Nejčastější otázky uživatelů APS

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Obecné

Mohu si prostě stáhnout instalační soubor AndroidAPS?

Ne. Pro AndroidAPS neexistuje žádný stažitelný soubor apk. Musíte si jej sami sestavit. Zde je odůvodnění:

Systém AndroidAPS slouží k ovládání vaší pumpy a dávkování inzulinu. Under current regulations in Europe, all systems classed as IIa or IIb are medical devices that require regulatory approval (a CE mark) which needs various studies and sign offs. Distribuce neregulovaných zařízení je nezákonná. Podobná nařízení platí také v ostatních částech světa.

This regulation is not restricted just to sales (in the meaning of getting money for something) but applies to any distribution (even giving away for free). Building a medical device for yourself is the only way to use the app within these regulations.

Proto nejsou soubory APK k dispozici.

Jak začít?

Za prvé, musíte si opatřit kompatibilní hardwarové komponenty:

Za druhé, musíte nastavit hardware. Viz příklad nastavení s podrobným návodem.

Za třetí, musíte nastavit své softwarové komponenty: AndroidAPS a zdroj CGM/FGM.

Za čtvrté, musíte se seznámit s funkcí systému OpenAPS a pochopit jej, abyste mohli kontrolovat parametry zásadní pro vaši léčbu. Základním principem uzavřené smyčky je, že máte správně nastavené dávkování bazálního inzulínu a inzulíno-sacharidový poměr. Všechna doporučení smyčky předpokládají, že vaše potřeba bazálního inzulínu je pokrytá a všechny vrcholy nebo propady, které vidíte na grafu glykémie, jsou výsledkem jiných faktorů vyžadujících určité jednorázové úpravy (cvičení, stres atd.). Úpravy, které uzavřená smyčka může provádět, byly z důvodu bezpečnosti omezeny (viz maximální povolený dočasný bazál v OpenAPS Reference Design), což znamená, že nechcete „plýtvat“ povolenými změnami dávkování dočasného bazálu na to, abyste jimi opravovali špatně nastavený základní bazál. Pokud jste například často příliš nízko ještě před jídlem, pak pravděpodobně vaše bazální dávky potřebují upravit. Můžete použít nástroj Autotune, který vám připraví řadu návrhů, zda a které bazální dávky a/nebo citlivosti na inzulín byste měli upravit, a také to, zda je nutné změnit inzulíno-sacharidový poměr. Nebo můžete vyzkoušet a nastavit své bazály postaru.

Jaká jsou praktická doporučení pro provoz smyčky?

Ochrana heslem

Pokud nechcete, aby někdo mohl snadno upravit vaše nastavení, pak můžete celou nabídku Nastavení chránit heslem tak, že v nabídce Nastavení vyberte možnost „Heslo do nastavení“ a zadáte své zvolené heslo. Při příštím vstupu do nabídky Nastavení budete muset zadat heslo, abyste mohli pokračovat dál. Pokud budete později chtít ochranu heslem odstranit, přejděte v nabídce do „Heslo do nastavení“ a odstraňte text.

Chytré hodinky Android Wear

Pokud máte v úmyslu používat aplikaci prostřednictvím hodinek s Wear OS na bolusy nebo změnu nastavení, pak je třeba zajistit, aby v systému Android nebyla blokovaná oznámení z AndroidAPS. Potvrzení různých akcí přicházejí prostřednictvím oznámení.

Odpojit pumpu

If you take your pump off for showering, bathing, swimming, sports or other activities you must let AndroidAPS know that no insulin is delivered to keep IOB correct.

The pump can be disconnected using the Loop Status icon on the AndroidAPS Home Screen.

Doporučení nejsou založena pouze na jediné hodnotě ze senzoru CGM

For safety, recommendations made are based on not one CGM reading but the average delta. Therefore, if you miss some readings it may take a while after getting data back before AndroidAPS kicks in looping again.

Další čtení

There are several blogs with good tips to help you understand the practicalities of looping:

Jaké vybavení pro případ nouze se doporučuje brát s sebou?

