The GNL AID Optimiser · The Glucose Never Lies®
An educational frame for the conversation in clinic.
You have been on the pump long enough to feel where it works hard and where it leaves you to it. The 3am rise that the algorithm clips before you wake. The post-meal spike that holds longer than the food alone explains. The 90-minute walk after dinner where stacked insulin-on-board does what no setting can quietly fix. Somewhere between the system’s automation and the day you are actually living, there is a question you have not been able to ask out loud: could these settings be working harder, or are they already working harder than my context tolerates?
Clinicians sit on the other side of the same conversation. The young person who came back to clinic with a tighter time-in-range than three months ago, and a hypo log that has crept up by a number you can see and a number you cannot. The parent who has read the manual front to back. The adult on a manual MDI regimen asking which of the four hybrid closed-loop systems would suit their job, their training week, their nights. None of these conversations resolve from a single algorithm-strength dial; they resolve from the trade-off between what the system can do automatically and what the person can see while it is doing it.
Researchers reading this page are orienting against the substrate beneath the synthesis. The AID Optimiser is built on the IOB family of papers (Pemberton 2023 on CGM accuracy and IOB visibility; Adolfsson 2022, the ISPAD exercise chapter; Moser and Pemberton 2024 on hybrid closed-loop safety and efficacy) plus the under-7 effectiveness anchor in Bassi 2025. The synthesis on top of that substrate is GNL’s; the substrate is published.
The Optimiser is the educational frame for that conversation, not the answer to it.
For people on a pump and the people supporting them
Read this as the map, not the route.
The AID Optimiser is an educational tool that walks through how the settings on a hybrid closed-loop pump (CamAPS FX, MiniMed 780G, Tandem Control-IQ, Tandem Mobi (CIQ+), Insulet Omnipod 5) might be adjusted at five different strength levels. It is not a medical device, it does not give you a personal dose, and it is not a recommendation for your settings. It shows what an experienced diabetes professional would consider when discussing settings on a pump like yours. Any actual settings change is a conversation with your diabetes care team. The figures shown are population-average estimates, not personalised; your own correction factor and insulin-to-carb ratio, set with your team, are what apply to you.
For HCPs, researchers, and industry partners
The framing block we carry on every AID Optimiser surface.
This block sits above any Optimiser inputs and above any Optimiser results. It is the relationship status with the manufacturers, the grade label on the synthesis, and the declared bias in the same paragraph. It travels verbatim; we do not soften it under optical pressure from the review record, and we do not let an editor inherit a higher grade onto the synthesis from the underlying components.
The AID Optimiser is a GNL educational tool. The five-level ladder of algorithm strength, and the key drivers and settings adjusted across each level, have been reviewed and refined with input from CamAPS, MiniMed, Tandem and Insulet global medical leads (Tandem covers both Control-IQ and Mobi (CIQ+), which run the same algorithm family). Their input has shaped which levers are exposed at each level and how they are described.
However, the levels themselves have not been validated directly against any manufacturer’s internal simulator or proprietary dataset, so this is not a manufacturer endorsement of the GNL ladder. The Optimiser remains a Grade D suggestion layer built on a Grade A and B evidence base (peer-reviewed RCTs, registry data, pharmacokinetic studies, and the GNL real-world dataset analysis: 33 structured assessments against a T1D-adjudicated continuous-data subset of approximately 1,300 individuals representing approximately 500,000 patient-days, drawn from an upstream Syntactiq Dynamics FlexCo dataset of over 10,000 individuals and 1.5 million patient-days collected 2013 to 2025).
The Optimiser is educational. It carries a deliberate, declared subjective bias toward the importance of insulin-on-board (IOB) visibility and the IOB-vs-algorithm-strength trade-off, because that trade-off is the dominant safety driver in real-world use and is under-represented in stock manufacturer guidance. Any deviation from manufacturer-recommended starting settings is a clinical decision made with the user’s diabetes care team.
The ladder
Five levels of algorithm strength, each system in scope.
