I went from 5.8 to 5.2 A1c just because Basal-IQ allowed me to run a lower BG at night.
So don’t discount the difference this can make!
1 Like
@Hammer, excuse my ignorance. How low does Basal-IQ allow you to run?
Basal-IQ is not closed loop, This is on the Tandem X2 pump with Dexcom G6, it only turns off basal when it thinks, or you are running low.
This lets me run a more aggressive basal at night and it keeps me stable at a lower BG without going low.
2 Likes
Stick with the loop.
In the long run, I think more focus on TiR, and perhaps tightening the range will help you reduce the risks of developing complications better than getting 6.1% A1C results with a significant chunk of time spent hanging around @ 65 mg/dl.
IOW, the A1C results don’t exist in a vacuum where every 6.1% is better than a 6.7%. I would suggest that you’re too focused on the number instead of the journey you took to get there.
Adam Brown has a nice graphic where he shows two charts that result in a 7.0% A1C one has a huge amount of variability to it, while the other has virtually none. Clearly, one of those 7.0% journeys is healthier than the other.
2 Likes
I found the answer to my question: “If the glucose level is predicted to be less than 80 mg/dL, or if a CGM reading falls below 70 mg/dL, insulin delivery is suspended. Insulin delivery resumes as soon as sensor glucose values begin to rise.”
That is fantastic. I had no idea that the FDA would approve anything this good. I assumed that the threshold would be 120. Maybe this is what it is for Medtronic. 120 does not do it for me.
@Hammer, did you set your basal rate at the high end so that effectively you are looping?
Yes, I was aggressive with my Basal rates knowing that Basal-IQ would regulate it.
I was also more aggressive with my boluses knowing it would automatically subtract my basal later on when I am on the downswing after a high carb meal.
1 Like
@Hammer, I appreciate that Basal-IQ is not advertised as closed loop. I consider this a brilliant move to get FDA approval for something that otherwise would not fly. I don’t see a functional difference between closed loop and Basal-IQ with a high basal rate setting. I hope this established precedence and it is here to stay. I hope FDA employees don’t linger here.
I saw my first pump failure on Loop this week. It took me 3 days to detect, even with wild data (running 300-350 for 3 days straight).
I, too have been able to be pretty darn aggressive with dosing, as long as the settings were finally tuned. They are not finely tuned anymore. I see the meals not playing out nicely anymore.
I’m worried about not being able to see the data. I’m gonna run some open loop testing and see what shows up.
So, I’m pretty happy with the standard deviation.
I think overnight open loop testing was ok, but it wasn’t perfect because of some kinda new communication failure last night that prevented me from bolusing. A late night correction seemed to have put things back into range. Despite all of this, I’m still 70% in range.
That’s what’s tricky. I see so many comm failures. Those things tend to push me high. But, I’m still running pretty well in range when things work. Maybe all the comm failures are just pushing the a1c a little higher. It fails high. If I were “in charge” of the system, then I would fail LOW.
When I was ‘in charge’ that 20% HIGH range, would instead be a 20% LOW range.
If you guys think this is cool, I’ll just keep on keeping on and see if I can work out some comm failures to improve the data.
I think the absolute biggest benefit of Loop is during the night when you can’t make adjustments until an alarm goes off saying you’re already out of range. This is literally the only reason I’d ever go on a pump again. You could just drop out of loop during the day and drop back in at night if that’s a better fit for you.
I think spending some time figuring out how to get the nights to work would probably be the best focus of your efforts. There’ve got to be some posts on this forum or others that discuss possible reasons for drop outs.
1 Like
Its the BlueTooth. I’m not optimistic about solving that. BT is sketchy at best.
I’m lucky, I guess, because my overnights have always been super stable.
I wake up very easily, especially if my BG is low. So, ill be ok there.
Last night the data was solid, flatline running open loop. It almost always it.
I’m surprised about how different we all are as diabetics. I know people get on loop because of overnight lows. I’m always surprised how big of a deal this is to other diabetics. Its interesting. Different than me.
