Plnění cílů
AAPS has a series of Objectives required to be completed to help the user progress from basic open looping to hybrid closed looping and full AAPS functionality. Completing the Objectives aims to ensure you have:
Configured everything correctly in your AAPS setup;
Learned about the essential features of AAPS; and
A basic understanding of what your system can do, in order to help instill confidence when using AAPS.
When AAPS is installed for the first time, each objective must be completed before moving on to the next one. New features will gradually be unlocked as progress is made through each Objective.
Objectives 1 to 8 will guide you from configuring AAPS on your smartphone to “basic” hybrid closed looping. This will take about 6 weeks to complete. You can proceed up to Objective 5 using a virtual pump (and using some other method of insulin delivery in the meantime). Objectives 9 to 11 are designed to test more advanced AAPS features with the aim of better control of your diabetes, and will take up to 3 months to complete, possibly longer. Further details on an estimated breakdown of time can be obtained here: How long will it take?
As well as progressing through the Objectives, if required, you can also remove your progress and go back to an earlier objective.
Backup your settings
Note
Exporting your AAPS settings is recommended after completing each Objective!
It is strongly recommended that you export your settings after completing each objective to avoid losing any progress made in AAPS. This exporting process creates a settings file (.json) which should be backed-up in one or more safe places (e.g. Google Drive, hard disk, email attachment etc.). This ensures that any progress made in AAPS is saved. If your phone is lost or if you accidentally delete your progress, the json file can be re-loaded to AAPS by importing a recent settings file. Having a backup settings file is also required if a new AAPS smartphone is required for any reason (upgrading/lost/broken phone etc.)
The settings file will save not only your progress through the Objectives, but also all your AAPS settings such as max bolus etc.
The Objectives will need to be restarted from the beginning should you fail to have a backup of your settings and anything happens to your AAPS smartphone. Progressing through the Objectives takes time, and having to re-complete them again because for example you lost your smartphone, is a situation to be best avoided.
Objective 1: Setting up visualization and monitoring, analyzing basals and ratios
Objective 1 requires the user to set up their basic technical setup in AAPS. No progress can be made until this step has been completed.
Select the correct CGM/FGM in Config Builder. See BG Source for more information.
Select the correct Pump in Config Builder to ensure your pump can communicate with AAPS. Select virtual pump if you are using a pump model with no AAPS driver for looping, or if you want to work through the early Objectives while using another system for insulin delivery. See insulin pump for more information.
If using Nightscout:
Follow instructions in Nightscout page to ensure Nightscout can receive and display AAPS data.
Note that URL in NSClient must be without „/api/v1/“ at the end - see Preferences > NSClient.
If using Tidepool:
Follow instructions in Tidepool page to ensure Tidepool can receive and display AAPS data.
Note - You may need to wait for the next sensor glucose reading to arrive before AAPS will recognise it.
Cíl 2: Naučte se ovládat AAPS
Objective 2 requires several ‘tasks’ to be actioned as shown in the screenshot below Click on the orange text „Not completed yet“ to access the to-dos. Jako vodítko pro případ, že dosud nejste obeznámeni s konkrétními kroky, mohou sloužit odkazy na dokumentaci.
Tasks to complete Objective 2 are:
Set your Profile to 90% for a duration of 10 min.
Hint: Long press your Profile name on the OVERVIEW screen. More information in Profile switch & Profile Percentage.
Note: AAPS does not accept basal rates below 0.05U/hr. If your Profile includes rates 0.06U/hr or lower you will need to create a temporary Profile with higher basal rates before completing this task. Switch back to your normal Profile after completing this task.
Simulate „taking a shower“ by disconnecting your pump in AAPS for a duration of 1h.
Hint: press the loop icon on the OVERVIEW screen to open the Loop dialogue.
End „taking a shower“ by reconnecting your pump.
Hint: press the „disconnected“-icon to open the loop dialog.
Set a custom Temporary Target with a duration of 10 min.
Hint: press the target bar on the OVERVIEW screen to bring up the temporary target dialog.
Activate the Actions plugin in Config Builder to make it appear on the top scrollable menu bar.
Hint: Go to Config Builder and scroll down to General.
Display the Loop plugin’s content.
Scale the BG-Chart to be able to look at larger or smaller time frames: toggling between 6h, 12h, 18h 24h of past data.
