New Control-IQ is this normal?

Thanks Dorie this is good advise and i’ll restrain myself from cheating. m

I know it’s hard. Kudos on your determination to keep those numbers in order. Once you’ve got the right settings it should do pretty well on its own. Keep us posted! How do you like the pump so far? What made you choose it, since it sounds like injections were going well (not kidding, just curious)?

Hey Dorie,

I like the pump and i’m sure i’ll like it increasingly after as you say, i get my settings tweaked.

First of all, its given me a lot of stress relief…I was constantly watching my levels anticipating corrections, but before I got so determined on corrections I was exercising like NO one should have to, because i’m so sensitive as soon as i’d see the arrow go from 3:00pm position “changing” to 2:00 pm position moving quicker i’d run and hop on the treadmill for 30 minutes - after about 20 i’d see that arrow go back to changing with a lower number or lower going down to 5:00pm position.

I was so exhausted from exercising 2-3 times per day. Then i thought, i’ll start correcting by half units and this worked well for me BUT i’d have to just blank out at the fact that I was injecting some days 6-7 times per day (include once long acting) to stay under 180 or peak at 190 at my highest. Months before making a final decision to pump, I started saving all my needles throwing them into a bucket till i topped it up - I was drained from managing this way and the visual of the needles threw me over the top - I wrote my doctor and said lets do this i’m ready. Relinquishing control over to a pump was a hard line from me to cross over too.

The good thing about how I slowly evolved to this point is for a month prior to the pump i’d been using the InPen which i’m sure you know about, gives a data recording of how much insulin you inject and IOB…so it gave me an idea of what its like to calculate with factoring IOB.

I like the sleep mode for now I wake up under 120 at least all this week I have. Before the pump, i’d go to bed over 150 seeing i barely had any IOB and i’d correct knowing it would head off a high. I never went low doing this because routinely at night hours after the meal then coming down i’d eventually go up again without insulin. My goal that I discussed with my doctor was “tighter range” head off highs which are way more common for me than lows. I can’t eat a simple dinner roll and not shoot over 200 even calculating the correct insulin to carb ratio it makes me insane. I guess this is what a T1D is…intolerant to complex starchy carbs and somewhat tolerable to other carbs.

So, i’ve really tailored my diet to a little bit keto and a little bit plant based and a little bit animal fat and then a couple of times a week throw in that white carb roll or corn muffin and prepare for the high and know when to head it off at the pass has been my strategy.

Honestly, i think you know that as a T1 at least for me its just constant this and that no matter how much technological relief we have…but i’m really relieved to not have to get up and on the treadmill to correct unless i want to or get up and go to the drawer to get my injector out and calculate what to take and see the dots still in my skin from previous hits.

Now the pump inconvenience is every 2-4 day switch out and whatever else comes with this pump that can annoy me…sorry i wrote so much, but its kinda nice that you asked and understand what i’m talking about. I’ve really really had to train myself to save my own life…its sad to say, but in a serious low which i’ve not had but maybe a few times - I don’t trust that my husband could or would know how to deal with it even though i’ve given him several tips and had many discussions about how to revive me in an emergency. I’ve just let it go and think ok i’m sure because right now lows are not my challenge that my G6 alarm and my body sensitivity will save me. I guess the IQ feature is meant to help with this as well…

i’m a very determined person and at some point got the guts to say nothing is going to stop me from living i love life so much i’ll adapt so that I won’t fall into thinking I shouldn’t do some things because i’m T1D. I hope you are having a great day. M

Way to go - love the attitude!
Did you know there is a nasal form of Glucagon out now? Your husband might be more comfortable using that should it ever get to that point. Of course, hopefully it will not but it is important for people close to you to be able to handle things.
Regarding switching out your infusion set, I have a shortcut: I load up several cartridges when I get a new vial of liquid gold - I mean insulin - and keep them in a Tupperware type container in the fridge so I have several ready to go when I change my site. I put in my infusion set while the tubing is filling - the whole process may take about 3 minutes.

Hi
I’ve had T1D for just about 50 years.
I have been reading this topic and I am close to trying T-slim. I was on Medtronic for over 20 years until they switched their platform to the 670 series. Tried it and extremely disliked it. Besides the fact it is bulky and chews up batteries, I was never able to get in sync with the auto mode. The sensor seemed to dictate my life with constant re-calibrations.

Fast forward, I am now on Omni Pod with the Dexcom g6. I manage to keep my A1C at 6.5 to 6.7 but it seems that I need to micro manage to do that. I am also finding that the pods are becoming more and more irritating to my skin. Omni-pods hybrid closed loop is still in process and I’m not sure I want to wait it out. I love not having tubing, it’s been a nice break.

I know that letting a pump take over for you is a difficult concept and you have to try and relax and get through the initial few weeks.

This particular topic has given me food for thought. Thank you all for your thoughts and ideas.

But I also wanted to mention that I wear my Dexcom 6 in my thigh and have had only 1 or 2 failures that I can remember. I have had to recalibrate on occasion but i have found them very reliable… There is always a lag time between blood glucose and the interstitial fluid that the sensor is reading and some times I forget that and get frustrated and over do it - either food to bring a low or insulin to bring a high back down.

Also, in regards to giving glucagon, I don’t even keep it in the house. I have never had extreme lows that would require it but have had occasions when my blood glucose became low due to stomach virus or gastroporesis and eating food was not an option. . My trick and my husband knows this too, is to put sugar under my tongue and it will absorb thru the mucus membrane. Don’t shovel a whole bowlful in but small teaspoons will help bring the glucose up.

Again, thank you all for your insites.
Dennis, I may need to pick your brain for T-slim and medicare.

