Nightscout is intended to be used as part of a data management system. The system provides for a “glanceable” secondary display of the information originating from the Dexcom CGM. A website allows the display to be presented on any device which can display websites to duplicate the display of the Dexcom.
The best way to get an idea of how people use Nightscout is to peruse the public testimonials of use, or the Facebook group.
The website URL is typically shared with caregivers and interested parties. This allows multiple people to monitor a Dexcom user’s glucose levels from any Internet connection. Multiple redundant displays eliminates transcription error and raises the fidelity of communicating current therapy status.
Displays are duplicated in multiple redundant locations. This alleviates people from needing to physically locate and attend to the receiver. For example, in scenarios where no therapeutic action is required, but the glucose levels must be considered, the glanceable display eliminates interruptions to existing activities. The lowered burden enables people to be more persistently aware, and therefore respond to scenarios with treatment with greater ease and fidelity.
The Nightscout project relies on commodity components, as well as the excellent work from the folks at Dexcom. The android software interacting with the Dexcom receiver attempts to faithfully transmit data from the receiver to a configured storage/data management service hosted on the Internet. The android software is agnostic of the data management service, and can be configured to work with several different data management service providers. While Dexcom has not sanctioned or approved the data management functions performed by Nightscout, the software has been designed to behave in the way that Dexcom expects all data management systems to behave. The data management protocol was obtained through analysis of Dexcom’s own data management software. An open analysis of the source code listings and comparisons of behavior reveals that the behavior of the Dexcom receiver is unaffected when this system is in use, and matches the intended behavior of Dexcom’s own data management software. The use or non-use of Nightscout has no observable difference in the Dexcom equipment or system, either while Dexcom is in use or after. Eg, we believe that Nightscout has no effect on Dexcom’s performance, quality, or safety. Dexcom became an FDA approved device in 2012 and the accuracy of the device is well tested by thousands of patients. Providing connectivity to manage communication of the Dexcom’s readings makes no changes to the accuracy. Nightscout does not modify the blood glucose readings and thus maintains the original data quality.
When Nightscout is in use, the community recommends that users maintain their normal therapy. Nightscout should not alter therapy plans or decisions. Many of the community members recommend falling back to baby monitors, phone, SMS text message, self monitored finger-sticks, and physically checking the Dexcom receiver as tools to augment therapy, even while Nightscout is in use. The guiding philosophy behind this advice is that technology is a tool for managing therapy; that people administer therapy, not technology. Nightscout is another tool using commonly available technology, like baby-monitors, to bring diabetes therapy, specifically communicating current status of therapy, more in line with the way the users of these tools feel is acceptable.
Nightscout is useful any time remote near-real-time monitoring of Dexcom readings are desirable. People with diabetes find it useful to keep mindfulness of glucose levels while biking or other activities requiring both hands. People with diabetes, or PWD find it useful to communicate fidelity of therapy, as well as find support from their teams of caregivers.
Due to the ease of use, parents have been able to co-ordinate with school Nurse to prevent or treat injuries which are otherwise common. In some cases, use of Nightscout has helped gain insight into how common these injuries are, and we believe that the community aggregation tool can be used to report these injuries to the FDA for increased oversight of Dexcom and Medtronic devices in the marketplace. The community has also received reports of some parents using Nightscout to co-ordinate sleep-overs or camp visits, and in some cases walks with Grandpa, many for the first time, that would not other wise happen. They all cite Nightscout’s remote telemetry in liberating these activities, in some cases with pictures indicating injuries staved off or critical rescue care co-ordinated.
Adult users have cited Nightscout in increasing discretion. A common complaint among users of type 1 diabetes medical equipment is that the mandated use of the equipment combined with the time it takes to use the equipment often presents the unknowing public with a rude experience. It often appears that a PWD is ignoring someone by favoring a phone or pager or just producing rude beeps. When Nightscout is in use, the requirement to touch one of these medical devices disappears, which allows incorporating mindfulness more often and in a variety of different ways into the every day work flow. As a result, fewer interruptions from physically touching the medical device increases discretion because social disruptions are also reduced.
An uploader device is an Android smartphone capable of “USB OTG” capability. These are commonly available. WIFI only versions, known as “android mini-computers” or and “Android TV box” are also commonly available. The prices vary widely from vendor to vendor, and depending on the cell network carrier subsidies.
Without any help, the DIY version requires downloading the source code from the Internet. Google’s Android software development kit is required to configure and compile the source listings from the git repository. This process requires that users know, or learn how to, prepare their device for debugging, go through basic debugging steps in order to configure, compile, and deploy the software as binary android package, and then install and run the software on their own smartphone.