The Optimiser presents five levels of algorithm strength on each of the five systems. The levels are calibrated against the manufacturer-recommended starting configuration as the entry point and step toward higher-strength settings (shorter active insulin time, lower target, higher automation of the high-glucose response) at each rung. The synthesis is GNL’s; the settings exposed at each level were reviewed and refined with input from the manufacturers’ global medical leads.
The active insulin time, target, and automation level reflect the manufacturer’s clinical position on the safe baseline for a new user. The Optimiser surfaces this configuration verbatim per system.
The IOB-visibility implication at Level 1 is that automation is doing more of the visible work; your reasoning sits closer to context (food, exercise, illness) and further from algorithm-internal stacking. Discuss any deviation from this baseline with your diabetes care team.
Active insulin time shortens by a small increment from baseline; target drops modestly where the system permits target adjustment. The IOB-visibility implication: a small increase in algorithm-internal correction work, which on shorter AIT can stack on top of a manual bolus the user gave 90 minutes ago.
The trade-off is that nights smooth out and post-meal peaks soften, with a slightly higher hypoglycaemia risk where stacked IOB meets exercise or a missed snack. Settings at this level are educational reference points; your team is the conversation.
Active insulin time shorter again; target lower where adjustable. This is the level where, in real-world data we have looked at, the IOB-vs-algorithm-strength trade-off becomes the dominant safety driver. Stock manufacturer guidance under-represents this; that is the declared bias the Optimiser carries by design.
At Level 3 the user benefits from being able to see IOB and reason about it, particularly around exercise, alcohol-context evenings, and post-prandial activity. Where a manufacturer’s position is that on-screen IOB is not a recommended decision input on their pump, that position is preserved verbatim; the IOB-visibility frame is the educational lens GNL has chosen, not a clinical override.
Active insulin time shorter still; target near manufacturer-permitted floor. The hypoglycaemia signal in real-world AID use rises non-linearly with stacked IOB on top of higher-strength settings; the trade-off is sharper time-in-range against tighter hypo margins.
Adolescents, older adults, and anyone with hypoglycaemia unawareness sit further from this level than the population average suggests. The care-team conversation matters more, not less, at this rung.
Shortest active insulin time, lowest target the manufacturer permits, highest automation of the high-glucose response. The level is surfaced as the educational ceiling of what the system can do, not as a recommendation.
Per-system manufacturer paediatric floors apply at this level regardless; see the next section. As at every level, settings changes are a clinical decision made with the user’s diabetes care team.
The five-level structure is a Grade D educational synthesis on a Grade A and B evidence base. The synthesis is GNL’s; the underlying evidence is the published hybrid closed-loop literature.
Per-system paediatric target floors
The floors apply regardless of selected level.
The Optimiser applies per-system manufacturer paediatric target floors regardless of selected level. One row carries a written manufacturer letter (MiniMed 780G, Cohen letter 28 April 2026); three rows carry working positions with a manufacturer-pending honesty banner where written confirmation has not yet been received. The page surfaces the gap rather than papering over it.
| System | Preschool 2 to 6 | Paediatric 7 to 14 | Adolescent 15 to 17 | Older-adult 65+ | Status |
|---|---|---|---|---|---|
| MiniMed 780G | 6.7 mmol/L (120 mg/dL) | 6.1 mmol/L (110 mg/dL) | 5.5 mmol/L (100 mg/dL) adjustable | 6.1 mmol/L (110 mg/dL) | Cohen letter 28 April 2026, locked |
| Tandem Control-IQ | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | Working position; written confirmation pending (Tandem fixed-target architecture) |
| Tandem Mobi (CIQ+) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | Working position; written confirmation pending (Mobi runs the Control-IQ family algorithm; lever values match t:slim Control-IQ at every level) |
| Insulet Omnipod 5 | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) | 6.1 mmol/L (110 mg/dL) UK / EU; 5.5 mmol/L (100 mg/dL) US-locale override | 6.1 mmol/L (110 mg/dL) | Working position; written confirmation pending (US-locale override excludes older-adult) |
| CamAPS FX | 5.5 mmol/L (100 mg/dL) | 5.5 mmol/L (100 mg/dL) | 5.5 mmol/L (100 mg/dL) | 5.5 mmol/L (100 mg/dL) | Working position; no CamAPS-specific paediatric target guidance has been received from the Hovorka group; honesty banner applies |
CamAPS FX is the only system with a sub-2 on-licence position (CE-marked from age 1); the Optimiser surfaces framing and a care-team referral on that band rather than a numeric output. On every other system the infant band returns: “Below age 2, the AID Optimiser is calibrated outside its evidence base. Please discuss with your paediatric diabetes care team.”
