Control IQ frustration

Hi I posted this buried in another thread so not sure if it will be seen so reposting. I am a long-time Basal IQ user, then come the new year and I unfortunately switched to Control IQ. I miss Basal IQ so much! I just can’t seem to be steady on Control IQ. I go Low so much more throughout the day and night, severe lows I haven’t seen in years! And then rebound highs. It’s really brutal. Basal IQ kept me steady over night, perfect really at a comfortable 120, but with Control IQ I go low overnight too. I was up 5 times taking tabs last night and got no sleep. I almost feel like Control IQ must turn off the basal later than Basal IQ. I feel like Basal IQ turned off basal when the glucose was higher and prevented my lows better, whereas by the time Control turns it off, it’s too late and I crash. Have any of you had experience with that? What are your thoughts on using Sleep Mode all day, would that act more like the old Basal IQ? I intend to call Tandem and try to do a swap out for a Basal IQ pump or if anything I guess a in-warranty downgrade if there is such a thing? Have any of you heard of anyone being able to exchange the pump for a Basal pump again? I know pump companies usually give you a test run 30 day period right? Why would Tandem not allow the pump upgrade to be reversed is beyond me. I believe they have to have software to do this in extreme cases. Thank you all for your thoughts!

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hi Denise, I don’t have much to add, but this is an interesting topic! I suggest that you carefully document your lows (times, duration, backup fingerstick data). You could possibly present this data as the medical device hurting you. This in my opinion, should motivate a medical device supplier to help you get what you want.

Tandem allows you to adjust your target, such as a higher target for exercise. I would experiment with a higher target as an additional first step as well.

good luck!

Great ideas, I will work on charting the last couple of weeks today. Also, interesting about the Exercise feature as it aims for a higher Target. With Basal IQ I could change the Target, but I believe Control is fixed for the standard feature at 110. I think the Exercise feature is set higher like you said. I believe the Sleep function, although a lower Target, does not give boluses, do you know if the exercise feature gives correction boluses? Thank you for your thoughts!

@RosiesAllStars, sorry to hear of your difficulties! Some people have had similar results from defective pumps, so replacement might be an option. If you’re not using Sleep mode at night, you could try that. It has slightly lower targets, but only adjusts basals - no auto-bolus. Also, you might need to retest pump settings. I went directly from DIY Loop to CIQ, no experience with Basal IQ, but I had to tweak all my settings.

Thanks Mike. Sleep mode is an option for sure. I’m trying to figure out if the extra boluses are the problem causes the lows, and if so, sleep mode might be the answer. What settings did you end up changing? Did you end up adjusting any of your Basal rates? Wonder if maybe I need to adjust those since I am so sensitive to the Pump’s presumable Basal/boluses corrections.

Hi Denise,

Software for the DIY Loop I was on was more aggressive in delivering extra insulin to correct highs. That’s what I needed, sort of the opposite of you. I had to change basal rates, carb ratios, and correction factors to deliver more insulin when I went
to the Tandem with CIQ (I just made the move last week).

You probably need to retest your carb ratios and basal rates with CIQ turned off. If I were you, I would start by fasting and testing basal during a time that’s been particularly troublesome. Any of your settings might need to be changed to lower insulin
deliveries.

If you can look back at your history when you’re going low, try to determine if CIQ made auto adjustments that preceded the low. If it did, then the problem might be related to your correction factor. If the pump predicts you’re going high, it calculates
a correction based at least in part on your correction factor. The BIGGER the number in the correction factor, the LESS insulin it will deliver. For example, if your correction factor is 1:50, changing it to 1:60 will cause less insulin to be delivered.

All settings and accuracy in carb counting work together, so it’s complex, but I hope this helps.

Mike

This is so helpful. Thank you.

Hi Denise @RosiesAllStars, it is unfortunate that Control IQ is giving you problems and not living up to your expectations. To answer one of your questions, in January, during the initial roll-out of CIQ, Tandem said that it was working on an software “update” that would allow reverting a t-Slim from CIQ to BIQ; check into your Tandem pump information page to see if that option is available to you.

One of the “necessities”, in my opinion, that I’ve written about on here several times, is that before using CIQ, all personal factors that are entered into pump Personal Profile, must be validated. Most critical is basal rates followed closely by sensitivity factorS, and carbohydrate ratios. You could toggle-off your CIQ function while you validate your basal rates by skipping meals and checking that your glucose level remains “in-target” with only your basal insulin being delivered. One of the best tools I have found for adjusting basal rates is the Tidepool “Daily” report [tidepool.org - a JDRF sponsored forum]; the Daily report has on one page all the data needed for analysis in graph format, including the automatic changes CIQ is making.

A few factors about the various “Activity Modes” in CIQ:

  • Mode = Target = A1c
  • Normal = 120 = 6.0%
  • Sleep , = 110 = 5.7%
  • Exercise = 140 = 6.5%

From the first full day, CIQ has worked pretty well for me; about the only time it has caused me concern has been when I grossly miss-count carbs, and when my exercise has either greatly exceeded what I had expected. My wife cooks some awesome meals, and my evening numbers show how I often plate more than I count. Very few times has my sleep been disturbed by needing to grab my Tab bottle when the pump is telling me I’m falling. I have been awakened a few times by G6 “Compression faults” on the first day of sensor usage; if I wake to see a sudden drop, I’ll roll onto my back and see my sensor readings return “to normal” within 10 or 15 minutes.

