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If you use both an insulin pump and CGM, do you currently use any of the following automated insulin delivery (also known as “predictive low glucose suspend” or “hybrid closed loop”) algorithms to help keep your glucose in-range?
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No pump
I’ve been using Control-IQ but I’m not happy with the level of control in my results. Why not me choose a target BG by time of day? And I so wish I could set insulin duration, 5 hours does NOT work for me.
I’m on tandem ctrl-IQ as well. For almost four years now. I, too, am dissatisfied with a number of things about the pump and am getting the new medtronic 780G with the new guardian 4 cgm, which gets good reviews (especially in relation to the older generations of guardian cgm).
Whereas I just had my first A1c after starting on Tandem C-IQ 4 months ago, and it was 5.7, 98% TIR, only the second sub-6.0 I’ve had in 40 years with T1. I tried the Medtronic 670G years ago and the experience left me pretty burned on the whole AID concept, not least b/c of the locked-in target and other settings. The whole thing was too HAL-9000 for me (“I’m sorry Dave, I can’t let you do that.”) Admittedly that was the older pump but I think their black-box design philosophy still obtains. I was leery of C-IQ for that reason but it actually seems to afford a lot more control over things and feels more like an assistant than a dictator to me.
I totally sympathize with where you’re coming from but I think the kind of user-oriented flexibility you’re looking for is only available via the open-source AID route. I did look pretty hard at Loop / OpenAPS but getting a pump that was compatible and doing all the DIY setup involved was more effort than I wanted to put into it.
More interoperability for ALL these systems would be a great boon to the T1 user community, but alas that’s not what the market forces dictate to commercial manufacturers.
Yea, I’m not happy with it either. I want more options, but not sure if they would work either.
I have answered Loop / OpenAPS / AndroidAPS as it is probably the closest of the options but the system is not self-built. I use the CamAPS FX /YpsoPump/Dexcom G6 set up and it works extremeny well
I’m on the Omnipod 5 but mostly I only use it for my basal insulin as I now use Afrezza for my meals.
How do you like using the Afrezza? Is it easier and accurate?
My son, age eleven, has been on the Tslim with basal IQ for just over four years. We are awaiting insurance coverage to move to the ILet.
I am trying to reply to someone who asked how I adjusted BG targets using the Tandem CIQ. I don’t.
But I am happy to share what I do, with the caveat that I am not a doctor. I am a retired engineer trained in process control so I approach diabetes control a bit differently than most docs.
Let’s start with a mindset shift that my seem simple, but it is huge in terms of adapting to any AID system. For ever how many years you have been on a pump, you have been adjusting targets, basal rates , and corrections to stay in control. But with an AID system, you should keep in mind that now there is a process going on behind the curtains that automatically makes many of those changes for you. The adjustments you now make to the pump settings change HOW the pump algorithm responds to your BG. Here are the fundamentals that work for me, and have produced a year of 5.8 A1C’s.
Minimize the changes in basal rate that you program into the pump because on the Tandem, the algorithm resets with each basal change. I use one rate for night and one rate for day. Period.
I put it in sleep mode for 6 pm to 8 am. That sets the target at 110. Check at bedtime to see if any correction is needed, since autobolus does not work in sleep mode. My logic is that IF I can keep my BG at 110 for half the day then the good A1C will follow.
This next one may seem counterintuitive to you but I will try to explain. The pump control is somewhat one sided in that the pump can up insulin rates to reduce you to a target, but if you are close to the target it will leave you a bit high to prevent unintended lows. Keeping that in mind, I studied my night time basal rates for a month, and then I set the night basal rate slightly higher than what I needed. Why? Because i want the pump to reduce my insulin rate to keep my at the bottom of the target range. By doing this I wake up every morning between 95 and 105. Without the trickery on the basal, I would wake up 110 to 125. 20 pts difference in BG over 12 hours is impactful on A1C. I do not have hypoglycemic lows using this approach at night.
Last technique. I am very active physically and I have found the Exercise mode does not work for me. The two reasons it doesn’t work is it doesn’t prevent me from going low in the first 30 min of activity and it always results in a big hyperglycemic spike after I finish. The big high comes from the fact the pump has been turning down the basal all the time I have been exercising so that none is on board when I finish. My solution, leave the pump alone, preload with about wi gram of fast acting carbs just as a I start a run or ride.
That was probably more of an answer than you wanted.
Richard Entrekin — That was an excellent write up no matter what was wanted or intended. Bravo. 🦖
Your strategy is very interesting as it is the opposite of mine. I have way too many lows and the pump, although it suspends, still sends me low. So I keep my “activity mode” on all the time to keep pumps goal up. I also set my goal at 120.
My A1c runs 7.1, which is low enough but not too low. I can’t say I’m ok with the SD of 45-50.
Very interesting indeed. Do you keep the correction factor, and the carb ratio the same all through as well? Has this affected your standard deviation, and the CV% as well? I assume you don’t go to bed at 6pm, so if you need a correction before going to bed, do you turn off the sleep mode? Juat a few questions!
Lena,
I keep the carb ratio and correction factor the same.
And I always check in at bedtime. If a correction dose is needed, I simply use the Bolus calculator and manually deliver. I do not take it out of sleep mode to correct at bedtime.
I’ve been using the Control IQ app since June, 2020. If compared to the previous 60+ years of MDI it has made a very positive difference. I agree with others who would prefer to set lower rates and personalize the active insulin time. I was told that both of those issues were being addressed with the next update.
The latest DIY version that seems to be getting a great deal of attention is iAPS. It’s been developed from the former FAX/oref1 algorithm for iPhone and shows a lot of promise. It seems many manufacturer’s are trying to monopolize their devices and software, eschewing the Tidepool AID and DIY systems, and focusing on “blackbox” approaches that hide the algorithm and ability of users to personalize or impact it, despite the YDMV nature of T1 and T2. Hopefully they’ll learn to incorporate the user and their particulars in the process as no “one size fits all” is going to work except a biologic replacement of the failing pancreas and it’s cells!
I love Control IQ, it solved the one thing that I could not do with over 50 years of T1D experience; land my BG at or near 110 each morning. It makes the rest of the day ever so much easier.
None of the off-the-shelf algorithms work for my needs (non-linear response). I want to try looping, but sourcing all the parts is complicated. So for now, I do it all myself with a CGM, pump and alerts.
I use Tandem IQ but I keep the sleep mode on the full 24 hours so it really doesn’t give me any automatic boluses. I still marked “Tandem IQ” as I did originally use the sleep schedule on only when sleeping.