I've been a Type 1 Diabetic now for nearly 25 years. The first thing that every techie does once they've been diagnosed with Diabetes is they try to solve the problem with software or hardware. Whatever tool they have, they use that too to "solve their Diabetes." Sometimes it's Excel, sometimes it's writing a whole new system. We can't help ourselves. We see the charts and graphs, we start to understand that this is a solvable problem.
我已经成为1型糖尿病患者近25年了。 每位技术人员一旦被诊断出患有糖尿病，要做的第一件事就是他们试图解决软件或硬件问题。 无论他们使用什么工具，他们也都使用它来“解决他们的糖尿病”。 有时是Excel，有时是在编写一个全新的系统。 我们不能自助。 我们看到了图表，我们开始理解这是一个可解决的问题。
However, innovation in Diabetes technology has two sides. There's the "what can we do within the medical establishment" side, and there's the "what components do I, the actual diabetic, have to work with" side. We are given insulin pumps, glucose meters, and drugs but we aren't involved in the development, which makes sense to a point.
但是，糖尿病技术的创新有两个方面。 有“我们可以在医疗机构内做什么”的一面，还有“我需要实际与糖尿病患者一起工作的哪些组成部分”。 我们获得了胰岛素泵，血糖仪和药物，但我们并未参与开发，这在一定程度上是合理的。
Fifteen years ago (yes, really, 15) I went on a trip with a PalmPilot, OmniSky wireless modem, Blood sugar meter, and insulin pump and quasi-continuously sent my blood glucose numbers back to a server and my doctor. Many many years later I demonstrated on stage at a Microsoft conference (video) how a remote management system like NightScout along with other innovations in IoT are taking these concepts so much further. It's through the work of hundreds of innovators and tinkerers that I think we're on the cusp.
15年前(是的，实际上是15岁)，我带着PalmPilot，OmniSky无线调制解调器，血糖仪和胰岛素泵出行，并将血糖值准连续地发送回服务器和医生。 很多很多年以后，我演示了在舞台上在微软发布会(视频)如何远程管理系统就像NightScout与物联网等创新都是如此多的进一步考虑这些概念一起。 我认为，通过数百名创新者和修补匠的工作，我们正处于风口浪尖。
Aside: If you are wholly unfamiliar with how Type 1 Diabetes works, please take a moment and read Diabetes Explanation: The Airplane Analogy. This post pretty clearly explains how blood sugar rises and falls and why fixing this isn't a simple problem.
另外：如果您完全不了解1型糖尿病的工作原理，请花点时间阅读《糖尿病说明：飞机类比》 。 这篇文章很清楚地解释了血糖如何上升和下降以及为什么解决这个问题不是一个简单的问题。
Four years ago - four years ago this week in fact - I wrote a post called The Sad State of Diabetes Technology in 2012, largely in frustration. It became one of my most popular posts. For some it was a turning point and was called "seminal." For most Diabetics, though, the post said what everyone already thought and already knew. Diabetes sucks deeply, the technology we are given to manage it sucks deeply, and we are pretty much tired of waiting. We've been told a "cure" (or at least, a mostly fool-proof way to manage it) is just 5 years out. I've been told this, personally, every year for the last 25.
四年前-实际上是四周前-我在2012年写了一篇名为《糖尿病技术的悲伤状态》的文章，这在很大程度上令人沮丧。 它成为我最受欢迎的帖子之一。 对于某些人来说，这是一个转折点，被称为“ seminal”。 不过，对于大多数糖尿病患者来说，这篇文章都说了每个人已经想过的事和已经知道的事。 糖尿病深深地吸着我们，给我们管理它的技术深深地吸着我们，我们已经非常厌倦了等待。 我们被告知“治愈”(或至少是一种万无一失的方法来管理)仅用了五年。 过去，我个人每年过去25年都被告知。
Here we are four years after I wrote my angry post and I'm actually feeling like we are on the edge of something big.
在这里，我写了我愤怒的帖子已经四年了，实际上，我觉得自己处在一个大问题的边缘。
I believe that now we are inside a 5 year window of time where we WILL make Type 1 Diabetes MUCH MUCH easier to deal with.
我相信，现在我们处于5年的时间范围内，这将使1型糖尿病的治疗变得更加容易。
Using this generation diagram from the JDRF, it's totally clear that the open source diabetes community is making Stage 4 happen today.
使用JDRF的这一生成图，可以很清楚地看到，开放源代码糖尿病社区正在使第4阶段发生在今天。
Let's stop and level set for a moment. Here's a generalization of your day if you're not diabetic.
