Managing a Type 1 Diabetic Preschooler with AndroidAPS

Sam, our 3.5yo T1D, just started preschool. In order to keep Sam safe with his BGL in a good range, reduce our stress and to help the staff at his new preschool we devised a plan that focused on:

1. making a custom Diabetes Action and Management Plans (called 504 plans in the US)
2. Automating with AndroidAPS’s SMB (super-micro-bolus) and Remotely controlling AAPS through SMS commands.

This post will go into each briefly to hopefully help anyone else going through similar stress.

Action and Management Plan

The default action and management plans contain a lot of information not relevant to Sam’s T1D management. The preschool staff shouldn’t have to filter through irrelevant or wrong information in these documents, so we made our own.

Sam’s Diabetes Action Plan

The action plan is a cheat sheet for managing T1D. It should be easy to find the information you need; the emergency information is at the top, followed by the most commonly needed information.

Management Plan, page 1/4

The Management plan is a more wordy document outlining Sam’s T1D and what is expected of the staff to manage it. The goal is to make the staff comfortable with T1D management by providing a complete guide.

Management Plan, page 2/4

We went over this plan in a meeting with the staff and our diabetes nurse. Making everyone comfortable with T1D management and their roles in it gives confidence in making decisions.

Management Plan, page 3/4

Food is of course the biggest issue. Each day Sam has 2 meals, and Sam’s preschool also does cooking as an activity, e.g. baking cake or bread or making smoothies. We told them that Sam can eat anything, we just need to know what it is and how much.

Management Plan, page 4/4

Setting expectations is important for staff to know that T1D management is never perfect. My personal target is 70% TIR while at day care. Last week we hit 68%, that is pretty close so I am happy.

Automation + Remote Control

To implement this plan we use AAPS’s Super-Micro-Bolusing (SMB) feature and targets using SMS commands.

An example of this interaction is:

1. the teacher messages us 15 mins before he eats.
2. we set the “target meal”, which is 5.0mmol/L for 60 minutes
3. the teacher then messages us the carbs in the lunch box (it is written on the lunch box)
4. We add the carbs with “carbs 30”
5. SMB will then slowly give small boluses every 5 minutes based on his rising BGL.

For example, our preschool said he would be eating in 20 minutes, so we put him in a meal target.

Soon after they will send us the messages:

When he started eating we added 30 carbs with the SMS command “carbs 30”. But he didn't eat everything, that is fine because SMB didn’t give him all the insulin at once. Then, about 40 minutes later he went back and ate the rest, that is when SMB gave him more insulin.

About 20% of the time SMB is not enough. If he is rising too quickly, or he gets too high, we will help SMB out by giving another a small bolus, e.g. SMS command “bolus 0.5”.

He has been dropping too fast once or twice but the alarms on Nightguard alerted the staff and they proactively messaged us about it, for example:

If he does need a hypo snack, we usually advise on what to give, but with experience we expect to get less messages asking what to give, and more telling us what they gave.

Settings + Results

We were very conservative on our initial settings, because it is easy to give insulin remotely, but not carbs. Preschool is between 8am and 2pm, during this time

1. Sam’s target has been 6–8mmol/L
2. increased his basal from what it was
3. increased “Max minutes of basal to limit SMB” to 60mins
4. Carb impact is maxed out at 12, max meal absorption time min 4 hours.

Results:

The main things we to make sure is that Sam is in good range, we are not over burdening ourselves or the staff:

1. 68% in range
2. 26% high, 5% very high
3. <1% low, 0% very low
4. 6–7 SMS commands per day
5. 20ish messages per day between staff and parents

We have room to make the settings a little more aggressive without risking lows. I also expect the number of messages from staff to decrease as they are asking a lot of questions at this early stage.

The information in this post is not health advice, since so much of it is based on specifically Sam and our management of his T1D. I hope this might give ideas or help you with your management of a T1D preschooler. If you have any questions, please reach out I am more than happy to help.