1 Like
Eh, IMO highs during the night are more annoying than lows. Afrezza helps A LOT with overnight highs, but insulin in general works slower when I’m sleeping. Having loop respond in real time to trends it is seeing before a high/low is pretty awesome.
My goals are relatively aggressive though. In the last 3 months I’ve spent less than 3% of the time above 180. As a women in my 30s, I have varying basal needs throughout the month. My overnight patterns are my best indicators of when I need to increase/decrease my dose. When I drop low/high at the beginning of the night, I need to decrease/increase my morning basal dose. When I drop low/high around 5-6 AM, I need to decrease/increase my 4 pm basal dose.
Loop would resolve a lot of that for me. Of course… if I were on a pump the whole basal situation would be different anyway.
I hate pumps though, and I have relatively good control without them. I just have to watch my patterns throughout the month and make the indicated basal adjustments that would practically be automatic with Loop.
Does that mean that the issue is with your phone?
I find the basals on Loop to be surprisingly resilient. Its really, very surprising.
Its possible that some issues have stemmed from the phone. But, apple has done some reworking on their BT implementation in the new operating system in an effort to improve it. Dexcom has also been working on their servers. And, Loop has been fixing stuff. So, its hard to know where current improvements have come from - probably some combination of all of these efforts. I find that its working better than it used to.
But, BT is not a super reliable method for communication. It fails a lot. Some of that is because BT implementations have been poorly written over time, but some of it is just the nature of the beast. Its on a crowded bandwidth. It can get interference from all kinds of stuff.
I don’t think that’s my issue. BT can’t transmit through the body. When I lay on my side, covered up with blankets, the signals sent from my sensor don’t reach the receiver.
Right now, in this moment, the phone can see the RL and the RL can communicate with the phone via BT (to confirm insulin pump commands were delivered and such). But, nothing can see the transmitter. So, instead, Loop is receiving sensor data through the internet and phone (which I can see because of the cloud icon - highlighted here in red). RL is left out. There’s an issue with the RL/phone receiving data comm from the sensor transmitter. I know from experience, that when I leave home, comm will resume on that channel. So, maybe I caused a failure when I let my RL run out of batteries earlier today. I’m not sure.
Things are just generally, a little buggy. I have had failures on the insulin pump side, but not many of those. Its primarily sensor data along the BT transmission to the RL that fails. I was blaming the RL hardware failures, but since its been replaced, I still see significant comm disruption. So, I’m not sure. Maybe theres somewhere in the loop app that I need to update the transmitter ID, and not just on the Dexcom app side. ???
From the docs…I think this was an older problem I had, but have updated since then…maybe…“the new style Dexcom transmitters changed their Bluetooth protocol. Loop’s code was updated for the new transmitters so that offline looping can continue to work. If you don’t update to get that fix, you will be forced to rely on internet-required looping because older versoin of Loop won’t have the updated protocols.”
Crap. That might be it. I dont know.
It says I’m using version 1.10.1. It used to say that I was using version Dev1.10.1
I know that I updated the code because I got new functionality.
However, that version number seems to suggest I’m running an old version of the code??? Possibly a version that doesn’t play nicely with the new firefly transmitter.
I just don’t know.
It’s just real strange because bluetooth is just not a problem for me. Basically ever. If I go in another room, then I’ll lose the connection, but I really don’t have any problems while I’m sleeping- even when I lay on the side that has the transmitter (sensors are always placed on the back of my arm).
I usually keep my phone on the shelf directly above my bed, but even when I go camping or spend the night somewhere else, as long as my phone is within a few feet then I have a good signal and will get alarms.
I can’t really tell from your posts if it is a Loop problem or a Dexcom (BT) problem. If it is a Dexcom issue, then you could try calling their tech help line. It’s been awhile since I’ve done that, so I don’t know if they’re as good as they used to be. They seem to have gone steeply downhill in regards to their customer service.
1 Like
I was doing tech support today. It gets worse than BT failures. Some people are seeing RF communication failures to the pump. That only happened to me once or twice lately, but others had had significant difficulty.
Halloween + pump failures = frantic parents
1 Like