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Apply Undercliffe's master revisions to dev (adapted)
Net effect of master commits 2ec96ce, 4d8be39 (Introduction),
370604d (ProfileTuning), 322e925 (WhereCanIGetHelp), applied
manually because dev's copy-edited versions conflicted with a direct
cherry-pick. Kept dev-side wording where it was already better
(OS-AID terms, Bluetooth casing, 'someone you are caring for') and
fixed typos introduced upstream (perosnalised, influenicng, unannouced,
fruit jucie, 'there now have').
Highlights: benefits list moved into the Advantages section (bottom
duplicate removed), outdated run-AAPS-from-smartwatch claim removed,
new profile-testing caveats (no failed pump/CGM, no unannounced carbs).
Co-Authored-By: Claude Fable 5 <noreply@anthropic.com>
Copy file name to clipboardExpand all lines: docs/EN/Getting-Started/Introduction.md
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@@ -19,14 +19,14 @@ In the near future, some so-called "dual-hormone" systems will also have the abi
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An artificial pancreas can be thought of as an [“autopilot for your diabetes”](https://www.artificialpancreasbook.com/). What does that mean?
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In an aircraft, an autopilot does not do the complete job of the human pilot, the pilot cannot sleep through the entire flight. The autopilot aids the work of the pilot. It relieves them of the burden of permanently monitoring the aircraft, allowing the pilot to concentrate on wider monitoring from time to time. The autopilot receives signals from various sensors, a computer evaluates them together with the pilot’s specifications and then makes the necessary adjustments, alerting the pilot to any concerns. The pilot no longer has to worry about constantly making decisions.
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In an aircraft, an autopilot does not do the complete job of the human pilot, the pilot cannot sleep through the entire flight. The autopilot aids the work of the pilot. It relieves them of the burden of permanently managing the aircraft, allowing the pilot to concentrate on wider monitoring. The autopilot receives signals from various sensors, a computer evaluates the data together with the pilot’s specifications and then makes the necessary adjustments, alerting the pilot to any concerns. The pilot no longer has to worry about constantly making decisions and this analogy can be applied to **AAPS**.
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(Introduction-what-does-hybrid-closed-loop-mean)=
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## What does hybrid closed loop mean?
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The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While we are waiting for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that doesn’t need any user input (like bolusing insulin for meals, or announcing exercise), with good regulation of blood glucose levels. At the moment, there are no widely available systems which are “full” closed loop, they all need some user input. The currently available systems are called “hybrid” closed loop, because they use a combination of automated technology and user input.
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The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While the type 1 diabetic (T1D) community waits for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that doesn’t need any user input (like bolusing insulin for meals, or announcing exercise), with good regulation of blood glucose levels. At the moment, there are no widely available systems which are “full” closed loop, they all need some user input. The currently available systems are called “hybrid” closed loop, because they use a combination of automated technology and user input.
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## How and why did looping start?
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**Figure 1**. Basic outline of the Android APS (Artificial Pancreas System), AAPS.
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Android APS (**AAPS**) is a hybrid closed loop system, or Artificial Pancreas System (APS). It makes its insulin dosing calculations using established [OpenAPS](https://openaps.org/) algorithms (a set of rules) developed by the #WeAreNotWaiting type 1 diabetes community.
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Android APS (**AAPS**) is a hybrid closed loop system, or Artificial Pancreas System (APS). It makes its insulin dosing calculations using established [OpenAPS](https://openaps.org/) algorithms (a set of rules) developed by the #WeAreNotWaiting T1D community.
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Since OpenAPS is only compatible with certain older insulin pumps, **AAPS** (which can be used with a wider range of insulin pumps) was developed in 2016 by Milos Kozak, for a family member with type 1 diabetes. Since those early days, **AAPS** has been continually developed and refined by a team of volunteer computer developers and other enthusiasts who have a connection to the type 1 diabetes world. Today, **AAPS** is used by approximately 20,000 people. It is a highly customisable and versatile system, and because it is open-source, it is also readily compatible with many other open-source diabetes software and platforms. The fundamental components of the current **AAPS** system are outlined in **Figure 1** above.