Hint: Long press on the chart or use the arrow at the top right.
Cíl 3: Prokázat své znalosti
Objective 3 requires the user to pass a multiple-choice exam which is designed to test your AAPS knowledge.
Some users find Objective 3 to be the most difficult objective to complete. Please read the AAPS documents in conjunction with the questions. If you are genuinely stuck after researching the AAPS documents, please search the Facebook or Discord group for „Objective 3“ (because it is likely that your question has been asked before - and answered by the group). These groups can provide friendly hints, or redirect you to the relevant part of the AAPS documents.
In the meantime :
To reduce the number of notifications / decisions you are asked to make (temporary basal rates) while in Open Loop, set a wide target range in your Profile e.g. 90 - 150 mg/dl or 5.0 - 8.5 mmol/l.
V noci budete možná chtít zvýšit horní limit (nebo dokonce vypnout otevřenou smyčku).
To proceed with Objective 3, click on the orange text “Not completed yet” to access the relevant question. Každou otázku si pečlivě přečtěte a vyberte správnou odpověď (odpovědi).
Pro každou otázku může existovat více než jedna správná odpověď! If an incorrect answer is selected, the question will be time-locked for 1 hour before you can go back and answer the question again. Také pozor na to, že pořadí variant odpovědí se může při dalším pokusu o odpověď změnit. Cílem je, aby jste je pečlivě četli a skutečně chápali, jaká je správná nebo chybná odpověď a proč.
What happens if new question(s) are added to an Objective when I update to a newer version of AAPS?
From time to time, new features are added to AAPS which may require a new question to be added to the Objectives, particularly Objective 3. As a result, any new question added to Objective 3 will be marked as “incomplete” because AAPS will require you to action this. Do not worry, as each Objective is independent, you will not lose the existing functionality of AAPS, providing the other Objectives remain completed.
Cíl 4: Začít s otevřenou smyčkou
The purpose of Objective 4 is to recognise how often AAPS will evaluate the user’s basal rate against glucose levels, and recommend temporary basal rate adjustments. As part of this Objective, you will activate open looping for the first time, and will accept 20 proposed temporary basal rate changes, and if required, apply these manually on your pump. You will also observe the impact of Temporary Targets. If you are not familiar with setting a temporary basal rate change in AAPS yet, please refer to the Actions tab.
The minimal time to complete this objective: 7 days. To je povinná čekací doba. It is not possible to proceed to the next Objective, even if all basal rate changes were enacted already.
Select Open Loop either from the Preferences > OpenAPS menu or by pressing and holding the Loop icon on the top left of the Overview screen.
Ručně proveďte alespoň 20 nastavení dočasných cílů, které vám systém navrhuje, a to během 7 dní; zadejte je do své pumpy a potvrďte v AAPS, že jste návrhy přijali. Ensure these basal rate adjustments show up in AAPS and Nightscout.
Use Temp Targets when necessary. After treating a hypo, use the predefined „hypo temp target“ to prevent the system from overcorrecting upon the bounce back.
To reduce the number of proposed basal rate changes while in Open Loop, you can still use the tips described in Objective 3. Additionally, you can change the minimum percentage for recommended basal rate changes. The higher the value, the fewer change notifications you will receive.
Note
You don’t need to action each and every system recommendation!
Cíl 5: Porozumění otevřené smyčce, včetně doporučení pro dočasné bazály
As part of Objective 5 you will start to understand how temporary basal recommendations are derived. This includes the determination of basal logic, analyzing the impact by observing prediction lines in AAPS Overview (or Nightscout) and looking at detailed calculations shown on your OpenAPS tab.
Estimated time to complete this objective: 7 days.
This Objective requires you to determine and set your “Max U/h a temp basal can be set to” (max-basal) value as described in OpenAPS-features. This value can be set in Preferences > OpenAPS. If you are still using a virtual pump, make sure this safety setting is set in both AAPS and your insulin pump.
You might wish to set your Profile BG target higher than usual until you are comfortable with AAPS‘ calculations and settings. You may wish to experiment with adjusting your BG target in your Profile being in a tighter range (say, 1 or less mmol/l [20 mg/dl or less] wide) and observe the resulting behavior.
If you have been using a virtual pump, change to a real insulin pump now!
