Key AAPS features

Autosens (זיהוי רגישות)

• Autosens is an algorithm which looks at blood glucose deviations (positive/negative/neutral).

• Autosens ינסה להעריך את הרגישות\תנגודת על סמך סטיות אלו.

• אלגוריתם oref ב-OpenAPS פועל באמצעות התחשבות בנתונים מ-24 ו-8 השעות האחרונות. הוא יבחר בנתון בו הרגישות גדולה יותר מבין חלונות הזמן הללו.

• In versions prior to AAPS 2.7, the user had to choose between 8 or 24 hours manually.

• From AAPS 2.7 on Autosens in AAPS will switch between a 24 and 8 hours window for calculating sensitivity. It will pick whichever one is more sensitive.

• אם משתמשים הגיעו מ-oref1, הם כנראה ישימו לב שהמערכת עשויה להיות פחות דינמית לשינויים, בגלל המשתנה של 24 או 8 שעות של רגישות.

• החלפת צינורית או שינוי פרופיל יאפס את יחס ה-Autosens בחזרה ל-100% (החלפת פרופיל באחוזים עם משך זמן לא יאפס את Autosens).

• Autosens מתאים את המינון הבזאלי ואת יחס התיקון-ISF (כלומר: מחקה את מה שעושה שינוי פרופיל).

• If continuously eating carbs over an extended period, Autosens will be less effective during that period as carbs are excluded from BG delta calculations.

סופר מיקרו בולוס (SMB)

SMB, the shortform of Super micro bolus, is an OpenAPS feature introduced from 2018 onwards, within the Oref1 algorithm. In contrast to AMA, SMB does not use temporary basal rates to control glucose levels, but mainly small super micro boluses. In situations where AMA would add 1.0 IU insulin using a temporary basal rate, SMB delivers several super micro boluses in small steps at 5 minute intervals, e.g. 0.4 IU, 0.3 IU, 0.2 IU and 0.1 IU. במקביל (מטעמי בטיחות) המינון הבזאלי מוגדר ל-0 יח«\שעה לתקופה מסוימת כדי למנוע מנת יתר (»zero-temping«). This allows the system to adjust the blood glucose faster than with the temporary basal rate increase in AMA.

Thanks to SMB, it may be sufficient for meals containing only ”slow“ carbs to inform the system of the planned amount of carbohydrate and leave the rest to AAPS. עם זאת, זה עלול להוביל לשיאים גבוהים יותר לאחר הארוחה מכיוון שלא ניתן בולוס מראש. Or you can give, if necessary with pre-bolusing, a start bolus, which only partly covers the carbohydrates (e.g. 2/3 of the estimated amount) and let SMB deliver the rest of the insulin.

SMBs are shown on the main graph with blue triangles. Tap on the triangle to see how much insulin was delivered, or use the Treatments tab.

SMB’s features contain some safety mechanisms:

1. Largest single SMB dose
   The largest single SMB dose can only be the smallest value of:

   • ערך המתאים למינון הבזאלי הנוכחי (כפי שמתכוונן על ידי Autosens) למשך הזמן שנקבע ב“דקות בסיס מקסימליות להגבלת SMB“, למשל מינון בזאלי למשך 30 הדקות הבאות, או

   • מחצית מכמות האינסולין הנדרשת ברגע זה, או

   • החלק הנותר של ערך אינסולין הפעיל המרבי בהגדרות.

2. Low temp basal rates
   Low temporary basal rates (called »low temps«) or temporary basal rates at 0 U/h (called »zero-temps«) are activated more in SMB. This is by design for safety reasons and has no negative effects if the Profile is set correctly. On the main graph, the IOB curve (yellow thin line) is more meaningful than the course of the temporary basal rates.

