Tandem T-slim with Dexcom running Control-IQ.
FIRST DAY: All over the place. Attempting to make a correction boluses because I’m too high. I might’ve under counted carbs. Then overnight frustration: waking up three times with low alarms overnight drinking orange juice and having candy bars and in my semi confused state telling the pump I was having carbs which made it bolus more and resulted in the problem coming back. The next morning I realized I’ve been an idiot. So made two changes: first reduce my nighttime basal from .59 to .55 and second, if I treat a low don’t bolus for it!.
SECOND DAY: Way better. Still giving additional boluses because maybe my insulin to carb ratio was a bit off or my correction factor perhaps was off.
THIRD DAY: Almost 100% in range! Far less work than I was used to doing multiple daily injections. The last few months I’ve given myself 10 or 12 injections a day trying to micro bolus and adjust for my ongoing insulin needs. Part of the challenge was that the lowest I could give was 1 unit. Even with all that work I was usually around 75% in range. Let’s see how long I can carry this forward.
I got a change my infusion site notification (not really worried but I have to remember all the steps) but for the moment I’m super pumped about pumping. Even though I still I’m not crazy about having this thing tethered to me 24/7.
If you’re thinking about it you should probably do it! I’ll update this as I go along.
Congrats on getting started with a pump. I think you learned valuable lessons already. Managing diabetes with insulin is a dynamic process. If something is not working, make a change and watch closely. If that change failed your intention, learn from that failure and try something else.
I’ve been following the business news about Elon Musk and his Tesla and SpaceX enterprises. His business philosophy is all about not being afraid to fail. He believes that failing fast and taking the right lesson from that failure is much better than spending long and arduous efforts to get it all right the first time out. I believe this iterative method can teach a lot if you’re paying attention and give it due thought.
The continuous glucose monitor (CGM) makes adopting this philosophy possible. You can still do this with a fingerstick meter but it takes more effort and more finger sticks than most people are willing to do.
Be aware that we tend to over-treat lows (not required and can be avoided with good discipline) and bolusing for the excess carbs can work well. If after-action analysis leads you to believe that you likely needed 10 grams of carbs to neutralize a low and you ate 25 grams then bolusing for excess 15 grams is a rational choice.
The goal here is eventually treat (whether with insulin or carbs) a dose size that does the job and nothing more. That’s easier said than done. The penalty can mean hopping on the glucose roller-coaster and wrestling with unwanted glucose variability.
Don’t be afraid to make mistakes but don’t let up with close monitoring and keeping a source of quick acting carbs handy.
I’m glad to read that you’ve already produced some good results by the third day. While failure can teach us a lot, we can learn from success as well. Just realize that exactly duplicating what you did on day three on the fourth day may not give you the same success.
This is what makes managing diabetes so challenging. It’s analogous to playing a sport where the rules can change every day. It’s like in baseball where one day the pitch strike zone is a standard size and the next day it’s twice as large and the following day it’s only half the standard size. Diabetes management isn’t always that variable, yet managing diabetes can be just like that.
Adopting a pump regimen makes you open to learning and it can teach a lot. Using a pump allowed me to learn well the concepts of insulin sensitivity, carb ratios, and basal rates.
I think that you can learn a great deal by changing up your diabetes management tactics. If you manage well using multiple daily injections (MDI) you may not choose to try a pump because you reason, “If it ain’t broke, don’t fix it!”
But commanding more tried and true diabetes management tools in your kit is better than fewer. You never know when life will impair or take away one favored method and your larger tactic kit permits you to change tools, adjust, and enjoy resilience.
Good for you for being open to trying new things! Even if you try and fail, the lessons learned will still accrue.
You managed to bring it in line in just 3 days. That’s pretty impressive. I was already a pumper for 20 years when I got my Tandem. It took me a month to get it working right.
The settings from Medtronic did not transfer over well.
I pretty much needed to do new basal testing. After that though it’s been really good keeping me in range much more consistently than anything I’ve ever tried before.
I really can’t wait for the patch pump That Tandem has in the pipeline of course I need to wait 3 years till my warranty is done. It might take taht long to get it released
Let’s see if I can get through another night without any alarms. Tonight was pizza so that made things more challenging. I have an extended bolus 50/50 but maybe 40/60 would have been better. I went low initially, then was up for a few hours. Now the auto bolus and raised infusion rate has me back “in range”. But dropping?
Uh-oh.
I’ve never really found a good way to eat pizza and Chinese food. Sometimes 2 slices of pizza takes 10 units of insulin spread over 2 hours. Sometimes 25 units won’t bring it down and I’m up all night.