If you are open looping with a virtual pump stop here. Only click verify at the end of this Objective once you have changed to using a „real“ pump which delivers insulin.
Cíl 6: Začátek uzavřené smyčky - s pozastavením pumpy při nízké glykémii
Closed loop will not correct high BG values in Objective 6 as it is limited to Low Glucose Suspend only!
Budete muset korigovat vysoké hodnoty glykémií samostatně (ručním posíláním inzulinu z pumpy nebo nebo perem)!
As part of Objective 6 you will close the loop and activate its Low Glucose Suspend (LGS) mode while max IOB is set to zero. You have to remain in LGS mode for 5 days to complete this objective. You should use this time to check if your Profile settings are accurate and LGS events are not triggered too often.
Minimal time to complete this objective: 5 days. To je povinná čekací doba. You cannot proceed to the next Objective before this time is up.
It is crucial that your current Profile (basal, ISF, IC) have been well tested before you close your loop in LGS mode. Incorrect Profile settings might force you into hypo situations which have to be treated manually. An accurate Profile will help reduce the need for low glucose treatments during the 5 days period.
If you still observe frequent or severe low glucose episodes consider refining your DIA, basal, ISF and carb ratios. Please refer to the Facebook or Discord group which has much discussion on this.
During Objective 6, AAPS will override the maxIOB setting to zero. This override will end when moving to Objective 7.
This means that when you are on Objective 6, if sensor glucose levels are dropping, AAPS will reduce your basal insulin delivery for you. But, if sensor glucose levels are rising, AAPS will increase the basal rate above your Profile value only if basal IOB is negative as a result of a previous LGS. Otherwise, AAPS will not increase basal above your current profile value, even if glucose levels are rising. This caution is to avoid hypos as you are learning to use AAPS.
As a consequence, you have to handle high glucose values with manual insulin bolus corrections.
If your basal IOB is negative (see screenshot below) a temporary basal rate (TBR) > 100% can be triggered in Objective 6.
Nastavte cílový rozsah o něco výše než by byl obvyklý cíl, tak abyste měli jistotu a vytvořili si bezpečnostní rezervu.
Enable ‚Low Glucose Suspend‘ mode by pressing and holding the Loop icon in the top right corner of the OVERVIEW screen and selecting the Loop - LGS mode icon.
Sledujte aktivní dočasné bazály zobrazené jako tyrkysový text bazálu na základní obrazovce nebo na tyrkysovou křivku bazálů která je součástí grafu na základní obrazovce.
Může dočasně docházet k výskytu nárůstů v důsledku reakce na hypo, bez možnosti zpětného zvýšení bazálů.
Cíl 7: Vyladění uzavřené smyčky, zvýšení maxIOB nad 0 a postupné snižování cílové hladiny cukru v krvi
To complete Objective 7 you have to close your loop and raise your maxIOB. maxIOB was zeroed out automatically in Objective 6. To se nyní vrací zpět. AAPS will start to use your defined maxIOB value to correct high glucose values.
Minimal time to complete this objective: 1 day. To je povinná čekací doba. It is not possible to proceed to the next Objective until this period of time has expired.
Select Closed Loop either from Preferences > OpenAPS or by pressing and holding the Loop icon in the top right corner of the Overview screen. Stay in Closed Loop over a period of 1 day.
Slowly raise your ‚Maximum total IOB OpenAPS can’t go over‘ (in OpenAPS called ‚max-iob‘) above 0, until you find the settings that work best for you.
The default recommendation for this setting is “average meal bolus + 3x max daily basal”, where “max daily basal” is the maximum hourly value in any time segment of the day.
Toto doporučení by mělo být považováno za výchozí bod. If you use this rule but are experiencing AAPS delivering too much insulin as glucose levels rise, you may need to :
lower the „Maximum total IOB OpenAPS can’t go over“ value;
review your Profile settings, only making one adjustment at a time.
Alternatively, if you are very insulin resistant, raise the maxIOB value very cautiously.
Once confident on how much maxIOB suits your looping patterns, lower your BG targets to your desired level.
Objective 8: Adjust basals and ratios if needed, and then enable Autosens
As part of this objective, you will revisit your Profile’s performance and will use Autosens functionality as an indicator for wrong settings.
Minimal time to complete this objective: 7 days. To je povinná čekací doba. It is not possible to proceed to the next Objective until this period of time has expired.
