During a week that I’ve spent more time interacting with the healthcare system than I’d perhaps like, it’s been interesting sharing OpenAPS with both the Diabetes healthcare world and those in the surgical area.
Let’s start with the Diabetes area. It was my annual pump clinic appointment and as per usual, I turned up, did the pre-appointment blood checks and weigh-in then sat and waited to be called in.
On this occasion I was called in to see a specialist registrar so we sat down and I explained what I do to manage my diabetes.
When I mentioned OpenAPS, it transpired she’d been at the training session given to the staff and students at Guys, and therefore was aware of it. I then walked her through my Nightscout page and explained about oref1 and it’s benefits, especially when combined with Fiasp (which, incidentally has now stabilised for me).
We took a look at my Hba1C, which was great (5.5%!) and of course the other big benefit is time in range.
The upshot was a good session where I felt comfortable explaining to the person I spoke with the new features of OpenAPS. It was a very reassuring appointment, and the letter to my GP acknowledged my use of the tools. It was pleasing that the team at Guys and St Thomas’s are very aware of what “We are not waiting” is doing.
It was a pleasure to speak to a diabetes team that were both aware of the OpenAPS platform, and supportive of its use, understanding that there are these types of project that can really make a difference to life with T1D.
My second visit was in rather less fortuitous circumstances, having been woken by severe abdominal pain overnight on Thursday night. The GP visit resulted in a referral to A&E to rule out appendicitis.
On arrival at A&E (I’d elected to use the same hospital that looks after my diabetes care, for probably obvious reasons), we went through the usual arrival checks and I was asked for a recent “BM”. Now for those outside UK healthcare, thanks to proliferation of Boehringer Mannheim testing gear in the 80s and 90s, the NHS tends to refer to fingerpricks as BM tests or simple “BM”s. I responded by showing the A&E nurse my current glucose on my Smartwatch, and his jaw dropped.
I then went on to explain the technology I was using and the benefits it provided, and both the nurses manning the A&E reception were all ears. They thought it sounded brilliant and suggested that I speak to someone at one of the London clinical centres about running a trial for it properly. It was great to see such interest in the technology outside the normal diabetes circles and the realisation of what it could do to help.
Once I was admitted, I was once again seen by a doctor, to whom I explained my set-up. Whilst they may have been less interested in it, they were impressed with the results and the achieved time in range. It came up again a few times over the duration that I was in the assessment ward, and the staff were generally very interested. They seemed to understand the benefits of having it there keeping things running whilst there are other things going on, allowing them and me to focus on the reason I was there and not have to take the T1D into as much consideration as they normally would.
Now had I been admitted for surgery, there would then have been an interesting conversation regarding what would happen whilst I was under general anaesthetic. I would have requested that they left everything running using oref1 and a temp target of around 7mmol/l, as I suspect that oref1 would do a better job than someone trying to apply a sliding scale or other approach, but it certainly would have raised interesting ethical questions, including those about the T1D when in hospital being in charge of their own treatment. Fortunately, this wasn’t required…
So what have I taken away from this? The staff in various departments at Guys and St Thomas’s hospital trust in the NHS appeared very open to the use of technologies such as this. They found it fascinating and interesting, seemed to understand the benefits it could bring and also used it as an indicator of the type of person with whom they were interacting. All in all it was a very positive experience for me, and I hope also for the people I ended up explaining to what it was doing and how it worked. Let’s hope more of those in the NHS look upon this type of thing so favourably!