Controls and Indicators

I’m curious if other people build “controls” into their daily routine to see how effective their dosing is that day/week/month? I used to and am starting to again today. I’ll explain what I mean.

When I was on MDI, my Lantus needs stepped up three times each month due to female hormone changes. In order to keep tabs on when it was time to step up my dose (b/c carrying too much Lantus too soon made those overdosed days a pain to counterbalance out my meal doses), I used my breakfast as my control. For breakfast all I had (I’m not a breakfast person) was 8 oz of 2% milk with 1T of Ovaltine and 1t of decaf instant coffee mixed in. I usually had to pre-bolus for those 17g of carb by 40 minutes due to morning hormones, etc. Every morning I would watch how my post-meal numbers were running for breakfast. As they crept up each week, then I’d have a pretty good idea when to up my Lantus dose for the week/month. It was also a GREAT indicator for how my other meals were going to behave…i.e. if it was going to be a particularly sensitive or particularly resistant kind of day. That was the tough part of Lantus for me: if it was a sensitive kind of day, it was going to be that way for the next 22-24 hours. That’s what I hope to eliminate by switching to the pump.

I’m going back to this breakfast routine on Omnipod in order to get my breakfast numbers under control (struggling with morning highs that bleed into lunch highs) and also to keep tabs on my female hormone changes.

On my logsheet, I track BG, Carbs, Meal Insulin, Correction Insulin, Basal. The Correction Insulin line is the most useful part of that system for me as I can pick out patterns pretty quick with that. I may revise it and add a Correction Carbs line in order to pick out lows easier each day.

Comments? Tips?

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Although you have someone better control with dynamic basal from the pump, it also includes the added variable of the pump site. In my experience the site often plays a bigger role than anything else… Not to mention how long the pump is on a certain site. Pros and cons. Another thing I’ve noticed is that a new pump site needs “saturation time” before really becoming effective, so I often increase basal or give an extra micro bolus. The outcome from the next mealtime bolus is usually a good indicator for how well that site is going to work.

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I like your idea of using a specific indicator though.

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Annoying thing with pump is the lack of being able to automatically change basal profiles for expected situation like you know next week is going to be higher then this week. Or Sat/Sun are typically going to be different than Mon~Fri. (ie - on an automatic schedule. Obviously can change manually but having it switch by itself based on a programmed schedule would be cool. And I think really useful. And a small change from an R&D / programming point of view.)

We use the Tandem t:slim X2 and can have multiple profiles with each their basal settings. But no automatic switching. Which seems trivial to program in and would be quite helpful. Can’t have everything.

Looks like the Omnipod can have 7 basal programs. So, you could create one program for each of the four weeks and switch among them. That might take care of the majority of the changes and then apply temp basal rates as appropriate on top of that. I think Omnipod allows temp basal max duration of 12 hrs?


I like your ideas and your thinking.

I currently have a Work Day and a Weekend basal profile. I currently use 12 hour temp basals for everything when I need them. I’m hoping that my theory that a proper “shape” to each day is all I need, + or - a percentage for hormone fluctuations. I haven’t had enough success due to site issues/skin issues/insulin issues yet to be able to ferret that out. And it seems that some month’s hormones behave better or worse than others. Hence me trying out a birth control experiment in a few weeks after I get established with Novolog (switched from Humalog) and with my new Flonase regimen on the skin. Also trying new sites this month for the first time. So I’m variables run amok right now!!!

I am sure you know better then me but there is obviously quite a difference among the various BC options which have substantially different impacts on BG levels as well as the change in BG level across the month.

When we switched from Humalog to Novolog, didn’t notice any chance of significance. Sounds like that is very much individual where some people see a difference and some do not. Probably no way to predict for any given person.

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Totally agree on both counts (insulin differences or not…and variety of BC options).

I’ve run my BC theory through three doctors and through IDS. We’re going with what we believe to be the best choice from a hormone and consistency standpoint. When I look back over my 12 T1D years, my best control was (1) pre-children and (2) when I was on this kind of birth control before. I started insulin and BC at the same time. Then I was trying to get pregnant, and having a baby, and trying to get pregnant a second time, having a second baby, and raising said babies over the last nine years. Obviously having little kids (sleep deprivation, erratic pre-bolusing abilities due to being only parent at home a lot of the time and little ones being rather demanding :grin: ) accounts (FOR ME, not for everyone) for some of my A1C uptick. But I’d like to go back to BC to see if it dampens some of the swings or at least makes them more scheduled. I’ll probably start a thread about that when I commence experimenting.

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The Cozmo 1800 had this feature. Didn’t Tandem buy the Cozmo patents? I bet they could make that feature without much trouble. And I agree, it would be SO useful.