Thanks Dennis - I always appreciate your input. Once before my doctor told me my basal/bolus ratio was off but I don’t recall the details. I sent her a message about that earlier today, and I reached out to my rep late Friday evening - when I hear back from them I’ll get their feedback. Of course I’m familiar with carb ratios but don’t think I was aware of one between basal and bolus insulin until my doctor mentioned it once - unfortunately I don’t recall the details any more…
Actually, Dorie @wadawabbit, there isn’t any basal/ bolus ratio that applies, or makes universal sense. An endo told me about a paper in which it was presented that we all should be 50/50. I’m 32/68.
If I increase my, basal ono percentage point, I would be constantly HYPO. M only other option is to cut in half all foods i consume. No dice.
Hey @Dennis. Just wanted to let you know I did go with my instincts yesterday and tweaked my overnight basal a bit. I got one low alert this morning when I hit 90, and waited to see what would happen. Previously I would get low alerts and keep dropping - there were no more alerts and I was about 120 when I got up. I’m going to give it a couple of days and if do I get more alerts (even if the system brings me back up) I’ll do a tiny tweak - I would prefer not to be woken up on a regular basis if I can avoid it.
My rep also got back to me. I had 4 basal rates set up before - she recommended one for overnight and another for the rest of the day, and we changed my carb ratio from 1:10, to 1:12. I’m going to try it for a week and report back to her, but hopefully the results will be promising. With the she settings in place for most of the day it will be easier to see where any changes need to be made. Sometimes it helps to have another set of eyes…
I’ll keep you posted! Thanks again for your wisdom.
Thank you Dorie @wadawabbit for keeping me / us posted, and sharing what you have learned. Like you, I am learning continuously, getting new ideas for managing MY diabetes. As you and I have learned well, we can get bits & pieces of information from others, give those tips a try and see if they work for others. That was one reason for coming to TypeOneNation.
What really struck me, and I’m waiting to hear how it works for you, was to have only TWO basal rate settings and two carb:insulin ratios over the course of 24 hours. I have many basal rate changes during the course of the day, including a big jump to 0.55/uph from 6:60 to 9:00 AM from a night-time 0.20/uph before returning to my morning rate of 0.25/uph. This covers the circadian clock dump of wake-up hormones; my sick-day profile [I have six profiles in my pump] that I’ve used for surgery when NOT eating, jumps my basal even higher.
Like you, I don’t like being awaken during the night by the pump - my bladder wakes me often enough. One of the best tools I’ve found to see effectiveness is the t-Connect “CGM Hourly Report”. This report breaks the day into 4 segments - Night, Morning, Afternoon, Evening; and breaks CGM readings into five categories.
You are very wise to wait a “few” days between making changes. One of the guides I use for calculating the ‘how much to change’ is to look at the “CIQ Bolus” amounts. Because most of the bolus my CIQ initiate are an hour following a meal, I use that information both for rethinking my carb counting, or adjusting a carb ratio.
I would love to have just two settings throughout the day! We’ll see how things go and I’ll report back.
It is interesting that the Tandem rep gave this tip, Dorie @wadawabbit.
Makes me wonder if there is re-thinking of the body need-changes over the course of the day. My “Base Profile” has 10 changes, the one of the Tandem promotion points is “Up to 6 different Personal Profiles can be created and up to 16 different time segments can be set in each Personal Profile”. I also have six Profile set for use with my different activities in which I engage.
I guess I’m boring enough to only need one profile, although up to now there were four or five different time segments within it. When I’m tweaking I’ll duplicate my profile and make the changes in the new one - the old one stays in place so technically I have multiples but I only use one.
The adjustments are starting of well, although I forgot to start my Exercise profile before going to the store today (still training myself to do that) - that always makes me drop and today was no exception. When I think about my control I like to picture my graph as resembling a bike ride or a walk through the park: a few rises you have to work at, and some downhill dips, but ideally no spikes like you’re climbing Everest or drops like an advanced ski slope. My graph has been in range for the most part with a couple of small excursions as you might expect, but I’m looking forward to seeing how things look over the next few days.
Got my lab tests back in preparation for my phone visit with my doctor next week - my A1C was 7.3, which is where it typically resides. Am looking forward to being in the 6s next time around!
Update: I am enjoying reading posts from fb group you recommended.
Great! Glad you’re finding it of some value.
@cgrover. FYI. Tandem has a program where you can “rent” their pump for the remainder of your current pumps warranty. I did this about 8 months into 670g. Hated the 670. Told another friend about it that was also on 670 and she did this program too. So much happier with tandem and dexcom G6. Seriously night and day.
The program is $999. Which I recognize may not be affordable for a lot of folks. It was not too complicated to switch from guardian CGM to dexcom either.