Anne

Hi @Anne98. I’ve seen posts from people who have changed from one pump to another but you’re the first who comes to mind that may be able to give comparative feedback on all three - you may be a unique resource! Please stay in touch.

Hi Anne @Anne98, if your current method, Pod & G6, is working for you, and you are satisficed with how you feel, why change what ain’t broke. I changed about a year after my MiniMed pump was almost a year beyond Manufacturer Warranty; I never had the “tubeless experience” with any of y four pump models.

Now the “quote”; it was a BIG step adjusting to letting the pump/iCGM/iAIDs take over diabetes management for me. For the last 30+ years I’ve been a hands-on micro manager - mostly positive results with only a couple of significant falls from over management.

My first couple of weeks were not difficult at all - in fact, looking back at Control IQ [CIQ] graphs, those weeks were awesome - just had to remind myself a couple of times “to keep my hands away”. What worked for me was to become fully aware of all features of the system by thoroughly reading and understanding the User Manual - take notes, and don’t accept all miss-information posted on the internet. The other, and possibly more important step is to validate ALL your pump Profile settings before beginning CIQ. Very much like the accountant’s gripe, GIGO - garage in, garbage out.

If you are currently a Medicare beneficiary, I suggest that you call Tandem directly, complete the on-line forms with your insurance information and let them do the insurance company negotiations. They did wonders for me and had the pump and three months supplies in my hands, fully paid - except for my 20% DMI, in less than a month. Pump supplies for me are $0.00 co-pay - yes, I have the highest up-front Medicare Advantage plan though United Health.

Hi Dennis

I so appreciate your voice of reason. After writing that last night it made me rethink my numbers and decided I needed to do a fact check on my basal rates. It has always been a good starting point for me in the past.
Changing to another pump won’t help if I need to tweak the numbers.
For now I think I will stay with what I have .

Omni Pod Dash does not fall under durable medical so I get a 3 month supply of pods thru my prescription plan. The PDM (personal diabetes manager) that communicates with the pods is not a 4 year lock out and doesn’t cost anything.
Not sure if their closed loop system will work that way. It is supposed be out
early next year.

Anyway, I am on Medicare now with a good supplemental insurance plan but the 3 month supply of sensors thru Byram Health is now 1 month at a time thru Byram Health. They tell me that is all because of Medicare. Do you find the same thing or are they not billing things thru my supplemental insurance or should they be?
thank you for your input. Your responses to people are always insightful and thoughtful.
Even after 50 years, there is always room for a pep-talk
Anne

Anne @Anne98, thank you!!!
I’ve found sticking my nose into this forum a couple of times every day gives me a boos - my periodic pep-talk. Even with 64 years living with diabetes, I still find that I can learn about diabetes.

Not too long ago - well before COVID isolation began, I met with an Insolet OmniPod representative so I could learn the features, and what to expect in the short-term. From what she demonstrated, the [hopefully] soon-to-be-released Omni Horizon has shown very good results in trial and reviews from test-users. I’m watching FDA releases to see id the new OmniPod/Dexcom receives the coveted “Class !! iAIDs” designated. So far, only the t-Slim / G6 system has that designation.

No, I’m not looking to change pumps - I just try to stay informed as a service.

Byram and Medicare. Yes, this weekend I received a one-month supply of sensors instead of the usual three-month supply. A text message I received a week earlier explained this to me; after a certain number of three-month supply deliveries, Byram must make a one-month delivery to balance out the year. Medicare prohibits delivery of more than 52 week supply per year.
I was told that three-month deliveries will resume with my next order.

Hi again @Anne98. I was thinking about your comment about the pods becoming irritating.
Some people do get irritation from the adhesive with their infusion set or CGM - from comments I’ve read I gather it may be changed from time to time. Most likely very infrequently but some people suddenly get irritation when there wasn’t any before. If the pod works well for you, you might see if placing some sort of barrier between the pod and your skin helps. Some people use Tegaderm or have found a liquid they apply to the area that helps greatly of not completely. If you really love your pod you might investigate before switching.
Do a search for “pods,” “adhesive” and terms of that nature and scroll through for experiences and solutions to try. Not to dissuade you from T-Slim by any means, but no sense “throwing the baby out with the bathwater” as they used to say.

Hi Dorie
Thank you for the input. The pods irritate my arms more than my abdomen or thighs. It’s when you peel them off that it is the most irritating and yet the other day one fell right off of me. As the saying goes “it happens”.
At this point I will stick with this a bit longer. You are right that all things considered, I’m doing OK so why switch. Their new system should be out next year too.
Thanks again for your input
Anne

I hope you can find something that helps with the irritation. In searching for diabetes supplies I’ve seen arm bands you can put over a pod to hold it in place, as well as patches that are designed to fit around different devices (I use a Simpatch over my Dexcom sensor/receiver).

I’ve not checked this site for awhile, I love that idea of prepping cartridges and so u leave them in Tupperware in the fridge and there is no altered chemistry in the cartridge for that long? Also I will look into the nasal glucagon. I am on my fourth TruSteel sample 23’ tubing and so far I like it so much better for delivery and no post-insertion high like I’m sure I was having on auto soft plastic cannula. Thanks for the tips!

I later learned that there may be some pressurization issues when filling in advance - it’s somewhere in this thread - so I encourage you to do some research if you’re considering it.

Mary @Disco2, prefilling and storage of cartridges for a week or more is not advisable because of altered chemistry. I don’t have the data at hand, so I suggest that you read the package insert included with a vial of insulin.

Lilly has the caution / directive to discard any insulin that has been in a cartridge / reservoir for more than seven days; this warning is on Humalog and Lispro - I haven’t yet read the package insert for Lyumjev. Thinking back to a study of about 15 years ago, I recall something about insulin crystalizing after being stored in plastic.

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This was my first instinct but wanted to know for sure. Thanks