The love given was because I highly appreciate your tone and civil disagreement!
No, but a little bit, kinda, sorta… I never had reason to think about if I couldn’t self-manage in the long-term before this thread. That’s why I find this all so interesting. While still on Basal-IQ, I had untreated inflammatory issues that made my insulin action painfully slow. It wasn’t realistic to pre-bolus an hour or more before meals, so I did build that into my basal profile, extended over several hours where I was likely to eat. It was enough to cover a moderate carb meal, but not entirely. Except, I actually reduced my basal rates later on to compensate, and still bolused in an attempt to be more accurate. It worked for me, but it looked like an absolute nightmare on paper and it’s difficult to explain. I couldn’t really on someone else to understand all that. Basal-IQ being only insulin suspension, the variables didn’t matter much. I’m on anti-inflammatories now, so have abandoned the need for crazy basal profiles.
I wish I knew more about Loop, but I was never able to have experience with it. My insurance doesn’t cover CGM supplies, so we didn’t decide it was a worthwhile investment until it integrated with my pump. I don’t know the pros and weaknesses of the system, but I’m guessing they’re different than the ones that come with Control-IQ, because your solution might work great on Loop, but it doesn’t jive with the strengths and weaknesses of Control-IQ as it stands right now.
Control-IQ is OKAY at keeping you inside a set target range (70-180 default, 140-160 exercise mode, and 110-120 sleep mode). How good it is is at keeping you in range is highly dependent on your own inputs and largely how good you are at managing without pump intervention. It’s why the tightest control window is reserved for when you’re supposed to be sleeping and having minimal inpact on it. Honestly, it’s pretty WEAK at bringing you down, once you’re already high. There’s a lot of safety mechanisms built into it that minimize it from over-delivering insulin, and consequently prevent it from bringing your glucose down in a timely manner. If you’re running in default mode where it can deliver correction boluses, it will only give you 60% of what it thinks you need. You’ll find a lot of discussion all over the interwebs if people trying to make it more aggressive at combating highs.
You’re best option is to try and prevent yourself from going high in the first place. What Control-IQ positively SHINES at, is low prevention by reducing basal and possibly suspending it altogether. It relies on correction factor to determine how to do that, though. So your plan of attack with the lowered correction factor, is basically cutting the Achilles tendon on Control-IQ, and relying on its weakest link to do the heavy lifting.
You’ve already mentioned that you don’t like the idea of screwing with basal rates, and I can understand that, but that is exactly what I would do if I needed Control-IQ to be closed loop. As far as I know, in a care home meals are a lot more regimented. They have to meet nutritional standards, so I’m guessing one could determine an average amount of carbs that might be eaten. I would increase basal for about three hours when meals are likely to be, and rely on the pump to suspend the unnecessary insulin. (My average dinner bolus is 5-7 units of insulin, for me that would be 55-77 grams of carb). I’m not afraid to be risky with my basal, and I would add 2.5 units to my basal for a 3 hour window. Yes, that sounds scary, but it’s really not in theory if you know the person will be eating it. And since Control-IQ shines at preventing lows, I trust it entirely to hold back the unnecessary insulin. It would of course be safer on a low-carb diet, but I’m taking about my personal dosages and I don’t restrict carbs, just try to eat balanced nutritious meals.
Of course, I already run higher than necessary basals. It comes with the caveat that you have to switch to a more accurate basal profile when the technology isn’t available, like during a sensor warmup. It’s how I like my system tweaked, but I understand it’s not for everyone. I can understand how many reading my comment here would scream “that’s dangerous to deliver such high basals!”, just as I bristled at the notion of turning down the correction factor so severely. With our current technology available, I don’t think there’s a perfect solution yet, so we have to take risks somewhere to bend the technology to our will. Personally, given Control-IQ’s strengths and weaknesses, I think the heightened basals have much less risk than the lowered correction factor.
