A thought for Basal-IQ, Control-IQ, and Loop users

Tips, Tech & Gear Pump
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I wanted to share something that came to mind recently.

If you are using any of the closed loop setups, imagine that for months and months your pump and CGM are churning along and making automatic adjustments.

It takes whatever your normal basal profile is and automatically adjusts it up and down (or just down in the case of Basal-IQ), based on what your CGM says.

All well and good…except if you aren’t paying attention to the changes it might be having to make all the time to your normal basal profile.

Now at some point, imagine you get a bunch of bad Dexcom sensors, or have an unexpected Dexcom transmitter failure, or your RileyLink dies, or you lose your cellphone, or something like that happens.

Now you have to go back to the normal - non CGM controlled - basal profile. Except maybe it has been months since it has been dialed in.

As kids grow, or adults gain or lose weight, or as their activity level changes, or their diet changes, or as seasonal changes happen - basal requirements change!

If you have not dialed in your basal profile lately, and you have been relying on automatic pump adjustments based on CGM, and then suddenly that is no longer available, for the reasons I mentioned above…

Anyway, just wanted to mention this for people who are relying on the automatic pump adjustments. Take a look at them from time-to-time and consider on occasion turning it off and manually running through a few nights when you still have your Dexcom available! Dial your basal settings back in.

It would probably be much easier and safer to do this on occasion when you still have the CGM, then on an unexpected night when suddenly CGM is no longer working, and your basal profile has been untouched for months…

I don’t use Loop much (only on rare occasions), so let me know if this idea makes sense.

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Thanks for this reminder!!

I’m using Loop for 7+ months now with OmniPod, and yes, your idea does indeed make sense. Really, using Loop is no different than MDI in that respect. IMHO, it is always best to monitor your basal, and all other values. It is easy to monitor with Loop, too, since insulin is shown right on the graph and all info is uploaded to Tidepool via Apple Health, as well as Nightscout if that is configured. I check out the graphs in their webapps throughout the day to see how my basal is doing. If it is above the graph then I’m getting more insulin then my profile basal, below, less. Then I figure out why and if that is realistic or maybe Dexcom is off, stress, etc., and the many other reasons (that you list @Eric) why basal might be off! For me, my insulin graph mostly stays flat at my profile basal. I see jumps for eating, zero basal for running, etc. So it is easy to understand what is going on in MOST cases. The difficult ones are when Dexcom fails, poor pod absorption, changes in exercise/routine, and stress! :face_with_raised_eyebrow:

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I agree with Trying. It’s not necessary to go open loop for a night to see if the basal is right. Just look in the morning at the graphs of active insulin and especially the insulin delivery. If they are balanced then the basal was right. If they show persistent adding or subtracting of basal, then there may be a reason to adjust the basal settings. I generally make a minimal change to basal settings if I see the same imbalance two nights in a row, and then check the third morning to see if it’s now right. I check the overnight graphs about once a week.

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Yes, all of that makes sense. I guess the main thing though is I think it is helpful to do some of that while you still have CGM running, so you don’t find yourself in a place where you have no CGM and have not modified your basal in months. To be proactive with it.

EDIT:
I guess another way of saying it is that people who are using a CGM controlled pump may be less likely to make changes to their basal rates as often, because their pump does it automatically. So they may not be as aware of the changes to their rates as someone who is constantly seeing highs or lows at night, and needing to make the changes more often.

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Eric, I like your thought process on this and also agree with @Trying and @bkh.

In the ~ 7 months I’ve been Looping I would say I’ve paid even more attention to my basal profiles and made more frequent adjustments to optimize how the closed loop works for me. To your point, when I have sensor issues now, I have a good handle on my current basal rates, insulin sensitivities and carb ratios.

Also, Looping has also motivated me develop 2 back up resources:

  1. I save pictures of the Loop setting screens before & after making changes so I can track +/- impacts of the changes.
  2. I utilize Nightscout historical data, like previous daily profiles. I didn’t start using Nightscout until I started Looping. It’s historical data is very helpful when troubleshooting issues, both for my own personal trends or specific Loop settings.
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All of this brings up a different question I have…

For the people who are using OmniPod Loop - @bkh, @Trying, @Millz, @ClaudnDaye (and I know there are others but I do not have the complete list) - when you go to the endo, and they want to do a pump download, what do you give them instead of a pump download?