Hi @Dennis. I haven’t touched base for a while and wanted to give you an update. We’ve done a little tweaking and things are looking good. I had to get a couple of filings today and am always afraid I’m going to drop during a procedure. So I turned on my Exercise feature and it worked like a charm! My Tandem rep has access to my TConnect and we’ll be touching base again in a few days. I downloaded TCONNECT onto my iPhone - you may have suggested it before but I forgot. I didn’t think I would like it but do find myself glancing at my phone target than pulling out my pump sometimes. And there’s no lag in readings add I hear there may be with Dexcom Share. Of course that’s probably because I’m in Bluetooth range and not transmitting across the miles. Anyway, things are looking good with just two settings a day.
Will keep you posted on further developments!
Dorie @wadawabbit, I use the Exercise Mode for situations like that.
I really like the tConnect app, especially in the expanded mode. I find it much simpler to see a CIQ aoto-correction there than on the pump. Avoids duplicate correction bolus, and associated insulin stacking. The Tandem app is better than the dexcom app - more information.
Happy to hear that CIQ is getting better for you.!!!
Yes, I did lose Basal IQ. When I turned off CIQ Basal IQ was no longer in place. I have my low bg alert set to 90. If my bg is going down I manually stop insulin delivery. In several minutes I receive an alert that insulin delivery has been stopped. I am at home so it doesn’t bother me. I seem to have better control this way.
Thanks for the feedback tSlim and the loaner program.
For the others, I’m very interested in the Tandem with ControlIQ and would like some feedback.
I am a very unhappy 670 user and after 10 months I think I need to break free. The entire time I’ve had the 670 I’ve continued to run my G4 in parallel. I was an original Medtronics CGM adopter 5-6 years ago the same time I was in a AP trial with UVA. The study was using G4 and I was to run both in parallel and found the G4 matched the meter within 3-5% which was perfect. The Medtronic CGM was horrible. Two years ago after my doctor said the 670s new sensor is much better I deiced to give the 670 a shot. Been on medtronic pumps since the 504, so a long time user.
First impressions of the 670 left me disappointed. I’ve studied and developed user interfaces and I’m totally insulted by this design. Simple, yet safe is the way to go, this is excessive, redundant and requires too many steps for even the simple things. I’m a quick bolus fiend and that’s basically gone, and really gone with auto mode. The sensor may be a bit better, but at the same time the Bayer Link meter is awful. In my frist 6 months Bayer swapped out my Link2.4 seven times. The worst part is the bad reading were so bad that the 670 was operating way off center. There were times the meter and 670 said I was ~140 by I felt low and checking with my OneTouch UltraLink found I was in the 40’s. To make things worse, auto-mode continued to deliver insulin to get down to my target. I had to disconnect for hours before it got back to a safe point and could reconnect. Similar things happened several more times, but in a less dangerous way and I was quick to catch the “odd” readings because I started to run two systems in parallel. In those cases the Link will measures 80-120 pts higher than my actual BG, not acceptable and extremely dangerous!!
With my instant dislike of the bayer meter I went back to my old One Touch Ultra Link which shipped with my pardigm (this is still my go-to meter, 10 years later). The OT and the G4 have been running in parallel with the 670. The data is amazing. The Dexcom and the OT are remain in sync even after 14 days. I find the G4 sensor actually becomes more stable 4 days in and then could run for another 6-10 days with very small errors. The 670 and the bayer can’t stay synced the values are off by more than 20% on average. (Side note: If I calibrate the 670 sensor with the OT meter… the results were almost as good as the G4)
The 670’s constant alarms are unacceptable. The small delay before repeated alerts and the increase in urgency add too much stress to the situation. I understand the need to elevate the alerts, but I’m often not in a position to service the pump within 30 seconds. If I’m asleep, sure the pump should sense it’s night time and go crazy. But if it’s the daytime… there should be some understanding that people may be doing other things than waiting to respond to a pump alert. I may be 40’ up on a ladder working on power, or driving at 70mph down the highway. I don’t need an alert every 30 seconds which gets more irritating and more stressful a couple times every minute. I could disable alerts but would have to do that for most of the day and that’s not helpful! I do not like this design.
I started look at the tSlim X2 this week. I hope either of the auto modes could help get the A1C down, reduce the spikes and curb the lows. I know that’s asking a lot but it sounds like it can deliver. I do have concern… it is something new, and like Wayne and Garth I fear change. But think I’ve given Minimed enough chances over the years and haven’t liked many of their recent “improvements”. I also break the medtronic clips nearly every 2 weeks. If the tandem are as bad and not covered by warranty I may go broke buying replacements.