Enable Autosens over a period of 7 days and watch Overview’s graph white line showing your insulin sensitivity rising or falling due to exercise or hormones etc. Keep an eye on the OpenAPS report tab which shows AAPS adjusting the sensitivity, basals and targets accordingly.
This is a good time to review your settings for Sensitivity Detection. You can view your sensitivity on the homescreen in an additional graph.
Additionally, you can use Autotune as a one off to check your basals remain accurate or do a traditional basal test.
Cíl 9: Povolit další funkce oref1 pro běžné používání, jako je SMB (super micro bolus)
In Objective 9, you will tackle and use „Super Micro Bolus (SMB)“ as one core functionality. After working through the mandatory readings you will have a good understanding of what SMBs are, how these work, and why basal is set to zero temporarily after SMBs are given (zero-temping).
Minimal time to complete this objective: 28 days. To je povinná čekací doba. You can’t proceed to the next Objective before this time is up.
The SMB section in this documentation and oref1 coverage in the openAPS docs are must-reads to understand SMB and the concept of zero-temping.
Once done, you can raise maxIOB to get SMBs working more effectively. maxIOB now includes all IOB, not just accumulated basal. This threshold pauses SMBs until IOB drops below this value (e.g. maxIOB is set to 7U and a bolus of 8U is given to cover a meal: SMBs will be paused and not given unless IOB drops below 7U). A good start is setting maxIOB = average meal bolus + 3x max daily basal where „max daily basal“ is the maximum hourly value in any time segment of the day. See objective 7 as reference.
Evaluate your carb absorption rate and consider changing the “min_5m_carbimpact”-parameter in Preferences > Absorption settings > min_5m_carbimpact if you find it too slow or too fast.
Cíl 10: Automatizace
Automations become available when Objective 10 is started.
Minimal time to complete this objective: 28 days. To je povinná čekací doba. You can’t proceed to the next Objective before this time is up.
Read the documentation page Automation first.
Set-up the most basic automation rule; for example trigger an Android notification in a few minutes:
Vyberte záložku Oznámení
Z horního 3 tečkového menu vyberte „Přidat pravidlo“
Zadejte název úlohy „Moje první automatizované oznámení“
„Upravit“, „Podmínka“
Klikněte na symbol „+“ k přidání prvního spouštěče
select „Time“ & „OK“, it will create a default entry AT TODAY HOUR:MINUTE
Klepnutím na MINUTE upravte čas tak, aby došlo ke spuštění za pár minut. Uzavřete kliknutím na „OK“
Kliknutím na „OK“ zavřete obrazovku spouštěčů
„PŘIDAT“ „Akci“
Vyberte „Oznámení“, „OK“
click „Notification“ to edit the message, enter something like „My first automation“
Wait until the time triggers the notification (note that depending on your phone, it can be a few minutes late)
You can then experiment with setting up a more useful Automation. The documentation page gives a few examples, and you can search for „Automation“ screenshots on the Facebook group. There is also a dedicated channel in the Discord community.
For example, if you eat the same thing for breakfast at the same time every morning before school/work, you can create an Automation such as „before-breakfast-target“ to set a slightly lower Temporary Target 30 minutes before having breakfast. V takovém případě bude vaše podmínka zahrnovat „opakující se čas“, který se skládá z konkrétních dní v týdnu (Pondělí, Úterý, Středa, Čtvrtek, Pátek) a konkrétní čas (6:30). The action will consist of „Start temp target“ with a lower than usual target value and a 30 minutes duration.
Objective 11: Enabling additional features for daytime use, such as Dynamic Sensitivity plugin (DynISF).
Minimal time to complete this Objective: 28 days. To je povinná čekací doba. It is not possible to proceed to the next Objective until this period of time has expired.
Ensure that SMB is functioning properly
Read the documentation concerning Dynamic ISF here
Search the Facebook and Discord groups for discussions around Dynamic ISF and read about other users‘ experiences and recommendations.
Enable the DynamicISF plugin and identify the appropriate calibration for your body’s uniqueness. Z bezpečnostních důvodů je vhodné začít hodnotou Korekčního faktoru nižší než 100%.
Návrat k předchozímu cíli
If you wish to go back in the Objectives for whatever reason you can do so by clicking at „clear finished“.