3. Un-Announced Meals
   Additional calculations to predict the course of glucose, e.g. by UAM (un-announced meals). Even without manual carbohydrate input from the user, UAM can automatically detect a significant increase in glucose levels due to meals, adrenaline or other influences and try to adjust this with SMB. ליתר בטחון זה עובד גם הפוך ויכול לעצור את ה-SMB מוקדם יותר אם מתרחשת ירידה מהירה באופן בלתי צפוי בסוכר שבדם. זו הסיבה לכך שעל UAM להיות תמיד מופעל עם SMB.

You must have started objective 9 to use SMB.

See also :

• OpenAPS documentation for SMB.

• OpenAPS documentation for oref1 SMB

• Tim’s info on SMB.

The settings for OpenAPS SMB are described below.

Max U/h a temp basal can be set to

הגדרת בטיחות זו קובעת את המינון הבזאלי הזמני המרבי שמשאבת האינסולין יכולה לספק. It is also known as max-basal.

The value is measured in units per hour (U/h). מומלץ להגדיר ערך סביר. A good recommendation for setting this parameter is:

max-basal = highest basal rate x 4

For example, if the highest basal rate in your profile was 0.5 U/h you could multiply that by 4 to get a value of 2 U/h.

AAPS limits this value as a »hard limit« according to Preferences > Treatments safety > Patient Type. The hard limits are as follows:

• ילד\ה: 2

• מתבגר\ת: 5

• מבוגר\ת: 10

• מבוגר\ת עם תנגודת אינסולין גבוהה: 12

• הריון: 25

See also overview of hard-coded limits.

Maximum total IOB OpenAPS can’t go over

This value determines the maximum Insulin on Board (basal and bolus IOB) that AAPS will remain under while running in closed loop mode. It is also known as maxIOB.

אם ה-IOB הנוכחי (למשל לאחר בולוס ארוחה) הוא מעל הערך maxIOB המוגדר, הלופ יפסיק את מתן האינסולין עד שהאינסולין הפעיל יירד אל מתחת לערך ה-IOB המקסימלי.

A good start for setting this parameter is:

אינסולין פעיל מרבי = בולוס ארוחה ממוצע + מינון בזאלי מקסימלי 3X

Be careful and patient when adjusting your max-IOB. ה-Max-IOB שונה עבור כל אחד ותלוי גם במינון היומי הממוצע (TDD).

AAPS limits this value as a »hard limit« according to Preferences > Treatments safety > Patient Type. The hard limits are as follows:

• ילד\ה: 3

• מתבגר\ת: 7

• מבוגר\ת: 12

• מבוגר\ת עם תנגודת אינסולין גבוהה: 25

• הריון: 40

See also overview of hard-coded limits.

Note : When using SMB, the max-IOB is calculated differently than in AMA. In AMA, maxIOB is a safety-parameter for basal IOB, while in SMB-mode, it also includes bolus IOB.

ראו גם תיעוד OpenAPS בנושא SMB.

Enable dynamic sensitivity

This is the DynamicISF feature. When enabled, new settings become available. Settings are explained on the DynamicISF page.

ערך מטרה זמני גבוה מעלה את הרגישות

אם אפשרות זו מופעלת, הרגישות לאינסולין תוגבר כל עוד יש ערך מטרה זמני מעל 100 mg/dl. המשמעות היא שהרגישות-ISF תעלה בעוד שיחס הפחמימות-IC והמינון הבזאלי ירדו. This will effectively make AAPS less aggressive when you set a high temp target.

ערך מטרה זמני נמוך מוריד את הרגישות

אם אפשרות זו מופעלת, הרגישות לאינסולין תפחת כשערך מטרה זמני מעל 100 mg/dl. המשמעות היא שהרגישות-ISF תפחת בעוד שיחס הפחמימות-IC והמינון הבזאלי יעלו. This will effectively make AAPS more aggressive when you set a low temp target.

Enable Autosens feature

This is the Autosens feature. When using DynamicISF, Autosens can not be used, since they are two different algorithms altering the same variable (sensitivity).

