New Tandem pump user frustration

I just started using the tandem t-slim pump a day and a half ago. Since then I have had 3 lows; 2 overnight, and 1 this morning. It’s kind of nerve-racking and scary. Wondering if my basal rate is too high? Is that something I could adjust myself or should I contact my endo? Not sure is messing with the settings is a smart idea or not? Thanks for any advice.

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Hi @DFBB Changing your own settings can be done if you know the settings and are comfortable doing it. I adjust all my pump settings and I tell my doctor what the current settings are when I see her.

Are you a new pump user? Or is the only thing new the Tslim? If you are a new pump user, getting basal rates right takes a long time. It means skipping meals in succession so you can check your in-between meal trends. If you are a pro then you know basal rates aren’t supposed to lower your blood sugar, a perfect basal rate means if you have no insulin on board and you skip a meal you aren’t going to see high trending or low trending blood sugar. For example if you went to bed at 10 with a bs of 180, a perfect basal rate you’d be getting up at 7am at 180. Sorry if you already knew this stuff.

It took me more than 6 months to get my basal rates right and I still have to adjust them periodically.
You can get the think like a pancreas book or the “pumping insulin” book and there are protocols for testing your I:c and your basal rates and how to do it. Good luck :four_leaf_clover:

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Thanks for your reply and info. I am a new pump user and was very surprised that I experienced 3 lows over a day and a half with just starting the pump. It’s scary when it happens so often over a short time period which is why I started questioning my pump profile numbers. I guess I have a long way to go to figure things out and gain confidence in using this technology.

@DFBB ok. Yes it is scary. Make sure you have glucose or candy with you, always, the first couple weeks. It is really common for either your daytime basal or your nighttime basal to be too high. You are supposed to set your basal 10-20% lower than your long acting shot. Did your Endo connect you to a pump person (a CDE or other specialist)? Typically you would want to have a hotline to someone the first couple days. If it is your Endo please do not hesitate to call them.

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Hang in there. Getting the right settings in place takes time, patience and experimentation. Keep records of your food, activity etc to share with your doctor or trainer - this will help all of you gauge whether you need to change a basal rate setting or carb ratio. In time you will get comfortable doing this on your own, but for now work with your team. You may end up having different settings for different times of day - that’s perfectly normal.

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Thank you again for responding so quickly. My endo set me up with a pump trainer this past Friday who was given the ratios by my Endo team. I have sent an email to my endo telling her what was going on so hoping to get a reply by tomorrow. I sort of thought that the control IQ would be controlling lows and highs? I was surprised when so many lows happened in such a short time period. I did have a very light food/lower carb day yesterday which may have contributed to lows? Being T1 sure can be unpredictable and confusing, I’m thankful for this forum.

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Thank you for the encouragement, I guess I have such a fear of going low that it makes me a bit nervous. I appreciate this forum and all of the great info and advice. So helpful.

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the pump setting are more important than the CIQ, In my opinion. I have not read the pump specs regarding how your IC and basal rates influence CIQ, but in my head I think that since the g6 is not 100% (they fail, they can be wrong, the session may end early, due to miscellaneous) that your “no feedback” settings are critically important. anyway I hope you get the trainers personal cell number, and can call them directly and whenever you have an observation, that’s the only way this works, you need extra care up front as you are tuning your basal settings.

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@DFBB there is a group at Facebook where two or three of the frequent author / commenters have working knowledge of the Tandem CIQ algorithm.

The group is Tandem Diabetes Control-IQ …

The group has really helped me tweak my CIQ settings.

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Diane @DFBB, welcome to the world of pumping. Yes, any unexplained “low” can be scary and sometimes happen without “user error” - such as missed guess on carb count or just taking on-board too much insulin. To answer your question, it could be that your basal rates are too high, but it might also be that your insulin to carb ratios [I:Cr] are also set too high.

I’m assuming that prior to your new infusion pump, you were managing your diabetes via MDI, multiple daily injections, meaning a background once or twice a day and bolus meal-time injections with either a Rapid-Acting" or “Fast-Acting” insulin, and your I:Cr worked really well. Your I:Cr may have been set too high to compensate insufficient background insulin - that is a very common practice. Now, as @Joe wrote, your basal - background - insulin is set by hourly rates per hour that will vary to keep your BGL steady, and now that the pump basal rates which can vary by the hour, are managing your needs better than the once or twice background insulin, you may be over-dosing for your meals, and this “extra insulin” could cause the “low” several hours later.

