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Merge pull request #49 from marionbarker/working-tips
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update Tidepool section, fix minor issues
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marionbarker authored Nov 4, 2024
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38 changes: 26 additions & 12 deletions docs/data/health.md
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Expand Up @@ -12,26 +12,40 @@ There's often confusion over the terminology surrounding Apple's health data sto
* **Health App** -- Apple allows iOS users to manage HealthKit permissions and view stored HealthKit data through the use of Apple's Health app (standard on iPhones and iPods, but not available on iPads).

## Loop's use of HealthKit
When you first install Loop onto your iPhone, you will be asked to setup Loop's access to the HealthKit database. Loop uses the iPhone's HealthKit to read and write blood glucose, insulin, and carbohydrate data depending on how you initially setup this section.

At a minimum, you will need these HealthKit settings:
!!! info "Loop and HealthKit"
Older versions of Loop, before version 3.0 was released, required the use of *Apple* Health for data storage older than 3 hours. This is no longer true.

*Loop*
Loop version 3.x uses internal core storage of 7 days of data independent of *Apple* Health.

* insulin data: read and write
* carbohydrate data: read and write
* blood glucose data: read and write
When you first install Loop onto your iPhone, you will be asked to setup Loop's access to the HealthKit database. It is recommended that you enable iPhone's HealthKit for these interfaces

*Dexcom* App
*Loop* App

* blood glucose data: write (if you have this disabled, *Loop* will still function but will not display blood glucose values older than 3 hours old)
* write to:
* Blood Glucose, Carbohydrate and Insulin Delivery
* read from:
* Blood Glucose, Insulin Delivery and Sleep

You can always check your HealthKit settings by opening the Health App, clicking on *Sources* at the bottom bar, and then clicking on the app's name you are interested in, for example, Loop.
*CGM* App

![Health App](img/healthapp.jpg){width="350"}
{align="center"}
There are a number of *CGM* apps. If the option is available, configure them with these permissions:

* write to:
* Blood Glucose

Depending on the app, there may be other items you want to have the app read from *Apple* Health. That depends on the CGM.

!!! warning "*Dexcom* CGM"
If you use one of the *Dexcom* Apps, enable it to write Blood Glucose to Apple Health.

If that is not enabled, *Loop* will still function but it will not display blood glucose values older than 3 hours old.

You can always check your HealthKit settings by opening the Health App, clicking on *Sharing* at the bottom bar, scroll down and tap on the row labeled **Apps** and then clicking on the app's name you are interested in, for example, Loop.

Potential conflicts can arise when third-party apps are granted access to HealthKit permissions that may interfere with Loop's specified data permissions.

Potential conflicts can arise when third-party apps are granted access to HealthKit permissions that may interfere with Loop's specified data permissions. For example, carbohydrate data is stored in *Nightscout* and Spike for some users...you wouldn't want to enable *Spike* app to write duplicate carbohydrate entries that Loop would be reading. Therefore, you should disable other apps from writing carbohydrate data to HealthKit so that Loop does not read those other entries unintentionally. Also, good practice, because carbohydrate entries in HealthKit that were created by non-Loop apps will not be able to customize carbohydrate absorption times nor be edited later if needed.
With Loop 3, it is no longer the default that the *Loop* app reads carbohydrate from Apple Health. This prevents a problem that used to happen where third-party food apps were used to record meals. You can customize your *Loop* app to change this setting, but be aware that carbohydrate entries in HealthKit that were created by non-Loop apps will not be able to customize carbohydrate absorption times nor be edited later if needed. Refer to [LoopDocs: Carbohydrates and Apple HealthKit](https://loopkit.github.io/loopdocs/faqs/apple-health-faqs/#carbohydrates-and-apple-healthkit){: target="_blank"}.

## Your use of Health App

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8 changes: 5 additions & 3 deletions docs/data/nightscout.md
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# Nightscout {: translate="no" }

[Nightscout](https://nightscout.github.io/){: target="_blank" } (NS) is a cornerstone of the DIY type 1 community. It is an excellent tool to remotely view Loop's actions and access insulin and blood glucose data. It allows for easy remote monitoring of *Loop* activities, troubleshooting of *Loop* errors, history of CGM, carbs, boluses, & temporary basal rates, and reports to analyze data trends and patterns. There is a *Nightscout* app in your iPhone App Store, or you can use a web browser to view the data. [Setting up Nightscout for Loop](https://loopkit.github.io/loopdocs/nightscout/new_user/){: target="_blank" } is free and fairly quick. Once set up, the site can be accessed by anyone that you share your unique *Nightscout* URL with.
[Nightscout](https://nightscout.github.io/){: target="_blank" } (NS) is a cornerstone of the DIY type 1 community. It is an excellent tool to remotely view Loop's actions and access insulin and blood glucose data. It allows for easy remote monitoring of *Loop* activities, troubleshooting of *Loop* errors, history of CGM, carbs, boluses, & temporary basal rates, and reports to analyze data trends and patterns. There is a *Nightscout* app in your iPhone App Store, or you can use a web browser to view the data. [Setting up Nightscout for Loop](https://loopkit.github.io/loopdocs/nightscout/new_user/){: target="_blank" } is low cost and fairly quick. Once set up, the site can be accessed by anyone that you share your unique *Nightscout* URL with.

