Two days ago, I switched from Freestyle Libre 2 + Novolog Flex Pen to Tandem X2 + Dexcom G6. My meter is the One Touch Verio and the Freestyle Libre meter. My main concern right now is the high plateaus I’m seeing, something that I didn’t have just 2 days ago for the same food item + time of day + number of carbs/exercise/sleep (as best as sameness can be maintained).
I looked at the Novolog flex pen insulin composition and compared it with the vial insulin composition and those are exactly the same. So, I’m not sure why pump insulin starts lowering my sugar 2+ hours after eating while the same amount of Flex pen insulin has been consistently reducing my sugar starting at the 55min minute mark after eating (Libre reading and meters check).
My sugar eventually does go down on the pump, between the 2.5 - 3 hour mark, so I’m not sure if it’s the infusion set that’s not inserted correctly or something else entirely that I can’t quite figure out just yet. A tandem trainer walked me through the whole setup 2 days ago so this is the first infusion set I’m using and will change tomorrow.
Since I’m super new to the pump, I feel like I’m missing something here. Any suggestions on what might be going on?
In addition to pre-bolus time, I would ask: Is your infusion set located in the same position that you normally inject? And is your cannula depth the same as you pen needle length?
@John_S2 great questions. I hadn’t thought about those yet! Infusion set is located where I normally inject (abdomen) but clear of previous injection sites used in the last couple of weeks. Cannula is 6mm, flex pen needles are 5mm.
I will try pre-bolusing tonight, something I’ve never done before on the pen nor on the pump yet.
For me when I had this same issue, I decreased my sensitivity. I was at 40 on my Medtronic pump but needed to go down to 25 on my tandem. It did the trick.
One thing that may happen is that your basal rate is adjusted by C-IQ to lower than normal, or zero. This will show up on pump screen. The effect of no basal or less basal will make your bg go up (or stay flat due to bolus.)
You can track this easier using the T:Connect mobile app. Are you using that?
When using a Novolog pen were you also using a long acting insulin to provide your basal insulin? If so, how did you determine what your pump basal rates are or should be? Many folks find that it takes them quite a while with some fasting experiments to get basal rates dialed in. Do you have an endo or CDE who is helping you with this?
@MM1 Yep using the app. I set my basal rate to whatever my endo suggested. But I think that needs changing. It’s 0.5u/hour right now and may need to go up?
@John_S2 I’ve used basal off and on (I’m LADA) but not consistently. Basal rate was set by my endo. I probably need to figure out how to do the fasting experiments to determine all my numbers again They were working with the pen but the pump not so happy with them.
On.pump you can still total 12 basal, but use different rates throughout day. .5 is often a starting point. Your T:Connect data will show what CIQ actually delivered, and may be helpful for you to review.
I started X2 in August (after 20+ years on Medtronic pump), but took about a month to get X2 settings right. Tweaking is expected.
Right and I’m happily tweaking away From what I understand, my insulin delivery mechanism has changed but not the type of insulin nor the quantity, which makes it a bit perplexing to see the vastly different behavior.
I was thinking maybe the cannula wasn’t inserted correctly and so it wasn’t delivering the bolus in entirety. I put a new one in today and will see if that helps pump behavior match pen behavior
@John_S2. I may have missed the answer to this question. The Tandem X2 pump and integrated Dexcom G6 CGM can be integrated in three (3) different ways. First, is bare. Second, the pump & CGM using Basal-IQ software. Third, the pump & CGM using Control-IQ software.
Please share the full description of your technology. The good answers can flow with out making blind guesses. BTW, if you have the Control-IQ, you will have a learning curve and many things will be different. It will be similar to moving from a manual typewriter to 500 page per minute word processor.
They were working with the pen but the pump not so happy with them.
match pen behavior