Closed loop and Medicare

I think Omnipod is not considered DME, except for the controller. Pods treated as pharmacy, but may be different based on plans.

@MM1, true. But @lainiep is also using Dexcom, which Medicare covers as DME. Their doctor is also pushing for a closed loop. So here is their chance to change to either a Tandem x2 with Control IQ, which I would recommend, or a MDT. I did not think this was an Omnipod/Medicare question.

There is not currently an Omnipod closed loop system and FDA is slow right now, so I don’t know when we might expect it out. One is coming.

I am also burned out.
I do NOT recommend any changes during periods of burnout.
It just won’t do any good. It too much work to change tech.
Its always emotionally exhausting to change tech.

If you want to play with new devices/tech, wait until you are interested in diabetes again.

I’d like to hear from the t:slim users, but I don’t think that there is any guarantee that closed loop systems are less work - I think of that as just marketing. Although, the crappier your a1c, the more likely you are to benefit from one. It might be less work if you naturally run an a1c = 8 or above.

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I definitely think Control-IQ equals less work! But, it’s by choice and extra effort in the beginning. It took me nearly a month to get my optimum settings worked out, but once they are, it’s like Ron Popeil is living in my pump. “Set it and forget it!” (Did I just date myself???)

I don’t bother counting carbs or stressing over every nibble anymore. Control-Iq can literally smooth over all the bumps. I’ve got my basal rates set intentionally high and my correction factor set low, and I stay in sleep mode nearly all the time. (I just learned @Laddie 's reference to “sleeping beauties” love it!) These are settings that make the system conform best to my needs. It opens the availability of insulin to the system, so it can use what it needs to keep me in a happy range. The reduced correction factor also improves it’s ability to prevent lows. The combined effect is that I can just generally throw insulin at food, stress much less about everything, and still obtain the best control of my life.

Some would find my behavior risky, but I don’t. I took way more risks using the R/NPH regiment for 28 years with it’s wild swings, and still slept through the night without any tech monitoring me. If the lows didn’t get me then, I’m sure as heck not afraid of them now with so many other safety measures in place.

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Ron WHO???..HaHaHaHa…HaHaHaHa.

OK I have composed myself now…OOPS…Sorry !

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@Robyn_H, please clarify. Are you saying that your correction factor number is set higher for less effect or lower for greater effect? This always confuses me. After a year, I am still hassling with CIQ to just maintain my previous A1c. I would love it to be less work.

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Actual lower number. My “true” correction factor should be 1:46, but I have it set to 1:40 or 1:42 in most segments. Small changes here make a big difference. You can see, it’s not a big enough change to really throw off the bolus calculator. (Not that I use it anymore, but I know most do).

Since Control-IQ works in both directions we can redefine what the correction factor is. It’s going to bring you back to target eventually, no matter what this number is, it’s exactly like trying to correct yourself with an extended bolus, though. You’re only getting a fraction of the correction every five (or 6?) minutes. It should now be thought of as how fast you want correction automations to work. The higher the correction factor, the slower the correction and the flatter your basal trend. Too high, and it’s like flat-lining your basal rate. It’s crippled for both correcting highs and lows. The lower the number, the steeper the basal changes happen. The lower the number, the faster you’ll recover from lows and more likely to avoid them in the first place, AND the faster you’ll bring down an elevated BG via basal changes alone.

So why not just set your correction factor at 1:1? Or some other ridiculously low number? That sounds like a good thing… But no, if you go too low, you actually get over-corrections on both ends. If you’re looking at your CGM stats, your GVI will go up. It will withhold too much insulin for a low, and you’ll shoot back up high, then it will deliver too much correction insulin and you’ll overshoot the low threshold before it can turn it around again… And the sharp up and down cycle repeats.

For those that understand wave dynamics, we’re talking a basic sine wave:

  1. Reduced numerical correction factor (the numerical value) = decreased wavelength and increased amplitude.
  2. Increased correction factor (the numerical value) = increased wavelength and decreased amplitude.
  3. The axis of your wave (mid-point, baseline, node) is established by your basal rate. If your wave is fluctuating nicely but your BG is staying too high, increase your basal. If it’s fluctuating nicely but your staying too too low, decrease your basal.

Wave

Sorry @lainiep . I know this is a lot of information, and may seem overwhelming. But once you get the settings dialed in where you want them, it does equal a much easier solution going forward from there.

Per the ref quoted below from the link below, another common term for “correction factor” is “Insulin sensitivity factor” or ISF.

Your ISF is the amount 1 unit of insulin will decrease your Blood Glucose. In the United States, this is measured in mg/dL (milligrams per decilitre). The number will look differently in other countries where BG is measured in mmol/L (millimoles per liter).

