Closed Loop at kindergarten. A difficult decision to take.

The difficulties of diabetes school management brings you in front of the dilemma to close the loop or not in a toddler.

Looping at Kindergarten
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Gregory is attending kindergarten for a few months now and his diabetes management at school is not easy at all. Various factors affect his blood glucose even though he is under insulin pump management.

  • Unexperienced teacher with diabetes management.
  • CGM failures during school hours.
  • Almost impossible to pre-bolus since it’s hard to know that your kid will eat his snack/lunch.
  • A bit hard to count carbs consumed.

I have read about closed loop and the benefits of using it. But I have also read about the risks, especially in such a small child. But since I am tech savvy Dad, I kept reading and asking in Type 1 Diabetes Forums about ways to mitigate the risks. I spoke with a couple of parents that were already looping their kiddo which was a bit older than Gregory and they highly recommended starting looping. I have decided with my wife at least to give it a try.

Below you can read some basic things about closing the loop and on later posts I will describe Gregory’s experience on looping.

Prerequisites to Close the Loop

Looping software

There is a variety of closed loop software but the most known ones are Loop for Apple iOS and AAPS (Android Artificial Pancreas System) for Google Android phones.

I have immediately chosen AAPS for Gregory. The reason is that AAPS has the SMS Command feature, something that might help us with remote bolusing Gregory after his snack or lunch.

Android APS (AAPS)

AndroidAPS (Android Artificial Pancreas System) is an open source app for people living with insulin-dependent diabetes that acts as an artificial pancreas system (APS) on Google Android smartphones. The main components are different OpenAPS software algorithms which aim to do what a living pancreas does: keeping blood sugar levels within healthy limits by using automated insulin dosing (AID). Additionally, you need at least a supported and FDA/CE approved insulin pump and continuous glucose meter.

How the loop works.

Insulin Pump

You need an FDA/CE approved insulin pump in order to start looping. Not all pumps are compatible with AAPS. There is a list with all compatible pumps in the official AAPS docs website. Good news is that Omnipod DASH is now fully supported.

Continuous Glucose Monitor (CGM)

A sensor that is attached to the patients body and provides real-time glucose readings every 5minutes. There is a variety of CGM’s in the market. The best performing ones at the moment for looping are Dexcom G6 and Freestyle Libre 2.

Android Phone

There is a big list of phones which are tested by AAPS users. Not all phones are compatible and not all Android versions.


In order for your phone to “talk” with your compatible insulin pump, a small device might be needed. This is called Rileylink. Other devices with similar functionality are also available, Orangelink and Emalink.



Nightscout is an open source tool that helps people suffering from Type 1 Diabetes to continuously monitor their blood glucose (BG). Their real-time BG data are uploaded from their CGM (Continuous Glucose Meter) to the cloud and presented in a personal website, smartwatch, smartphone apps and widgets. I have posted a comprehensive Nightscout setup guide that will help you build your personal Nightscout site in around 30mins.

Ways to add your CGM data to the cloud/nightscout.
Ways to add your CGM data to the cloud/nightscout.

Where can I find a loopable insulin pump?

There is a big chance that the compatible insulin pump is not available in the market. It’s not uncommon that many of the compatible pumps are pumps of older technology. The reason is that it was easier for the loop developers to break/hack the communication protocol of the pump. Diabbetech Marketplace is one of the places where you can find a loopable pump.

When can I close the loop?

Here is the tricky part. Most people want to immediately close the loop. Close the loop means that AAPS will fully manage your diabetes and inject insulin when the algorithm decides that this is needed. For security reasons though, AAPS has implemented a very clever learning curve in order to ensure – for security reasons – that someone will start looping only if he/she passed all the Objectives set.

“AndroidAPS has a series of Objectives that need to be completed to walk you through the features and settings of safe looping. They ensure you have configured everything detailed in the sections above correctly, and that you understand what your system is doing and why so you can trust it.”

You can close your loop after passing Objective 6, but it takes around a month to finish all Objectives. But believe, it worth waiting as day by day you feel more and more confident with using AAPS and of course managing Diabetes. Reading the official documentation again and again will help a lot solving any questions you might have.

Is there any support forum?

It is expected that every new looper has many questions. Fortunately there are places were you can ask your questions and get support either from developers or fellow AAPS users.

Disclaimer And Warning

All information and thought described here is intended for informational and educational purposes only. Consult your doctor for any medical decisions. The post is not endorsed nor promoted by any of the companies mentioned.

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