You have to have the same emergency equipment with you like every other T1D with insulin pump therapy. When looping with AndroidAPS it is strongly recommended to have the following additional equipment with or near to you:

  • Battery pack and cables to charge your smartphone, watch and (if needed) BT reader or Link device
  • Pump batteries
  • Current apk and preferences files for AndroidAPS and any other apps you use (e.g. xDrip+, BYO Dexcom) both locally and in the cloud (Dropbox, Google Drive).

How can I safely and securely attach the CGM/FGM?

You can tape it. There are several pre-perforated ‘overpatches’ for common CGM systems available (search Google, eBay or Amazon). Some loopers use the cheaper standard kinesiology tape or rocktape.

You can fix it. You can also purchase upper arm bracelets that fix the CGM/FGM with a band (search Google, eBay or Amazon).

Nastavení AndroidAPS

The following list aims to help you optimize settings. It may be best to start at the top and work to the bottom. Aim to get one setting right before changing another. Work in small steps rather than making large changes at once. You can use Autotune to guide your thinking, although it should not be followed blindly: it may not work well for you or in all circumstances. Note that settings interact with one another - you can have ‘wrong’ settings that work well together in some circumstances (e.g. if a too-high basal happens to be at the same time as a too-high CR) but do not in others. This means that you need to consider all the settings and check they work together in a variety of circumstances.

Celková doba aktivity inzulínu (DIA)

Popis & testování

The length of time that insulin decays to zero.

This is quite often set too short. Most people will want at least 5 hours, potentially 6 or 7.

Dopad

Too short DIA can lead to low BGs. A naopak. Pokud glykémie stoupá, bazální dávka je příliš nízká.

If DIA is too short, AAPS thinks too early that your previous bolus is all consumed, and, at still elevated glucose, will give you more. (Actually, it does not wait that long, but predicts what would happen, and keeps adding insulin). This essentially creates ‘insulin stacking’ that AAPS is unaware of.

Example of a too-short DIA is a high BG followed by AAPS over-correcting and giving a low BG.

Základní bazální dávka (U/h)

Popis & testování

The amount of insulin in a given hour time block to maintain BG at a stable level.

Test your basal rates by suspending loop, fasting, waiting for say 5 hours after food, and seeing how BG changes. Repeat a few times.

If BG is dropping, basal rate is too high. A naopak. Pokud glykémie stoupá, bazální dávka je příliš nízká.

Dopad

Too high basal rate can lead to low BGs. A naopak. Pokud glykémie stoupá, bazální dávka je příliš nízká.

AAPS ‘baselines’ against the default basal rate. If basal rate is too high, a ‘zero temp’ will count as a bigger negative IOB than it should. This will lead to AAPS giving more subsequent corrections than it should to bring IOB ultimately to zero.

So, a basal rate too high will create low BGs both with the default rate, but also some hours hence as AAPS corrects to target.

Conversely a basal rate too low can lead to high BGs, and a failure to bring levels down to target.

Korekční faktor / citlivost na inzulin (ISF) (mmol/l/U nebo mg/dl/U)

Popis & testování

The drop in BG expected from dosing 1U of insulin.

Assuming correct basal, you can test this by suspending loop, checking IOB is zero, and taking a few glucose tablets to get to a stable ‘high’ level.

Then take an estimated amount of insulin (as per current 1/ISF) to get to your target BG.

Be careful as this is quite often set too low. Too low means 1 U will drop BG faster than expected.

Dopad

Lower ISF (i.e. 40 instead of 50) meaning insulin drops your BG less per unit. This leads to a more aggressive / stronger correction from the loop with more insulin. If the ISF is too low, this can lead to low BGs.

Higher ISF (i.e. 45 instead of 35) meaning insulin drops your BG more per unit. This leads to a less aggressive / weaker correction from the loop with less insulin. If the ISF is too high, this can lead to high BGs.

