Tidepool and Loop

If you weren’t aware, I am now working with Tidepool to release Loop as a supported, FDA-regulated mobile app available in the App Store. So, now there’s a DIY Loop to talk about and a Tidepool Loop.  There’s a lot of work to be done to accomplish this project, and a LOT of people pulling for us to do well. If you are interested in staying up on the progress, you can fill out this form to get updates.

With that introduction made, now I am going to talk a little bit MY personal involvement with Tidepool from even before Loop days.

As a person with diabetes, you’re probably carrying around a lot of different devices that are holding a lot of different data; a blood glucose meter for your finger sticks, pump for insulin delivery, continuous glucose monitor for real-time glucose measurements, phone app for tracking meals, etc. When you go to your endocrinology office, you probably start the process by dropping many of those devices at the front desk to be individually downloaded and then having to pack all them away 20 minutes later.

Then your clinic staff have the less-than-efficient process of trying to overlay all those different devices into some sort of cohesive strategy for how your diabetes may need some tweaks. Our clinic currently has to look at separate reports from Medtronic pump, Contour Next Link BG meter, Dexcom CGM/Clarity, and our iPhone Health app. Oh, how I don’t envy them.

Enter Tidepool. Tidepool said “Hey, this is your data and all that data is more useful when viewed together.” So, Tidepool is like your diabetes data hub. Upload all those devices into ONE place so that the meal that you ate, the blood glucose response, pump actions, and the finger checks all overlay into a nice single timeline. Makes figuring out how to adjust your diabetes settings a whole lot easier when you can see this all at once.

Actually, let me borrow my own employer’s words:

Our mission is to make diabetes data more accessible, actionable and meaningful for people with diabetes, their care teams and researchers.

We believe that connected data leads to better decision-making. Tidepool’s free software liberates data from diabetes devices, and places it in context of the real world. Tidepool is designed to help you discover insights and bring context to your diabetes management. And, to help make your data more actionable, we allow you to share your data with anyone you choose: caregivers, clinicians, endocrinologists, friends, researchers – anyone.

We started using Tidepool when Anna was on the Omnipod pump and Dexcom. We would plug in her Omnipod PDM and Dexcom receiver into our desktop computer, use the Tidepool Uploader program and <voila!> Anna’s data be in one lovely place for us to see. Were there drawbacks? Yup, had to remember to actually do it myself. Which eventually ended up being about every week before an endo appt.

While I didn’t have the forethought to capture screenshots of our Tidepool data at the time, it looked much like this for comparison…

And then we started Looping, and life was grand as far as our diabetes lifestyle.

However with Looping, we had to stop using Tidepool. There just wasn’t a way to upload from our old Medtronic pump. Tidepool only had (at the time) uploader support for the following Loop-compatible pumps: Paradigm 523 /723 and Veo 554/ 754. We started Loop using a 722.  We were out of luck. As were all of the people using 522, 722, 515, and 715 pumps.

We ran into a couple issues with Looping when it came to viewing our data using other means, too.

• Medtronic’s pump gets so clogged up by the numerous temp basal records being recorded that the endo clinic can only pull about 7 days of data from the pump.

• Endo clinic basically lacked an overlay of basal/bolus actions with BGs from our Dexcom, which really limited their ability to recommend any settings changes.

• Nightscout reports could fill some of the gap as far as overall management, but the problem was with the actual gathering of the reports. It’s a little hard for the endo clinic to bring up your NS reports live time, and I am terrible about remembering to print them out ahead of time. Plus, the data presentation was just not quite the same as the Tidepool look I had grown accustomed to.

• • I don’t bother to make manual notes in my Nightscout’s careportal about things we are doing…so if the endo asks me “What happened here?” chances are good that I won’t remember a darned thing about it and there will be no note. Trying to find an old meal to help with the next time we bolused/ate it? Forget about it.

• • With all my experimenting with Dexcom gear *cough, cough* I sometimes cluttered up my daughter’s clarity account with my BG data unintentionally. Dexcom’s servers did not always like my constant switching of accounts and transmitters, so sometimes our Clarity reports would print out as a black ink jet blob basically. Oops.

Well, I’m here with wonderful news!

Tidepool is bringing in Loop data!  

How does it work?

The Tidepool Mobile iOS app is getting an update (soon to be in beta release) to sync a Looper’s diabetes-related Health data into their Tidepool account. The app will continuously upload that data so long as the Tidepool Mobile app is open, even if it is only open in the background. That data will then be viewable in two places: on the Tidepool Mobile app itself or on your Tidepool account using desktop Chrome browser (although they are not identical viewing platforms, see discussion below). This means a Loop user will not have to plug any of their devices into a USB cable in order to upload their information to Tidepool.

Is this a replacement for Nightscout?

Nope. This was not designed nor intended to be a replacement for your Nightscout site. I think they complement each other, rather than compete. This new upload of Loop data will allow me and my clinic to have a powerful tool to analyze Anna’s Loop data through an easy-to-use, shared hub.

What data will you see in desktop Chrome view?

