Question on basal setting

Type 1 and LADA
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So, I set the basals so they are flatline if I am sitting in a chair on the computer all day.

The thing about this that I don’t like is that there is so little resilience in the system.

If I work in the yard, I hit 250. If I eat anything at all (even salad), the bolus dosages are absolutely obnoxiously high.

I’m getting post-pranials of 300, unless I quadruple my typical bolus.

What makes me uncomfortable about this is that I miscalculate a meal, there is risk of severe low.

Am I better off just bumping up the basals across the board so I can take a more moderate amount of bolus?

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If you do this, you will likely be trending down all day, and snacking to bump up.

Do you still loop? Strategy may be different if you do, as it could control basal.

I expect the numbers (carbs, correction factor/sensitivity rate, carb factor to be an approximation. Every day can differ, more or less on many factors.
So I do alot of mini bolus or temp basals to match the oddity of that day. I don’t trust that calcs based on settings can be right (for every situation), and adjust as needed.

I recently started Tandem X2, so some adjusting is now being done for me, but I still tweak.

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If you are looping your pump may not have it, but if not, most pumps have different basal profiles. I currently operate 3 different ones.

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Oh, no - I should have spread the word around.
I stopped Looping around Christmas of last year.

Yea, @MM1, I guess I kinda do the same - I play everything by ear. Like, I don’t use any pre-defined pump settings (except basal program).

Maybe I’ll start by trying out @Rphil’s suggestion and see what happens. I’ll just program in a quick increased basal profile and run it (with caution) for a couple days. That will improve my post-pranials.

What is causing me to move slowly and carefully and seek others advise was today’s A1c. A1c = 5.7. That’s so low as to be well into the ‘danger zone’ for me. I would typically be uncomfortable running under 6.1, due to variability in the data.

But, perhaps I am a different diabetic than I used to be - using different tools.
A previous endo and I decided under 6.1 was too dangerous because of risk of seizure.
I don’t know if that fear still has any teeth. I’ve been checked by a neurologist and am solid. I am not driving much at all because of covid. I feel ok pushing the envelope a little on a1c.

Thanks for helping me think through this stuff.

Covid is finally coming, I think. I think the data is in on that. I expect it to arrive, in force, by Halloween or shortly thereafter. The decisions that we make now are critical.

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@mohee0001 I have different settings for my IC ratio from the morning to the night. Literally up to 11 am I have double the amount of insulin versus by mid afternoon. Plus if I haven’t exercised I need more insulin and if I’ve exercised more I will keep trying to drop. (snorkeling days).

If you set your basal higher for everyday than you actually need your basal rate you run the risk of dropping if you don’t eat. Say you stay in bed longer, or don’t want to stop to get something to eat you will end up running too low.

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I found that decreasing my sensitivity settings by half made a huge difference and I have better control

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Maybe the issue that I am ALWAYS eating.
I dunno. Let me try and argue my position and then reflect on if it is insane.

I’ve only had the basals set correctly for a couple of days and I feel like I can’t continue on like this for another day. I’m so sick most of the day (in the 300’s), unless I take bolus dosages that terrify me. I’m sorta afraid to take 20 and 25 unit bolus dosages because that much bolus seems almost deadly. That’s the equivalent of a days worth of basal for me. So, the balance gets super lopsided.

I guess I’m less afraid of drifting low, slowly over the course of hours, than I am of taking a 20 unit bolus.

I guess I’ll keep the overnights identical because those are dead on the money.
And, then no basal increase until noon…just for safety’s sake.

I’ll run a little test and see how these increased basals fit when I try them on. Nothin too extreme upfront.

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Your right, I’m doubling those AM meal bolus’s, not quadrupling them. That should be fine. I don’t want to be quadrupling in the eave before bed. I’ll start small with the increases around midday.

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I’m curious as to why you stop looping. I just started a couple of weeks ago and it has resulted in a significant improvement in my average blood glucose readings and improvement in timing range.

When I first started treatment for diabetes a few decades ago I was surprised when my endocrinologist congratulated me on my low A1c and then strongly advised me not to strive for such tight control because I would lose the ability to recognize lows which would be more dangerous. He wanted me to keep my A1c around 7.0.

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I dunno. I was on it for 6 months.
I think that when you implement any strategy there are advantages and disadvantages.
I tried it with the hope that I would not die. I did not die. Total success on that front.

