Profile Setting for Control IQ

Type 1 and LADA
1

Thursday; I was able to go live with Control IQ and am in love with it. I do have an issue and would like to pick your brains for a solution.

I believe it involves my profile settings (shown below) and I am not sure what to adjust. My target is 110 and today my BG has ridden right at 127. However; around 2:00 AM my BG typically starts to rise and continues to do so. I don’t sleep well and usually turn off SLEEP at that time. It gets higher than I would like and wonder what adjustments to make to give me better overnight control. The cause for the rise is either Dawn Phenomena or Fat in a meal. I do realize that in SLEEP MODE there is no Correction insulin delivered. That is why I turn off sleep when I see BG rising.

Based on the profiles below I would appreciate your input. You guys are better than any CDE.

Profiles: Basal 0.4, Correct 1:30, Carb 1:17, Target 110

Thanks for your help.

2

Are you always running 0.4u 24/7, without an increased early morning basal rate for dawn phenomena? Do you know you can ser up different basal rates to start at different times? You can edit your basal rate under options>my pump>personal profiles. Just select the profile you want to modify and then select “edit”. Personally, I would be setting up a higher basal rate to start delivering about an hour before you start to rise. Use your correction factor to determine how much extra insulin you need.

There are other tweaks you can make to make the system more aggressive. I never turn off sleep mode, unless I’m doing physical labor on our farm, then I switch to exercise mode. I’ve raised my basals by ~30%, upped my weight by 20 lbs, reduced my correction factor by ~25%, and programmed my total daily dose to be what I would use on very high carb day. Each and every one of those points let’s the algorithm be more aggressive in corrections/adjustments, and I haven’t haven’t had any lows that weren’t because of over-bolusing.

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3

Wonderful; I will try that. Thanks so much.

4

I should have prefaced explaining what MY pump settings are with the fact that you seen way more insulin sensitive than me. My basal rates are like 3 times what you’re running. So proceed to tweak Control-IQ at your own risk. You may want to try just one tweak at a time. The increased basal nighttime basal I stand by, though.

1 Like
5

I use the profiles I did before my pump was automatic. If I was starting now I think I’d set everything as good as I could on full manual mode before using Control IQ esp. to get time of day variations covered.

Once IQ is on I use profiles up or down as needed based on what is happening at stable times: If pump shuts off a lot I need a lower setting. If pump doesn’t even reduce basal I need a higher setting. (I don’t let it sit at the 110 level.)

My basals are set to cover the min I ever need and the max I am likely to need split into even increments. This makes it easy for me to adjust esp at night when I need to make changes. The pump tries but doesn’t fully keep up with the wide basal range I need.

6

Go ahead and increase, maybe, 0.1 per day, until you stop seeing that rise in the AM.
Yo might need to start that increase a little prior to the rise in order to keep it at bay.

7

Dear Nan
here is basic way to find right basal setting for you.

  1. find daily total insulin requirement in unit for normal case : weight in pounds /4
    for example 120 lb require 120/4= 30 unit
  2. use 50% as basal insulin in this case 15 unit. when i start to find basal setting, my pump trainer start as 35% to total unit as start point. in this case 30*.35=10.5 unit so each our setting 10.5/24=0.4375 unit per hour. so i programmed my pump basal as 0.438 unit
  3. to find basal unit for midnight to 7 am- i ate dinner at 6PM with know food with each measurement with scale and do bolus, just watch TV no physical activities except go to bath room just enjoy movie.
    at mid night 12 AM start measuring glucose level for each 15 min until 7 AM. my trainer trying find from 12 AM to 7AM glucose level change less than 20mg/dl and when dawn start how start. i send data to trainer she modify basal rate and rate adjustment at 4 am 4:25 an to accommodate dawn problem.

i give some of detail procedure to find right basal rate. we could see the tandem pump history see total daily dose, basal, bolus and compare with simple calculation of total daily insulin requirement. from these information you could see where current basal rate, carb rate,

most critical matter is discuss with pump trainer or doctor before start change your current setting. hopefully this information give knowledge how to communicate with trainer or doctor to get right basal and other settings.

8

Kn1,

Thank you for the information. My numbers are much improved, including morning readings.

Over the past two days I have been in target range 86%, 0 Lows, 14% High. For me, that is a record. I have a new goal of 95% in Target Range. Will be anxious to see my next A1C.

