So how long did it take you??
@DrBB:
I just got my Tandempump the 1st of April switching from Omnipod because trial with loaner pump with only Basal IQ was such a great experience. I had bad reactions to Omnipod´s adhesives and probably the teflon as well. No I´m on Tandem Control IQ and steel cannulas. No training, no basal testing, just started.
This is second and third day:
6,6 mmol/L = almost 119 mg/dl
SD 1,3 mmol/L = 23,5 mg/dl
Målrområde = target range = 3,9-10 mmol/L = 70-180 mg/dl
This means I´m mostly cruising between 95 and 140 mg/dl.
Pros:
1.Dexcom is really consistent due to less stress (I think).
(It´s been a nightmare with failing sensors and bad accuracy so this is really a miracle)
2.Tandems algorithm is in sync with my own mindset and does exactly what I would have done, only better. Feels like I´ve got a second brain so mine doesn´t have to be on the job 24/7.
3.No reactions to the adhesive or the steel cannula.
4. Hardly any need to adjust too much insulin with carbs anymore.
5. Getting a full night sleep without interruptions because the algorithm just works.
Cons:
None so far.
Hope you get a great experience with your new pump as well.
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4 weeks. I have zero resistance to change
I came to Tandem from MDI and the onboarding went really smoothly. I went straight into Control IQ with the same basal total just split up into 24 and the same I:C ratio. Although I made several changes over the course of the next few weeks I didn’t have anything happen that Control IQ couldn’t smooth out.
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@DrBB:
Regarding basal testing,- I forgot to mention that I use a flat basal rate. That could have something to do with the ease of transition.
Flat basal on a pump without automation meant that I did all the basal stops and the temp basals myself. Now Control IQ does the job. Just a thought.
I started using flat basal rate after reading Stephen Ponders book «Sugar surfing», and it has served me well.
That’s really interesting and kind of surprising. I currently have six basals programmed, mainly around dealing with two factors. One is that I apparently produce some endogenous insulin that kicks in around 3-4pm to around 7pm, so I ease the rate around then. Bigger problem though is I have pretty severe dawn phenomenon that starts kicking in from around 3-4 a.m. That’s what convinced me to go on a pump to begin with—just nothing I could do about it on MDI short of getting up at stupid-o’clock in the morning and giving myself an injection. It was also the deal-breaking failure for me with the 670G, 5 yrs ago. The system just didn’t see DP coming soon enough or respond strongly enough, so I was always starting the day with a fasting BG way higher than I’d been getting with my manual basals. “Why doesn’t this thing let you just program that kind of thing IN to the system???” So that’s one of the things that’s promising for me about the Tandem algorithm, that (as I understand it) it works with your basal settings rather than trying to take the place of them.
So it’s useful to have your perspective on how it works in practice, at least for you. One thing I didn’t have going through my previous pump transitions is a lot of other users’ experiences to draw on. With my first pump the DOC wasn’t really a thing, or at least not to the extent it is now, and I was pretty much at the mercy of super-uber-hyper cautious CDE trainers, not T1s themselves, who were terrified I might go a little low at some point. So I finally just said, screw it, I’m doing my own settings. And then with the 670G I was a pretty early adopter, first one in my Endo’s practice, so again it was mainly down to MedT trainers and they just weren’t gonna tell you anything that wasn’t strictly by-the-book. Not to mention YouTube has exponentially grown since then and there are many good Tandem vloggers as well.
So I feel like I’m already getting more real-life-experience info about this new pump than my previous times, and that’s great. Glad to hear about yours.
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@DrBB:
A single basal rate vs numerous basal rate settings are explained here:
The Basal Rate Parallax by Stephen Ponder.
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I also have a severe predawn spike. My pump has flattened it completely. But I change from 1 unit per hour to 1.3 from 4 am till 6 am. And because it’s not consistent, control IQ keeps it so flat I can say I dont see it anymore. My other basal rates are so close that I really could have just 1 at 1.1 units per hour and it would probably be fine, having many just keeps my time in range a bit tighter.
I currently have 5 different ones.
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I basically have two situations I’m trying to account for: late-afternoon lows due to presumed endogenous insulin, and early-a.m. DP. That equates to four basals, counting returning to normal: 7 a.m. normal, 3pm low, 7pm normal, 3am high. At some point my endo thought it would be useful to refine that a bit and added two more, so I actually have six programmed now. But I think she was just feeling the need to do something b/c I generally handle things so well by myself. Those extras aren’t really doing all that much.
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My last appt, my endo suggested some basal changes that worked well. She must have read the Ponder article. The changes were minimal, but made a nice improvement.
With my Tandem pump, I got significant rebound after a long basal suspend, and the improved settings helped reduce that from occurring.
So is your Tandem pump on its way???
Arrived last week (see upthread). I’ve done some initial set-up stuff, connected it to my Dexcom, discovered and cleared some glitches getting the necessary apps downloaded and pairing with my Dexcom—stuff I don’t want to waste trainer time on. Starting next Monday. Could probably just launch on my own but I’m not in a super tearing hurry due to other stuff going on in my life.
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If you are making endogenous insulin, I can see it being a problem. Especially since it works opposite than make logical sense. When you got high it pumps out more insulin and you correct it with insulin, but then the endogenous insulin finally hits and you go low.
