Next Level Diabetes Management: Austin’s Experience with Android APS Technology

Welcome to Think Like a Pancreas, the podcast where our goal is to keep

Hello everyone. I am Kathryn Alvarez and I'll be hosting the podcast today. I have an awesome guest with me. His name is Austin. I'm gonna get to know him today and kind of his journey with Type one Diabetes. He is a very busy guy. There's gonna be a lot for us to talk about.

Yeah, sure. So I'm Austin. I was diagnosed at eight years old in October of, think in the early two thousands that I'd have to go find the date. But I've been diabetic since I was eight. I'm now, uh, 27. So, 20 years as a, as a type one diabetic. Yeah. And what, what else can I tell you about myself? What else do you wanna know?

What are you studying? Um, tell everyone you're going for Yeah. PhD, which is just impressive in itself.

Yeah. So I'm doing like a bunch of different things at the same time. So I'm doing my PhD in chemical engineering studying stem cell differentiation using electrical stimulation at Iowa State University. Man, that's a mouthful. There's always like a, a crazy title for every university. Um, so I'm about two years into that. And then in addition, I also am an engineering specialist for Merck Animal Health making swine influenza vaccines. So I'm doing both at the same time.

Do you know when you're expected to finish your PhD?

I'm hoping in the next two years, and then in my professional role, I can transition to something that's more R and D based instead of being more applied engineering. So that's kind of the outlook right now. I think with any PhD it's a little, it's always kind of uncertain 'cause it's based on how your work progresses. So, there's not a perfectly defined timeline, but yeah, that's what I'm hoping for.

Yeah. That's really awesome. Did you do your undergrad at Iowa State as well?

Yeah, so my, my kind of education arc was that I went to high school in Northern Illinois and then went to my undergraduate degree here at Iowa State, also in chemical engineering. After I got done was towards the tail end of COVID, I went into industry and then worked for about three years. And then after that decided I wanted to get some more credentials and get some more education, and it just kind of worked out that I was able to do both at the same time. So, yeah.

Awesome. And you also, while going for your PhD, also live with type one diabetes and you have a wife and you have a cat with diabetes now. Yeah. Mochi And cycle. So, how challenging has it been with just everything that you do to manage your diabetes?

Yeah, so like you said, I have, I got married about a year ago, uh, now, and also riding and racing my bike and there's, beyond the diabetes side, just balancing all the stuff together and carving out time for everything is hard in itself. Throwing diabetes into the mix makes it like you have to make more decisions more consistently. And like all of the other things, you, you can't just stop and take a break whenever you want to.

yeah, a little

more complicated. Yeah.

When you're gonna go home and stuff, but at least you have these bags that are prepared and yeah, you grab them.

Yeah.

Let's talk about your transition and just for our listeners. So Austin, you came to IDS and what do you remember what your main goal

Yeah, so my first goal was, uh, my wife and I are sort of doing family planning and we're trying to mitigate the effect that diabetes can have on our ability to have children. So the primary goal was to lower my A1C, um, and be as healthy as possible when we're in the stage of family planning. And then in addition to that, my personal goal was that I would really, really love to get down to a 6.0 A1C.

man, and so good, and I mean, a lot of the focus from a family planning standpoint is on women, but we see more and more how important it is for men too. So, yeah, it's so good that you're taking that step, and hopefully that can be a little bit of an inspiration for more guys, too. You were using the Tandem and with cycling, or, I mean, just in general, what do you feel like the Tandem wasn't able to achieve?

I ride my bike about, hmm 13, 14 hours a week. And I race like road bikes, kind of like the Tour de France, but the United States doesn't have a scene that looks like that. It looks a little bit different, but you could think of it that way. So amateur cycling of course, and all of those sports take a lot of time and there is like an aerobic and an anaerobic component. So different ways of using energy with different workout types and the Tandem insulin pump for me at the time.

Mm-hmm.

Um, but those buffers became more of a constraint to me managing my blood sugar rather than, um, you know, a benefit. For instance, I would, I would go and set up a workout and then go do the workout and immediately have low blood sugars, even though I'd have exercise mode on or something. And the default turned into just taking my insulin pump off and getting no insulin until I saw my blood sugar kind of flat line. And then it would slowly kind of start to rise.

