Control IQ and LCHF

Long time lurker, first time poster!

I’m in the market for a new pump having used both Omnipod and Medtronic 7XX pumps in the past (sometimes as dumb pumps, sometimes with Loop/AAPS). The X2 seems to be a favorite and I wouldn’t mind an out of the box closed loop since connection failures were my biggest issue in the DIY world. For targets sleep mode is enough for me, maybe run basal more aggressive to drive it down further.

My question is about how this works with an extended bolus in the Dr. B way of eating. When I’m MDI I take R and with Loop I’d say I ate “carbs”, really FPU equivalent, and do a 6 hour absorption but it looks like with Control IQ you can only do 2 hour extended boluses. Is the algorithm good enough to deal with that? It’s not uncommon for me to eat 8-10 oz of ground beef in a single sitting which is like 6-7U of insulin for me. I feel like that would be a lot to have the pump “assume” to give due to bgl rise.

Extended boluses must be done with Control-IQ OFF.
So that is something you unfortunately lose with it turned on.

Guess I didn’t answer everything.
I have changed my settings in a few ways for the system to work well for ME.
I set my weight and total daily to the MAX. These seem like a safe change with little to no real adverse affects for me.
Then I adjusted my carb ratio. This is more dangerous as it can give you too much if you don’t pay attention to hose you bolus for a meal.
And then you can have a much more aggressive basal profile.
This too can be dangerous if your pump loses connection with your CGM for too long. It will continue to dose your basal and not lower or stop your basal when you are trending downwards.

I rarely lose connection with my CGM, so I have aggressive basals (I did this before with Basal-IQ and it helped out a LOT! ). And I changed my carb ratio dramatically! I have mine now set at 1:10 for bolusing. This was my biggest change in how Control-IQ works for me to bring down and control the later bumps in my BG.
I will often see my BG raise a little, and I just manually do a bolus and let it calculate it with my ratio. It is trying to hit 112, and my goal is 85, so it is usually pretty accurate (by the time I give a correction bolus, the system has already been ramping up my basals, so I rarely get the full bolus.)

Oh yeah, I have been on the X2 pump for a couple years now.
I was averaging my A1c between 5.6 to 5.8.
Basal-IQ helped me drop it to 5.2
And Control-IQ helped me drop it to 5.1 (even though I have ate a LOT MORE CARBS on Control-IQ!!! )
Btw, this is while using Fiasp for my insulin. I would NOT be this aggressive with Novolog.

That’s probably how I would use it as well. My target is anywhere in the 80s usually. With those settings I take it the pump is aggressive enough that it’ll see a rise from 100-120 (for example) and try to pull you down? If so that might be enough for me to experiment with a no bolus solution on protein.

I can’t use fiasp. I tried to pump it before, even split it with Humalog, but both solutions I may have well been using water.

My A1C would probably go up, I’m at 4.6 last visit, but the less I have to touch diabetes stuff the better.

I wouldn’t say the pump is aggressive on it’s own, you really need to change your settings to get it to be more aggressive. But not too much that you are going low too often.

I will say that I have enjoyed a greater freedom, greater quality of life, and a slightly better A1c. I will be honest though, I have been a ‘bad diabetic’ as far as my diet goes. I have really been torture testing the Control-IQ to see how I can make it best suit my needs.
If I was to go on a better diet, I have no doubt I could get my A1c well under 5 now. I am not sure I want to at this point it time, but I know I could.

I mostly agree with @Hammer, except you CAN do extended boluses with Control-IQ active. You’re right, though, it is limited to just 2 hours now (I think it’s 4 hours without Control-IQ active).

I, too, run it in sleep mode all the time and weigh the settings down for the lower target. I’m not strictly a low-carber, though. I usually fall under 100g/day, but I don’t set any limits other than only allowing myself one carb-rich item per meal, and we only eat twice per day and maybe a snack… but a lot of my meals just happen to fall into the LCHF category. For those meals, I’ll go ahead and do a 2-hour extended “super-bolus”, and set it to “deliver 0% now”. A super-bolus usually means to add your basal dose for the next few hours onto your bolus up front, so you benefit from a more aggressive peak, and then rely on automatic basal suspension to subtract the extra insulin later… But in this case, I’m really just being lazy in not wanting to guess how much insulin I’ll really need. I just deliver that 2 hour bolus equivalent to my basal rate (or a little more), and I can use what I need of it, and suspend basal delivery if I don’t need it. I find that Control-IQ can ramp up my basal enough to cover the rest of the really slow digesting HCHF meals just fine on its own. I don’t have to keep bolusing for them, just let Control-IQ work it’s magic.

It takes a little fine tuning to figure out how to make Control-IQ work best for you. I hated it “out of the box”, but I’m loving it now. I really don’t think you’ll regret choosing it, you’ll just have to have a little patience to learn the tweaks.

I also need to add, make sure you set up a basal profile with your “true” settings. You’ll want to revert back to it during dexcom warmups and anytime you’re having CGM issues. I go hypo otherwise.

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