My CDE used to only suggest. But lately she has wanted to change things herself, which I haven’t allowed her to do.
Maybe the manual needs some more work and editing. They may have been in a hurry to get it released at the same time as the FDA’s approval of Control IQ. Glad to hear that’s something that can be changed by the user.
Interesting Control IQ review from someone part of the early access program.
From the review:
" I am happy with my self-management outcomes if I achieve the clinical time in range goal of spending >70% time between 70-180 mg/dL, an HbA1c below 7 (most recent HbA1c was yesterday and it was 6.3, during the fall it was 6.5, over the summer it was 6.0"
However, this is the A1c range I had over the 10+ years I used the Animas Ping with less technology (no CGM), less monitoring time and less preoccupation over my diabetes. My desire is for a lower A1c with less involvement, not the same with more.
I am currently using Basal IQ and find it to be taxing even though I have turned off all the alarms that I could. I like the Tandem x2. I like the touch screen, the information it gives and the visibility of it all for me. That said, I must say that after using Basal IQ for the last 3 months, it is taxing and time-consuming. The basal adjustments were critical. Now I am working on the c:i ratios.
Yes, the entire x2 algorithm and pump action are different and taking a lot of my time to adjust. I haven’t had an A1c since I started using Basal IQ so am really curious to see if there is an improvement. Some will say that Time in Range is the goal and A1c is unimportant. But I am not sure at this point. Bottom line… not sure if I am willing to switch to Control IQ. I will probably wait and see what others report before I make a decision.
But you can’t be certain that this A1C Pre-cgm was as a result of lower overall bgs in the desired range -vs- many severe, prolonged lows which can artificially drive that a1c down… At least unless you are very hypo alert.
I’m also in the wait and see camp with Control IQ.
It sounds like you would be happier to operate without a CGM. If I was feeling that way, I would drop the CGM. Many people don’t like CGM for many different reasons.
Can you share a little bit about that? Like what parts are time-consuming?
I don’t use that pump, but I think a lot of the same functionality will be in any CGM controlled pump. I don’t enter carbs for anything, so that kind of screws up any CGM pump for me.
I am very hypo alert. Have always been. Yes, I did have more hypos before. But not enough to be ultra concerned about.
Probably. But I do like the information it gives. The more the technology, the more time spent “feeding” it and tweaking.
I did not use the carb calculator in the Ping but now I do use it on the Tandem x2. I also have to correct more. I guess the fault may be in me and not the technology. But given more technology, one tries to adjust things to get better and better results. Maybe I feel that at this point in my life (age 79), with many years living with DM, good 'nuff IS good 'nuff.
I tried using the calculator on my pump for a few weeks. It was funny to me. After figuring out how much insulin to take at every meal for a million years of my life, having a pump tell me how much to take - and always being wrong - just didn’t work out for me. I went back to just manually doing it.
Is your pump easy to use without any of the extra stuff? Without Bolus IQ or anything? Without a bolus calculator, but just entering a bolus amount manually? And no CGM stuff?
To me, my pump is just a remote controlled insulin syringe. It does not tell me anything to do, I just tell it what to do. I like it that way!
Yes, after years of calculating my own boluses I decided to “join the technology.” It seemed to be the way to avoid both over-bolusing as well as stacking. I was encouraged to do so by the CDE who writes my prescriptions. I am at the point where I am tempted to go back to doing it myself off the cuff. I can still run it past the pump bolus calculator and then override it if I want to. I must say that the Basal IQ works very well for me at night as long as I don’t eat within about 4 hours of bedtime. The CGM’s almost straight horizontal line is awesome!
@Eric, this line really stood out to me:
I tried using the calculator on my pump for a few weeks. It was funny to me. After figuring out how much insulin to take at every meal for a million years of my life, having a pump tell me how much to take - and always being wrong - just didn’t work out for me. I went back to just manually doing it.
Because this is how I feel. But lately I’ve been wondering if there’s a way to somehow back-calculate a basic formula that I could use and really ideally give to other caregivers… like, sure, I may know that pizza requires 4X the insulin, over 10 hours or whatever, but it’s just easier for others (and me, when I’m feeling distracted) to default to something programmed in. Have you ever had any success calculating some other formula that guides your bolusing decisions, or is it more like you have a mental library of bolusing strategies in your head that you pull out on a case-by-case basis?
I understand how difficult it would be for a caretaker or teacher or school nurse to do this!
I don’t really have a list of things I think about too much. It isn’t like a checklist - it’s just a collection of things that I feel make sense and it just kind of pops into my head.
There is some experience involved - because people will generally eat the same things more than once.
But a lot of it is based on circumstances, like being more aggressive at home, and less aggressive if I am away from home and do not have access to my fridge.
I honestly have never tried to come up with a formula for meals. But it might be a useful mental exercise to put something like that together.
I think the thing to start with would be a list of what considerations you have.
A preliminary starting list…
So with all these variables, how on earth can they offer a bolus calculator that is supposed to do the job for everyone every time every day rain or shine! Frankly, I think it is an impossible task.
The way I went through the process - first I tried just taking the number from the pump. That was horrible. I kept messing with the pump settings to try to get better numbers.
Then I took the pump bolus recommendation and adjusted it. But it made no sense to do that. I mean, if I am changing the number, then I must think I know better. So why have a recommendation from a pump?
The whole thing for me lasted only a couple of weeks before I just went back to doing it from my head.
Here is a suggestion for people who are working on using a pump calculator. Before you count carbs or enter carbs or anything - look at your food and take a bolus guess first. After your guess, count up the carbs, enter the carbs and see what the pump suggests.
How close were you? Is the pump’s recommendation better than your guess? Would you want to adjust the pump’s bolus calculation? Why or why not? What reasons would you give to think you need more or less than the pump’s recommendation?
Doing this helps you get comfortable with just eyeballing your food and making your own bolus calculation.
Try it for a few weeks and see what you think.
Great suggestion, @Eric! I went through that many years ago when I started with my first Ping. And arrived at the same conclusion you did. My CDE didn’t like it and told me so. But I recently began using the Tandem Basal IQ… new algorithm, new CGM. It HAD to be better. So I have been trying it and getting quite frustrated. There are just too many variables in food intake to have one carb calculator to fit all. There can’t even be one calculator to fit ME all the time even if someone were able to customize one.
So I just read through this whole thread since I can’t sleep AGAIN and have some questions since I am in the process of maybe getting a x2.
So am I required to put in my carb count to use control IQ?
Cause I’m like Eric (according to what I read) and I calculate everything in my head. I know for a certain meal how much insulin I need. And to only count carbs for BG control is ludicrous to me. A high fat meal, how much protein I eat, what kind of carbs, all makes a difference. I exhausted just thinking about having to calculate or even count carbs. I get a general count but I never count to the single digit.
So if I use control IQ can I manually bolus wo inputting carb counts?
I am starting to think I just might go back to my Medtronic 722 to give me the convenience of not having to do needles for awhile and give me easy basal adjustments. I tend to be a control freak and if I can’t tweak this pump myself I’m not going to be happy. 
But on the other hand I can always use the x2 manually and get a free pump and have that same option.
Of course you can just bolus the amount you wish (in units) without putting in the carb count.
Can confirm. My son would not use the pump if it required you to enter the number of carbs. He just looks at a meal and boluses directly using his internal units calculator which appears to be relatively fine tuned. We use Control IQ to great effect and all boluses are directly entered without using the bolus calculator.
Thanks Chris, that makes me way more comfortable to proceed with getting the pump. I’m going to put on my old Medtronic today for fun. Be nice to just take a break from needles. Kinda nice just to push a button.