In addition to basal and meal calculations, do not forget that ISF rate - Insulin Sensitivity Factor or Correction Rate - also enter into the ESTIMATED t-Slim calculated dose. Observe this additional insulin and make gradual changes in your Personal Profile(s).

Certainly, YOU can, and should be making pump adjustments as long as you know what you are doing and are being careful and cautious. I’m currently using my 4th pump model, the t-Slim x2 which is the very best for me, and no doctor has ever set my pump Patterns or Profiles - I report changes to the doctors after-the-fact. The doctor who prescribed my first pump [he was professor of endocrinology at the medical school] told me to do my own calculations and set Patterns as I see fit, offering the one guide - to set my pump so that total insulin that the pump would deliver would be only about 70% of the amount I would use on a usual day. That was my starting point, from which I made changes as needed.

Best wishes for using your new pump - it will be gradual getting used to it and I hope it helps you as mine has helped me.

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Hi again. I’ve been in a pump for over 25 years now. My endo had two other patients interested in pumping at the same time: we all had office training together, practiced with our Minimed 504s using sterile saline for a couple of weeks, and made the switch in hospital where we could be observed while the doctor checked our settings. Ramona and I both had two or three decades of Type1 under our belts and were told to expect to stay 2 or 3 nights.
We had free range of the hospital and were told to eat in the cafeteria, record what we ate and bolus accordingly; and were “released into the wild” after the second night, with instructions to check our numbers frequently (we still used fingersticks) and keep in touch so he could make any additional adjustments.
I’m curious - is pump start-up still done that way?

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Certainly wasn’t for me, I met with trainer for about 2.5 hours and then it was off to the races, I sort of like your approach better, seems more careful.

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Wow! I did appreciate the more cautious approach. How are your today? Is Monday so I hope you can reach your doctor soon if you have not yet.

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Thanks so much for your replies. Things have normalized, I finally heard back from my pump trainer who looked at my data and said if I didn’t have any low last night (which I didn’t) to wait and see what sort of pattern emerges and then we’ll tweak the I:C ratio and/or basal rate. I prematurely pushed the panic button as this new technology, while looking beneficial also elicits some anxiety on my part. I think once I feel totally comfortable and know how to adjust my own profiles it’ll be much better. Thanks again.

CGM data is great but when you’re new all that information can be overwhelming - especially when you see the arrows! Hang in there - you’ll get used to things in time.

You will learn very fast that you have to mess with your settings. Unless you have a doctor living with you, YOU have to do it. A good rule to work from that came from my Endo. If you are low or high 2-3 hour AFTER a meal, your bolus settings are wrong. If you are low or high BEFORE a meal, your basal settings are wrong. We are humans and those rates will, 100% guarantee, not last. I have changes as the seasons change those should be adjusted. If you are having a bad mental day, those are not adjusted for. It’s just life. I am not familiar with the Tandem pump but both your basal and bolus setting naturally change throughout the day. I have 7 different basal rates during the day. Since you are a newbie, your doctor probably expects you to be consulting but they usually want at least a week of “life” before making a change.

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I really resonated with what you said Larry about gaining the confidence to mess with the settings and to just do it. Of course I’m cautious and try to search out answers and advice but ultimately we’re the ones most invested in our health, even with good health care teams. Thank you.

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Own it!! Make very small changes and see what happens. We are humans, not robots. I love analogies. Bosses hate reports that ask for permission to do everything. Ask what the goal is and you get there the best you can.

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The very first time I tried changing my basal rate on my own I lowered of by a full unit and went sky high later. I’ve found that even 1/10th of a unit can be beneficial so you might keep that as a frame of reference for “small.” It will take a few days to see what kinds of new patterns emerge so give each one time. I do suggest you work in concert with your endo white you’re first learning though.

Yes @DFBB the goal for me is to “not die” and this goal has served me well. General rule for basal rates is 10%. So if your basal rate was 2 units per hour, an adjustment would be, up or down, about 0.2 (2.2 to 1.8). Then for me it take me 3 days of observation. If your basal rate is 0.8 units per hour, adjustments would be +/-0.08 or if your pump doesn’t allow that +/-0.05 units per hour. Good luck :four_leaf_clover:

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