让我们停下来，水平设置片刻。 如果您不是糖尿病患者，那么这是您一天的总结。
Here's what a Type 1 diabetic (like me) does:
这是1型糖尿病患者(和我一样)的作用：
What we need is for the "loop to be closed."
我们需要的是“闭环”。
用于糖尿病管理的闭环系统是否像无人驾驶汽车一样？ (Is a Closed-Loop System for Diabetes Management like a Self-driving Car?)
You know how the press just loves to call the Tesla a "Self-driving car?" It's not. I've driven one for over 15 thousand miles. It has two main features and they are both effectively cruise-control. There's the cruise control that slows down when there's a car in front of you, and then there's the "Tesla Auto-Pilot" feature. Amazing, sure, but realistically it's effectively "side to side cruise control." It will keep you in the lanes, usually, to a limit. You can't go to sleep, you shouldn't be texting. You are in charge. This isn't to minimize the amazing work that Tesla has done, but using a closed-loop insulin stages above as a parallel, a Tesla is barely stage 3 or 4.
您知道新闻界怎么喜欢将特斯拉称为“自动驾驶汽车”吗？ 不是。 我已经开车超过15,000英里。 它具有两个主要功能，并且都具有有效的巡航控制功能。 当您面前有汽车时，巡航控制系统的速度会降低，然后还有“ Tesla Auto-Pilot”功能。 令人惊讶的，可以肯定，但实际上，它实际上是“左右巡航控制”。 通常，它将使您保持在极限状态。 你不能睡觉，你不应该发短信。 你负责。 这并不是要最小化特斯拉所做的出色工作，而是将上述闭环胰岛素阶段作为并行使用，特斯拉仅处于第3或第4阶段。
However, this is still a fantastic innovation and for a diabetic like myself, I *would* like to take my hand off the diabetic wheel as it were, at least for the easy stuff like staying in the lanes on the freeway while going straight. Automatic basal insulin dosing (background insulin dosing) would free my mind up a LOT.
但是，这仍然是一项了不起的创新，对于像我这样的糖尿病患者，我*会*像平常一样将自己的手从糖尿病车轮上拿下来，至少是为了轻松起见，例如在高速公路上直行时留在高速公路的车道上。 自动基础胰岛素剂量(背景胰岛素剂量)将使我的精力大为减少。
It's possible and it's happening.
这是可能的，而且正在发生。
闭环需要什么？ (What's required for a closed loop?)
In order to close the loop, what are the components we need? For this simple exercise please assume that "safely and securely" applies to all of these statements.
为了闭环，我们需要什么组件？ 对于此简单练习，请假定“安全”地适用于所有这些声明。
- The ability to tell an insulin pump to deliver insulin 告诉胰岛素泵输送胰岛素的能力
- The ability to read data from the insulin pump. 从胰岛素泵读取数据的能力。
- The ability to read current blood sugar from a continuous glucose meter 从连续血糖仪读取当前血糖的能力
- Some CPU or "brain" where an algorithm or controller lives to coordinate all this. 一些CPU或“大脑”，其中算法或控制器用于协调所有这些。
- Storage, cloud or otherwise, to keep all this historical data 储存，云端或其他方式来保留所有这些历史数据
There are a number of issues to think about, though, if the open source community wants to solve this before the commercial companies do.
但是，如果开源社区想在商业公司之前解决这个问题，则有很多问题需要考虑。
Most pump manufacturers don't like the idea of remotely controlling them after a series of insulin pump proof of concept "attacks."
在一系列胰岛素泵概念证明“攻击”之后，大多数泵制造商都不喜欢远程控制它们的想法。
- This means that some systems require the use of an older pump to allow remote control. We, the community, need to encourage pump manufacturers to create pumps that allow secure remote control. 这意味着某些系统需要使用较旧的泵才能进行远程控制。 我们社区需要鼓励泵制造商制造能够进行安全远程控制的泵。
Most CGM manufacturers don't publish their specifications or like 3rd party apps or systems talking to their stuff.
大多数CGM制造商不会发布其规范，也不会像第三方应用或系统那样谈论他们的东西。
- We, the community, need to encourage manufacturers to create glucose meters that allow secure access to our sugar data. 'Cause it's our data. 我们社区需要鼓励制造商创建可以安全访问我们糖数据的血糖仪。 因为这是我们的数据。
- Universal concern that someone will accidentally hurt or kill themselves or someone else. 普遍担心有人会意外伤害或杀死自己或他人。
- Where should the "closed loop brain/algorithm" live? The cloud? Your phone? Another CPU in your pocket? “闭环大脑/算法”应该放在哪里？ 云端？ 您的手机？ 口袋里还有另一个CPU？
在过去的四年中，糖尿病技术生态系统发生了什么事情？ (What happened in the Diabetes Technology Ecosystem in the last 4 years to make this possible?)