Last night I ate a high fat meal but stayed 120 or below all night. Very impressed with Control IQ.

9

Dear Nan

since you are willing to improve your diabetics, i will give several check point how to lower down 14% high.

  1. since your dinner with high fat meal give good control with control IQ, you should get the picture what kind of food basically to make glucose spike beyond 180mg/dl . i will give my typical daily meal then you should get some idea how i get control.
    a. BF : 180g ( exact measurement my scale is 0.1g increment, using exact same milk and probiotics to making own kefir.)
    b. lunch: salad, measured blue berry, one egg, 2 cheese, ham or tuna, nuts wit olive oil and balsamic vinegar ( no salt, sugar, sugar substitute)
    c. dinner: baked vegetable, cooked ham or chicken or fish or beef with olive oil source.
    Please see all the successfully well control diabetics peoples first matter is change eating habit and right selection of food,

  2. i see the a lot of post regarding how to control high if carb, protein calculation is right then most case peoples think pump can inject higher unit of insulin such 15, 18, 20 unit one time. there is max unit for stable insulin effect. i read one of pump book 10 year ago. Author who is Yale diabetics doctor, he find that after see so many pump user data, he see the max limit to 9.5unit for pump injection. so many time i see my max pump deliver limitation. My case i always use as 8.75 unit max for food bolus.

hopefully you could compare with daily bolus data and food selection and time of injection. some food must inject before meal but this statement also depend on current your glucose reading. since i am using tandem X2 with control IQ with sleep mode if you have question please post .

thank you

10

I don’t fully understand this, but I definitely disagree with it. I guess I’m one “of those” referred to people. I don’t eat that way often, but if pasta or pizza are on the menu, I’m probably going to need a 12+ unit bolus of insulin to stay within range. An arbitrary cap at a lower number isn’t going to cut it. Grant it, I would extend part of that bolus to account for delayed absorption, though. Could that be the missing piece here?

11

okay i will give example to better way how to control max range issues

  1. if you want pizza which require some kind of extend insulin delivery due to the food nature of fat,protein,oil and carb. yes i will delay converting glucose. so it could set bolus with 12 unit but using extend mode of pump you could deliver 50% -60% last of 2 hour or up to 3 hour to mach food conversion time. in this case there is no issued using 12 unit insulin. after look over CGM data it could get more data how to set up for this case.
  2. if you want to have hamburger , fry, with die coke. in this case it may need more than 9.5uint of insulin if person are full stage of T1. but peoples bolus 12 unit once than actual 12 unit effect may not happen. it could impact actual insulin cover and easily go over 180mg/dl need correction bolus later on.
    if carb, protein, fat conversion calculation is right than simple math show 12 unit- correction unit is actual insulin effectiveness show at given food case.
  3. in hamburger case i have two options. a. protein style hamburger or i ate without burn with die coke. b. if i want fry with hamburger, i use 8.75 unit delivery and best effect some portion of fry to eat close possible as 8.75 unit.
    since i am using control iQ hopefully little off of calculation easily modulate by CIQ program.

thank you

12

Hi Robyn,

I found your post very interesting and I am working on gaming Control IQ a bit more than the way it was designed as well. My issue is that I go to bed at 10pm and often times my digestion is slow so when I go to bed I have a great BG but will often wake up in the morning with it around 180 which is too high. Are you saying with all of those changes you have made to your settings you feel that control IQ is much more aggressive? If I may ask what was your correction factor before and what do you have it set at now? In fact if you don’t mind sharing your before and after numbers that would be awesome. Since this technology is so new there isn’t much out there with people changing settings to get more control from the pump than it was “designed” for!

13

I have changed it to show my weight as 308 and TDD of 100. Both the MAX amounts allowed by this system.
I also changed my correction factor from 1:20 to 1:15.
These changes have definitely helped.
I mainly wanted to change how Control-IQ works, without overly affecting the normal profile I use. I do this in case the sensor goes out, the time between warmups, or just lost connection for whatever reason.
I don’t have a problem with the correction factor being part of my normal profile, as that is something only used during a manual bolus that could cause issues. Control-IQ will only use this in very modest ways, but it will allow the basal changes it makes to be a little more aggressive.