I don’t want to color your own independent analysis. The community needs feedback about automated systems. Take some time with the device, and ask me again around Christmas. :wink: We can have a more involved conversation once you have a few months to play with it. Maybe we can get a conversation going between people using a variety of automated systems.

I’ll give your question some thought and try to formulate a legitimate, honest answer. There were a lot of factors at play, so its hard question to answer, I think. There’s different ways to view it. I guess that I could answer your question honestly in a number of different ways, so I don’t want to say anything definite right now while you are still experimenting. I guess that I don’t think there’s a black and white answer. There are a lot of reasons and they all come together into something kinda gray. Talking to you might help me understand my experience better.

I think Loop was really hard because there wasn’t much opportunity for discussion between members of the community. I think that I would be able to answer this question more directly if there had been.

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Here’s one thought that lingers with me, @zatff.

Every strategy has costs and benefits, right? What was nice about Loop is that it is super simple. What is bad about Loop is that it is super simple.

So, Loop is not what you would call a traditionally predictive system, like those that have been designed since the 1950’s. I cold called a diabetes researcher to ask them about this and he said something smart. I asked him about Loop’s model and if that was gonna be sufficient. He said that I should think of Loop as a ‘rule based system,’ not a predictive system, which made a lot of sense to me. How we define the system sets our expectations about what it can and cannot do.

I think that for some people, following the very simple rules that our Doc’s give us might be sufficient. For others, control is more of an art. You will see lots of people on this site who might kinda start from the basic rules of how to manage their system, but then they branch into strategies that are highly individualized to them and meant to overcome cases where the rules fail. Loop doesn’t allow for those types of individual strategies. Loop is inflexible in that way. It makes your toolbox for how you solve problems kinda small. You have a few tools that you can try. Without Loop, you might have a much larger set of strategies and tools that you can try.

Does that make sense?

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Like, what I am doing now - setting the basal high to avoid ridiculous/dangerous bolus dosage is not possible with Loop. Loop wants the basals set to run flatline. If I were running Loop right now, I would be required to allow Loop to dose 25 unit meal bolus. I am personally uncomfortable with that. I don’t want to deliver a dose like that and I definitely don’t want an automated system delivering that. That stuff needs to be done thoughtfully and consciously. This is a phase that will pass. What happens when it does? How do I recognize that on Loop? Will Loop keep delivering 25 unit meal boluses? Of course it will. That’s a recipe for guaranteed critical failure.

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Thanks for the comments.

My primary motivation for trying the loop program was to see if it could help me avoid my frequent night time lows. My usual pattern was to be very high after my evening meal and then needing to take a considerable correction bolus before I went to bed but often this would result in a nighttime low so I would have to get up and eat to restore my blood glucose levels. I’ve been using the looping program now for over a couple of weeks and it has been successful in curtailing my night time lows. This is reduced my fear of having a serious hypoglycemic reaction which could result in a trip to the ER or worse.

But I have had some new daytime lows which were unusual for me. But a daytime low is easier for me to manage since I’m generally awake and aware of what’s going on and can make the necessary adjustments.I believe part of the reason for daytime lows is due to my improved time in range and overall a lower average of my blood glucose levels. A 50-60 point drop has little risk of running me too low when my average readings are 180 or more but now when many of my readings are 110, it will result in a too low episode.

But diabetes as you well know is often unpredictable in how it affects us. And for reasons I’ve never been able to determine every once in a while my nighttime readings would be way too high which made things complicated. Tonight I’m having one of those episodes where over eight hours since I ate my evening meal my blood glucose levels were up over 200. Here the looping program is helping because it has significantly increased my basal rate and now my levels are back down to 163. In the past without the looping program I would have probably gone over 300.

The thing I like best about the looping program is that it will make adjustments to my basal rate even if I’m not watching them or paying attention to them, like when I’m sleeping.

I think part of the reason the looping program often results in an improvement in a person’s time in range is that it offers more feedback and generally increases the amount of time we are spending monitoring our blood glucose levels and making adjustments to our insulin levels. As you well know the looping program tends to have various problems that require frequent attention. Losing connection is the most common one and often happened several times a day and this can be a source of frustration when you’re trying to figure out how to get the program working again. I can understand why some people would just decide to give up on it, especially if they weren’t seeing any significant improvement in their blood glucose levels.

My endocrinologist is very pleased with my improvement in time in range and overall lower blood glucose readings. Since I am retired and like most elderly people mostly shut in because of the pandemic I have adequate time to monitor my looping program. I think it would be a lot different if I was working full-time and needing to focus my time and energy on other issues.