My almost three months using CIQ have been good, my standard deviation has greatly narrowed. Just this morning while charging my pump, I opened t:Connect and was impressed by the two month report posted:

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That chart looks fantastic. Way to go! Thank you for the settings info. I looked at the pump info and the software version is Moonlight v7.3.1 and no option to revert back. I think I may need to validate my basals as the first step like you suggest. Thanks for your help. I feel so frustrated as things were going along just fine before, and I think this would make it more fine. I’ll keep you guys posted what transpires. I only have the online Manual so it’s not as convenient to flip through and find answers.

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Hi Mike. So would you say that Sleep mode is the equivalent to Basal IQ since it sounds like it won’t give correction boluses, just reduces and stops basal if going low?

It’s probably more complicated than that, but, yes, that’s how I understand it. I think the high/low range is tighter. Some people are running in Sleep mode 24 hours.

If you use Facebook, consider joining the “Control IQ while keeping a tighter range” group and the “Tandem T-slim X2 users” groups. Both are closed and both give you quick access to others’ experience. Search either group for Sleep mode to see how others
are using it.

Mike

Just joined. Great idea thank you!

Thanks Denise @RosiesAllStars .
Something I didn’t mention earlier, is that there are two types of target; the “Target” I show above is for the automatically generated Control IQ bolus. Separate from those fixed targets, you can enter into your profiles a meal-bolus target.

Being extremely brittle and having had to deal with many unexpected lows for 60+ years, I try not to keep my glucose too tight so I only use “sleep” [set automatically] for times when I’m actually in bed.

Wow, this is what I’ve been looking for! Thank you Denise, along with Dennis, Mike and Joe!
I’ve been considering updating from BIQ to CIQ since I first heard of it. I did the training and immediately had second thoughts. Like Dennis I’m a brittle T1D for 48 years with bad lows when sleeping, involving convulsions, and even breaking my ankle in 1999.

The tight control in CIQ seems to assume that our bodies react to food, exercise, and stress in the same way, all the time. Putting in exact carb and correction factors is difficult for me as these can change, both suddenly and slowly over time. I usually update my basal rate every 3 to 6 weeks to keep it in line with my goals. And one main goal I have is to not have lows at night! It’s a big thing for me and I think sleep is extremely important for us to reduce stress in our waking hours, thus making it easier to control our BG.

I’ll be looking into the Loop site, along with the FB sites, but I’m very interested in whether Tandem will implement an update that allows a patient to go back to BIQ from CIQ. When I took the training in March I was put off from Updating specifically because of the clause that it was Non-Retroactive, and recall someone saying that Tandem was looking to leave BIQ in the past, the same way Apple deals with their iPhone updates.

Also, I’ve had to check my BG with my OneTouch Ultra 2 whenever I start my G6 sensor. If it’s close, great, I’ll only check it a few more times in the next 10 days. If it’s off by a lot, but not quite enough for a recalibration, I keep a close eye on it by BG testing regularly. And recalibrating when needed. Has anyone else found this to be true?

I wonder if anyone has a way to connect with Tandem about this. Their Tech Support line is fine for on the spot fixes, but the fact that people are “hacking” CIQ to fit their bodies actual needs seems to infer that the program needs some fixing.

I look forward to hearing from you.
Thanks

Great thoughts. Hacking is totally the right word! I’m trying to see what I can do about exchanging for the Basal pump but I need to go through the rounds of trying different things first before they’ll approve it. It seems so easy to just have a software fix. My rep told me they were going to add it for rollout but the FDA wouldn’t approve have two softwares on the device for fear of someone thinking they are on one but using the other. If they get enough negative feedback, maybe it will happen sooner than later.

I’ve had to check my BG with my OneTouch Ultra 2 whenever I start my G6 sensor.

I’ve been on CIQ for almost 4 months and mandatory daily G6 calibrations have been a major disappointment.

There was nothing in the CIQ online training about recurring, required calibrations and Dexcom has not updated their documentation: Page 96 of the User Guide states: “If you have not used the calibration code, you must manually calibrate your G6 using values obtained from a blood glucose meter and fingersticks daily.” I always enter the calibration code, usually with my phone’s camera, but with the most recent sensor change I entered it manually. I am still being prompted to calibrate daily.

So, either Tandem/Dexcom hasn’t been entirely transparent about calibration for the CIQ system or the Dexcom iPhone app has a recurring bug.

Anyone else having required daily G6 calibrations?

I’ve been on the G6 since the first day it was released. I enter the four digit code manually, and have never been forced to calibrate the system. I use the iPhone app and do nothing CGM related on my X2.

Same here . . . until Control-IQ (CIQ). There was a short period after I manually turned off CIQ to use a temporary basal (before figuring out that a profile could have the same effect) that I wasn’t prompted for daily calibration, but a few weeks ago I started getting the calibration messages and they have persisted.

I’m active on half a dozen diabetes forums, and you’re the only person having this issue. I’d call Dexcom and have them trouble shoot the issue.

Hi @Dennis. My G5 warranty runs out in a few weeks and I’m looking forward to starting on the G6 with Control IQ​:tada::tada::tada:. I’ve done the training and the reading but can’t recall anything about compression faults. Please advise - thanks as always for your wisdom and insight.