Yeah, I mean we have, we, we do have Control IQ plus now, which is really helpful for a lot of people. But yeah, at the time we had to like create different profiles in order to, because exercise mode, you know, wasn't, wasn't doing the trick. So creating these different profiles with significantly higher correction factor to try and prevent some of that auto bolus insulin. But I was like, there's just, there's better things.

Yeah, that's a rarity in, in the US

It really is. I used to recommend Android APSA lot to parents that had little kids with type one diabetes because it was the first where you could do remote features. So that's where majority of the people that come to IDS are still from the United States, but we, we do have some people overseas. Um, just not as, as common. Well, that was like my main exposure to AAPS, and of course I ran it because I needed to better assist these people that I was helping with.

Yeah.

Yep.

One of my biggest problems throughout all the time I've had diabetes is remembering to get insulin before a meal. And you'd think, you'd think that like 19 years of doing it, it's, it should be automatic. There's this tagline that sits in my mind of when I first got diagnosed of a doctor that told me eventually diabetes would be like brushing your teeth.

That's how I look at it. Like it does feel like that for me. Like I just feel like, like, yeah, life with type one diabetes. I don't. It doesn't bother me at all. It's more the, uh, like prescription management and trying to figure out insurance and having to do prior authorizations. That is what gets me.

I think I'm getting closer and this was one step closer, and eventually I hope that, uh, I get there, but it always has still, I don't know it having to put like OmniPods on still and prep stuff, bring things with and make sure I remember. Everything that I need to be successful with it. Uh,

to not die.

To not die. Putting it very frankly, yeah, Uhhuh. To live on a regular basis. It's a hard thing to get across to people who don't have it or don't have like somebody really close to them who they've also had to give them like whatever their snack is for a low blood sugar. But going back to your original question, my problem was that I would, I would get my insulin for every meal. It just might be a few minutes behind the first bite because I'm excited to eat. I'm like, I wanna sit down.

did you? Yeah, yeah, yeah. And you the big, big one. But yeah.

Yeah. So that's been really, really great. Then also the SMBs at nighttime. Now that we've sort of gotten my profile tuned, I don't think I've had blood sugars this sort of stable overnight in years, and we're like within, I can be within like 10 milligrams per deciliter of target for like a nine hour period just sleeping and it feels amazing. So that's really, really great. But yeah, that's the coolest tool in my mind.

Yeah, and you kind of have like these scenarios and rules you can set up too, which a lot of people like that are on AAPS. They never go through all of the objectives and with the last objective, it gives you the ability to set up like scenarios. If you get to a particular GPS location, then turn on like switch to exercise profile, right? Which I think is really helpful because like you said, you know, you get excited to eat, but I mean just we're naturally forgetful.

Sure. Or like you're the person that goes and does weightlifting at the same gym. You've had the same gym membership for five years to the same spot. Yep. Every time you show up there, it's just gonna solve your problem for you without even having to do anything.

Yeah. You, yeah, it's just all set. So it's like, it's really streamlining and just making everything easier. You have to think about so much less, which is so amazing and so many people on open source systems they're doing, they're just completely not announcing meals and some people like they'll come frustrated. You do announce your meals still. Yeah, at least for the most part.

Yeah.

And um, since that slows down the impact of the food or on our blood sugar at least then, um, I can create those smooth outcomes. Is there any reason why you've chosen not to take a GLP-1?

Good question. Yeah. So I'm not, I'm not particularly against taking GLP-1s. For my own reasoning that I haven't taken one yet. I would put it down to like, I'm a, I'm a researcher and I'm also in pharmaceuticals, and I look at data and I don't doubt that it works, but the current usage case has been about a few years and my approach to, I don't know, the, so the outcomes of like GLP-1s is slower digestion. You could have weight loss.

Yeah, and I mean sometimes if you're, if you're cycling and potentially having like low treatments that impact your blood sugar or pull you up as quickly could be kind of problematic.

And I mean, another like aspect of that is that when I eat riding on the bike. I eat the most sugary, like, concentrated stuff. And that's what the sports gels and gel blocks and high carb mixes and bottles and things are meant to do is to absorb as fast as possible 'cause you're burning through stuff right away. I, I would love, I want my digestion to be as quick as possible and to process as many carbs as I possibly can so I can feel better later in a, in a.