Thanks for the stimulating comments. Stay safe, stay healthy, and stay connected.

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Yea, this could be a really good time to play with Loop. Let me know how it all works out. There’s a strong chance that it helps out with some of those problems. I think that the time commitment involved was always a problem for a lot of people. It was for me.

Your still having connection problems, eh? The bluetooth connection was a common problem when it first came out. I’m kinda less of a fan of BT, now, after using Loop because its a weak signal that tends to get lost.

Holy crap - not to get distracted, but police radio has a worker reporting a suspicious bag in the parking lot of Medtronic. They think there are bones sticking out of it. Halloween prank? Who can say in these times…OMG!!!

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From your experiencing looping I wonder if you can offer me some insights or advice on my main issue. I generally seem to do quite well in the evening or late night after I’ve stopped eating and my carbs are all absorbed. But I seem to have problems during the daytime when I eat with going too high and then going too low. I’ve been trying to tweak the settings for carb ratio and ISF but haven’t found a happy medium. I’m also uncertain as to what is a reasonable expectation for time in range I was down in the 60s before I started looping and sometimes when I have a real good couple of days I get up to the low 90s but overall I seem to be averaging somewhere in the mid 70s. Any suggestions on how I should pursue tweaking the settings to try to smooth things out so I don’t go too high and then too low?

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If you have the settings correctly adjusted, then its possible that the algorithm isn’t a good fit. I think you would prefer to talk to someone other than me, though. I’m gonna direct him to you. Do you find that you are able to alter your eating as a method of making the bolus calculations work? Does it work for small meals or low carb meals?

Loop was always a bad fit for me because I’m not a carb counter. Have you always used a bolus calculator? If you need help doing bolus testing for meals, I can help you with that. I’m good at bolus testing. Let me know if you think that is the hangup.

If you have only been on the thing 2 weeks, then I would expect the settings to be correct.

How long did you spend verifying your settings before starting loop? I spent a long, long time because the RileyLink was backordered when I started by a month or 6 weeks. Around Christmas there was (possibly) a change in the algorithm during an update. That threw everything out of control for me. Prior to the update, things were Ok, so I’m suspicious that they used a more conservative algorithm as the number of users is growing. The first algorithm might have been more aggressive and more effective. But, some people will disagree with that statement.

Without any forum for the community to discuss these things in detail, I don’t think we will get to the bottom of it. DO NOT make a statement critical of the algorithm on their forum. They will not be friendly to that.

If there were a lot of Loop users that moved over here, you could form your own discussion section and could make a strong, meaningful dialog. Right now, there are only about 4 of you here.

Its hard because either you have fully tested and implemented appropriate controls, or you haven’t. If you have, either the model works for you, or the model is insufficient. Only you will know that and there is no opportunity for deep discussion between members.

I have not used it in almost 6 months. So, I am not really a great person to talk to. I had to step aside a long time ago. You could try talking to @BradP, but he just had surgery and so might be out of commission. He might not pop up for a week or so.

I have a phone number for someone, but I know that she is drifting out of control.

If you do not open loop periodically and re-adjust your settings, you will be, as they say “automating your own death,”

The only other hope is to make sure that your settings are on the dot.
If your settings are on the dot, then the model is failing you.

I suspect there is a high probability that the model will fail you (at least in some ways). The question might then become, can you overcome those failures in the model? Or, do you enter into a form of hand to hand combat with the model where you are fighting the system automation? When that happens, its very likely things might get get continually worse and worse until there is is critical failure. If you see that happening, pull the plug.

In general, the tighter your control was prior to starting Loop, the less likely you are to see benefit from it ( I suspect). The crappier your control, prior to Loop, the more likely you are to see benefit from it.

Overall, I think their data showed a wash (or, a minor benefit). But, some people disagree with that. Have you looked at the preliminary results published by Jaeb? I’m calling that a wash.

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You don’t wanna talk to me, @zatff. You want to talk to about 100 other Loop users. Unfortunately, there is no forum for that. Perhaps we need to move some of you into the special Loop section of this website. I dunno. You need a self sustaining area where you can all talk to and help one another, like we do here.

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@Terry4

Terry says I should show you where the loop section of the webpage is. Let me find it…

I see. Its here. This is where you can find some Loop - specific discussions, @zatff.

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