I’m a bit confused with your reference to closed loop. Are you asking to choose day 1 or day 2 as a choice between loop vs not loop?.
I think a choice would be influenced based on the availability/choice to use an automated system, thus reducing risks regarding lows.
I’ll answer again when I have a closed loop system.
Closed-Loop system would change my answer as well. It would probably make scenario two much more achievable.
Unfortunately, it’ll probably be a year or more before I have access to a system that suspends for lows, much less anything more sophisticated.
The Medtronic 670G has a preset partially closed loop cycle with a 120 set point that cannot be adjusted. If you are using that option, when your bg go above 120, then the pump increases basal rates; if your bg goes below 120 it decreases insulin delivery until at bg of 70 it automatically suspends insulin delivery for up to two hours. This is very conservative and Medtronic says that the FDA required that in order to approve the 670G auto mode. It does not have a glycogen option built in to raise bg levels from lows which would be a fully closed loop system, but the auto system is as close as you can get right now in a commercial system. If the set point could be adjusted down to around 100, I would consider switching to the 670G but not with a set point of 120. That is too high.
I agree. I’m looking forward to the tandem pump for my next pump. Currently using MM 723 with Dexcom G4. Not closed loop!!
Terry is using DYI Closed Loop, with older MM pump with dexcom.
Sorry I wasn’t clearer. Day 1 and Day 2 choices are really just distillations of two different personal philosophies. These can be applied to whatever treatment method chosen as well as the emerging closed loop systems.
It’s basically this question: Would a higher blood glucose and an elimination of hypos be preferable to a little more hypo risk in exchange for more time in range and a lower average? It’s a personal value question.
I was thinking that personal BG-control styles would be equally distinct across the technologies but I see your point that a closed loop system could enable you to take on a little more risk. I hadn’t thought of it that way.
Is Health Canada or any of the provinces considering any Tandem technology?
I was lucky to have chosen Loop before the 670G became available or I may have been tempted to give it a try. Even though there are many happy users, I feel like I dodged a bullet. My Loop target is 83.
The t:slim with G5 is already approved. Just waiting on insurance forms for those with private insurance coverage. Provincial coverage will probably take longer (possibly more than a year).
The Dexcom G6 has not been approved in Canada yet, although apparently it’s just around the corner. Hopefully, once this is approved, the t:slim with Basal-IQ will come soon. I plan on getting that as soon as it’s available. I think it would make a major difference in my diabetes management.
I chose the higher option because realistically that is much more normal for me then the lower option. I’m more likely to have a day with 60 to 70% in range, 2% hypo, and the balance high than anything else. However Afrezza does allow me to be more aggressive then I used to be and my A1C is slowly coming closer to my own personal ideal.
The tools we have absolutely influences the risks and benefits I evaluate to choose my actions.
I’m not satisfied with a Loop pump unless I can also choose a set point in the 4-4.6mmol/L (72-83 mg/dl) range.
Unfortunately, none of the current choices offers this, and I remain on the hunt for a Loopable MiniMed
#2 without a doubt - and clearly with the aid of a CGM. Your standard deviation of 13 mg/dl is enviable, also. That is one wickedly tight day! Did you eat normally or do anything different that day? 
I ate a normal meal pattern for me, but different from most people. I eat a late breakfast, 11 a.m. - 1 p.m., and then dinner around 5 p.m., only two meals per day. If I can resist evening snacking temptations then this schedule of eating builds in a 16-hour + intermittent fast each day.
I limit my carb consumption to < 30 grams/day. I consider this as “normal,” but others may not agree. Before October 1, my carb limit was more generous at about 50-75 grams/day. I’m doing much better BG-wise with the lower carb limit.
I’m not getting results like the posted example, Day 2, every day. That was a particularly good one.
I was told today that the Dexcom 6 will be covered by Blue Cross this month. But the allowance for blood testing supplies here in Alberta is only $600 per year, which I can go through in about 3 months.
I know Dexcom is pricey, I don’t think I could afford it…
But the Dexcom G6 has not been approved yet?
Also, Blue Cross coverage of CGMs depends on if your plan has it as a covered benefit. Mine does not. I just got my fourth CGM denial last week.
My plan does cover the Libre. So that will be my next attempt, even though I don’t meet all their ridiculous criteria (that you need to re-apply and meet every year for continued coverage). We shall see how that goes.
Yes - normal blood glucose levels with 58 minutes in the upper hypo range would be best for me as my kidneys are now showing some deterioration. I do believe there is a new medication on the trials that will eliminate Hypos altogether?
All the best to you Jen. I know how much work this takes and the expense involved. My Blue Cross is non-group coverage so that likely is part of the problem I imagine, but I don’t know for sure. I work for the department of health in research and data analytics and there is currently an ongoing research project that is trying to prove that new technologies result in better health and less complications for diabetics. We shall see…
@Sheryl, has the G6 been approved by Health Canada? I had heard it was coming soon, but not yet approved.
I would choose the 1st option if that meant that I had the flexibility to eat the foods I wanted (with adjustments for meeting weight goals of course). We all have some limitations with regard to our diets, but I do not personally believe that I could obtain the 2nd option unless I was on an extremely low carb diet with many restrictions.
I love going out to eat with friends and trying new foods. These experiences make me very happy and increase my quality of life substantially. There is not enough research to prove that the second option would result in a significantly lower chance of complications, so the risk/benefit analysis clearly indicates the 1st option as a better choice for me.
Most days I fall somewhere between the 2 with an average in the 110s and a standard deviation of 30-40. I require a cgm to be able to obtain those values though.
I think this question is strange because you’re attempting to isolate results from diabetes management strategies used to obtain those results. However both the results and the chosen strategies each individually impact quality of life.
If in a magical universe I could obtain the 2nd outcome without changing my quality of life, then I would choose that one. Since I do not live in a magical world, I would choose the first with my current strategies and higher quality of life (for me).
Its not what I would choose but what I have chosen. Higher Clucose readings over lower ones. As a Diabetic 9th Cronin Kidney decease I have constant conflict between my Endocrinologist and my Nephrologist. As to where they want my A1c to be. The Endo doc. likes around 6.5 and the Nephrologist wants around 7.5. The long point is of course is not letting the highs get to high that my Novalog dives me low.
A god send to me was last November I started with a Dexcom G5. This device when used with a smart phone allows me to see which direction my glucose level is “heading” prior to any set alarms going off.
You face tough choices. I know little about chronic kidney disease. Does your nephroligist’s preference for higher glucose levels mean that hypoglycemia is particularly bad for kidneys?
You were smart to start on a CGM. I see it as providing the best customized education about your unique glucose metabolism. I hope it helps you to steer a reasonable path between the competing advice of your doctors.