And as an athlete, you know, you need to consume more calories as well. So, and protein is incredibly important for muscle recovery. It, it would make it more difficult to consume what you would require as an athlete.

Yeah.

GLP-1 as as well. And I think a lot of people, you know, they are just looking for more of that long-term outcome and research to make the next step and take it. Um, but for other people, I mean, as people with type one, we don't produce a hormone that slows down gastric emptying and is also a satiety hormone called amylin. And so as people with type one, we do tend to feel a bit hungrier and see the impact of carbohydrate a bit quicker. So bolus timing is so incredibly important.

I think there's a use case for every single thing that's made out there. And I think the hardest part is getting through who it's appropriate for and at what time and yeah, when, when to use it. So I'm not hesitant about drugs, that's why I work in the pharmaceutical industry.

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Okay, so now let's shift a little bit. I'm gonna talk about the objectives because this is unique to AAPS and I guess

Right.

So tell me about it. Like how did you feel, uh, going through the build? And, and then, then we'll talk about the objectives as well.

Sure. So I'll say the build scared me too initially, and then I started doing reading, like in my PhD program. Whenever you need to do something, sometimes there's people that teach you how to do it, but there's a lot of cases where you just have to figure it out. So they turn you loose, go read some documents, figure out how to do a thing, whether it's like 3D printing or like mixing new chemicals and making some new solution, whatever. So that was my approach to the Android APS build.

It's super cool too, which is so great. I mean, 'cause I don't have AAPS in front of me anymore. So you can just, yeah, go in there and, and search what you're looking for.

It's great. They have so much detail about, just about everything android APS, and then they also have links, like outside links. So if you wanted to know where the idea came from for SMBs or, how much you should get for SMBs or how you calculate your own SMBs, there's always some extra source for where stuff came from. You can get as deep an explanation about everything as you want. So yeah, the components I needed to build it included my Apple computer.

Yeah. And everything is free with AAPS and you do not like our, um, iPhone based things, we do not require like no Apple developer. So you don't have that $99 a year, um, which is just great.

Yeah, it's a really low barrier of entry in terms of cost, and once you get the app set up on your phone, after you get past that and it's set up correctly, the objectives will kind of take care of the rest to verify that the app is working correctly as you work through it. And I don't know about other open source systems 'cause Android APS is the only thing I've used, but can you run any of the other systems on a virtual pump?

Yes.

Okay. Yeah, that would make sense. I think that was a great feature to start feeding it glucose data and it let me double check that my sensor's working first and then make fake corrections on things and

mm-hmm.

Yeah, it's just, that just made so much sense that they included a system like that too. So

Yeah, you get to see like how it's functioning

Yeah.

Beforehand,

right, exactly.

Really, yeah, you can... so the build is great, you know, you can do it on any type of computer, which is so good. Um, which you can with Loop and Trio now as well. Now the objectives. One more thing I wanted to say about the build, actually. The build, I feel like is, it is definitely a, probably the number one reason why people will choose not to go like the open source route. And the online community is so incredibly helpful.

Yeah, right.

It's amazing. All they do too, to help people get through it. And I mean, I feel like also it's kind of like my comparison I always give to people is it's kind of like following the instructions to put together furniture. Putting together furniture is really stressful, but you know, you'll probably eventually get the end product even though you have no idea what you did. Yeah. But then I started putting together some furniture as I got my first house and that did not go well.

really good at diabetes, not so great at building IKEA furniture.

Yeah, definitely. Okay, so the objectives, what were your thoughts going through those? Did you have any challenges when you were to the point, what is it? Objective three? Where it's asking you to essentially prove your knowledge? Or did you have trouble like kind of getting through any of them?

Yeah, the prove your knowledge was hard. Which is, at first I was like really frustrated because you know, you get handed any insulin pump through a company and they have you train with somebody, either a qualified educator or somebody's like a rep for that pump, and I was like, man, I don't wanna wait. Just give me all, just open everything up. Let's, let me just. I'll just figure it out.

Mm-hmm.

Read the docs in detail so you can't just like skim it. You know, like prepare for your Friday quiz or whatever in grade school and read something real quick. No, you, you have to know the information, and you have to know it intimately to pass the questions.