This is how it was for me in my first year after diagnosis. Staying in range was very hard and also using NPH back then didn’t help.
After I stopped making insulin things settled out quite a bit.
I started every pump that I’ve had, before I was trained, because I’m impulsive and I figure I can just figure it out.
The reality is with the Tandem, I should have done my basal testing before and figured out my carb ratio and correction factors because it was very different than on Medtronic.
I had a sensitivity factor of 18 on Medtronic and I needed to be at 35 on tandem. So there was no real correlation.
I got the 35 number from my trainer based on my average basal requirements.
@DrBB:
I just had my training this week and learned something interesting. Usually doctors strive for a 50/50 basal-bolus split, but the Tandem pump is set up for 40% basal and 60% bolus. When I go back and check my data for the first three weeks with Control IQ my split has actually shifted from 50/50 to 60/40.
How did your traning go?
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That’s not a Tandem preset, by any means. The Tandem model understands that everyone has different insulin needs and we can’t all be squeezed into the same presets and as assumptions. It’s simply reporting what insulin you used and when, based on your settings and actions.
The 50/50 split is a fairly old school idea that still lingers from the days of painfully slow insulin, carb exchanges, and eating to your insulin dose. It should have went out the window with fast acting insulins and carb counting. Your basal needs are relatively fixed, but bolus needs can vary significantly based on diet and lifestyle choices.
Tandem may make a lot of gentle basal adjustments, depending on the activity setting, though. Especially if you use sleep mode often, any increased insulin given will be counted as basal. So there’s may be a little basal bias built into the system that way.
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Thanks @Robyn_H for making that clearer than I could.
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That’s not a Tandem preset, by any means
My Tandem-rep said that´s what Control IQ strives to achieve. She did not say it was a preset.
It’s simply reporting what insulin you used and when, based on your settings and actions.
And TDD. After six days Control IQ adjusts to your actual use of insulin, not only the number of units you put in your pump when you started Control IQ.
The 50/50 split is a fairly old school idea
I know, but using my Omnipod Dash for years with a single basal and using temp basals as a tool in addition to bolusing and mimicking an algorithm to stay in range, almost always gave me a 50/50 split.
Now using Control IQ for three weeks I looked back at the data out of curiosity and it had shifted to 40% basal and 60% bolus. It was interesting to see how it shifted when I no longer acted as my own algorithm but left it to the pros.
So there’s may be a little basal bias built into the system that way.
It´s the basal that has gone down from 50 to 40% and the bolus up from 50 to 60% just like the Tandem rep said.
I´m just n=1 and understand that insulin needs is wildly different from person to person, it was just a little fun fact. Mostly wondering how @DrBB is doing with his new pump.
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Some medical myths die hard, even within the profession itself. Maybe especially there. This concept was still clinging to life even at Joslin Diabetes Center when I was getting pump trained back in 2013 or so, and that was ten years after I’d switched from R/N to basal-bolus carb counting. I remember my trainer harping on it, and I’d never heard of it before. I’d had 20 yrs on the old-school R/N regimen and even with Lantu/Novolog I never embraced the “eat what you want and bolus for it” philosophy—I’d always end up spiking and roller-coastering and it was easier just to stick with the avoidance practices I’d had to adopt at DX back in the dark ages. So I was like “No way I’m going to raise my carb intake just to meet some arbitrary 50/50 goal you guys made up.” I’ve relaxed that over the years as I’ve gotten better at things like pre-bolusing and dual-wave, but I think I still run around 70/30 basal/bolus.
EDIT: and then I went and looked at my Tandem stats, and holy crap it says I’m 45%/45% (with the balance made up by corrections)!!! I’m shocked! I honestly don’t care, when it comes right down to it, the point is what my TIR and BG average are—and I’ve been shocked and THRILLED with how this system has been working for me because of how much control it leaves in my hands even as it does its AID thing. Gonna do a separate post on that maybe… But I am truly surprised.
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You’re right, I misread what side of the equation the 40/60 split moved to.
But what I’m trying to say is relevant to this notion that Control-IQ is “striving for” and particular ratio. This is false. I’m sure the rep knows this (or I really hope so, at least!), but something got poorly communicated. There is nothing in the automation that strives for any sort of basal/bolus split. This is 100% what makes Control-IQ different than Medtronic and Omnipod’s automation, which try to manufacture a supposedly ideal basal rate based on basal/bolus split rules and your TDD. Control-IQ simply uses your settings to target BG ranges.
Not trying to be difficult, but I do think this is an important difference between the systems to keep the facts straight on.
Regardless, I hope you best experience possible with your new pump!
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I´ll ask her to clarify next time I speak to my Tandem-rep.
I´m not trying to be difficult either or trying to spread misinformation. It was just surprising to see that my basal/bolus split shifted, and that it was the basal that decreased. I would have thought it should be the other way around.
I´m looking forward to a whole new post with your experiences, @DrBB. Glad to hear you´re thrilled about your new pump.
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My 30 day split is 66% basal/34% bolus. This is about what I was with Lantus/Humalog. Take a look with T:Connect at your basal over time. C-IQ will change it depending on the Decom reading.
In this image I had a compression low, which is good because it illuminates C-IQ in action. Basal was dropped to zero. With C~IQ basal at least for me is seldom constant.
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