I assume there is nothing they can download directly from your phone. What takes the place of that?

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Tidepool data + Nightscout reporting. That’s it for us

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My endo has never asked for a pump download — with a long history of A1C a little under 6 and no lows that required assistance, the endo doesn’t feel any need to get involved. He just keeps an eye on my lab results to watch for anything that would warrant further investigation.

After I started loop I printed out a 1-month AGP report from Dexcom (I’m using the standard dex app on the phone for CGM) as an indication that loop is a good thing, and gave that to him.

As an aside, I’m on loop v2.0 with an old medtronic 722, not pods.

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It looks like Tidepool does not give you upload for Loop, only uploads for Dexcom, some other pumps, and meters. Is that right?

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Yes. Our endo looks at Nightscout reporting and apple health to get specific loop info. Tidepool for cgm data.

They get what they get.

We are the first patients that use omniloop with our endo so we are teaching her. And like @bkh, our management is great so they have no issues with how we are managing things. They know i don’t need, nor do i want their advice on “how to diabetes.”. We’ve got this… If i have questions, I’ll let them know.

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Well yes, of course. I feel the same way. I’m not really going for advice either, just scripts.

The reason I’m curious about the pump download is to see if there is an easy way to get the pump prescription from them by giving them some bogus data download that does not generate a bunch of pointless questions and talk from them.

Like if I could just create a nice clean pump report. Everything even and perfect with all boluses making sense and nothing that looks out of the ordinary for them.

Rather than trying to go through the explanation of how they don’t need my pump data, just creating a “report” (in quotes! :grinning:) and handing it to them.

As it is, my pump looks like a totally random set of numbers. No carbs entered, random BG times, random boluses without carb entry, randomly started and stopped temp boluses.
.
As it’s been, they lecture me on how they need to get a pump download since I don’t hand it over to them.

I am trying to get in and out as easy as possible. So a bogus report would make it easy.

Yes, I know, I’m horrible.
:man_shrugging:

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I find it hard to believe you let anyone lecture you. :laughing:

Seriously… Why do they need the data? You actually know what you are doing. Is there some legal reason they “must” view parient loop/cgm data??

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I haven’t read this thread yet, but the ability to vary basal rates is exactly why I’m looking so forward to a closed-loop system. My basal rates change so much throughout the month that I have no idea what they are most of the time anyway. It would be SO NICE if a computer were able to help me keep on top of that. If the system failed, I’d just look at the history to find out what my total basal had been for the past week and use that as a starting point and fine-tune from there. That would be no different from what I do every day now…

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I also use Nightscout reports. I just print 2 weeks of day-to-day graphs which includes bolus, basal, carbs, BGs, avg BG and a1c. I also track my running in Nightscout so can see hours, calories, etc., for each run (I sync it with Apple Health Workouts). I also give my Loop settings. My clinic only has one other patient using Loop so fortunately, so far, they are open to using it!

I also use Tidepool which is great for online viewing, but Nightscout reports are much better for sharing. Tidepool doesn’t really provide any reporting AFAIK.

I don’t give either URLs (Tidepool or Nightscout) to my clinic.

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Loop syncs its pump data (carbs, bolus, basal, etc.) to Apple Health. Tidepool gets that data from Apple Health. So Tidepool displays all pertinent data including BGs from Dexcom. You do need to install the Tidepool mobile app on your iPhone and enable sync Apple Health to get this data though.

Latest version of Loop also will allow you to sync BGs to Nightscout directly. This was implemented due to the Remote Override issues caused by Dexcom Share server being down a month or so ago.

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You could certainly do that with Nightscout. That data is managed by you on your own, authenticated server and stored in your MongoDB.

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For my last visit I only printed the Nightscout overall, 2 page summary. My Endo asked a few ratio questions about ratios, which I answered, then showed her the Loop app itself (she seemed interested in the user interface for Loop).

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For me, my endo just pulls the Dexcom report. This last visit a few weeks ago he pulled a sample week and said I was in range 100% of the time and very impressed! A1C was 5.4%. He also said he mentioned looping to several of his patients and some were interested. No pump data needed.

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