Chinese food seems to have 10 billion carbs hidden in a teaspoon of food. It’s encapsulated and it just explodes into your blood stream like bomb of glucose and the wreckage takes a day to clean up.
So I pretty much gave up on both of those.
Besides I’m entertaining a low fat diet lately and it allows me more carbs with better control. So those two foods are kind of off the table anyway.
I have another thread of time in range challenge. Maybe you can post your progress there. I had 7 days run, but since then, 2.5 days is my record. In range 60-180
Tandem helped a lot: it was pretty good in-range evening and over night. Often I’m fighting for a flat line although I have previously managed pizza mostly with good luck and a series of injections — but a delayed bolus for carbs /protein gave me a decent night with only one wake-up alarm demanding an orange juice box.
Of course just when you think you’ve got it dialled in, something wonky comes up and I won’t give up easily if that (when that) happens.
How long was your extended bolus for pizza? I’ve tried out various ratios; they are reliable for a year or so, even with the same pizza, but then I have to make a change. But what doesn’t change is that I need a 6-hour extended for more than two slices of a medium pizza. For one or two slices I can just do an ordinary bolus.
Welcome to the Tandem family!
I do think it’s easier to adjust to it from MDI than a previous pump. I too came from MDI and slipped right into it fairly seamlessly. I also think the cartridge change is less frustrating coming from MDI, because it’s rather similar. You’re just stabbing a plastic receptacle instead of yourself. That was before automation, though. And of course, now that I’m adding a type 2 med to my regime, I’m on a rollercoaster of adjusting settings.
They’re trying to get more customization options approved for future Control-IQ upgrades. I really hope they bring back the longer extended bolus times. I really need 3 hours for pizza! They used to let us do 4. You still can do longer if you turn control-IQ off, if that helps you any.
You might also find that correction factor still needs tweaking. Theoretically, you should be able to over-bolus up to an amount equal to 2 hours worth of basal insulin, i.e. a “super bolus”, because Control-IQ can suspend what you don’t need from your basal delivery and that extra insulin basically gets used as basal instead of bolus. It’s the correction factor setting which tells the pump how much insulin to suspend to avoid a hypo, amongst other things. If it’s not able to adequately do that, it’s probably because that setting is off.
One last tip, you won’t need to treat lows in the way you’re accustomed to anymore, because Control-IQ is already treating them in the background. It will actually give you an alarm saying something like “Control-Iq has predicted you will drop below 70mg/dl”, that’s when you know you need to help it along… But just a little bit. You can actually use the bolus wizard to help you figure it out. If you go in and click “view calcination”, it will show you a negative value in red as a correction dose of insulin which take into account suspended basal and how much insulin you have on board. That negative value is an insulin dose, though, so you have to use your I:carb ratio too estimate how much carb you need. Example, my I:carb is 1:11 most of the day. If the “view calculation” screen shows a red “0.5” in the correction field, then I know I need half of my I:carb (11)… So I only need to eat 5.5 grams of carb.
Great tip!
Thanks.
i worked near a chinese restaurant in my younger years, and use to see them loading dollies full of honey…the cook told me most of their sauces had honey, combined with deep fried foods=hyperglycemia
You might be going to Chinese Restaurants that use a lot of carbs. Rice is pure sugar, as I am sure you know. Stay away from Mandarin dishes, obviously sweet and sour, anything with breading, and limit rice or noodles to something you can measure (with a cup or your eye). So are rice noodles and pretty much the same as Wheat noodles (although they do have some protein, depending). My fiancé is Chinese. She is a great cook, and her cooking is mostly low carb and low fat (lots of vegetables, protein, with a little fat and carbs in the sauce, but not much). This is the way she learned to cook, in China, long before she knew anyone with T1D (me). I measure 1 cup rice cooked flat to the top of a measuring cup (45 grams carbs), usually add about 25 grams carbs to this, apply my ratio, and no problem. I eat Chinese food (hers and going out) 4 times per week or more. My A1Cs are nearly always in the sixes.
Ok so you suggested taht I eat Chinese food that has none of the delicious things in it that make Chinese food so fun to eat.
Have you ever tried pizza with no crust and no cheese? Yes kinda like that.
How about unsweetened lemon aid.
If ima eat Chinese food it will be breaded with sweet sauce and fried in oil, with white rice and noodles.
Then I’ll regret it.
Well last night I was so good until I wasn’t. I didn’t quite calculate for the (thick) burger and then a smallish piece of apple pie probably had more carbs than I figured and we were having some beer while sitting by a campfire which included ONE s’more and do it goes. . .
Sugar was stubbornly high for a few hours from 11 pm to about 3 am but without me having to tell it to, the pump raised basal rate (I know that’s how it works) as well as some boluses and I was in range from then on.
