Blog for parents of kids with diabetes who fancy tinkering with Technology

As soon as I got home from the hospital, I started looking online for solutions that could help me to control my daughter glucose measurements and capture the data that the Free Style Libre 2 sensor sent to my mobile. This would allow me to have access to continuous readings and not have to swipe the phone on the sensor using the NFC reader every time I wanted to know how my daughter was.

What we are going to see in this article?

• The Nightscout Project
• Nightscout technology
• Yes, but … How much does it cost?
• Create Nightscout with ns.10BE.de
• Nightscout Web Configuration
• Conclusions

The Nightscout Project

Searching and searching, I stumbled upon The Nightscout Project «We are not waiting» and could see a glimpse into the darkness. I couldn’t believe what I was seeing! There was a large community of diabetics who had come together in 2014 to create an Open Source social movement that gained access to glucose meter data and was able to achieve continuous monitoring. They wanted to solve the problem that many of us still have today when we want to access our children’s glucose monitoring data when they are at school or at night when they are sleeping.

To achieve this, a software engineer, John Costik developed a software to transfer data from glucose measurement sensors to the cloud and shared it on Twitter. My dream come true! This application allowed John to read the continuous readings of the Dexcom G4 sensor of his 4-year-old son Evan diagnosed with type 1 diabetes, upload the readings to a spreadsheet hosted in the cloud and be able to see the data on the web, on his Android mobile and even on his Pebble watch. You can read his story  in this article that tells it (or in this one from the New York Times).  I hope you enjoy this story as much as I did because I saw myself recognized!

“I wanted our lives to be simple,” Mr. Costik said, “and I wanted Evan to live a long time, and diabetes to be a nuisance, not a huge struggle.”

A Do-It-Yourself Revolution in Diabetes Care. The New York Times. Fe. 22, 2016

And for those who wanted to investigate a little more in the story of John Costik, I leave you below a small video from 2018 that tells his story. I hope you like it!

Nightscout technology

Nightscout’s technology is based on the fact that there is an additional element to the sensor (which can be a hardware receiver or an application on the mobile) that connects to it and captures glucose measurements and sends them to an Internet website, where any other device can connect and follow the readings.

Esto puede parecer muy simple a primera vista, pero en realidad no lo es tanto. Pues tanto el hecho de tener que configurar el receptor, como los servicios en Cloud donde se almacena la información, no es nada trivial para «torpes» como yo. Por eso he querido escribir este tutorial para contaros cómo he configurado yo el sistema. Seguro que habrá otros métodos mejores, más efectivos o incluso más baratos, pero yo quería explicaros cómo lo he conseguido yo y cómo me ha funcionado (¡que ya es todo un orgullo para mí!).

Yes, but … How much does it cost?

Many of you will wonder, will it have a cost? Well, the truth is that there are several ways to configure Nightscout to be free, using Heroku to host your particular Nightscout website and MongoDB as a database (just till November Y22 due to recent announcement of Heroku not to be free). But I sincerely believe that the process is quite complex and I have not managed to make it work easily. If you are interested in following this process, you can find the instructions to configure it in this link: Classic DIY Installation.

The truth is that I did not want to complicate too much and that is why I have chosen to use ns.10BE.de which is a fully managed service and therefore you do not have to worry about it. This service was created in 2017 and allows you to create your Nightscout website with little effort and above all without having to be aware of updates, maintenance, database space and CPU sizing. I think all this is well worth the cost, which is € 4.99 / month (July Y22). Additionally, I especially appreciate that it is hosted in Germany / Finland, as I believe that it is a guarantee that the data will be treated confidentially thanks to European legislation (GDPR) and that it will be safer against cyberattacks. There are other alternatives, such as T1Pal Hosting, but they are placed in North American and, apart from having a higher cost of $ 11.99 / month, they do not offer me as many guarantees regarding data protection regulation.

Create Nightscout with ns.10BE.de

The steps to create our Nightscout website where we can send the data of our glucose sensor continuously are the following:

Registration

First of all, you need to create a free account through the following link.