The interesting part about this problem is that there are many ways to solve this. In fact, there are multiple closed loop OSS systems available now. Lots of things have made this possible.
关于此问题的有趣部分是有很多方法可以解决此问题。 实际上，现在有多个闭环OSS系统可用。 许多事情使这成为可能。
Here's a rough timeline of the Open Diabetes Ecosystem.
这是开放性糖尿病生态系统的大致时间表。
Insulaudit - Ben West starts an open source driver to audit medical devices
Insulaudit -Ben West启动了开源驱动程序来审核医疗设备
Decoding CareLink - Driving an insulin pump with Python, Oct 2012
解码CareLink-使用Python驱动胰岛素泵， 2012年10月
Decoding Dexcom - Pulling data off a Dexcom CGM 3 years ago!
CGM-Simple-Reader - Using Windows 8 DLLs from Dexcom Studio to get CGM data. Next step was uploading it somewhere!
CGM-Simple- Reader-使用来自Dexcom Studio的Windows 8 DLL获取CGM数据。 下一步是将其上传到某个地方！
Pebble - Being able to remotely view Nightscout Data on your wrist on a pebble.
Nightscout - Remote viewing of glucose data by pulling from a CGM and uploading to a web app. The addition of a REST API (Web API) was the killer that kick started other apps.
Nightscout-通过从CGM中提取并上传到Web应用程序来远程查看葡萄糖数据。 REST API(Web API)的添加是启动其他应用程序的杀手er。
Parakeet Google App Engine - Gets data from The Parakeet Unit and talks to xDrip over the cell network. "OnStar for diabetes"
Parakeet Google App Engine-从Parakeet单元获取数据，并通过单元网络与xDrip对话。 “ OnStar糖尿病”
Nightscout Share Bridge - Takes Dexcom G5 data and copies it over to Nightscout.
Nightscout Share Bridge-获取Dexcom G5数据并将其复制到Nightscout。
xDrip - Talk to a CGM without a Receiver. Pulling the signal off the air itself. Can we improve their algorithm ourselves?
xDrip-在没有接收者的情况下与CGM交谈。 从空中拉出信号。 我们可以自己改进他们的算法吗？
PingRF - Talking to the Animas Ping Pump via RF
PingRF-通过RF与Animas Ping Pump交谈
OpenAPS - Open Artificial Pancreas System. A platform for building a closed-loop with open tools. There are almost 100 people running their own closed loops, today.
OpenAPS-开放式人工胰腺系统。 一个使用开放工具构建闭环的平台。 今天，几乎有100个人运行着自己的闭环。
RileyLink - A bridge that can talk a Medtronic Pump. Make a the pump's RF programmatically available via Bluetooth
RileyLink-可以与Medtronic泵通话的桥。 通过蓝牙以编程方式使泵的RF可用
Loop - iPhone-based closed loop that uses RileyLink
循环-使用RileyLink的基于iPhone的闭环
xDripG5 - iOS Framework for talking to Dexcom CGMs over Bluetooth
xDripG5-通过蓝牙与Dexcom CGM对话的iOS框架
OmniAPS - Talking to an OmniPod Pump
OmniAPS-与OmniPod泵交谈
I realize this isn't comprehensive, but the point here is to understand there are dozens of ways to solve this problem. And there are dozens (hundreds?) of excited and capable people ready to make it happen.
我意识到这并不全面，但是这里的重点是要了解有很多方法可以解决此问题。 有数十(数百人)个激动而有能力的人准备实现这一目标。
Here's the systems that I have. This is my Dexcom G5 on my iPhone showing my blood sugar in near-realtime. Here I can see my sugar, but I have to make my own decisions about dosing.
这是我所拥有的系统。 这是我iPhone上的Dexcom G5，几乎实时显示了我的血糖。 在这里我可以看到糖，但是我必须自己决定加药量。
Here is a Raspberry Pi running OpenAPS. This is the brain. The algorithm runs here. It's talking to my Dexcom, to Nightscout in the cloud, and to my Medtronic Pump via RF via a USB device called a CareLink.
