump therapy. The conversations will not need to change regarding the evaluation and adequacy of those settings.
  • Duration of insulin action is automatically set to 6-hours for the rapid-acting insulin models built into Loop, matching published data for those insulins. The settings in the pump for duration of insulin action are not used by Loop.
  • Reasonable values for the suspend threshold and maximum basal rate should be discussed. These two settings are not part of normal pump therapy and should be discussed with your endocrinologist. Typically to start Looping, setting the maximum basal rate not much above your highest scheduled basal rate is an excellent way to get used to Loop and safely double-check that your settings (ISF, carbohydrate ratio, and basal schedule) are reasonably accurate. As you gain experience and confirm your settings, raising the maximum basal rate can help Loop become more effective to correct rising blood glucose more quickly.
  • Develop a plan for how you will be providing Loop data to your health care provider in advance. Ask what information they would like to review so that you can have reports ready at each appointment. The usual downlaod of a Medtronic pump or Omnipod PDM will not be sufficient for many clinics once you start Loop. Instead, you may wish to discuss Nightscout or Tidepool data reports to provide the information those downloads would have otherwise provided.
  • Develop a plan for how you will deal with pump failure. Many health care professionals will cite the age and out-of-warranty aspects as concerns for Loop users. Having a clear plan, in advance, for how to deal with possible pump failure will help with that concern. The two most obvious steps would be to have a backup pump available and an active prescription for long-acting insulin. A gentle reminder to the clinic that even in-warranty pumps can fail also helps frame the conversation regarding the need to always be prepared, looping or not.
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