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14

Yes, I definitely think the changes I made affect how control-IQ works in a positive way. My recent lifestyle makes it a little difficult to answer your specific questions though. I actually haven’t been wearing my pump at all during the day for the better part of the last week because even exercise mode and a reduced profile wasn’t enough to combat the physical stresses of the home remediation project I’ve been working on. (Long hours in a hot attic space w/ halogen work lamps in a tyvek suit sauna… Then literally wrestling insulation and other “ick” into containment bags.) I’ve been intentionally chugging juice to boost my BG to 250, then working myself hypo again over the next few hours, rinse, repeat…

My last A1c was nearly a year ago, and was an 8.1, and honestly that’s one of my better ones in recent years. I’ve been struggling with “sick house syndrome”, where I’m basically allergic to my house, and the varying degrees of inflammation have made managing my diabetes a nightmare. That was also pre-CGM, as I’ve only been on the Dex G6 for about 90 days. Decided to pay cash out of pocket for it in anticipation of Control-IQ. Any further numbers mentioned are actually estimates according to xdrip+, as I have no official labwork. The CGM alone made a massive difference (and Basal-IQ, since I had fewer rebound highs). I was able to achieve a 30+ day estimate of 6.4. knowledge is serious power in these circumstances. With my weighted settings, I had a 7 day estimate of 5.9, with some individual days as low as 5.4 (xdrip+ only shows statistics for today, yesterday, 7 days, 30 days, and 90 days and I don’t yet have enough data for longer estimates). Like I mentioned above, most of this week has been null/void since I’ve been disconnected from my pump and on a roller-coaster, but the evenings I’ve been connected again are still beautiful, and have averaged me out to 6.1.

The increased basal rates I mentioned probably aren’t necessary for many others. I would definitely recommend 24/7 sleep mode, and otherwise @Hammer 's suggestions. Since sleep mode can’t automatically bolus, a lower high alert setting is helpful, so I can decide whether I need to act myself. Since these only possibly go off after eating, I don’t mind getting them occasionally through the day. I just swipe them away on my phone.

For ME, though, the increased basals have been a lifesaver. My insulin needs are forever changing, thanks to the inflammation. I had over 30 different timed settings going for my previous standard profile, including built-in pre-boluses because on bad days it can take almost 90 minutes for my insulin to start working, and I was forever tweaking them based on CGM trends… And then they’d be completely ineffective the next day. Since Control-IQ works so well to decrease basal, I can afford to just run with higher basal rates and only use what I need of it. I only have three changes now throughout the day (daytime, nighttime, and early increase for DP). I do have to be cautious of Dex disconnections, though. I had a pretty bad hypo the other day when I forgot to switch to a lower profile during sensor warmup.

15

I am supposed to go on the G6 when I get my next transmitter. And my Medtronic Paradigm pump is out of warranty so I can choose a new pump. I have seen many of your posts and believe you are a proponent of Tslim and G6 and would appreciate your input.

I may not have the terms exactly right but believe the Tslim to be a hybrid closed loop system.

I’m considering changing to Tslim and G6 but have the following concerns.
G5 is fine for me and I’m having my best month at ave Bg of 103 and std dev of 18 and TIR of 99%. Have read that Tslim is great for TID who have AIC of 6.5 and higher who want to improve. Not so good for people that have an AIC of 6.0 or less.

It seems that by being aggressive you are making the Tslim adapt to your more aggressive goals. That’s great as I have the same concern.

If I dislike the Tslim can I shut of Basal IQ and Control IQ and would it then operate as a standard pump with me making all the decisions.

Is Basal IQ as good as I read? I NEVER EVER shut off my basal as I simply take fast acting carbs to raise my BG when I am low. Shutting off the basal will affect my readings for 4 hours whereas food will affect my readings for only 1 hr.

I have heard that Tslim makes basal changes based on predictive values. So is predictive value based on my personal input such as correction factors, IOB, duration, etc. or does it make predictive values based on external factors that I would not consider? Does Basal IQ work for you and do you believe it in theory?

Finally I dislike the fact that Tslim will make basal and bolus decisions based on the CGM which is sometime inaccurate. I still take blood tests because I don’t trust the accuracy of the CGM so this seems like I am going way overboard trusting Tslim to make basal and bolus adjustments based on CGM datapoints?

Do I have legitimate concerns? Would lover your opinion.

