I hope this is in the correct category. I have Tandem Control IQ and look at my reports online from t connect. However, I do not have a good handle on how to use the info to make basal adjustments. I look at where I have my basal set compared to where control IQ is setting me but it seems so random. Has anyone figured out how to manage basal settings based on the tandem reporting??
Look at your setting compared to what was actually pumped.
The data is only good while you are not eating.
Night readings are a good place to start.
So if I have .75/hr set for midnight-3am and I look to see what was the rate at that time. If it is .9. Then I know I need to adjust my setting up a little. If it’s shutting off or reduced, then you need to decrease it.
I use a higher rate during mealtimes because it works better for me.
I experiment altering just a few hours at a time so I can see how it works before changing others.
So midnight to 3 am. Then wait a couple of days to see how it is, the make more adjustments or move on to 3am to 6am.
Then move on until you’ve adjusted or checked the whole day.
I have lower schedule on weekends because I’m more active.
It’s not really necessary though because ciq does a good job adjusting, it’s just a habit that I had before I had a looping pump
Thanks… needed to hear the “ take it in segments part” and “ no eating” Good advice!
I don’t know a lot about how the Tandem CIQ system works but I suspect that its basal modulation strategy is similar to what the DIY Loop system uses. If this basic assumption is incorrect, you may discount these remarks.
We’re all familiar with the teeter-totter playground set of our youth. When the two children, one on each end of the teeter-totter, are of equal weight, it doesn’t take much energy in either direction (when the child uses his/her legs to push up from the bottom position) to quickly and easily change the balance. But when there’s a significant weight difference between the two ends, then the lighter child’s leg push to change the direction is much more effective than the heavier child’s effort.
Similarly with DIY Loop with well-tuned basal rates, I think of these rates as a point where the addition of either insulin or glucose will deflect the glucose level quickly and easily. If the basal rate is too heavy or too light, it will take either much more insulin or much more glucose to deflect the glucose level. It will deflect more slowly as well.
What I’m trying to say is that a well set basal rate establishes the glucose metabolism at a balance point and it doesn’t take much force to cause the glucose level to deflect.
I’m assuming that CIQ, like DIY Loop, makes use of this concept although the exact algorithm is probably different.
I use the 14-day ambulatory glucose profile or AGP report to help me calibrate my basal rates. This is not a one-and-done adjustment. As we all know, diabetes is never that easy. I need to change my basal rates on a regular basis, several times each month. Our bodies’ metabolism ebbs and flows as it changes in insulin sensitivity over the typical day. Exercise and meal loads also complicate things.
So, how do I use the 14-day AGP report to set basal rates? This report shows 14 days worth of CGM data represented as if it occurred in one 24-hour period – the standard day. Five percentile lines traverse the standard day: 90, 75, 50 (median), 25 and 10.
For changing basal rates to avoid hypos, I pay attention to where either the 10th or 25th percentile line crosses my hypo threshold line. I set mine at 65 mg/dL but this concept still apples if you choose 70 or 80 mg/dL. I consider the 10th percentile line crossing my hypo threshold as a yellow light caution. If the 25th percentile crosses my low line, I consider that a red light danger.
I then observe what time of day that that crossing occurs and I adjust the basal rate starting at two hours before that crossing. I’ll use an example of my current situation.
As you can see, I’m now faced with both lows and highs that I’d like to mitigate. I always work with lows first. Sometimes the highs will then disappear on their own without any further direct adjustments.
At about 5:30 pm my 10th percentile line crosses my low threshold that I’ve set at 65 mg/dL. So I check my basal profile and see that I’m set at 0.5 units/hour starting at 3:00 pm. I could have chosen to change the time to 3:30 pm but considered the 3:00 pm change close enough.
I changed that basal rate to 0.4. I now watch as my next day’s glucose is traced across the day to see if that change helps. I then use that new information to iterate this process. I will do the same exercise for the 9:00 pm crossing by the 10th percentile line.
I actually made this change two days ago. Here’s the day before the change with the dip around 6:00 pm.
Here’s the day after the change.
This description is more complicated than this process feels once you start to use it. I guarantee you, however, that mastering this tactic will pay you immeasurable dividends with a better, less volatile, glucose metabolism. I don’t ever expect perfection but satisfy myself with better.
You can find this video in the Tidepool library. I think that t:connect now shows the basal adjustments but you can always download your pump to Tidepool if t:connect doesn’t show what you need.
The video is Dr. Saleh Adi talking about adjusting basal based on Tidepool results. He doesn’t recommend basal testing where you fast and don’t lead your normal life.
This is a link to the Tidepool Webinar Library and you may find other helpful videos here: Tidepool
Exactly what I need. You think deeply and understand what is going on. I cannot thank you enough! My Endo just said” you are in the range we suggest for pregnancy so what is the problem?” This is not a supportive statement.
In addition to my questions here, I am seeing a new Endo in Charlottesville, VA because they advertise as up on the latest hybrid pumps and my niece used them for pumping trials. I just pray someone there will be supportive.
I encourage you to watch the video that @Laddie linked to as well. I’m only into about a third of it but it is definitely high quality.
The University of Virginia has earned a good reputation in its work with automated insulin dosing systems. I hope that your endo reflects that good reputation well.
Good luck with your pregnancy! Please realize that my remarks are primarily based on my n = 1 experience of an older male living decades with T1D. Your mileage will vary.
Ha!!! I am not pregnant and it was just Endo comment. In other words he was asking me why I want to be in that range. He feels an a1c of 5.7 is not necessary if you are not pregnant and I am not so why am I achieving this?
That’s a question that exposes your doctor’s fundamental values? I believe, like Dr. Bernstein, that people with diabetes are entitled to normal blood glucose. It may not always be achievable but should never be conceded so easily.
If an A1c of 5.7 (or less) is what the human body with its infinite wisdom acquired over hundreds of thousand of years of evolution and decided is best for health, why does your doc disagree?
As a T1D, it’s not easy to accomplish normal blood sugars but you can become better with practice. Your current A1c is great. Congrats!
Your doctor’s uninspiring stance is all too common today. With knowledge, experience, persistence and today’s modern tools, most people with diabetes can live with normal blood glucose.
Sorry for the misread about your pregnancy status!
Yes, I walked out of there determined to go somewhere else. I am going to ask for more for myself.
I’d be interested in using Tidepool, as I like the sound of @Terry4 and @Laddie 's solution, but I’ve never figured out a way to upload data. I use Linux, so windows/Mac software doesn’t work for me. And my phone is Android, so the IOS app doesn’t work for me. The Android app pretty much sucks, it just lets you write notes about your data.
Does anyone know of a way to wirelessly upload data? As in, entering Dexcom and/or T:connect account info? I’ve not found a way to do this yet.