The under-7 effectiveness anchor for the framework is Bassi 2025 (Franzone D et al, Frontiers in Endocrinology 16:1590964, n=41 children under 7, 12-month single-centre Gaslini AHCL retrospective). HbA1c moved from 7.50% to 6.59% over twelve months; there were no severe hypoglycaemia events, and three DKA episodes from set occlusion as the safety signal. The effectiveness figure does not travel without the safety signal; in young children the cannula is the load-bearing failure mode and clinicians and parents need to see both numbers in the same breath.
Correction-dose framing
The Optimiser does not output a personalised insulin dose.
Where a numerical correction-insulin figure is surfaced, it is a population-average estimate at the user’s total daily dose, not the user’s dose. People have their own correction factors, set with their diabetes care team, based on their TDD, glycaemic history, age, hormonal context, exercise patterns, and other factors. The user applies their own correction factor to their current glucose and their personal target to compute their actual dose. If the user does not know their correction factor, they do not act on the figure; they speak to their team.
The five-level CF table inside the Optimiser (80/TDD to 110/TDD across the rungs) is presented as a population-average synthesis, not as the user’s correction factor. The output text reads: “These are population-average correction-factor rules used by the GNL framework at each strength level. Your pump’s current CF, set with your diabetes care team, may differ. The Optimiser is educational; do not transfer these values to your pump without discussing with your team.”
This page will not say:
- “Take X units.”
- “Your correction dose is X units.”
- “Recommended correction: X U.”
- “Correct with X units.”
- “You need X units.”
- “Adjust your dose by X units.”
- “The correction needed is X units.”
Every numerical figure carries the population-average qualifier, the TDD anchor, the personal-CF reminder, and the care-team referral. The figure may be displayed; the framing around it is what makes it educational rather than prescriptive.
Age-band routing
Six bands, runtime selection, weight is king.
The Optimiser routes age through six locked bands: infant (under 2), preschool (2 to 6), paediatric (7 to 14), adolescent (15 to 17), adult (18 to 64), older-adult (65+). The runtime band is selected by the user every session; profile date of birth is not pre-filled into the band selector even for logged-in users with a known DOB. GNL is educational and population-average, not personalised; pre-filling would imply a personalised default that the platform does not give.
Weight is king. Carb-per-kg and insulin-per-kg stay weight-driven across all bands. The age band routes the AID Optimiser specifics (per-system manufacturer paediatric floors, infant refusal on Control-IQ, Mobi, MiniMed 780G and Omnipod 5, the CamAPS-only sub-2 framing carve-out), the alcohol-explorer 18+ refusal, and the citation-anchor selection on Hypo and Hyper. The age band does not drive the dose-per-kg arithmetic; the dose-related outputs of the Optimiser remain uncapped (the 60 kg carb cap belongs to Exercise Planning and Hypo Treatment, not here).
Substrate authority
The synthesis is GNL’s. The substrate is published.
The Optimiser is built on the IOB family of papers (Pemberton 2023 on CGM accuracy and IOB visibility; Adolfsson 2022, the ISPAD exercise chapter; Moser and Pemberton 2024 on hybrid closed-loop safety and efficacy) plus the under-7 effectiveness anchor in Bassi 2025. John is co-author and section-lead on the carb-floor tables in the Adolfsson 2022 ISPAD exercise chapter; the structured-education and clinical experience that anchors the synthesis comes from the Birmingham Women’s and Children’s NHS Foundation Trust paediatric clinic, where John supports over 300 children with type 1 diabetes and their families, plus DAFNE structured-education work on the adult side.