Příklad:

  • BG is 190 mg/dl (10,5 mmol) and target is 100 mg/dl (5,6 mmol).
  • So, you want correction of 90 mg/dl (= 190 - 110).
  • ISF = 30 -> 90 / 30 = 3 units of insulin
  • ISF = 45 -> 90 / 45 = 2 units of insulin

An ISF that is too low (not uncommon) can result in ‘over corrections’, because AAPS thinks it needs more insulin to correct a high BG than it actually does. This can lead to ‘roller coaster’ BGs (esp. when fasting). In this circumstance you need to increase your ISF. This will mean AAPS gives smaller correction doses, and this will avoid over-correcting a high BG resulting in a low BG.

Conversely, an ISF set too high can result in under-corrections, meaning your BG remains above target – particularly noticeable overnight.

Inzulínovosacharidový poměr (IC) (g/U)

Popis & testování

The grams of carbohydrate for each unit of insulin.

Some people also use I:C as abbreviation instead of IC or talk about carb ratio (CR).

Assuming correct basal, you can test by checking IOB is zero and that you are in-range, eating exactly known carbs, and take an estimated amount of insulin based on current insulin to carb ratio. Best is to eat food your normally eat at that time of day and count its carbs precisely.

POZNÁMKA:

V některých evropských zemích se používaly chlebové/výměnné jednotky pro stanovení toho, kolik inzulínu je na dané jídlo potřeba. Z počátku odpovídala 1 výměnná jednotka 12 g sacharidů, později se to změnilo na 10 g sacharidů.

V tomto modelu bylo množství sacharidů fixní a měnilo se množství inzulinu. („Kolik inzulínu je zapotřebí k pokrytí jedné výměnné jednotky?“)

Při používání inzulino-sacharidového poměru je naopak fixní množství inzulinu a mění se množství sacharidů. („Kolik g sacharidů lze pokrýt jednou jednotkou inzulínu?“)

Příklad:

Faktor výměnných jednotek (VJ = 12 g sacharidů): 2,4 U/BJ -> potřebujete 2,4 jednotky inzulínu na jednu výměnnou jednotku.

Odpovídající inzulino-sacharidový poměr: I:C - 12 g / 2,4 U = 5,0 g/U -> 1 jednotka inzulinu pokryje 5,0 g sacharidů.

VJ faktor 2,4 U / 12 g ===> IC = 12 g / 2,4 U = 5,0 g/U

Převodní tabulky jsou k dispozici online, např. zde.

Dopad

Lower IC = less food per unit, i.e. you are getting more insulin for a fixed amount of carbs. Can also be called ‘more aggressive’.

Higher IC = more food per unit, i.e. you are getting less insulin for a fixed amount of carbs. Can also be called ‘less aggressive’.

If after meal has digested and IOB has returned to zero, your BG remains higher than before food, chances are IC is too large. Conversely if your BG is lower than before food, IC is too small.

Algoritmus APS

Proč se na kartě “OPENAPS AMA” zobrazuje “dia:3”, i když mám ve svém profilu nastavené jiné DIA?

AMA 3h

In AMA, DIA actually doesn’t mean the ‘duration of insulin acting’. It is a parameter, which used to be connected to the DIA. Now, it means, ‘in which time should the correction be finished’. It has nothing to do with the calculation of the IOB. In OpenAPS SMB, there is no need for this parameter any longer.

Profil

Proč se nyní používá 5 h jako dolní limit DIA (doba působnosti inzulínu) namísto 2–3 h?

Well explained in this article. Don’t forget to ACTIVATE PROFILE after changing your DIA.

Co způsobuje, že smyčka často snižuje mou glykémii až k hranici hypoglykémie bez COB (žádné aktivní sacharidy)?

First of all, check your basal rate and make a no-carb basal rate test. If it is correct, this behavior is typically caused by a too low ISF. A too low ISF looks typically like this:

ISF too low

Co způsobuje výrazné vrcholy po jídle při používání uzavřené smyčky?

First of all, check your basal rate and make a no-carb basal rate test. If it is correct and your BG is falling to your target after carbs are fully absorbed, try to set an ‘eating soon’ temp target in AndroidAPS some time before the meal or think about an appropriate prebolus time with your endocrinologist. If your BG is too high after the meal and still too high after carbs are fully absorbed, think about decreasing your IC with your endocrinologist. If your BG is too high while COB and too low after carbs are fully absorbed, think about increasing your IC and an appropriate prebolus time with your endocrinologist.