16

The Basal-IQ was a wonderful upgrade for me at the time.
My A1c had been floating in the 5.6 to 5.8 range for quite some time.
I was 5.8 before starting Basal-IQ, and dropped to 5.2, my lowest A1c yet, from the Basal-IQ upgrade. I didn’t change my habits of eating (maybe ate a little more.) But I did get more aggressive with my basals, especially at night. This is where I saw the biggest overall improvement with the Basal-IQ update. I am one of those that always have higher BGs at night, whether fasting or eating pizza, I always struggle with my overnight BGs.
I would see Basal-IQ turn off my Basal’s for 15 minutes to 2 hours, depending on what I was doing. It actually did a really good job of this while using Fiasp.

Now, with the Control-IQ and G6. Once I figured a few things out on the G5, I have been GOOD with Dexcom and readings. The G6 I had to add an overnight presoak to the sensor before starting it, and I am great with it now!
I will say that I am NOT as aggressive with my basals yet with the Control-IQ as I was with them on Basal-IQ. Not that I will not be, but I wanted to start making changes in the safest way possible and see how well Control-IQ would handle it.
I will say that I have been torture testing it lately :wink: I have been eating way off my normals for different meals, timing, etc.
I think if I get a little more aggressive with my Basals again, I will have OUTSTANDING numbers again, all the while paying attention less, and eating more (not a bad thing really!)
That being said, I am not trying to set an ideal diet to test Control-IQ right now, I want to figure out my worst case stuff, see how far I can push the update, then go back to normal.

That being said, if I eat a sensible and controlled diet, this thing is wonderful! I stay between 90 and 105 most of the time. If I adjusted my basal and correction factor a little more, I think I can even bring that down a little more without worrying nearly as much about what I eat.

The Control-IQ will vary the basal, both up and down, based on your CGM readings. If you are using the sleep mode, 112 to 120 is the range. If it sees a TREND where it will go above or below that range, it will adjust the basal accordingly.
I think it does a VERY good job of controlling the lows. Even better than Basal-IQ was. It will slow down the basal at a higher BG, and shut it off if it keeps going lower. This makes for a much smoother graph when you watch your BGs dropping. Basal would just shut it off, but at a potentially lower number.
Also, all CGMs are usually very accurate when you are working within their sweetspot. I think 90 to 140, or something like that (just guessing memory what their ideal range is for the highest accuracy.) And for most of us, this is right where we want to be.
BUT, lets just say it reads too high, and gives a higher basal. The amount higher that it will give can only be so much, so it would be very doubtful that it could cause you to go hypo and you not sense something is out of whack.
If it reads too low, it slow/stops the basal and lets your Bgs rise more, but this isn’t life threatening.
To be honest, if you are having good reliable numbers from your G5, I see nothing to be concerned about. If the numbers are ok, but not always on par with expectactions, I would look into trying to improve them. The number one thing for my was HYDRATION. I can’t state that enough! I tested this more than once, and it always proved itself. Drink more water and get more accurate numbers. The second was where I placed the sensor, and at what angle. This is a LOT easier with the G6 for me.

And, in the end, turning off either Basal-IQ or Control-IQ takes only a few screen selections. Then it just works like a normal insulin pump and with whatever factors you have programmed in for your profile.

1 Like
17

Thank you for your very thoughtful response. I particularly wanted to hear from someone who was aggressive in managing their diabetes and thought they could continue to do so.

18

Yeah, for a while I thought that I would not do the Control-IQ update because of the range it was set for.
But the more I thought about what parameters it used, the more that I thought I could tweak my profile to make the setup work for ME.
I think I still might keep a pretty low A1C, but keep a lot more time in range. So my A1c might go up slightly, but my quality of life will go up tremendously!

19

Totally understand and agree.

20

Btw, I wanted to clarify, either Basal-IQ or Control-IQ, when it shuts off your basal, I do NOT see a long term affect. It really isn’t turning it off for very long, and makes very little difference ‘after the fact’.
If it only turns it off for 30 minutes, chances are that will balance out what it should have been at anyways (more so with Control-IQ).
That being said, my experience is using Fiasp for an insulin. When using Novolog with Basal-IQ, it worked, but not nearly as well. I could not be as aggressive with my basals as I could be with Fiasp.
For me, Novolog is a like a freight train when it’s heading on a downward path.