The Optimiser sits inside the broader GNL evidence base of approximately 500,000 patient-days from approximately 1,300 people living with diabetes over more than 10 years, drawn from an upstream pool of over 10,000 individuals and 1.5 million patient-days. The substrate is the GNL Grace wiki backbone; the synthesis on top of it is graded honestly as D because no manufacturer simulator validation has been accepted into evidence.
The IOB-visibility bias in the synthesis is declared, not hidden. Where a manufacturer states that on-screen IOB is not a recommended decision input on their pump, the manufacturer’s position stands verbatim; the IOB-visibility frame is the educational lens GNL has chosen for the Optimiser, not a clinical override of any manufacturer’s algorithm position.
The GNL AID Optimiser is an educational tool, not a medical device. Grace, the substrate behind the Optimiser, is an educational tool, not a medical device. The Grade D label on the synthesis is the load-bearing fact about the tool; it is not inherited from the underlying components.
Where the explorer lives
The Optimiser explorer runs in the GNL app.
The hub page is the educational frame; the explorer itself sits inside Grace at app.theglucoseneverlies.com. Grace is free at point of use for both audiences (PWD and supporters; HCPs, researchers, and industry partners) at the registered tier. The disclaimer architecture (population-average framing, “not a medical device” attestation captured at registration, correction-dose framing, care-team referral, banned prescriptive language) is the safety gate that the audience-opened decision rests on.
Register for Grace and run the AID Optimiser explorer at your own pace.
Open the GNL app, app.theglucoseneverlies.comThe five strength levels are constructed inside the explorer per system. The Optimiser does not give a personal dose; it gives a population-average map of what an experienced diabetes professional would consider when discussing settings on a pump like yours.
Care-team route. Any actual settings change is a conversation with your diabetes care team. The Optimiser is the shared frame for that conversation, not the recommendation; the team holds your correction factor, your insulin-to-carb ratio, your hypoglycaemia history, your activity context, and your continuous glucose data.
Close
The map is here. The route is yours, with your team.
If you are reading this page as someone considering an AID system, or as someone already on one and wondering whether the settings could be working harder, the priority is the conversation with your diabetes care team about what fits your context. The Optimiser is the educational map; the choice is yours, with the team. Grace, the substrate behind this Optimiser, is an educational tool, not a medical device; nothing on this page is medical advice; clinical decisions about AID settings belong with the diabetes care team.
If you are reading this page as a clinician supporting AID users, the §1 framing block above sits verbatim at the top of the peer-clinical surface for a reason. The Optimiser is reviewed by manufacturer global medical leads; it is not endorsed by them. The Grade D label on the synthesis is the load-bearing fact about the tool; it is not inherited from the underlying components. The IOB-visibility bias is declared because real-world hypoglycaemia risk in AID users is dominated by stacked insulin-on-board on top of higher-strength settings, and stock manufacturer guidance under-represents this trade-off. The conversation in clinic about which level fits which person is the work; the Optimiser is the shared frame for that conversation.
Sponsorship and educational-grant routes for partners are at /gnl-grace/#commercial-routes. Single inbox for every commercial conversation about the Optimiser: john@theglucoseneverlies.com. No public price sheet; each engagement is scoped and priced in conversation against the substrate the work touches.
The GNL AID Optimiser is an educational tool, not a medical device. Nothing on this page is medical advice. Clinical decisions about AID settings belong with the diabetes care team. The figures shown are population-average estimates, not personalised; your own correction factor and insulin-to-carb ratio, set with your team, are what apply to you.
Single inbox for every commercial conversation about the AID Optimiser.
Educational-grant routes, sponsorship-of-explorers routes, and Grace Max bespoke routes all sit on the same intake. No public price sheet; the values filter and the win-win-or-pull-out test run on every conversation.
Start the conversation, john@theglucoseneverlies.com