The past year I’ve taken a step back from “Tight Control” I used to shoot for. Meaning if I’m running in the 120 range I’m not too concerned about trying to get below 100 and will just ride it out. The primary reason is letting ControlIQ do its thing and less focus on “perfect” control.
Anyway with my most recent A1C I was fully expecting a 6+ A1C, but to my surprise it came back at 5.4. My clarity shows my 90 day GMI at 6.3, my average as 123 and SD is 33. My previous A1C was 5.7 had similar clarity data.
All I can think is less bouncing around has a positive impact on my A1C and cancels out the higher average BG.
Anyway I thought it was interesting and maybe I’m less concerned about CIQ not having a lower target BG.
I have a similar story to yours.
I even abused the system by eating a LOT of carb heavy meals (not in a row,) and saw my BG numbers rise, then lower.
Now, I will be honest, some of these big meals will get my BG over 200 at times, but they come right back down.
My last A1a was 5.6
My best A1c with super tight control was 5.1 and another at 5.2
Otherwise, I have been in the 5.6 to 5.8 area for the last couple years.
What does this mean?
My quality of life has improved a LOT with CIQ!!!
I eat more ‘normal’, and spend a lot less time trying to micro manage this blasted condition/ disease we have.
Maybe not perfect numbers, but I really don’t care.
Of course I do sometimes think ‘hmm, now what would it be like if I ate better and paid more attention, I bet I could get under 5!’
Then I remember how much time it takes, and lack of food choices. To heck with that!!
That is really impressive with not paying much attention. My son’s isn’t that good, but him not having to pay as much attention as before is priceless.
@Chris it took a year to get all my settings locked in for CIQ to work how I hoped it would. That was a frustrating and tremendous amount of work, but it’s paid off big time. You’re absolutely right about the time saved by not micro managing everything. Priceless is an understatement
After dealing with all of my steroid injections this past year and coping with trying desperately with micro managing high BGs just to keep everything in TR, I realized that I was more comfortable being slightly higher than I’ve been accustomed to. I changed my TR so that I dont freak out at a BG of 130, and will not do any corrections if I am below.
I feel perfectly comfortable and am no longer fearful about taking walks and going low (even with a bag full of Gtabs and a Transcend gel pack)
My last and current A1cs have been 5%. And I havent gone above 5.2% in years now. If my next A1c (which I am anticipating) is around 5.6% I plan on not freaking out or being hard on myself. I even discussed this with my endo and he was very surprised and actually pleased with my decision (due to the multiples of very bad lows I have had over the years day after day I doubt highly that I’ve gotten through even one day without many many lows, some times in the low 30s ! )
This thread is so fascinating for me on a couple of levels.
I am also on Control IQ and am being coached by my endo on how best to let it work. It is a really exciting system.
Can you tell us what some of the things you were tweaking were? Because I have not done anything much with my Control-IQ, so I’m wondering if there’s something I should pay more attention to to get the system working even better.
the other place where I find this fascinating is as a demonstration of the huge variety of treatment protocols among diabetics. I get treated at the Joslin Clinic in Boston, and they are much more concerned about lows than highs. They are happy with my A1C at 5.6 or 5.7 but are concerned if they see lows on a periodic basis. So that’s how I’ve been trained over the years.
Diabetes is a disease that is easy to overmanage. The Control-IQ seems to work best the less us humans intervene - aside from bolusing for meals of course.
Here is something I wrote to answer someone else when I was setting up CIQ for myself when it first came out.
Blockquote
I hesitate some to say, but I leverage every single data point that I can manipulate.
I set max weight and TDD.
I also use more basal than needed. Same trick I used with Basal-IQ.
I also changed my carb ratio and my correction factor.
One thing, I didn’t want my pump to give me too much insulin if it lost connection with the G6 for too long. So I am not TOO far overboard with the basals.
Thing is, I know what I should be giving myself for a bolus to get to 85, which is my real target.
But, with a MUCH stronger correction factor, it will be giving a lot stronger basal when needed than it would otherwise.
One thing I do is to see if I am going higher than I intended from a meal, I will do quick correction boluses. I let the pump calculate them, then figure out if I will let it do it, or make my own bolus.
I find that if I am not too high, I will use the pump’s bolus.
If I am pretty high, I usually scale it back some, but not always.
Btw, my correction is now at 1:8 and I am contemplating lower it another point soon.
This is safe as long as I pay attention to what the pump tries to give me for a bolus. Honestly, it is rarely off that much! Kind of scary.
Either way, I am happy with how I have it working for me, for now.
I know that it works far better than it ever did before. And I know that I will keep tweaking it some more to fine tune it.
