Continuing the discussion from Tandem decision:
So a few people on the other thread asked how it was going since I made the decision and started on the Tandem, but after trying to respond there it felt like I needed a new thread. I wanted to write the review that I would have liked to encounter when I was researching this and never quite found. There are a lot of reviews out there—the pump and CIQ have been out for several years after all. But what you’re really seeking is to somehow get a sense of what it feels like to live with this thing you’re going to be wired to 24/7/365 for years. And it’s hard to get that kind of gestalt from reading about how this or that function performs, or lists of discreet pluses and minuses. So this is my attempt to get at that.
I look at it like this: a system like this is kind of an act of communication between the designers and the patient/user. For me, with the 670G—my first and rather disastrous experience with an AID pump—that communication went like this:
Dave: “Open the pod bay doors HAL!”
HAL 9000: “I’m sorry Dave. I’m afraid I can’t do that.”
And like this:
“No 9000 computer has ever made a mistake or distorted information. We are all, by any practical definition of the words, foolproof and incapable of error.”
And like this:
HAL 9000: “This mission is too important for me to allow you to jeopardize it.”
So that fed into my apprehension about AID in general, and why I procrastinated about getting a new pump for well past the warranty expiration. Actually ten years if you count the fact that after giving up on the 670 I went back to my old Paradigm, my first pump, that I got in 2013.
But this has NOT been my experience with Tandem CIQ. With the 670, it seems like the MT designers understood their task to be to redesign the traditional pump from the ground up, with a view toward making the user’s experience to be a set-and-forget black box they wouldn’t even have to think about 90% of the time. But in the execution that meant locking away all the controls and leaving you staring at a blank wall when you needed to modify it to fit your own metabolic needs.
Tandem on the other hand seems to have started from a much more humble place. Like they looked at the manual pump with its programmable, if fixed, basal rates and instead of proposing to replace it wholesale, said “What if we just added a layer of programming on top of what it already does so the CGM can adjust things where necessary and otherwise leave well enough alone.” Like they realized there would be a human in the circuit who also might have a sense of what their own body was doing, and they realized it would be advantageous to let them sit in the pilot’s chair on the flight deck rather than manacling them to a seat in the passenger section.
My old pump just could not get ahead of my DP, even thought that early a.m. rise was as predictable as clockwork. There must be SOME way to tell it that’s going to happen, isn’t there? “I’m sorry Dave. I’m afraid I can’t do that.” Whereas with the Tandem it has my early-a.m. basal rate in it, transferred from my manual pump, and it can just let that rate do its thing, or it can give it a bump or pull it back a little if the data and algorithm indicate that will smooth my ride. If I’m not satisfied I can raise it myself and then that will be the baseline CIQ is working from thereafter.
For another example, bolusing. At first I kinda got the assumption that there was a hard-wired requirement to always enter a carb value and have the pump do all the calculations to set my dose. Now I’ve gotten lazy about that stuff—I have a pretty decent sense of how I’m going to react to most foods and can make a pretty good seat-of=the-pants estimate of what I’m going to need. But NBD, I thought, I can deal with carb counting. Only then I accidentally touched the “Units” field while setting up a bolus and realized, “Oh, I can just put my own number in!” Turns out all the fields are like that. BG auto-populates from your CGM, but you can tap it and put your own number in if, say, you’ve just done a finger stick but haven’t recalibrated yet.
And none of this requires you to quit out of CIQ mode. So if you’re off, your pump is still going to be tracking your BG and evaluating whether you need a nudge up or down while your meal is metabolizing.
In short, it feels like a smart BG assistant, not a little robot that’s completely uninterested in your feckless input. In short, it feels like the people who programmed it were very much aware of the user as a participant and collaborator in the process. That impression that it starts from a position of valuing and accommodating user preferences and input is a huge difference from my apprehensions and goes a long way toward mitigating the few irksome things I have encountered.
Just my perspective. Hope others find it useful.
EDIT: I don’t know anything about the Medtronic 780G and don’t mean this to be a comparison. I’m only using my experience with the 670 as a point of contrast to explain what’s so drastically different about CIQ and why I like it as much as I do.