## Nightscout Display
*Nightscout* is highly recommended for *Loop* users, especially those using *Loop* as caregivers. *Nightscout* displays are often the easiest way to troubleshoot *Loop* settings if you are having problems and seeking input from others. Below is some discussion about the general *Nightscout* display, as well as some <span translate="no">Loop</span>-specific display information.
Expand All @@ -22,11 +22,13 @@ Insulin boluses are also automatically uploaded to NS by the *Loop* app. The bol

### Temporary Basal Rates

Within your NS profile, you will enter in the scheduled basal rates from your *Loop* settings. This is not automatically updated when you update the *Loop* app; you will have to manually update your basal profile in your NS site if you change your basal profile in *Loop*. If you don't update the NS basal profile, it doesn't cause any problems in *Loop* function...you simply won't have an accurate VISUAL representation of high/low temporary basal rates within NS. The dashed blue line represents the scheduled basal profile (as entered in your NS profile). The solid blue lines indicate the actual basal amounts set for a given time...so as *Loop* sets temporary basal rates higher or lower than your scheduled basal rate, the solid blue line will jump above or below your dashed blue line. There is a slight delay (up to 2-5 minutes) in the rendering of basal changes on the blue lines, so if you want the accurate current basal rate, you should check the *Loop* pill.
Within your [NS profile](https://nightscout.github.io/nightscout/profile_editor/){: target="_blank" } , you can see in the scheduled basal rates from your *Loop* settings. Your *Loop* Therapy Settings profile is stored in your Nightscout site as the Default profile. Nightscout allows the user to have named profiles, but when used with Loop, the current profile is always called "Default" and it is uploaded from the *Loop* app. Fun Fact: your saved Override Presets are uploaded and saved in your Nighscout database and can be downloaded if you later need to start over with a brand-new *Loop* app. Refer to [LoopDocs: Onboarding](https://loopkit.github.io/loopdocs/loop-3/onboarding/#connect-loop-to-nightscout){: target="_blank" }.

The dashed blue line represents the scheduled basal profile (as entered in your NS profile). The solid blue lines indicate the actual basal amounts set for a given time...so as *Loop* sets temporary basal rates higher or lower than your scheduled basal rate, the solid blue line will jump above or below your dashed blue line. There can be a slight delay (up to 2-5 minutes) in the rendering of basal changes on the blue lines, so if you want the accurate current basal rate, you should check the *Loop* pill.

### Predicted Blood Glucose

The purple line to the right of the blood glucose readings is Loop&#39;s predicted blood glucose curve. Watching the behavior of that purple line can help you understand why *Loop* is making decisions regarding high or low temporary basal rates. You can read more on that topic in the [Algorithm](https://loopkit.github.io/loopdocs/operation/algorithm/temp-basal){: target="_blank" } section of *LoopDocs*.
The purple line to the right of the blood glucose readings is Loop&#39;s forecasted blood glucose curve. Watching the behavior of that purple line can help you understand why *Loop* is making decisions regarding high or low temporary basal rates. You can read more on that topic in the [Algorithm](https://loopkit.github.io/loopdocs/operation/algorithm/temp-basal){: target="_blank" } section of *LoopDocs*.


### <span translate="no">L&#8203;oop</span> pill
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15 changes: 5 additions & 10 deletions docs/data/overview.md
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In order to assess your Loop's performance and more specifically your settings, having access to your historical data trends is invaluable. Seeing what your Loop was predicting, what actions were being taken, how blood glucose was reacting, and how insulin needs have been changing is critical when trying to assess any settings changes.

## Problem with traditional methods
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, a pump for insulin delivery, a 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 of them away 20 minutes later.

Then your clinic staff has 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. Because of Loop use, a clinic currently has to look at separate reports from Medtronic pump, Contour Next Link BG meter, Dexcom CGM/Clarity, and our iPhone Health app, as a typical example. There are also a couple of issues with Loop when using this separate download method:
When you go to your endocrinology office, they need to have a method to view all your Automated Insulin Delivery system data in one place.

* Medtronic’s pump gets so clogged up by the numerous temporary basal rate records being recorded that the clinic can only pull about 7 days of data from the pump at most.
* If you use an Omnipod Eros or DASH pump - there is no PDM for your clinic to read insulin dosing records
* If you use a Medtronic pump, the memory is full of the many commands sent from Loop

* Clinic basically lacks an overlay of basal rate/bolus actions with blood glucose from Dexcom, which really limits their ability to recommend any settings changes.
## Available solutions for DIY apps

* DIY solutions could fill some of the gaps as far as overall management, but the problem was with the actual gathering of the reports. It’s a little hard for the clinic to bring up reports live time, and sometimes remembering to print them out ahead of time just doesn't happen.

* Manual notes the various tools are not the most streamlined experience (especially for young kids and teens to manage). This inefficiency can lead to people neglecting to note times of site failure or compression lows, for example. If the health care provider wants additional information about a particular blood glucose event(s), chances are good that there would be no notations to help explain the event without effort. If there was a note, it may be in *Nightscout*, *Dexcom*, or in text messages between caregivers...not really centralized and integrated.

## Available solutions
The good news is that the community has some very useful tools to help address the shortcomings in the traditional data aggregation for Loop users. There are several tools available to help you and/or your endocrinologist evaluate your Loop data. Specifically, this section covers:

* Health app
* *Apple* Health app
* *Nightscout*
* *Tidepool*
* *Perceptus*
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