I trust my life to the Dexcom G4 and if the G6 is as good (although shorter wear time) I think I’ll continue to be a fan. I wish Medtronic would just drop thier sensor and partner with Dexcom, then I could possibly coexist with with the 670. Right now, I fear for my life with the 670 Sensors and Bayer Link!
I’ve also got a OpenAPS/Looped compatible 527 (?) and I made my only RileyLink board so I may give that a shot. I just finished making a RileyLink and haven’t got any further with making the Looped phone app. There’s quite a bit, even for a guy who develops similar closed loop control systems! I think the OpenAPS with micro-bolus mode sounds very promising. Only real downside is I’m not a phone-centric person and prefer to avoid the phone when possible. I like that the tSlim can be used without a phone.
I’ve been using TSLIM CIQ fit a couple of months now and absolutely love it. Of course the correction features for highs and lows work only as well as your background settings - basal rates, insulin duration, etc. You’re probably already aware of that. I found I needed to make some adjustments - in the past I only tweaked my basal rates, but found I needed to modify my duration and correction factor as well. That may be annoying to set up, but once in place should work well.
You do not need to calibrate the G6:tada: at least so long as you enter the 4 digit sensor ID when you start a new one. I’ve never, not used the ID so I don’t know how often you need to calibrate of you don’t. BTW, just yesterday my feelings didn’t match my readings so I did a fingerstick - it was 1 point off from my CGM reading! You can use the meter of your choice.
Regarding alerts, my only complaint is I may get one telling me "Your BG is [my designated high or low], followed within a minute or so with another saying “You are predicted to go above/below ###” or something to the effect that “CIQ is correcting but you are running high.” I wish they two were combined but they go away when I silence them. You can set how frequently you want to be reminded after the first alert if you continue to run low or high - there is a minimum of 20 minutes but you can increase it. BTW, those messages I typically get because I’ve miscounted my carbs or forgotten to activate my Activity setting - user error.
The clip that came with my pump stayed in the pump but tended to slip off my waist band. That was a frequent complaint and they have recently made new clips that grip better. BTW, if you clip to your waistband horizontally the numbers are at the top, so if you bend the pump towards you, you will be reading upside down. You can also wear the clip vertically. My old clip tended to slip out in that position and I haven’t tried wearing the new one that way.
PS - some people who switch from Medtronic to Tandem find the fill process lengthy and annoying. I switched many years ago and it doesn’t bother me. My tip is to do several vials at once and storing them so ask you need to do is insert a new infusion set and fill the tubing.
@jd1 Hello Jeff, and welcome to the JDRF TypeOneNation Forum! I hope that you have enjoyed your brief time here, and that you are finding what you need. I urge you to post occasionally sharing tips that you have learned during your time living with diabetes. I am not a licensed medical professional; what I share here are bits and pieces that have helped, or hindered, my many decades with diabetes.
I began using Control IQ [CIQ] within two weeks of its release in January 2020, and I have found the system [AIDs] to be proactive, very helpful, non-invasive, and close [but not there yet] to perfect. Unlike you, I am using CIQ to safely and effectively INCREASE my Hemoglobin A1c percentage while at the same time significantly narrowing my Standard Deviation, increasing time-in-Range [TIR], and lowering CV percentage. CIQ has helped in all these areas while running in the background; my only intervention is to enter carbohydrate guess, change Profile on days I anticipate other-than-usual activity, and to start/stop “Exercise Mode”.
Before making any switch to the Tandem/Dexcom/CIQ algorithm, please read and understand the entire User Manual. **Don’t rely on of the information you may see posted on this, or any site other than Dexcom or Tandem. **. It is also imperative that before relying on CIQ - you must give it your full trust - that you validate data entered onto your various Pump Profiles. I have found that the Tandem t-Slim x2 is easier to use than the three MiniMed/Medtronic pumps I previously used - and the DexCom G6 is significantly more accurate than the Medtronic devices designed to operate with my old  MiniMed.
- Validate all insulin sensitivity factors [correction] - I have my ISF at conservative levels to avoid over correction;
- Validate basal rates for all hourly periods - might be most critical settings;
- Quantify meal-time insulin:carb ratios.
Recall the accountant’s GIGO excuse -
garbage in, garbage out.
Adjustment you CAN NOT make - these are locked by CIQ:
- Insulin Duration is defaulted at 5 hours. Although this is an across-the-board requirement, it is set as a safety factor designed to prevent user insulin stacking;
- Automatic bolus corrections are to 110 mg/dl - with a 40% reduction in calculation estimate - automatic bolus corrections are not permitted while in Sleep Mode.
these are a few of the features that brought me to CIQ.
I just wanted to add that while the insulin duration defaults to 5 hours you can change the duration itself if you need to.