nightscout / cgm in the cloud presentation at the june 2014 diabetesmine d-data exchange

NightscoutAdrien Ben Bryan Dan Don Jason Jason John Lane Peter Rajat Ross Scott, Toby

and many many more

what

Nightscout

cloud

Watch Web browser “app”

CGM Remote monitoring for people wearing CGM:

CGM + USB Cable + Android + Database + Cloud Server + App running on Glanceable Display = Safety and Peace of Mind

whathow

John Costik: type 1 dad / tweeter / hacker / system engineer / awesome guy

How1. Social software development– Community support– Blogs, emails, tweets, stackoverflow, Github– Open means OPEN

2. #Wearenotwaiting

1. Basic functionality: 20 lines of node.js “Frankencode”

2. Added trend arrow, sensor time, current time

3. Added direction and sparkline (primitive trend)

4. Added primitive graph with d3.js Frankencode

5. Changed graph to hypo-maximizing scale, added auto-dimming

6. Added prediction half an hour into the future

7. Added prediction if signal is temporarily lost, added audible alarms based on future predicted

danger, added multiuser alarm acknowledgement, added alarm snooze / shelving, made minor changes

to screen layout

8. Added buttons, added remote access (port forwarding on home router), cleaned up graph

9. If one watcher acknowledges alarm then BG turns purple and alarms are suppressed for xx min

10. Added “other watcher(s)” for shared situational awareness / coordination

11. It only gets colorful / noisy if action is required

12. Added retrospective review (panning)

13. Added meal / bolus display

14. Added retrospective prediction

http://nightscout.github.io/

whathow

why

Thanks Nightscout, low treated before dexter alarmed

Nights

Love having this by my bed. So much easier having it always available to see especially at night.

Nights

Nights

“After multiple nights of persistent growth hormone highs, we have finally dosed aggressively enough to break the high before morning. Having the cloud just made stacking the necessary insulin in the middle of the night much easier to monitor.

Puberty with Type 1 is going to be quite the challenge. I think this technology is going to make a big difference for us.”

Glanceable

Glanceable

“The new "must see TV" in our house!”

Glanceable

Glanceable

“Went to the gym, Starbucks, Costco and watched an NBA game in my den all while making sure things were going great in the blood sugar world. No More Screaming "NUMBER!!!" from upstairs (or...TMI...The bathroom...lol).”

Glanceable

“What is this you ask?? Oh it's a pebble watch, and a constant reading of my DAUGHTER'S BLOOD SUGAR!!!

At the moment Tay's around 107. She is out shopping with Ki.

This is the best Mother's day present!!!”

Date night is even better because of the CGM in the Cloud...

Glanceable

“This morning my dad wanted to take Jojo to his workshop to build a dog bed for his DAD, Dexter.

Now, grandpa isn't the most well informed on the t1 front, he is afraid to do something wrong so this is his first outing with J in a year and a half.

Thanks to cgm in the cloud I am able to let my dad know how to handle things, when I see he is still dropping, one more quick action to make it right again. Yay!!”

With inexperienced people

“Evan's at piano a few miles away. My watch buzzes and this is what I see on my phone.

We were able to text his piano teacher to have him drink some juice.

Such great technology!”

With inexperienced people

At the grocery store with my hubby and am able to see that our daughter is trending down (she was at home in bed with my mom).

Was able to get home and catch low blood sugar before it got out of hand!!!

Thank you to everyone who has worked so hard to get this set up and help us not so tech Savy parents through this setup. We are so glad God made you!!!

you are such a blessing to all of us tired and and weary parents!!!

With inexperienced people

Dropped Adam off at Drama Camp at CGM 90 but now is the time to text him to have a half tab as he is in a slow drop...

He is very comfortable and functional between 60-80, so with the cloud I will be able to micromanage from a distance to my comfort level.

With inexperienced people

With inexperienced people

“At church this morning and Jojo is off in his class, but mama still can keep an eye on him now! The teachers were almost as happy as I was”

Being active

My intervention from a distance was without a doubt lifesaving for us.

This single instance is noteworthy but after 3 weeks, we have multiple situations that have occurred where the presence of this technology has improved not only the timing of our management strategies but also our peace of mind and most importantly the quality of our relationship interactions with our son.”

“I picture him mid lap when the unfamiliar extreme hypo symptoms hit him and with 70 - 100 kids in the pool, what would have been the lag time for the pool staff realization that he was in trouble?

Being active“It's 100 degrees outside. Luke is out with his brothers and all the neighborhood kids in the front yard playing on the slip'n slide.

Activity like that usually causes him to drop so I normally have to stay out there and watch him. Not anymore Luke's kit is on the porch near him and I am in the air conditioned house watching Lord of the Rings with my husband and I know Luke's fine.

Love love love this and how it brings some normalcy back to our lives and I don't have to hover over Luke as he plays so he can just be a kid.”

Being active

“Running a 6 mile loop around the lake with my dogs. Stella is the blur on the bike ahead if me.

We used to stop every 15 minutes to test. Not anymore”

School“I'm going to say it again, I am so grateful. Luke is at preschool I'm 23 miles away at work. I see him start to drop quickly so I text the preschool assistant director and you can see what happens and how 1/2 juice box landed him at a perfect 113.

He never had to stop playing and he never went low and I'm a happy mom right about now! If they had waited till snack he would have been low for sure.

So glad I don't have to just sit around anymore and just hope he will be ok when I am away from him!!”

“This is making living with T1D better.

Today my 5 year old won't come home from preschool crazy high because I am able to work with the preschool staff and prevent that.

Our preschool is amazing- they have gone over and beyond caring for Luke - but they still get worried sometimes which is completely understandable. They love the cloud too because they know I am helping watch over him! Less stress on everyone! It's been a month now with this technology and I can't imagine going back to not having this. Thank goodness for #wearenotwaiting”

School

School“Witness a diabetes paradigm shift here. This BG data sharing technology allows a parent to be instantly aware of blood sugar trends in the child (or any other person willing to share these data) from any distance. In this case, it allowed prompt intervention by the parent directly to the school medical staff to avert an impending low.

Note that this is NOT a commercially sold device but one of several prototypes discussed on a sister FB page.

This kind of "instant surveillance at a distance" will alter the dynamic of how schools interact with parents regarding the health of their children. It could be a spirometer or other health monitoring system that sends instant reports too. No real limits.

Of course the quality of the data being collected is another variable. You are simply seeing data being moved around. What's done with it and how it is critically reviewed is even more critical.

These technologies will require changes to the way schools are prepared for frequent calls (at times) from parents and ultimately will redefine the role of the doctor’s office as well. Get ready for a very interesting ride!”

Value1. Not just for Nights– Teachable moments– Shared learning / troubleshooting– More flexibility– Before / during / after school

2. Discoveries– New alarm techniques– Humane alarms– Shared situational awareness challenges– Blurs line between real time and retrospective use

cases– Huge unmet need

Thank you

I went to my son's pediatric endo office this morning. Two doctors were in the office, and I went up to them and said "Check out my new watch". They said "That's nice". And I said "No, that's my son's blood sugar." ... Silence ... then bug eyes ... then "THAT. IS. SO. COOL." They took pictures and I left them my drawing of the high level setup, with the facebook page information. Other parents were asking about it too, and I sat there for at least twenty minutes talking about it and answering questions. This project is so infectious and incredible. I had to share.