A pump uses the ISF (or CF) to determine how much insulin to bolus to correct a high BG. You divide the amount you want your BG to decrease by the ISF to get the amount of insulin for the bolus. Because you are dividing by the ISF, a smaller ISF results in a larger bolus.

@Robin_H
Thanks for such a complete response. I had already adjusted my Correction Factor down to make it more aggressive. Now I scooched my food time basals up a bit to counterbalance. I will see how it works. I am running Sleep Mode 24/7 and my nighttime line is beautifully horizontal. I am not looking to lower my A1c. But it would be lovely if my management with CIQ were less work. I do hope this puts me in the right direction. Thanks!

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I am an insulin dependent T2 on Medicare and just switched from a Medtronics 670 to a t:slim X2 with Dexcom G6. Medicare pays for the insulin and pump supplies. They did not pay for the Medtronics CGM sensors, but they do pay for the G6 sensors and transmitter. I switched because Medtronics next generation isn’t available yet and I saved money because the G6 supplies are paid for.

IMO, closed loop is the way to go. It does take some fiddling to get the parameters set correctly but there are resources available to help.

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I don’t understand the basic sine wave, but I do understand that readjusting my correction factor might help me avoid those insane highs and lows I am currently getting. I do not have the privilege of consulting an Endo and my PCP does not understand the insulin pumps at all. I used the Tslim for 5 years prior to the X2 CIQ. I find the X2 to be a lot more than I understand at present and overwhelming at times. I almost felt like giving up on the pump completely.

But I generally do not give up easily. I am grateful for the information shared in this post that also helps other people, like me, who might not understand how to make something happen on the pump.

I am not interested in having a low A1C but I am interested in understanding how to make my day to day life a little bit less stressful.

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I believe the key to understanding CIQ is uploading the data to t:connect (or Tidepool) and looking at the graphs. I also like the Android app better than the t:slim x2 display because it shows the micro bolus data.

My PCP also doesn’t understand pumps but they did submit (and renew) the paperwork necessary for me to consult with the local hospital’s diabetes clinic. I see them every 90 days to keep Medicare happy.

Tandem employs trainers for the pump who are also available after training to assist with adjustments to settings. I email questions and get an answer usually within at most, 1-2 business days.

I want Ron P living in my pump! I see the CDE tomorrow. No clue what Control IQ is but I like the sound of it.

So, medicare covers at least part of the closed loop cost?

I’d love to stay with my wireless oPod, but closed loop does sound worth exploring, other than the learning curve aspect. Then again, after 17 years on insulin, I seem to be experiencing less control than ever. Need to make change of wine sort.

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Thanks. I need a much easier solution. Wondering where Medicare stands on coverage, though.

Thanks, Willow. I’m wondering about Medicare for closed loop.

That was a very detailed explanation for trouble-shooting, but it’s really not that complicated. The whole point of these automated systems is to simplify things to make greater control available to everyone. Your doctor will start you with recommended settings, and they should understand the troubleshooting steps. My explanation was for the Type-A personalities, like myself, who aren’t willing or patient enough to depend on their medical team for adjustments.

Sorry, no insight on the Medicare part as I am still on private insurance company.
But I am using the Tandem Control IQ system. Each and everyone has a different experience with whatever treatment plan you use. I have tried @Robyn_H and go aggressive on correction so I don’t have to do a second bolus after the pump does its first correction. So I dropped down and spent so much time in the very low category that I had to just go back to the standard protocol that is recommended. So my correction is back to 1:100 and lows have leveled out. I have found for me doing everything the company recommended has worked perfectly for me. Weight is correct, correction factor is correct, use sleep mode when sleeping and exercise mode if lower at start of walk. And I will say, for the first time in my 50 years, I don’t think about my diabetes all day long. It has been so freeing to not think so much about my diabetes. I can really go all day and never pull my pump out. No testing, no calibrating, just change the infusion set every three days. Very sweet.
You might be one of those people that might need to tweak the system to get the most out of it. You might be like me and everything works like it should. Good luck with whichever way you go.

Medicare pays for my Tandem t:slim x2 w/Control-IQ, my pump supplies, my insulin, my Dexcom G6, and my CGM supplies (transmitter, sensors).

With my Medtronic 670G, Medicare paid for the 670G, my pump supplies, and my insulin. They did NOT pay for the CGM sensors.

Both of these options are considered “closed loop” so, @lainiep, the actual answer to your question is “it depends”. Medicare will add new options as time goes on. They have requirements that the manufacturers have to meet and when they do, Medicare will cover the costs.

I should add that Medicare paid for BG test strips for 5-6 tests per day with the 670G but that number has been lowered with the Dexcom G6 to 1-2 tests per day.