Mm-hmm.

Nobody's gonna give you the answer. That's the one thing the community is not gonna do. They're not gonna give you hints for the answer. It's if you wanna use the system, you gotta get past that objective and understand everything. So,

yeah, no, they'll guide you a little bit, like if you look in the Facebook group, yeah, that's true. People will kind of give you like some pointers or where to look, but yeah, it won't give you the answer,

which is great. Yeah, so getting through that was difficult, but once I was through that section, after that, it was just introducing a complexity layer, one piece at a time until you had kind of the most complicated version of Android APS that you're running. And I think the very first thing you do is, is set up your profile and then afterward you start getting access to stuff like basal suspend.

Mm-hmm. Yeah. That's really great. And when you were doing that, your time in range was pretty great right off the bat, but I do think you're probably paying a little more attention as well, just kind of starting on a new thing.

Yeah.

You know, just starting on a new thing in general can be pretty stressful. Did you feel like it was the wrong decision ever to put the Tandem down?

No, I, I don't think so. It was refreshing to be on a totally new insulin pump after being on the same thing for many, many years. And moreover, switching to an Omnipod was new for me too. Uh, 'cause it was the first time I didn't have any tubing on me, and that was so refreshing that there were enough upsides that I never felt like, oh, I made the wrong decision. It was more just figuring out the bumps in the road for getting proficient at using Android APS.

Have you ever considered, this is just like a random thing that I'm now suddenly super interested in, so since you have the ability. So with AAPS you can use the Eversense, and there's talk on like Zop chat of using it. Um, like it'll likely be compatible with Loop as well. Um, of course Trio I'm sure would be in line for that as as well. But with Eversense, like, have you ever given that any thought? To potentially try that as your, your CGM?

I haven't, no. The current CGMs haven't bothered me so much. Like I've been using Dexcom since they were on the G4. I don't think they called it the G3 when they came out with the third one at the time. Yeah, maybe it was called the G3

I know.

I have to think really far back, but I've been using those ones for years and years since they first got approved for pediatrics and haven't used really anything else. And those have kept getting better and better with more wear time up until like the 10 day period. And I think now they even have the 15 day period. Mm-hmm. Which may be a little bit long for me to keep them actually stuck on to my, mm-hmm to my body.

Yeah. Well, and I mean, when you look at the data, a significant amount did not make it to the 15 days. So

yeah,

it is kind of expected.

Yeah.

I'd be curious to see what they're gonna do with, if they're gonna ease up on replacements or,

yeah. I haven't given the Eversense any thought. I think it's a nice idea for some people the implantable device. I work on some implantable devices, some stuff related to the eye. And I think in the, again, in the right use case scenario, I think it's a really, really great idea. And for the right patient, I think it could work really well. But yeah, I also don't want to be, like we talked about earlier, I don't want to be stuck on one technology for the sake of being comfortable with

well

insert.

Well, and well now they have the 365, so whole entire year.

For a whole year. That's crazy.

It's different though, because you can just take that top piece off and then it's just, you know, it's your arm. Yeah. And Gary, the boss, my boss has had one in for just under... he got it implanted and never got it removed. So it's been in there for, I don't even know how many years. We'll have to ask him.

No, he's had no issues with it being implanted that long?

No.

Interesting. Yeah. Huh uh, have you tried one before?

No, I haven't, but I've had quite a few people ask about it recently because Dexcom, especially with these, my littles, my littles just have a heck of a time. Like they are all over the place and just the sensors are jumpy, jumping all around, which I'm sure you've had jumpy sensors too. Especially recently, it just seems like something's going on with the quality and we're, we're not having, we're not having some great luck with the sensors recently, but it's especially true for little ones.

Yeah. The absolute worst case scenario for me for sensors is having a compression low in the middle of the night, treating it with something and then going back to bed. And at nighttime I have a slight preference to run a little bit higher if I've had low blood sugars and then keep sleeping. 'cause my sleep feels that important. Of course, I have like a high threshold. Anything over like one 90 I'll get alarms for, to wake up and do something about it.

It looks clean.

Yeah. Okay.

