Loop Installation @ BC Diabetes

Living With Diabetes, Patient Care + Research + Clinical Trials, Technology

Author: Tristan Elliott

Artificial Pancreas Systems (APS, also termed “automated insulin delivery” AID systems) are here and we are not waiting! On 2020-Aug-1 BCDiabetes began supporting in-house installations of DIYAPS with the tubeless Omnipod Eros-Dexcom G6-Riley link-iPhone master branch “Loop” system. Although not Health Canada approved, BCDiabetes considers this version of Loop to be the best DIY APS available. It uses a conservative algorithm that has been installed by our estimates on more than 20,000 individuals worldwide & is more affordable ($20/day) given coverage by BC Pharmacare of both the Omnipod system & Dexcom G6.

For those who are looking for a tubed system or who are not willing to use a non-health Canada approved solution, we strongly recommend the Tandem T-slim with Control IQ. As of today we do not currently recommend the Medtronic 770G system because its algorithm currently only supports temporary basal rate – once Medtronic’s microbolus algorithm is available to users (it is currently being considered by Health
Canada), we will again recommend Medtronic APS. The Ypsopump is expected to come to market with CamAPS in 2023. If you wish to start with either the Medtronic or Tandem systems email us & we will support you by filling in the necessary forms and continue to work with you afterwards. For a CAD$ cost comparison of the various APS options in British Columbia see rows 7-9 of this spreadsheet. It assumes no BC
Pharmacare subsidy & that the up-front cost of the pump is amortized over 5 years.

BCDiabetes has to-date installed “Loop” in its various flavors (Loop, freeAPSX =FAX, AndroidAPS =AAPS) on 220+ clients (including the youngest at 18 months of age, on 20 children under 10 years of age, and in 17 adults older than 70). The majority of clients use advanced algorithms either FAX (iPhone) or AAPS (Android). Loop’s simpler algorithm has a simpler interface is our preferred choice for children under 14 and some adults. For reasons some prefer Loop over FAX click here; to hear the argument “Why should iPhone users choose
the Loop app at all?” click here. The average Time in Range (TIR) immediately pre-Loop was 64% – three weeks later it was 83%. The average A1c immediately pre-Loop was 7.2 – three months later it was 6.5. Quality of Life measures (Diabetes Distress, Fear of Hypoglycemia and Insomnia index) were favorable pre Loop and 3 months later even more favorable. We have seen only one episode of severe hypoglycemia on
Loop in almost 200 patient years of Looping experience and no DKAs. For the slidedeck of BCDiabetes’ Looping experience presented at UBC Endocrinology’s Research Fest 2022-Sep-9 click here & for a 20 minute Zoom presentation of the same slidedeck click here.

Read a BCDiabetes client’s experience of the first two weeks of using Loop with Autobolus. These clients (& the parents of kids on Loop) are all sleeping through the night and experiencing life without the rigors of diabetes for the first time in years. All they need to do is change their pod every 3 days, their CGM every 10 days, charge their smartphone as usual and their Orangelink (if required) every couple of weeks.

For users with good tech skills who are looking to Loop with advanced algorithms, BCDiabetes default installation is with freeAPSX Nex Gen (“FAX” for iPhone users, Omnipod Dash pod compatible, no Orangelink required) & androidAPS (AAPS for Android users). Otherwise the Loop app is used (Loop-dev v 2.9 with the option to use Omnipod Dash pods without Orangelink or Omnipod Eros pod with Orangelink).

In case you want to configure & install Loop yourself, here is a one-pager with all the requirements. See also this instructive powerpoint from our 2020-May-20 webinar, this 55 minute 2020-May YouTube recording of The Weekly webinar focussed on closed-loop pump systems in general, and a 55 minute lecture on the fascinating history of Looping given by Ben Mammon.

Because Loop & androidAPS are not Health Canada approved we require a signed consent & waiver before we will consider installing it for you. BCDiabetes adult clients must complete this online written consent & waiver for adults.  Guardians of a minor BCDiabetes client must complete this online written consent & waiver for minors  Applications for the installation of Loop or androidAPS for minors also require the written (email is sufficient) consent of the treating pediatric endocrinologist or pediatrician (send to moa@bcdiabetes.ca).

At the time of your appointment (in-person preferred) you need to have with you the following:

iPhone (6S or newer for Loop) or android phone (running 9+) with an active data plan

Omnipod “Eros” pump (with spare pod)

Dexcom G6 up and running

“Riley link” either an Orangelink (an upgraded Riley link from the US, US$150) or an Emalink (European, 3 sizes, US$180)

Looping Safety/Emergency kit in case of failure of one of the system components.

We will share a link to either the Loop app with Autobolus option (from BCDiabetes’ account on TestFlight, Apple’s beta-test app store) or androidAPS and help you with all the configuration, at no charge.  If you are not a BCDiabetes client you first need to register online, get a referral from any Canadian Physician (click here for quick referral form), and be seen for a regular appointment either in-person or virtually.  Once we have the referral you will be seen within 2 weeks.  The cost of the appointment and follow up will be covered in full by your Canadian provincial medical plan with the exception of Quebec. For Quebec residents the fee is $1200 (initial appointment plus up to two weeks of daily follow-up).

When you are ready to try Loop or androidAPS email us requesting an appointment for the set-up. The appointment itself can be either in person or can be done remotely/virtually (on Zoom).    

We will have you up and Looping in 90 minutes and follow you along until you don’t need us any more. Most Loopers are completely independent within two weeks.  We will also provide you with an instant no-cost Nightscout account as long as you remain a BCDiabetes client.  Nightscout makes for easy sharing of data with your loved ones and your diabetes-care team.  Nightscout is not available yet in app stores though you could build it painstakingly yourself in 4-6 hours.

If you are not trained on the Omnipod Eros pump and are a BC resident we will fill out and fax a Special Authority application for BC Pharmacare & a Medical Necessity form to Insulet (the manufacturer).  A starter kit with two pods will be delivered to your home within a week: once you have completed basic online training (two sessions 3 days apart) and been certified, you are ready to Loop.

For the Omnipod pump email Andrew Muirhead phone +1–604-754-6195

For the Dexcom G6 order online or email Anthony Petrovich phone +1-604-363-8776.

For the Emalink order online.

For the Orangelink order online.

For the Medtronic 770G pump email Brenda Heaney phone +1-604-312-7101.

For the Tandem Control IQ email Teri Currie phone +1-778-995-1268

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