这是运行OpenAPS的Raspberry Pi 。 这是大脑。 该算法在此处运行。 它正在与我的Dexcom，云中的Nightscout以及我通过称为CareLink的USB设备通过RF与我的Medtronic Pump进行通信。
Here is OpenAPS again, this time running on an Intel Edison sitting on a SparkFun Block with a battery and a TI C1111 RF transmitter. The Edison is the brain and has Bluetooth. The TI transmitter can replace the CareLink.
这又是OpenAPS，这次是在Intel Edison上运行的，它坐在带有电池和TI C1111 RF发射器的SparkFun模块上。 爱迪生是大脑，有蓝牙。 TI变送器可以代替CareLink。
As an alternative to OpenAPS, here is a RileyLink custom board that can also talk to the pump, but doesn't have a brain. There is no algorithm here. Instead, this is a bridge with RF in one hand and Bluetooth in the other. It makes a pump controllable and readable. The brain lives elsewhere.
作为OpenAPS的替代产品，这是一个RileyLink自定义板，它也可以与泵通信，但没有大脑。 这里没有算法。 相反，这是一只手握有RF，另一只手握有Bluetooth的桥梁。 它使泵可控且可读。 大脑生活在其他地方。
Here's the RileyLink in a 3D printed case. I can keep it all in my pocket and it will run all day.
这是3D打印盒中的RileyLink。 我可以将其全部放在口袋里，它将整天运行。
Here is a build of Loop from Nathan Racklyeft that uses Bluetooth to talk to both my CGM (Glucose Meter) and the Pump via the Riley Link. In this example, the phone is the brain. This is good and bad. You can't really trust your phone to keep stuff running if it also runs Candy Crush AND has a crappy battery. However, if both my Pump AND CGM spoke Bluetooth, we can imagine a world where the brain of my "artificial pancreas" is just an app on my phone. No additional hardware.
这是Nathan Racklyeft制作的Loop的构建，它使用蓝牙通过Riley Link与我的CGM(血糖仪)和Pump通话。 在此示例中，电话就是大脑。 这是好是坏。 如果它还运行Candy Crush并且电池电量不足，您将无法真正相信您的手机能够保持运行。 但是，如果我的Pump和CGM都使用蓝牙，那么我们可以想象一个世界，其中“人工胰腺”的大脑只是我手机上的一个应用程序。 没有其他硬件。
The most important point here is that a LOT of stress could have been avoided if the manufacturers had just created open APIs in the first place.
这里最重要的一点是，如果制造商刚开始创建开放的API，就可以避免很多压力。
There's also amazing work happening in the non-profit space. Howard shared this common on my original "Sad State" Diabetes Post:
非营利领域也发生了惊人的工作。 霍华德在我原来的《悲伤状态》糖尿病邮报上分享了这个共同点：
Since then, Howard created Tidepool and recently spoke at the White House! On the commercial side, there are lots of players rushing to market. Medtronic may '>'>'>have a hybrid closed loop called the 670g by spring next year although trials move slowly so I'm thinking later or possibly 2018. Lane Desborough from Bigfoot Biomedical has also closed the loop and they are bringing it to market...soon we hope!
从那以后，霍华德创建了Tidepool ，最近在白宫发表讲话！ 在商业方面，有很多参与者涌向市场。 美敦力可能“>”>“>的弹簧称为670克明年的混合闭环虽然试验缓缓移动，所以我以后或可能2018想着弄德斯伯勒从大脚生物医学还关闭循环，他们将其带到市场...我们希望很快！
For more information, go watch Mark Wilson's talk at D-Data Exchange 2016. It is an excellent 30 minute overview of the ecosystem and a call to action to everyone involved.
有关更多信息，请观看Mark Wilson在D-Data Exchange 2016上的演讲。 这是对生态系统的30分钟精彩概述，并呼吁所有相关人员采取行动。
Check out this visualization of 6 years of Hacking Diabetes. These are all the projects and commits as folks dump into Open Diabetes Hacking Community.
查看此6年的Hacking Diabetes的可视化。 这些都是项目，随着人们转入Open Diabetes Hacking社区而提交。
What's the take away? It's an exciting time. It's happening. It can't be stopped.
有什么好处？ 这是一个令人兴奋的时刻。 正在发生。 它不能停止。
更多糖尿病阅读 (More Diabetes Reading )
Introducing Web Tiles for Microsoft Band - My diabetes data on a Band!
Diabetics: It's fun to say Bionic Pancreas but how about a reality check
It's WAY too early to call this Insulin Pump an Artificial Pancreas
翻译自: https://www.hanselman.com/blog/the-promising-state-of-diabetes-technology-in-2016
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