Yeah, I, I don't know. I'd have to look more into. You know, about using the same place? 'cause I'm, I'm not sure about that, but I mean, it is only 18 plus, so not to be, I don't wanna confuse people by talking about the littles, but yeah, it's, it's just for adult use. And also the 15 day for Dexcom is also just for adults, 18 plus. So that won't impact them either. But yeah, I mean it's, it's definitely, it's gonna be more accurate.

Yeah. Yeah. Yeah. I think this just kinda speaks on the whole technology development and how important it was for me to do, to try something new anyway.

Mm-hmm.

And even if I'm not committed to it, that's okay. And I know you mentioned earlier about the prior authorizations and insurance related problems and things.

Yeah.

And if I ever want to, I can jump ship at any time.

True. Yeah, you no lock in.

So yeah, that. Is great that I can walk away from it.

Well, and I have had a lot of people that, because it's a pharmacy benefit, um, even if they had like a lock in, um, or you know, their contract, they could still get the pods. It's almost like the insurance company just didn't realize. I think it's only ever been once that like somebody got caught and they were like, you have this contract. But for everybody else didn't realize and they were able to get the pods even though. Did, was your contract ended when you, when you did it?

No, I still have a Tandem insulin pump in my closet with a bucket load of supplies and it is serving as my, as my backup. But at the same time, I could go try control IQ plus at this point because I could get the download and, and set it up. But yeah, as I'm still, I'm really enjoying Android APS right now. 'cause like I said, there are features on it that act as a safety net for when I'm not being the most attentive to, uh, treating myself.

Well, and you know, there is still some shortcomings of the control IQ algorithm for you. Yeah. Just you can get so much more customizable with AAPS.

Yeah, exactly.

Yeah.

So, yeah. What have you heard about the the Twist pump?

Yeah. So the Twist pump, it's, they compare it to like double stuffed Oreos. It's a little bit bigger than that. Okay. And it's going to, so it's a very old version of Loop, essentially. And so it's not at all what people with Loop are used to using the like interface looks the same, but when they go into like the overrides, they're not gonna be able to customize in all of these different overrides. So that's like a big, big feature that people are gonna be disappointed.

So, so do you think that the Twist would be like a gateway for somebody that hasn't used open source stuff to start with that 'cause it's got FDA clearance and then move to open source when they decide they want more features or do you think it'll be open source people who want FDA company-based support and backing who will move outta open source to that?

I think, I think there'll be a lot of that. And then I think that when they make the switch, unfortunately they might be a bit disappointed.

Hmm.

In that decision, and they might kind of wanna go back to open source. And then I think some other people are gonna go on it that wanted to use open source, but they were like, you know, didn't have the ability to build or, you know, they were, they're scared off from it. And I think maybe for 'em, it'll be like a gateway.

Yeah,

for sure.

Cool.

There's so many great people just working for that company, and I think that hopefully it'll progress pretty quickly. Yeah. You know, at this point, I think majority of people would still choose to go, you know, on Tandem or another system. Big reason is, I mean, the Twist pump is, it's not very sleek, kinda,

yeah. Define sleek.

Um, it's like a gray circle. It kind of reminds me of a hockey puck.

Yeah, that's what I thought too. Yeah.

Yeah. So,

and it also still has tubing, but it's also a patch pump?

Right? Yeah. Uh,

like a Mobi, but in the middle, a little bit tube bunk.

Yeah. Okay. So, uh, yeah. Yeah, I don't know. I hope they make some big, some big updates and lemme see great things from them-- from Sequel. But yeah, at this point, not something I, personally, I'm gonna go, but there's definitely a group of people for every system out there. So some people are gonna, it's gonna be perfect for 'em.

Yeah, definitely.

The other thing I wanted to talk to you about is your wife is from Germany, right? So Germany? Yeah, yeah.

Yep. From Germany. That's right.

How often do you guys go to Germany?

Well, as much as we can. Right now we're doing like green card applications, uh, since we had just gotten married and I'm doing my schooling here in the US. Um, so as soon as we can get that stuff filed and done, then we can

yeah. Very good. Yeah. That's so nice. And do you have any challenges with the international travel

man. Yeah, I have tons. So I imagine most of the audience here would be from the United States. The people that are gonna see and listen to this. Um, but if you're going from the US and traveling over to Europe, understand that the food in Europe they say is different because it tastes this, that and the other thing. The nutrients profile is also very, very different. They don't make breads with sugars in them. Everything to used gonna not taste sweet.