@bostrav59 sleep mode 24/7 is a must. If you’re not using the pump this way, you’ll hate CIQ with a passion. The tweaking was mainly the basal rates, ISF, and carb ratios which I hardly use. I just guess how much insulin I’ll need for whatever I’m eating or drinking and after 39 years of this, I’m pretty good at my guestimates. The weight isn’t a factor, although many will tell you it is but it absolutely is not. I know this because I asked a high level Tandem engineer and he told me the weight setting is a data point for Tandem to collect and the tech support reps get no training or literature on the weight portion of the pump.
My greatest success came from running 1 basal rate all the time at 1.75 units per hour instead of a dozen rates that were as high as 2.50 at some points during the day.
My advice is just starting adjusting the settings, wait a day and see where you’re at and go from there.
Be interesting to see your next A1c. My theory is your average BG may be higher, but lower variability caused by recovering from lows may offset the higher average BG in your a1c.
Can you elaborate on this? I am familiar with sleep mode, and my pump goes into sleep mode at night. But are you suggesting that you keep the pump on sleep mode all day? And if so, why?
Absolutely use sleep mode all day!
It starts adjusting your basals for anything over 120.
Normal mode won’t do anything until it thinks you will be over 160/180, or something like that.
And when it gives a bolus, it will only give 60% of what it thinks the bolus actually should be.
This lets your BGs get pretty high before it brings them back down.
In sleep mode it starts acting much sooner, and in smaller more predictable ways.
This may occur if/when cgm is consistently 20-30 points high resulting in GMI to show higher. But your A1C doesn’t directly measure bg, and won’t be impacted by the “off” cgm. Meanwhile, CIQ is more effective at driving real bg down, when cgm is reading high.
I learned this by doing more BG testing, but NOT calibrating sensor unless really off (typically after sensor restart.)
So I had similar experience of lower A1C than expected from cgm numbers.
Very interesting! I sent your note along to my endo - and he pointed out that sleep mode does not adjust for post-meal boluses or some such (you know how CIQ will give you higher basal rate after a meal…).
So, just something to be aware of.
It does sound interesting and could be very valuable if you are trying for tight control. I’ve been taught to manage against lows, so I’m quite content to be running BG at 150/160. I think the sleep mode might help give me tighter control, but I’m not really looking for that right now.
He is correct, it does NOT give a bolus.
But, keep in mind that bolus that CIQ gives is only 60% of what it should be, and it doesn’t even give it until your BG is rising above what most of us are comfortable with, let alone how high it will let it go.
Basically, for most of us, letting CIQ give partial boluses like this is ‘too little, too late.’
Sleep mode starts giving a higher basal at a much lower number. The great/safe part of this method is that it only makes small basal adjustments. So if you suddenly excercise, or do something else to make you go low, it will only affect it so much.
The trick to making CIQ adjust the basal rates enough to make a difference it to adjust the variables that you can.
Correction factor is the biggest one for me to change.
Just having a higher basal rate and letting CIQ manage it by reducing or stopping basal (if needed,) works very well! With the previous version where it only did this, I bumped my basals up and dropped my A1c from 5.6 to 5.2 (everything else as close to the same as diabeticailly possible.)
Now, most endo’s are not going to advise you to adjust setting like a number of us do. That is your right to either go with what they advise, or what you feel best about how to best treat yourself.
I am lucky, my endo is a T1 with a T1 daughter. She is very happy with my control, lack of low BG issues/incidents. And understands that I am very in tune with my T1 and how I manage it.
Oh, and please don’t think I am telling you how to manage this.
I may be opinionated, and I definitely feel strongly that CIQ can do an absolutely wonderful job for us, I feel that this first itteration of their software still needs some tweaks.
I highly recommend that if you do decide to make adjustments, to be very watchful, and make them slowly over time and with a close watch.
Example, I run a new ‘change’ for at least two weeks and look back on xDrip and Tandem’s website (I used to watch my two week through Dexcom.) Only after looking over this data will I make my change. If you look at an average of 2 weeks data, you can get a pretty good idea of your true average curve that you are adjusting for.
The tools that we are given can make a big difference in how we are able to manage this disease.
And in the end, we are the only ones that can understand our own body, and the reality of OUR life with diabetes.
Thanks @hammer for the tip. It does sound interesting and my next question was going to be “how do you make the change?”
A couple of clarifying question - when we say that the sleep mode doesn’t do a bolus, we are talking about the auto bolus of CIQ. You can still do a manual bolus before a meal while in sleep mode, correct? And you yourself do bolus before meals, correct?
Yes. My son uses 23.9 hour sleep mode and that along with manual meal boluses works wonders. He has really been able to mostly ignore the mid-day corrections and things that he used to do every hour, and instead just do the meal boluses, let CIQ do it’s thing and keep his A1c in a reasonable range (6’s)