Autosens looks at blood glucose deviations (positive/negative/neutral). It will try and figure out how sensitive/resistant you are based on these deviations and adjust basal rate and ISF based on these deviations.

When enabled, new settings become available.

רגישות מעלה את ערך המטרה

If this option is enabled, the sensitivity detection (autosens) can raise the target when sensitivity is detected (below 100%). In this case your target will be raised by the percentage of the detected sensitivity.

If the target is modified due to sensitivity detection, it will be displayed with a green background on your home screen.

This setting is available when one of ”Enable dynamic sensitivity“ or ”Enable Autosens feature“ are enabled.

תנגודת מורידה את ערך המטרה

If this option is enabled, the sensitivity detection (autosens) can lower the target when resistance is detected (above 100%). In this case your target will be lowered by the percentage of the detected resistance.

This setting is available when one of ”Enable dynamic sensitivity“ or ”Enable Autosens feature“ are enabled.

אפשר SMB

אפשרו הגדרה זו כדי להשמש ב-SMB. If disabled, no SMBs will be given.

When enabled, new settings become available.

הפעלת SMB עם ערכי מטרה גבוהים

If this setting is enabled, SMBs will still be delivered even if the user has selected a high Temp Target (defined as anything above 100mg/dL or 5.6mmol/l, regardless of Profile target). אפשרות זו נועדה להשבתת SMB כאשר היא מושבתת. For example, if this option is disabled, SMBs can be disabled by setting a Temp Target above 100mg/dL or 5.6mmol/l. This option will also disable SMBs regardless of what other condition is trying to enable SMB.

If this setting is enabled, SMB will only be enabled with a high temp target if Enable SMB with temp targets is also enabled.

הפעלת SMB תמיד

If this setting is enabled, SMB is enabled always enabled(independent of COB, temp targets or boluses). בהפעלת הגדרה זו, שאר הגדרות ההפעלה שלהלן לא ישפיעו. However, if Enable SMB with high temp targets is disabled and a high temp target is set, SMBs will be disabled.

This setting is only available if AAPS detects that you are using a reliable BG source, with advanced filtering. FreeStyle Libre 1 is not considered a reliable source due to the risk of infinitely repeating old BG data in case of sensor failure.

Noisy data could cause AAPS to believe BG is rising really fast, resulting in the administration of unnecessary SMBs. For more information about noise and data smoothing, see here.

הפעלת SMB עם פחמ« פעילות

If this setting is enabled, SMB is enabled when the COB is greater than 0.

This setting is not visible if ”Enable SMB always“ is switched on.

הפעלת SMB עם ערכי מטרה זמניים

If this setting is enabled, SMB is enabled when there is any temp target set (eating soon, activity, hypo, custom). If this setting is enabled but Enable SMB with high temp targets is disabled, SMB will be enabled when a low temp target is set (below 100mg/dL or 5.6mmol/l) but disabled when a high temp target is set.

This setting is not visible if ”Enable SMB always“ is switched on.

הפעלת SMB אחרי פחמימות

If enabled, SMB is enabled for 6h after carbohydrates are announced, even if COB has reached 0.

For safety reasons, this setting is only available if AAPS detects that you are using a reliable BG source. It is not visible if ”Enable SMB always“ is switched on.

This setting is only available if AAPS detects that you are using a reliable BG source, with advanced filtering. FreeStyle Libre 1 is not considered a reliable source due to the risk of infinitely repeating old BG data in case of sensor failure.

Noisy data could cause AAPS to believe BG is rising really fast, resulting in the administration of unnecessary SMBs. For more information about noise and data smoothing, see here.
This setting is not visible if ”Enable SMB always“ is switched on.

תדירות מתן SMB (דקות)

This feature limits the frequency of SMBs. This value determines the minimum time between SMBs. Note that the loop runs every time a glucose value comes in (generally 5 minutes). Subtract 2 minute to give loop additional time to complete. E.g. if you want SMB to be given every loop run, set this to 3 minutes.