Další nastavení

Nastavení Nightscoutu

NSClient v AndroidAPS hlásí ‘není povoleno’ a nenahrává žádná data. Co mohu dělat?

In NSClient check ‘Connection settings’. Maybe you actually are not in an allowed WLAN or you have activated ‘Only if charging’ and your charging cable is not attached.

Nastavení CGM

Proč AndroidAPS hlásí ‘Zdroj glykémií nepodporuje pokročilé filtrování’?

If you do use another CGM/FGM than Dexcom G5 or G6 in xDrip native mode, you’ll get this alert in AndroidAPS OpenAPS-tab. See Smoothing blood glucose data for more details.

Pumpa

Kam pumpu umístit?

There are innumerable possibilities to place the pump. It does not matter if you are looping or not.

Baterie

Looping can reduce the pump battery faster than normal use because the system interacts through bluetooth far more than a manual user does. It is best to change battery at 25% as communication becomes challenging then. You can set warning alarms for pump battery by using the PUMP_WARN_BATT_P variable in your Nightscout site. Tricks to increase battery life include:

  • reduce the length of time the LCD stays on (within pump settings menu)

  • reduce the length of time the backlight stays on (within pump settings menu)

  • select notification settings to a beep rather than vibrate (within pump settings menu)

  • only press the buttons on the pump to reload, use AndroidAPS to view all history, battery level and reservoir volume.

  • AndroidAPS app may often be closed to save energy or free RAM on some phones. When AndroidAPS is reinitialized at each startup it establishes a Bluetooth connection to the pump, and re-reads the current basal rate and bolus history. This consumes battery. To see if this is happening, go to Preferences > NSClient and enable ‘Log app start to NS’. Nightscout will receive an event at every restart of AndroidAPS, which makes it easy to track the issue. To reduce this happening, whitelist AndroidAPS app in the phone battery settings to stop the app power monitor closing it down.

    For example, to whitelist on a Samsung phone running Android Pie:

    • Go to Settings -> Device Care -> Battery
    • Scroll until you find AndroidAPS and select it
    • De-select “Put app to sleep”
    • ALSO go to Settings -> Apps -> (Three circle symbol in the top-right of the screen) select “special access” -> Optimize battery usage
    • Scroll to AndroidAPS and make sure it is de-selected.
  • clean battery terminals with alcohol wipe to ensure no manufacturing wax/grease remains.

  • for Dana R/RS pumps the startup procedure draws a high current across the battery to purposefully break the passivation film (prevents loss of energy whilst in storage) but it doesn’t always work to break it 100%. Either remove and reinsert battery 2-3 times until it does show 100% on screen, or use battery key to briefly short circuit battery before insertion by applying to both terminals for a split second.

  • see also more tips for particular types of battery

Výměna zásobníků a kanyl

The change of cartridge cannot be done via AndroidAPS but must be carried out as before directly via the pump.

  • Long press on “Open Loop”/”Closed Loop” on the Home tab of AndroidAPS and select ‘Suspend Loop for 1h’
  • Now disconnect the pump and change the reservoir as per pump instructions.
  • Also priming and filling tube and cannula can be done directly on the pump. In this case use PRIME/FILL button in the actions tab just to record the change.
  • Once reconnected to the pump continue the loop by long pressing on ‘Suspended (X m)’.

The change of a cannula however does not use the “prime infusion set” function of the pump, but fills the infusion set and/or cannula using a bolus which does not appear in the bolus history. This means it does not interrupt a currently running temporary basal rate. On the Actions (Act) tab, use the PRIME/FILL button to set the amount of insulin needed to fill the infusion set and start the priming. If the amount is not enough, repeat filling. You can set default amount buttons in the Preferences > Other > Fill/Prime standard insulin amounts. See the instruction booklet in your cannula box for how many units should be primed depending on needle length and tubing length.