Yeah,

not, not the same amount. There's a lot of relaxing and then also eating those high carb meals.

Yeah, because you told me they don't really have like the gyms in Germany, right?

No, everybody's so much more active on a daily basis anyway. 'cause people walk and ride their bike to work. Like my brother-in-law, the other day we were, or a few months ago, we were on, uh, vacation to visit my sister out on the west coast here in the US. We're in a city and we walked like, like eight miles or something like that in a couple of hours. And I was complaining 'cause I was like, oh, my feet hurt. We just finished walking eight miles in like a small amount of time.

Yeah, yeah, definitely. Which is, I mean, it's so cool and to. See such difference in

Yeah, for sure. I was thinking about, you were talking about the Facebook group, we were talking about the support community behind the open source stuff. One of the most interesting things to me is to look at all the different languages that pop up on the Android APS Facebook page.

Yeah.

As you know, Androids are way more popular across the world and like the US is very committed to iPhones because everybody kind of has fallen into that sort of like cultural phenomenon of being in Apple and being a part of the ecosystem. And so there's a ton of users over in Europe and like to watch the different languages pop up, whether it's like Dutch or German or French, or spanish or whatever is like, is really funny and it's a big worldwide community that's tied into the whole thing. Yeah,

yeah. It's so, so cool. And I mean, it's cool too they have so many like systems or pumps that we don't have here. The one I'm very interested in is the Medtrum, which they have in Germany.

Okay.

You have to look for it. It's, it's a lot smaller than the pod. I mean, I guess not a lot, but like it seems significantly.

Is this the, it's like a little gray sort of still looks like a square. Yeah. Yeah. Can you describe this one more? Is this, does this one have like a removable cartridge?

Gotta pull up a picture of it so you can really, yeah,

please. Yeah. Yeah, yeah, yeah. So the gray piece, unclips.

Yep.

Yeah. Okay. So you can kind of substitute or match up the cartridge size that you want. Is that true?

Yep.

Yeah, that's it's,

it's like,

yeah. That's awesome.

Yeah, that's really cool. And you can use it with AAPS.

That's cool.

Yep. That's pretty awesome. Apparently the sensor is not great, though. That's what someone in, I don't know what country he was in, but he told me the sensor's not great, and that's a big reason why he wanted to set up AAPS so that he could use it with the Dexcom.

They have their own sensor for it, I'm guessing. Yeah. Okay. Man. Makes it difficult.

Yeah. But you know, with AAPS, you can use, that's like the whatever you want. Yeah. You just use, use Dexcom. There you go.

Yeah, that's great. Cool.

I really appreciate you coming on here and sharing your story. There's just, I mean, I feel like we could talk about life for, for hours, but

Yeah. I. I have fun coming on these. Not only, uh, because like every time I talk to a new host, I find find out about new diabetes technology. And uh, like I said, the hardest part after being on one thing for so many years is to branch out and try other stuff and start like asking things. And I think if it's difficult for you to get the device in hand for either like a cost problem or switching is difficult or something.

Yeah,

yeah, yeah,

yeah. So we got to talk about kinda your experience of starting up on Android APS, why you shifted from Tandem to open source, and we talked about your travel over to Germany. We didn't talk too much about cycling, but I, we did, we did brush on it a little bit. Thank you so very much for joining us.

Yeah, thanks. This has been great. And uh, also a shout out to IDS because if I hadn't come out with you guys, I would've never done the switch anyway. So thank you guys for all of your information and your help getting the switch done and uh, yeah, all the continued work and stuff that you guys do for helping me manage my diabetes, so

thank you. It's a pleasure to work with you.

Thanks for tuning in to Think Like A Pancreas, the podcast. If you enjoyed today's episode, don't forget to like, follow, or subscribe on your favorite podcast app. Think like a pancreas. The podcast is brought to you by Integrated Diabetes Services where experience meets expertise, passion meets compassion, and diabetes care is personal because we live it too. Our team of clinicians all living with type one diabetes understands the challenges firsthand.