You will see your temp basals, Dexcom CGM readings, boluses, notes, and various metrics about your data distribution. If you separately load your BG meter or any other supported device to Tidepool, those will also overlay. See discussion below about what’s missing (hint…carbs aren’t showing yet).

How can I share this data?

Sharing the data is simple. You can click on your account’s Share option and enter in the email addresses for those that you want to share with. Those people will need a Tidepool account. If they don’t have one currently, they will follow easy prompts for an account setup after they’ve received your share invitation. Clinics using Tidepool will have a Tidepool account email that you can add to your account, enabling the clinic to easily view your data. You can also remove access for anyone with a simple click.

Are there any known issues?

Sure, of course…you may have missed the word BETA in all the excitement. There are some bugs currently being worked out. For example, the carbs associated with the Loop uploads are being uploaded by Tidepool Mobile, but they aren’t currently rendered in your desktop view or the Tidepool Mobile view. If you look at the Daily view screenshot a little above…notice that the little yellow carb circles are missing? We will be getting that bug addressed. Soon, hopefully, your chart will include little carb circles like below (rendered with my crude skills for demonstration only).

There are some calculated data areas that need updating, too. If you see a NaN (“not a number”), it is a placeholder for where a number will eventually go. We know and we don’t like seeing those either. We are keeping a list of the things that need addressing.

What will I see in the Tidepool Mobile app?

The Tidepool Mobile app is not a live-viewing app of looping data. For people coming from Nightscout, this may be a bit confusing but realize the intended purpose of the Tidepool Mobile app isn’t live-viewing. It is the place that you can (1) upload/sync Health data, (2) easily add/edit/delete notes to the data set, and (3) search for notes and view Loop data surrounding that note.

In fact, you will basically see NO data in the Tidepool Mobile app unless you have Tidepool data uploaded and notes are added. Once you add a note, you are basically placing a bookmark on the data set. You will be able to click on the note and see 7 hours of old data before the note, and then the note will continue to collect 7 hours of data to display after the note. So, technically, you’ll be able to refresh the app’s view to see current data for approximately 7 hours after a note is placed.

For example, here’s Anna’s data tonight as I was typing this blog post. Over the last couple hours, Anna noticed that she was staying above target (unusual for us on Loop and with the meal she had) for quite a while. She had given a couple small corrections without result. Which then she started her secondary troubleshooting…if it’s not the food, maybe it’s my site? Ah yes, she realized it has been 4.5 days since changing her site. So, she just logged a note using the app. That note showed on my phone, shows up on her Tidepool data for her endo to see too, and we can refresh the view to see how the BGs go for the next 8 hours after the site change if we want.

 

What cool thing does Katie use this Tidepool Mobile app for?

I think the best thing about this Tidepool Mobile app (other than importing all Anna’s valuable Loop data automatically) is that I can keep a really easy searchable log of meal boluses. If you are still learning new meals in Loop…how much to bolus, how long of a carb absorption…these notes are searchable and super easy to add. Learning how to bolus for that Tofu Breakfast Burrito? (Don’t ask, that’s really a thing Anna is eating now.) Simply record a note of how you bolused for it. If you want to, come back afterwards and leave yourself some suggestions for the next time to try. This searchable information can also help for those teens that are learning and exercising independent skills. If they aren’t sure of how to bolus for a meal, this could give them an easy way to get tips from past success without necessarily having to stop and ask a parent. As much as a parent might scoff at the idea of a kid looking up a meal, if the alternative is asking a parent…that might be all the motivation it takes. Anna learned this little trick pretty quickly. Or how about co-parenting? Want to leave a note that another parent or caregiver can look up? How were the last Chicken McNuggets bolused for or when was the last site change can easily be tracked and retrieved with notes.

Search for the word burrito (doesn’t have to be a hashtag) and any notes with the word “burrito” will be available for review, as well as any added comments.

 

Another useful thing to track…hormones. What day-of-the-month and how did I change the basals? Looking to find patterns in those female hormones? This could be a really slick tracking tool to easily log periods of insulin resistance and what part of the cycle they are occurring at.

Is this app only for Loop users?

The updated Tidepool Mobile app will upload diabetes-related Health app data regardless of the source. Loop users store their data in Health app, so this is a nice fit. Other diabetes devices (e.g., OneDrop BG meter) and apps (e.g., Spike and Dexcom) also store their data in Health app. Some people even manually enter their diabetes data into Health app. For all those uses, the Tidepool Mobile app will upload the Health data. OpenAPS does not store its data in Health app, so this will not upload OpenAPS-related data.

How can I get this?

Frankly, probably a lot of Loop users may not be familiar with Tidepool at all…so this post was part introduction and part announcement. Tidepool’s goal is to get a limited number of beta testers to help us identify bugs or problems.  We’d like to cover a variety of  Health-app users such as Loop, Dexcom, InPen, OneDrop, SpikeApp, SugarSense, OneTouch Reveal, and Accu-Check Connect. We’d like people who are willing to report bugs and won’t curse my name if you find one.

In summary, if you are interested in being a Tidepool Mobile iOS Beta participant, click here to fill out the recruitment form.  Thanks!