It seems if I up my basal I stay around 100 but I have multiple red lines cutting off basal. Should I be concerned? If I am getting the numbers I am looking for does it matter?
It’s purely a matter of opinion. Some people (including some doctors) think it’s a sign of bad settings.
Personally, I keep my basal a little high and my correction factor spot on accurate. So long as your correction is right, it helps Control-IQ know the right time to reduce your basal. It’s a risk I’m comfortable with because I feel like I’m getting the best results and using Control-IQ to it’s full potential. I’m also not very afraid of my insulin, though, like others.
Many others will tell you that programming your pump to deliver extra insulin carries an inherent threat of hypos, especially when you don’t have accurate CGM readings, or otherwise lacking signal.
You’ll have to decide for yourself how you feel Dexcom is working for you and if you’re comfortable with and prepared for the possible hypos.
Be aware, though, that your CF has absolutely no influence over full suspensions at all. That is purely based on where your BG is projected to be in 30 minutes. Insulin doesn’t resume until you’re predicted to be out of the hypo, which can sometimes be a very long time given how slow Dexcom is to show changes in trajectory. You might be shooting yourself in the foot if you’re getting rebound highs after the suspension.
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So far not getting rebound highs so I am happy. CF is pretty much spot on.
If you are seeing roller coasters of rising bg and stopped deliveries this is a result of the CF being too aggressive. There is some misinformation posted here about the CF having no impact on the drop. In CIQ the setting of the CF in your profile basal rates has a direct impact on the aggressiveness of the reduction or cutting off of the basal. Moreover, if the basal is not on the mark and the CF is too aggressive the action and the bg will roll up and down, like a roller coaster. If you are seeing that basal testing would be an excellent way to address changes along with reducing the CF to minimize the impact on the basal shut off. This is even more impactful in sleep mode when only basa rates are being adjusted.
There was no misinformation in what I said, because I didn’t say this. You misinterpreted what I said.
What I said was:
FULL SUSPENSIONS
This is true. CF is not a factor in the pump determining when to fully suspend insulin, nor when to resume insulin. These are solely dependent on Dexcom’s predictions of where you’ll be 30 minutes in the future… Which I feel are too slow and could pose pitfalls, like rebound highs. An accurate CF is what helps the system curtail insulin to prevent the suspension in the first place, but it is only in play when you’re predicted to be above the hypo limit (70 or 80 mg/dl depending on activity set).
I agree with the rest of your statement. It’s just not contrary to what I already said.
I’m a massive proponent of how critical CF is to Control-IQ behavior in general. I’ve long since spoken out against the trend of “improving” Control-IQ with an artificially aggressive CF, because it does undermine the safety mechanisms of the system and increases glycemic variability. With an accurate CF, the programmed basal rate is mostly about determining how much insulin is available, not how much insulin is actually delivered.
The big possible negative running an inflated basal rate poses (besides the obvious hypos), is that it hides insulin from the IOB calculation, so you likely have a little bit more on board than the system knows. Having a SLIGHTLY inflated basal uses this to your advantage if you want to hover just under the 110 target, because it can’t reduce insulin it doesn’t know about. But if your basal rate is set TOO high, it can’t know to reduce basal enough to avoid the hypos because you’ve hidden insulin from it. It’s about walking the line to find the balance you safely desire.
I personally don’t give a darn how often Control-IQ reduces or suspends my insulin, so long as I’m pleased with the results. Given my awful carb-counting skills and my massive fluctuations in daily insulin needs, I’m happy to make the extra insulin available and let Control-IQ withhold whatever I don’t need.
The exact converse is true of basal rates that are too low, also. Since IOB is all insulin given that it’s greater than your programmed basal rate, IOB will read artificially high if the programmed basal is low.
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Fact about CIQ that is often misunderstood, the CF is used to adjust the basal rate in CIQ, up and down, and the duration.