My 13 year old is a type 1 diabetic. He has used an iPhone SE / mini since he was 7. He plays ice hockey and has a pouch in his hockey pants for his phone. It’s never had an issue through all the bumps that ice hockey brings.
We also use an iPhone SE for our T1 teenager. One drowned in the ocean a few years back, but other than that they've been pretty robust and reliable for us. We do Otter Box them with a screen protector.
Hopefully Apple keeps up releasing the smaller phone range. I would like to get an iPhone for my son, still a bit too big for him. Maybe when he is 7 :)
Not the OP of this thread, but for our setup the phone is just for the CGM. The pump (Tandem T-Slim) talks directly to the CGM (Dexcom G7) and doesn't need the phone as an interface between them.
The phone just sends the CGM data on to the cloud so we can see his numbers any time.
I also have a NightScout setup that's downloading his CGM data and saving it for us. It's not strictly necessary for anything we're doing, but I like the saved data and it's was useful for working with his Endo when they hadn't yet bought a Dexcom clinic license.
OmniPod pumps have both iOS and Android apps, as well as a prepackaged Android based device (without a cellular modem.)
This is an area in which technology is hugely helpful, however the development cycle is incredibly slow. Like glacial. It’s unclear how much that’s helping…
That said, I’m super happy to have the options we have at this point.
Why does it need to be a smartphone and why isn’t there a dedicated device for this?
Given the obvious costs and issues associated with a full-featured phone, it seems like this could be something like an old school pager (which could be smaller and much more durable).
They're using it to receive data from the continuous glucose monitor and to run Android APS, which is an open source closed loop 'artificial pancreas' system. Some pumps (like the Tandem T:slim X2) will receive data directly from the CGM, so you technically don't need a phone in that case - but a phone is still useful as it can constantly share blood glucose data with other people (in this case, probably the parents).
Seems like they ought to use a lower-level system. I hate to see the day when someone's smartphone-based pacemaker or whatever crashes or gets hacked and kills the person attached.
You could have a low power system like ESP32 or STM32 act as the artificial pancreas and transmit data to a smartphone over BT
The only blocker for a lot of these things to exist is just someone to make it. There is no money in it, the software is life and death sometimes, the total amount of users you can reach is world wide is probably like 2-3 million. The only stopper is just someone making it.
Regulation in the US makes single purpose devices basically impossible to justify from a cost perspective. Also, as the user, a commodity off the shelf device, which can do more than one thing (e.g. CGM and Pump from different manufacturers) is fantastic. +1 million better.
The Venn diagram of what the device needs vs what a cell phone has is so close, and the scale cell phones are made brings down their price so much, that a dedicated device would be more expensive, worse and more difficult to get.
I get that, which is why I suggested something pager-like as a concision, but that doesn’t really answer my question. Many devices can have connectivity while not being a phone. I’ve built a half dozen types of (non-human body) sensors for remote use with various radios, including LTE, and I can access them from anywhere.
Some insulin pumps now connect to continuous glucose monitors (CGMs) to create a full-loop system. This means some t1ds can stop using their phone for the first time in over ten years. It is very liberating.
The phone is needed for caregivers to get the numbers. The CGM direct to Pump connection is all closed down as well, so features like remote Bolus don't exist in those systems.
Any iPhone in an Otterbox case. Don’t do fanny pack. Do cross body bag with the bag on chest.
This is not something you want to go cheap on. iPhones are flat out better hardware than everything shown. I went down the Android route for Omnipod/G6. Was horrible UX and unreliable. (For a while, the OmniPod app would only work on <10 Android phone models. Ugh).
The requirement he missed is Dexcom Remote. That’s not a “cheap” phone thing.
We’re on year two of an iPhone Mini in an Otterbox case. The Android phone didn’t make it 9 months.
I wish iPhone made smaller phones. At the moment we are also in AAPS for features like remote Bolus, which means only Android, which at least has some options. The Dexcom limitations are worked out using BYOD or similar work arounds.
Yeah, by far the best devices. From the original story it sounds like the OP wants them as cheap as possible, which I think contradicts - but on second reading it seems like physical size is the biggest concern.
Ack --> I misread your article and thought your child was 14 years old, not 4. I don't believe kids that young qualify for any of the auto-adjusting toolkits. The medtronic has a minimum age of 14 (I think). In any case, the best advice I can give is to get your child on something like medtronic's pump + cgm + smartguard as soon as you can. Ideally the minimum age limits will drop and the quality of the treatment will keep improving.
I left the no-longer-relevant-to-you comment below in case it would be interesting to others.
This is a different suggestion than you were talking about in your article, but:
If possible, I would highly suggest trying out the medtronic minimed 780g with guardian 4 or simplera using the "smartguard" feature. This is the first out of the box solution I've ever tried that almost (but not quite) felt like magic in terms of achieving good control that was mostly automated.
This setup provides 3 things not yet available in the dexcom associated systems:
1) auto adjusts your basal rate (via a weighted average or 6ish days)
2) aggressively adjusts basal rate to avoid lows
3) aggressively micro boluses to help prevent highs.
I have recently switched from a tandem x2 with dexcom g6 and g7 and used with xdrip+ android phone app (similar or same as the nightscout you mention, depending on where you get it.)
The dexcom cgm with the tandem auto correct would typically take (for me) 6 hours to correct a high from something like too low meal bolus. The medtronic usually takes less than 2 hours and doesn't peak nearly as high.
More importantly, the hypoglycemia prevention is a complete game changer. I have not had a severe low blood sugar since switching -- and this means avoiding the hypoglycemia followed by 24-48 hours of higher insulin resistance.
The out of the box systems are getting really good, and are advancing at a quick pace now (which until recently hasn't been the case). The quality of control I have now is much better than with xdrip+ and the auto controls available in the tandem x2.
I used to eyeball my android phone many times during the day to follow trends and try and catch highs or lows early. Now, I don't need to adjust basal rates. If I miss calculate the carb counting for a meal, the auto correct takes care of it. Now I only need to pay attention to longer trends relating to meals boluses and relying more on a1c values to double check that the control is really ok.
We looked at the Medtronic 780g system, there are a bunch of problems for a four year old. Most obvious is the tube, it gets in the way, the omnipod is waterproof and just works. The next is inserting the guardian sensors used to be horrific (as I understand it they have an applicator now) but my son barely feels the dexcom G7 insertion.
AAPS is good, it could be better, but it has a complete set of features we need. Just need a phone
In the US and EU, children that young are authorized to use CGM and Omnipod. It’s functionally equivalent to the tube based systems, expect that it only lasts 3 days. Ugh.
But the total automation of basal based on realtime CGM is a lifesaver.
with Medtronic, I am always concerned about the tube as you've to carry it around and with kids, it becomes difficult, so we're opting for Omni Pod. I hope they make it tubeless some how and CGM + Pump in 1 system . With Med, you still have to manage the dose prior - no ?