A tip, as the page is in German, if you go down completely and click on the English flag, you can see the page in English (it is easier to understand for me than German!)

Once you have registered, you will have your username and password for this website. You will have to validate the username and password by accepting the invitation that has arrived at your email.

As soon as you confirm the email address, you will receive an email with your username and password to the email inbox, so that you can authenticate yourself on the ns.10be.de website.

Create an instance for the server

Once you have authenticated, you can access the Server-Management/Profile screen which is where we are going to configure the Nightscout service in ns.10be.de.

In the top menu, in the Server tab, click on the menu option «+Create Server» and fill in the «Name» and «Api-password» fields. This name will be part of the link to your Nightscout website, so choose it well! Also write down the Api-password because you will use it later to authorize access to the server. The rest of the options I have left with their default values. It is important that you select here the values for hypo and hyperglycemia alarms, because after they cannot be easily modified in Nightscout. Once you have filled in the fields, click on the «Save Server» button and the server will begin to be created, which after a few minutes will become operational.

If you have followed these steps, you will have created your first Nightscout server on the web to be able to upload all the information of the readings of your sensor to the Cloud and then be able to share this information. To access the Web page on this example server that I created you would have to access this address: https://prueba.10be.de:6392 which is located where it indicates “Server-URL”.

Create the pay-per-instance subscription

In order for your server to be accessible from the Internet, you must complete the payment on the website, selecting from the Payments menu and then selecting the option «+Add Payment +». Once there you have to fill in the payment data and register a payment to create the server. For each paid subscription you can create a server.

Once we have created the server and registered a paid subscription, if we click on the menu in “Servers” and select «Show Servers», we can see the «Global Status» page of our active instance of the Nightscout web server. In the example below you see that I have created the server, but I have not yet registered the payment of that instance, but it is necessary to do so.

Access to the Nightscout website

Next we will see that we can directly access the Nightscout website that we have created through the link: https://prueba.10be.de:6392 and voila!. We have created our personal Nightscout website!

Nightscout Web Configuration

Once we enter the Nightscout website, first, it will ask us to create the user’s profile (Profile Editor).

In this section you can configure the basic parameters that we want our system to consider. In my case, I have left them as they were proposed.

Next, it is necessary to authenticate to the Web by clicking on «Authenticate» and entering the API that we have selected when creating the instance, in my case «contrasenaAPI».

At this point we will have authorized the administrator user and the user will appear as authorized. We can close the Profile Editor by clicking on the «X» in the upper right corner next to «Values loaded».

Once we have done that, we will go to the home screen of our Nightscout website, which, as we are not yet sending you information from our sensor, will appear empty, but ready to receive the data.

We have finally created our Nightscout website, which is ready so that we can start loading information from our sensor. At the top left we can access the configuration menu by clicking on the three horizontal lines. In this menu we can configure the entire web.

You can configure the language, the units of measurement (recommended mg / dL), activate and deactivate the alarms (which by the way have had to configure the limits of hypo and hyperglycemia in the ns.10be.de server) and also activate and deactivate the different plugins that Nightscout has, which will allow us to later make predictions of readings, incorporate the age of the sensors, enter carbohydrate or insulin data, etc.

Conclusions

Well. So far, so good! This article has come that I have called «How to configure Nightscout for dummies (like me)». The truth is that the process is not very difficult, but if you have never done it before, it is not obvious.

In the following article I will explain how we can send the glucose measurements of our sensor to our mobile terminal and from there to Nightscout and thus start continuously feeding the database we have created.

To do this we will have to use some of the methods I described in the article «How to make your Free Style Libre 2 a Continuous Glucose Meter» (Spanish) that will be worth to capture the measurements that the sensor is sending by Bluetooth continuously to the LibreLink application of our mobile terminal and send them directly to our Nightscout website.

But I will not reveal in this article the secret of how to achieve it! I’ll wait for you in the next article where I will explain how to do it through software, with Diabox Apps and the Abbott Librelink App itself patched. Which are the simplest and lowest cost methods to achieve this.

I hope this post has been useful!

Regards,

Daniel