Default value: 3 min.

מקסימום הדקות של בזאלי אליו SMB מוגבל

This is an important safety setting. This value determines how much SMB can be given based on the amount of basal insulin in a given time, when it is covered by COBs.

Making this value larger allows the SMB to be more aggressive. You should start with the default value of 30 minutes. After some experience, increase the value in 15 minutes increments and observe the effects over multiple meals.

It is recommended not to set the value higher than 90 minutes, as this would lead to a point where the algorithm might not be able to accommodate a decreasing BG with 0 U/h basal (»zero-temp«). You should also set alarms, especially if you are still testing new settings, which will warn you well before a hypo.

Default value: 30 min.

Max minutes of basal to limit SMB to for UAM

This setting allows to adjust the strength of SMB during UAM, when there are no more carbs.

Default value : the same as Max minutes of basal to limit SMB to.

This setting is only visible if ”Enable SMB“ and ”Enable UAM ” are switched on.

הפעלת UAM

With this option enabled, the SMB algorithm can recognize unannounced meals. This is helpful if you forget to tell AAPS about your carbs or estimate your carbs wrong and the amount of entered carbs is wrong or if a meal with lots of fat and protein has a longer duration than expected. Without any carb entry, UAM can recognize fast glucose increase caused by carbs, adrenaline, etc., and tries to adjust it with SMBs. This also works the opposite way: if there is a fast glucose decrease, it can stop SMBs earlier.

Therefore, UAM should always be activated when using SMB.

Minimal carbs required for suggestion

Minimum grams of carbs to display a carbs suggestion alert. Eating of additional carbs will be suggested when the reference design detects that it requires carbs. In this case you will receive a notification which can be snoozed for 5, 15 or 30 minutes.

הודעות של דרישה לפחמימות יכולות להישלח ל-Nightscout אם תרצו, ובמקרה זה תוצג ותשודר הודעה.

In any case, the required carbs will be displayed in the COB section on your home screen.

הגדרות מתקדמות

You can read more here : OpenAPS docs.

Always use short average delta instead of simple data If you enable this feature, AAPS uses the short average delta/blood glucose from the last 15 minutes, which is usually the average of the last three values. This helps AAPS to be steadier with noisy data sources like xDrip+ and Libre.

Max daily safety multiplier This is an important safety limit. The default setting (which is unlikely to need adjusting) is 3. This means that AAPS will never be allowed to set a temporary basal rate that is more than 3x the highest hourly basal rate programmed in a user’s pump and/or profile. Example: if your highest basal rate is 1.0 U/h and max daily safety multiplier is 3, then AAPS can set a maximum temporary basal rate of 3.0 U/h (= 3 x 1.0 U/h).

Default value: 3 (shouldn’t be changed unless you really need to and know what you are doing)

Current Basal safety multiplier This is another important safety limit. The default setting (which is also unlikely to need adjusting) is 4. This means that AAPS will never be allowed to set a temporary basal rate that is more than 4x the current hourly basal rate programmed in a user’s pump and/or profile.

Default value: 4 (shouldn’t be changed unless you really need to and know what you are doing)

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סיוע ארוחה מתקדם (AMA)

AMA, the short form of ”advanced meal assist“ is an OpenAPS feature from 2017 (oref0). OpenAPS Advanced Meal Assist (AMA) allows the system to high-temp more quickly after a meal bolus if you enter carbs reliably.

You can find more information in the OpenAPS documentation.

ניתן להגדיר יח«\שעה מקסימלי של בזאלי זמני (OpenAPS max-basal)

This safety setting helps AAPS from ever being capable of giving a dangerously high basal rate and limits the temp basal rate to x U/h. מומלץ להגדיר ערך סביר. A good recommendation is to take the highest basal rate in your profile and multiply it by 4 and at least 3. For example, if the highest basal rate in your profile is 1.0 U/h you could multiply that by 4 to get a value of 4 U/h and set the 4 as your safety parameter.