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## What are the advantages of the AAPS system?
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The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data. Some of the reported advantages of using AAPS are extensive fine-tunable options, automations and increased transparency of the system for the patient/caregiver. This can result in better control over your diabetes (or that of someone you are caring for), which in turn may give improved quality of life and increased peace of mind.
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The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data.
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Some of the reported advantages of using **AAPS** are extensive fine-tunable options, **Automations** and increased transparency of the system for the patient/caregiver. This can result in better control over your diabetes (or that of someone you are caring for), which in turn may give improved quality of life and increased peace of mind.
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With investment of your time, **AAPS** can potentially lead to:
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- alleviating the stress and burden of managing type 1 diabetes;
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- reducing the multitude of mundane decisions that arise from type 1 diabetes;
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- the provision of personalised and dynamic insulin dosing based on real-time data which can cut down the need for hypo treatments and reduce hyperglycemia episodes;
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- an increased knowledge of insulin management and confidence to better fine tune your settings;
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- the ability to create automatic settings (**automations**) that are tailored to fit in with your lifestyle;
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- improved sleep quality and overall reduction in the frequency of nighttime interventions;
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- remote monitoring and administration of insulin delivery for caregivers of type 1 diabetics; and
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- streamlining of all your portable diabetic equipment (continuous glucose monitor receiver and insulin controlling devices) by using an Android phone controlled by **AAPS**.
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Ultimately, **AAPS** can empower individuals to better manage their diabetes, resulting in stable blood sugars and improved long term health outcomes.
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### Specific advantages include:
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#### 2) Hardware flexibility
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**AAPS** works with a wide range of insulin pumps and sensors. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. That offers flexibility as life changes. You don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. AAPS is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves.
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**AAPS** works with a wide range of insulin pumps and sensors and offers flexibility as life changes. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. Users don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. **AAPS** is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves.
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#### 3) Highly customisable, with wide parameters
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There are multiple possible monitoring channels (Sugarmate, Dexcom Follow, xDrip, Android Auto _etc._) which are useful for parents/carers and adults in certain scenarios (sleeping/driving) who need customisable alerts. In some apps (xDrip) you can also turn alarms off totally, which is great if you have a new sensor “soaking” or settling down that you don’t want to loop with yet.
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#### 5) Remote control
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A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or AAPSClient) to send a wide range of commands back to the **AAPS** system. This is used extensively by parents of kids with type 1 diabetes who use AAPS. It is very useful: for example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is possible to monitor the system (_e.g._ Fitbit), send basic commands (_e.g._ Samsung Galaxy watch 4), or even run the entire AAPS system from a high-spec smartwatch (**5**) (_e.g._ LEMFO). In this last scenario, you don’t need to use a phone to run AAPS. As battery life on watches improves and technology becomes more stable, this last option is likely to become increasingly attractive.
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A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or **AAPSClient**) to send a wide range of commands back to the **AAPS** system. This feature is used extensively by parents of kids with type 1 diabetes who use **AAPS**.
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The remote control features can be very useful: for example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is also possible to monitor the system from a smartwatch (_e.g._ Fitbit) or send basic commands from it (_e.g._ Samsung Galaxy watch 4).
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#### 6) No commercial constraints, due to open application interfaces
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Beyond the use of an open-source approach, which allows the source code of **AAPS** to be viewed at any time, the general principle of providing open programming interfaces gives other developers the opportunity to contribute new ideas too. **AAPS** is closely integrated with Nightscout. This accelerates development and allows users to add on features to make life with diabetes even more convenient. Good examples for such integrations are [Nightscout](https://nightscout.github.io/), [Nightscout Reporter](https://nightscout-reporter.zreptil.de/), xDrip, [M5 stack](https://github.com/mlukasek/M5_NightscoutMon/wiki) etc. There is ongoing dialogue between open-source developers and those developing commercial systems. Many of the OS-AID innovations are gradually adopted by commercial systems, where developments are understandably slower, partly because interfaces between systems from different companies (pumps, apps, sensors _etc_) need to be carefully negotiated and licenced. This can also slow innovations which are convenient for the patient (or a small sub-population of patients, who have a very specific requirement) but do not generate any sizable profit.
