People living with Type 1 Diabetes (T1D) lose the ability to produce insulin naturally. To compensate, they inject synthetic insulin. One common way to inject insulin is through automated insulin delivery systems, which use sensors to monitor their metabolic state and an insulin pump device to adjust insulin to adapt. In this paper, we present the Metabolic Operating System, a new automated insulin delivery system that we designed from the ground up using security first principles. From an architecture perspective, we apply separation principles to simplify the core system and isolate non-critical functionality from the core closed-loop algorithm. From an algorithmic perspective, we evaluate trends in insulin technology and formulate a simple, but effective, algorithm given the state-of-the-art. From a safety perspective, we build in multiple layers of redundancy to ensure that the person using our system remains safe. Fundamentally, this paper is a paper on real-world experiences building and running an automated insulin delivery system. We report on the design iterations we make based on experiences working with one individual using our system. Our evaluation shows that an automated insulin delivery system built from the ground up using security first principles can still help manage T1D effectively. Our source code is open source and available on GitHub (link omitted).

翻译：1型糖尿病（T1D）患者丧失了自然分泌胰岛素的能力。为弥补这一缺失，他们需要注射合成胰岛素。常见的胰岛素注射方式是通过自动化胰岛素输注系统，该系统利用传感器监测患者的代谢状态，并通过胰岛素泵装置动态调节胰岛素输注量。本文提出了一种全新的自动化胰岛素输注系统——代谢操作系统（Metabolic Operating System），该系统从底层架构即采用安全优先原则进行设计。在架构层面，我们应用分离原则简化核心系统，将非关键功能与核心闭环算法解耦；在算法层面，我们评估胰岛素技术的发展趋势，基于当前技术前沿设计了一个简洁而高效的算法；在安全性层面，我们构建了多层冗余机制，确保系统使用者的绝对安全。本质上，本文是对构建与运行自动化胰岛素输注系统的真实实践经验的总结。我们基于与一位系统使用者的协作经验，报告了设计迭代过程。评估结果表明，采用安全优先原则从零构建的自动化胰岛素输注系统，仍能有效辅助管理1型糖尿病。本系统源代码已在GitHub上开源（链接略）。