I resisted the urge to pump more units of Humalog into myself to hasten things along. But should have bolused better for that dang pie! Another day, another chance to do better.
(Like golf!)
Here’s a omething you could never do with MDI:
1 - you undercounted carbs slightly (or perhaps didn’t lead the meal quite long enough) and glucose was rising.
2 - with CGM, pump recognized you were going high.
3 - pump give a bolus of 0.193 u
4 - then glucose started dropping, so pump suspends basal delivery for 20 minutes
5- resumes basal at a lower rate transiently
— blood glucose settles out exactly on target.
Never leaves range!
Hello. It’s all so frustrating. Long story short changed insurance to a Medicare advantage. Were supposed to cover all diabetes supplies. I wanted to go back to Omnipod. So everything they said was not true. Still going to get the DASH for a $47 co pay but then you hit something called a “donut hole”. Not sure what they will cost then. Have a minimed but really do not like and don’t want to upgrade. If this doesn’t work out cost-wise, plan to go way back to MDI. Then maybe consider a tandem. Oh and my Dexcom not on their formulary. Going to try the Libre 14. Dexcom drives me nuts anyway.
@Jane16 so sorry to hear about your struggles. As if just dealing with diabetes weren’t sufficient! I hope you are able to work out coverage for that you can handle your diabetes as well as you can.
In Ontario, all pump-related costs are covered by public health insurance.
NOT insulin or testing supplies, weirdly!!
Anyway, Dexcom is the only GCM I’ve ever tried, and it’s covered by private (work supported) health insurance. They also cover insulin and other drugs — including Eyelea, an injection that goes directly into your eyeball and hopefully will preserve my vision. At $3,600.00 a month!!!
Anyway, now a week into the pump and the latest challenge: wedding receptions! I tried a delayed bolus with 100 grams of carbs, thought I’d be fine but there was a plateau at around 18 mmol/L (325) which took a few hours to fix. Tandem did it with minimal input required from me, fortunately. It cranked up basal for a few hours. And sent me low at 5 am, of course.
Should have tried harder to either calculate the amount of carbs, or just keep myself to my standard evening carb of 70 gm. To my credit, I did not have any wedding cake .
And at the end of the day, I managed to just squeak into TIR of 72%. That’s now nine days over 70%. Approaching a new record for me. . .
Live and learn.
Hi MBW. Thanks for replying. Doing a lot of investigation on YouTube. Will try the freestyle Libre alone and then may get the miaomiao transmitter. It’s a one time purchase that goes over the Libre and makes it work like a true CGM. Through an app will give me readings on iPhone and Apple Watch. As for the pump I have been having pump fatigue for awhile now so not too upset to stop for awhile. Guess it’s all what you get used to. I am pretty OCD about my numbers. My TIR is set at 90%. I very rarely miss that unless my pump malfunctions. I eat less than 100 carbs a day. Usually around 50. But I would have eaten some cake lol. I’m a nurse and a needle in the eye even makes me cringe. I’m 73 and still work so all this technology gives me a headache. Thanks for letting me gripe.
Not yet 60, so still working. I’m pretty active and I eat a healthy mix of everything. We like to cook so it takes time to see how new recipes affect me. I need to have protein (which for me means eating animals) and I don’t do well if I try to go too low on carbs. I try to stick to 40 carbs am, 40 at lunch, 70 at supper. When on MDI, before pump, I Injected Humalog pre-meal at 6, 6, and 10 u with Toujeo as basal 16 u at bed time.
Overall time in range was 75% or thereabouts but every 4-5 days something would throw me off and I’d see 50-60% TIR. And nights were often hard; I’d often be trending upwards or downwards, depending on the alignment of the planets or who knows why. So that’s something that the pump helps with. My line is much flatter (excepting of course wedding reception, or another evening recently of excess of some type or other).
How variable are your basal settings throughout the day and night? Mine are very variable with 8 different settings ranging from 0.1 to 0.775.
I have a sense that there is a lot of trial and error needed to get to that level of precision, where you have 8 different basal rates!
I have three settings only: midnight to 7 am, then 7 am to 4 pm, and finally to midnight again.
Initially I was going low overnight with alarms, so I made some changes. Basal is set at 0.55 from midnight, 0.59 for the rest. CF is is 1:3.5 (or 1:61) except afternoons when it’s 3.3. (56)
Finally I:C is 1:8 except after 4 pm it’s 1:9.
I am making very small adjustments where I see myself consistently going higher than I like or lower, though. So I expect these will change. I am considering raising basal marginally in the afternoon, for example. But I want to observe how other changes i have impact the numbers.