Nightscout on the 640g: Six Months of (We Are) Not Waiting

A little over a year ago, Janki received her 640g pump and CGM sensors. We were (and are) very grateful. This system, whilst far from perfect, has transformed the management of her diabetes. But, back then, remote access to her pump data seemed like a pipe dream. Nightscout was not available due to the encrypted radio protocol and Medtronic could not give a release date for their MiniMed Connect system on the 640g.

In six months, as a community, we've gone from a proof of principle, to something more elegant, to direct communication with the pump via an Android phone. With Lennart Goedhart's work and its beta release, we now, essentially, have an Open Source MiniMed Connect:

 (NB At present, some of the additional info in the Nightscout grab above is coming from periodic use of the earlier NS solutions for the 640g, but more functionality on the Android app is planned)

For me the message is clear: if the patient community has the technical skills they won't wait to find a way to get access to tools that they feel will be of benefit. #WeAreNotWaiting goes beyond Nightscout. It's a way of thinking that can't be put back in its box and presents a huge challenge to both commercial device companies and Regulatory Authorities.

This is independent of commercial forecasting - our kids have Type 1 now, not next financial year (by the way, in case there was any doubt in commercial-land about whether patients and carers want remote access, around 15,000 people have taken the time to read my blog pages on the even the early Nightscout solutions for the 640g).

It has been produced without Regulatory oversight. And just to be 100% clear, I'm in favour of regulation (my day job is centred around Regulatory frameworks set up to protect patients and staff in my area of healthcare) but the Regulators - as well as each med tech company involved - have to wake up and smell the community coffee. Processes, interpretation and (eventually) legislation has to change (in my humble opinion).

I spent a lot of last year wishing I had access to Janki's data - particularly for overnight and school trouble shooting (or worse). The first iteration of Nightscout on the 640g was not, actually, the post I put up back in November 2015. It was a mechanical rig that would (on a timer) use an actuator to push a side arrow button on the pump. There was a phone camera, with a fish-eye lens clipped on to grab the whole pump screen at short range. That was sent to Dropbox and would display on a remote phone. Did I mention there was Meccano involved? And eye-rolling from Mrs Little D.... Of course if Janki rolled over onto this contraption, the infusion line may well have failed before the Meccano...*

*Seeing this Bigfoot post the other day did, however, bring a huge smile to my face -

So "First Generation" of Nightscout was a bounce via CareLink.

Because of the relatively large dataset size being handled (CareLink could only issue a whole day's CSV report) the scripting was handled on a local PC rather than being buried neatly remotely on Azure, where data charges may have started to kick in. That certainly complicated installation.

I added in other pump information, including basal and bolus information as well as pump alarms:

Tom Collins came on-board as a user of the First Gen system and then quickly put his skills to work building a neat .Net uploader, which took away the need for some of the installation layers - we had reached "Second Generation" :)

And then after months of work by a small group, analysing pump data via the Bayer Contour Next Link 2.4 stick, Lennart made a - the - breakthrough we'd been hoping for: direct communication with the 640g (via a Bayer stick). With his original Python debugging code, it was easy for me to add to and connect to Nightscout, but not ready for prime-time.

For a public release, Lennart led the way again, heavily adapting the original Android Medtronic Uploader to deal with the 640g data he had unlocked directly. This "Third Generation" is what the vast majority of 640g users will have been waiting for.

Over the last six months, I'm very proud to have helped dozens and dozens of families to get remote access to their pump data. It's been fantastically rewarding, as has working with people like Tom to solve issues and think up better solutions. There's still a rich seam of pump data and information to be mined and included in the 640g implementation of Nightscout. The journey's just begun.