Pozadí

You can find the AndroidAPS wallpaper for your phone on the phones page.

Každodenní používání

Hygiena

Co dělat při sprchování a koupání?

You can remove the pump while taking a shower or bath. For this short period of time you may not need it, but you should tell AAPS that you’ve disconnected so that the IOB calculations are correct. See description above.

Práce

Depending on your job, you may choose to use different treatment factors on workdays. As a looper you should consider a profile switch for your typical working day. For example, you may switch to a profile higher than 100% if you have a less demanding job (e.g. sitting at a desk), or less than 100% if you are active and on your feet all day. You could also consider a high or low temporary target or a time shift of your profile when working much earlier or later than regular, of if you work different shifts. You can also create a second profile (e.g. ‘home’ and ‘workday’) and do a daily profile switch to the profile you actually need.

Volnočasové aktivity

Sporty

Budete muset změnit své staré sportovní návyky z doby, kdy jste ještě nepoužívali smyčku. Pokud budete při sportu dokrmovat sacharidy jako dříve, systém uzavřené smyčky to pozná a bude se snažit je korigovat.

Takže byste sice měli více zkonzumovaných sacharidů, ale smyčka by na ně zároveň vydala inzulin.

Při používání smyčky byste měli vyzkoušet tyto kroky:

Provedení změn před sportem a po sportu je velmi důležité. Proveďte změny v čase před sportem a zvažte vliv svalového plnění.

Pokud se věnujete sportu pravidelně ve stejný čas (např. lekce ve fitku), zvažte možnost použití automatizace pro přepnutí profilu a nastavení dočasného cíle. Bylo by možné použít automatizaci na základě polohy, ale obtížně se pak kontroluje včasné provedení změny nastavení.

Procentuální hodnota přepnutí profilu, hodnota pro váš dočasný cíl Aktivita a optimální čas pro změnu nastavení jsou velmi individuální. Při zjišťování správných hodnot se v zájmu bezpečnosti držte při zdi (začněte raději s nižší procentuální hodnotou a vyšším dočasným cílem).

Sex

You can remove the pump to be ‘free’, but you should tell AndroidAPS so that the IOB calculations are correct. See description above.

Požívání alkoholu

Drinking alcohol is risky in closed loop mode as the algorithm cannot predict the alcohol influenced BG correctly. You have to check out your own method for treating this using the following functions in AndroidAPS:

  • Deactivating closed loop mode and treating the diabetes manually or
  • setting high temp targets and deactivating UAM to avoid the loop increasing IOB due to an unattended meal or
  • do a profile switch to noticeably less than 100%

When drinking alcohol, you always have to have an eye on your CGM to manually avoid a hypoglycemia by eating carbs.

Spánek

Jak mohu provozovat smyčku během noci bez mobilního a WIFI záření?

Many users turn the phone into airplane mode at night. If you want the loop to support you when you are sleeping, proceed as follows (this will only work with a local BG-source such as xDrip+ or ‘Build your own Dexcom App’, it will NOT work if you get the BG-readings via Nightscout):

  1. Zapněte na mobilu režim letadlo.
  2. Počkejte dokud není režim aktivní.
  3. Zapněte Bluetooth.

You are not receiving calls now, nor are you connected to the internet. But the loop is still running.

Some people have discovered problems with local broadcast (AAPS not receiving BG values from xDrip+) when phone is in airplane mode. Go to Settings > Inter-app settings > Identify receiver and enter info.nightscout.androidaps.

xDrip+ Základní nastavení komunikace mezi aplikacemi Identify receiver

Cestování

Jak se vypořádat s cestováním přes časové zóny?

With Dana R and Dana R Korean you don’t have to do anything. For other pumps see time zone travelling page for more details.

Lékařská témata

Pobyt v nemocnici

If you want to share some information about AndroidAPS and DIY looping with your clinicians, you can print out the guide to AndroidAPS for clinicians.

Kontrola u vašeho diabetologa

Výkazy

You can either show your Nightscout reports (https://YOUR-NS-SITE.com/report) or check Nightscout Reporter.