You cannot choose any value: For safety reason, there is a »hard limit«, which depends on the patient age. The »hard limit« for maxIOB is lower in AMA than in SMB. For children, the value is the lowest while for insulin resistant adults, it is the biggest.

The hardcoded parameters in AAPS are:

• ילד\ה: 2

• מתבגר\ת: 5

• מבוגר\ת: 10

• מבוגר\ת עם תנגודת אינסולין גבוהה: 12

• הריון: 25

See also overview of hard-coded limits.

מינון אינסולין פעיל מרבי ממנו OpenAPS לא יחרוג (maxIOB)

This parameter limits the maximum of basal IOB where AAPS still works. If the IOB is higher, it stops giving additional basal insulin until the basal IOB is under the limit.

The default value is 2, but you should rise this parameter slowly to see how much it affects you and which value fits best. It is different for anyone and also depends on the average total daily dose (TDD). For safety reason, there is a limit, which depends on the patient age . The »hard limit« for maxIOB is lower in AMA than in SMB.

• ילד\ה: 3

• מתבגר\ת: 5

• מבוגר\ת: 7

• מבוגר\ת עם תנגודת אינסולין גבוהה: 12

• הריון: 25

See also overview of hard-coded limits.

הפעלת חישוב רגישות אוטומטי (Autosens)

Here, you can choose, if you want to use the sensitivity detection autosens or not.

וויסות ערכי מטרה ע“י Autosens

If you have this option enabled, autosens can adjust targets (next to basal and ISF), too. This lets AAPS work more »aggressive« or not. The actual target might be reached faster with this.

הגדרות מתקדמות

• Normally you do not have to change the settings in this dialogue!

• If you want to change them anyway make sure to read about details in OpenAPS docs and to understand what you are doing.

Always use short average delta instead of simple data If you enable this feature, AAPS uses the short average delta/blood glucose from the last 15 minutes, which is usually the average of the last three values. This helps AAPS to work more steady with noisy data sources like xDrip+ and Libre.

Max daily safety multiplier This is an important safety limit. The default setting (which is unlikely to need adjusting) is 3. This means that AAPS will never be allowed to set a temporary basal rate that is more than 3x the highest hourly basal rate programmed in a user’s pump. Example: if your highest basal rate is 1.0 U/h and max daily safety multiplier is 3, then AAPS can set a maximum temporary basal rate of 3.0 U/h (= 3 x 1.0 U/h).

Default value: 3 (shouldn’t be changed unless you really need to and know what you are doing)

Current Basal safety multiplier This is another important safety limit. The default setting (which is also unlikely to need adjusting) is 4. This means that AAPS will never be allowed to set a temporary basal rate that is more than 4x the current hourly basal rate programmed in a user’s pump.

Default value: 4 (shouldn’t be changed unless you really need to and know what you are doing)

Bolus snooze dia divisor The feature “bolus snooze” works after a meal bolus. AAPS doesn’t set low temporary basal rates after a meal in the period of the DIA divided by the “bolus snooze”-parameter. The default value is 2. That means with a DIA of 5h, the “bolus snooze” would be 5h : 2 = 2.5h long.

Default value: 2

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סקירה כללית של מגבלות קשיחות

	ילד\ה	מתבגר\ת	מבוגר\ת	מבוגר\ת עם תנגודת אינסולין גבוהה	הריון
בולוס מקס«	5	10	17	25	60
משך פעילות אינסולין מינימלי	5	5	5	5	5
משך פעילות אינסולין מקסימלי	9	9	9	9	10
יחס פחמ« מינימלי	2	2	2	2	0.3
יחס פחמ« מקסימלי	100	100	100	100	100
אינסולין פעיל מקסימלי-AMA	3	5	7	12	25
אינסולין פעיל מקסימלי-SMB	7	13	22	30	70
בזאלי מקסימלי	2	5	10	12	25