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With **AAPS** it is easy to keep track of things like: pump insulin levels, cannula age, sensor age, pump battery age, insulin-on-board _etc_. Many actions can be done through the **AAPS** app (priming the pump, disconnecting the pump _etc_.), instead of on the pump itself, which means the pump can stay in your pocket or belt (or that of someone you are caring for).
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#### 8) Accessibility and affordability
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**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a world-class hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) [Android phones](https://docs.google.com/spreadsheets/u/1/d/e/2PACX-1vScCNaIguEZVTVFAgpv1kXHdsHl3fs6xT6RB2Z1CeVJ561AvvqGwxMhlmSHk4J056gMCAQE02sAWJvT/pubhtml?gid=683363241&single=true). Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](#accessibility-for-users-aaps-who-are-partially-or-completely-blind).
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**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) [Android phones](https://docs.google.com/spreadsheets/u/1/d/e/2PACX-1vScCNaIguEZVTVFAgpv1kXHdsHl3fs6xT6RB2Z1CeVJ561AvvqGwxMhlmSHk4J056gMCAQE02sAWJvT/pubhtml?gid=683363241&single=true). Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](#accessibility-for-users-aaps-who-are-partially-or-completely-blind).
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#### 9) Support
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No automated insulin delivery system is perfect. Commercial and open-source systems share many common glitches in both communications and temporary hardware failure. There is support available from community of AAPS users on Facebook, Discord and GitHub who designed, developed and are currently using **AAPS**, all over the world. There are also Facebook support groups and help from clinic/commercial companies for the commercial APS systems - it is worth speaking to the users, or former users of these systems to get feedback on the common glitches, the quality of the education programme and the level of ongoing support provided.
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#### 10) Predictability, transparency and safety
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**AAPS** is totally transparent, logical and predictable, which may make it easier to know when a setting is wrong, and to adjust it accordingly. You can see exactly what the system is doing, why it is doing it, and set its operational limits, which puts the control (and responsibility) in your hands. This can provide the user with confidence, and a sounder sleep.
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**AAPS** is transparent, logical and predictable, which may make it easier to know when a setting is wrong, and to adjust it accordingly. You can see exactly what the system is doing, why it is doing it, and set its operational limits, which puts the control (and responsibility) in your hands. This can provide the user with confidence, and a sounder sleep.
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#### 11) Access to advanced features through development (dev) modes including full closed loop
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This **AAPS** documentation focuses on the mainstream **“master”** branch of **AAPS**. However, research and development is going on all the time. More experienced users may wish to explore the experimental features in the **development** branch. The development innovations focus on strategies for full closed looping (not having to bolus for meals _etc._), and generally trying to make life with type 1 diabetes as convenient as possible.
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## What benefits can I get from AAPS?
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With investment of your time, **AAPS** can potentially lead to:
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- alleviating the stress and burden of managing type 1 diabetes;
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- reducing the multitude of mundane decisions that arise from type 1 diabetes;
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- the provision of personalised and dynamic insulin dosing based on real-time data which can cut down the need for hypo treatments and reduce hyperglycemia episodes;
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- an increased knowledge of insulin management and confidence to better fine tune your settings;
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- the ability to create automatic settings (**automations**) that are tailored to fit in with your lifestyle;
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- improved sleep quality and overall reduction in the frequency of nighttime interventions;
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- remote monitoring and administration of insulin delivery for caregivers of type 1 diabetics; and
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- streamlining of all your portable diabetic equipment (continuous glucose monitor receiver and insulin controlling devices) by using an Android phone controlled by **AAPS**.
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Ultimately, **AAPS** can empower individuals to better manage their diabetes, resulting in stable blood sugars and improved long term health outcomes.
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Interested in how to get started with setting up AAPS? Take a look at the [preparing](../Getting-Started/PreparingForAaps.md) section.
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