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Merge pull request #1703 from openaps/peterleimbach-patch-1
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Peterleimbach patch 1
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peterleimbach committed Sep 20, 2023
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1 change: 1 addition & 0 deletions docs/EN/Getting-Started/Safety-first.md
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- AAPS allows you to control a child's phone remotely via text message. If you enable this SMS Communicator, always remember that the phone set up to give remote commands could be stolen. So always protect it at least by a PIN code.
- AAPS will also inform you by text message if your remote commands, such as a bolus or a profile change, have been carried out. It is advisable to set this up so that confirmation texts are sent to at least two different phone numbers in case one of the receiving phones is stolen.

(Safety-first-aaps-can-also-be-used-by-blind-people)=
## AAPS can also be used by blind people

On Android devices TalkBack is part of the operating system. It is a program for screen orientation via voice output. With TalkBack you can operate your smartphone as well as AAPS blind.
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8 changes: 4 additions & 4 deletions docs/EN/introduction.md
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Expand Up @@ -97,7 +97,7 @@ Beyond the use of an open-source approach, which allows the source code of **AAP
With **AAPS** it is easy to keep track of things like: pump insulin levels, cannula age, sensor age, pump battery age, insulin-on-board _etc_. Many actions can be done through the **AAPS** app (priming the pump, disconnecting the pump _etc_.), instead of on the pump itself, which means the pump can stay in your (or your dependant's) pocket or belt.

#### 7) **Accessibility and affordability**
**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a world-class hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) Android phones. Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](https://androidaps.readthedocs.io/en/latest/Getting-Started/Safety-first.html#aaps-can-also-be-used-by-blind-people).
**AAPS** gives people who currently can’t afford to self-fund, or don’t have funding/insurance, access to a world-class hybrid closed looping system which is conceptually years ahead, in terms of development, of the commercial systems. You currently need to have a Nightscout account to set up **AAPS**, although the Nightscout account is not required for day-to-day running of the **AAPS** loop. Many people continue to use Nightscout for collecting their data, and for remote control. Although **AAPS** itself is free, setting up Nightscout through one of the various platforms may incur a fee (€0 - €12), depending on what level of support you want (see comparison table) and whether you want to keep using Nightscout after setup or not. **AAPS** works with a wide range of affordable (starting from approx €150) Android phones. Different versions are available for specific locations and languages, and AAPS can also be used by people who are [blind](Safety-first-aaps-can-also-be-used-by-blind-people).

#### 8) **Support**
No automated insulin delivery system is perfect. Commercial and open-source systems share many common glitches in both communications and temporary hardware failure. There is support available from community of AAPS users on Facebook, Discord and Github who designed, developed and are currently using **AAPS**, all over the world. There are also Facebook support groups and help from clinic/commercial companies for the commercial APS systems - it is worth speaking to the users, or former users of these systems to get feedback on the common glitches, the quality of the education programme and the level of ongoing support provided.
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#### Safety considerations around improving blood glucose control too fast

A rapid reduction in HbA1c and improved blood glucose control sounds appealing. However, reducing average blood glucose levels _too fast_ by starting any closed loop system can cause permanent damage, including to the eyes, and painful neuropathy that never goes away. This damage can be avoided simply by reducing levels more slowly. If you currently have an elevated HbA1c and are moving to AAPS (or any other closed loop system), please discuss this potential risk with your clinical team before starting, and agree a timeplan with them. More general information on how to reduce your glucose levels safely, including links to medical literature is given in the [safety section [here](https://androidaps.readthedocs.io/en/latest/preparing.html#safety).
A rapid reduction in HbA1c and improved blood glucose control sounds appealing. However, reducing average blood glucose levels _too fast_ by starting any closed loop system can cause permanent damage, including to the eyes, and painful neuropathy that never goes away. This damage can be avoided simply by reducing levels more slowly. If you currently have an elevated HbA1c and are moving to AAPS (or any other closed loop system), please discuss this potential risk with your clinical team before starting, and agree a timeplan with them. More general information on how to reduce your glucose levels safely, including links to medical literature is given in the [safety section [here](preparing-safety-first).

#### Medical safety around devices, consumable supplies and other medications

Use a tested, fully functioning FDA or CE approved insulin pump and CGM for an artificial pancreas loop. Hardware or software modifications to these components can cause unexpected insulin dosing, causing significant risk to the user. If you find or get offered broken, modified or self-made insulin pumps or CGM receivers, do not use these for creating an AAPS system.

Use original supplies such as inserters, cannulas and insulin containers approved by the manufacturer of your pump and CGM. Using untested or modified supplies can cause CGM inaccuracy and insulin dosing errors. Insulin is highly dangerous when misdosed - please do not play with your life by hacking your supplies.

Do not take SGLT-2 inhibitors (gliflozins) when using **AAPS** as they incalculably lower blood sugar levels. Combining this effect with a system that lowers basal rates in order to increase BG is dangerous, there is more detail about this in the main [safety section](https://androidaps.readthedocs.io/en/latest/preparing.html#safety).
Do not take SGLT-2 inhibitors (gliflozins) when using **AAPS** as they incalculably lower blood sugar levels. Combining this effect with a system that lowers basal rates in order to increase BG is dangerous, there is more detail about this in the main [safety section](preparing-safety-first).

## How can I approach discussing AAPS with my clinical team?

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e) You will be able to provide **both CGM and insulin looping/pumping information** as combined reports at clinic meetings (through Nightscout or Tidepool), either printed out or on-screen (if you bring a laptop/tablet). The streamlining of both CGM and insulin data will allow more effective use of your clinician’s time to review your reports and aid their discussions in assessing your progress.

f) If there is still strong objection from your team, hand your clinician printouts of the reference articles linked here in the text, and give them the link to the **AAPS** clinicians section: [For Clinicians – A General Introduction and Guide to **AAPS**](https://androidaps.readthedocs.io/en/latest/Resources/clinician-guide-to-AndroidAPS.html)
f) If there is still strong objection from your team, hand your clinician printouts of the reference articles linked here in the text, and give them the link to the **AAPS** clinicians section: [For Clinicians – A General Introduction and Guide to **AAPS**](Resources/clinician-guide-to-AndroidAPS.md)

#### Support for DIY looping by other clinicians

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2 changes: 2 additions & 0 deletions docs/EN/preparing.md
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An expanded index of the documentation can be found [here](https://androidaps.readthedocs.io/en/latest/index.html), and you can also use the tabs on the left of the page to navigate through the different sections.

(preparing-safety-first)=

## Safety First
“With great power comes great responsibility…”

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