Okay. What i am trying to figure out is how to get auto mode to give me enough insulin. That’s what it boils down to. In theory, auto is supposed to keep track of your insulin needs and your blood sugar trends for up to 6 days and is supposed to give you a “dynamic” insulin delivery based on your history, your IOB, any carb intake, and your current sensor glucose and trend. I think this is what makes up the algorithm. There’s also some debate over whether or not it takes into account your sensitivity factor, but supposedly it doesn’t use that OR your programmed manual mode basal rate. Now remember, all of this is based on your sensor… which is a whole other issue, but we’re not there yet.
Here are the basics… auto mode used micro boluses in order to deliver your “basal”. Auto will take all of those factors into consideration and decide on the appropriate size of each micro. The micros are supposed to target a BG of 120, but it will only correct down to a 150. The correction boluses are also calculated according to a whole bunch of things we’re not really sure of, but the corrections are WEAK. There were times that on a 300, it would give me .8 units of insulin. I believe this is called a “200 minute high excursion” as it is supposed to take that long to bring you back down. Many times it never got me there at all. What else?? The other way it “holds” you at 120 
is by withholding insulin all together. This can mean ONE skipped micro (meaning 9 minutes without insulin) but can reach 2.5 hours. There’s no communication during this. In fact, there’s no way to tell what you’re receiving at any point without adding up your micros (pink dots) on your graph screen (available for 24 hours) OR looking it up on Tidepool. I plan on using this, but I still haven’t gotten the chance to see whether or not it, in fact, shows micro size.
Over night, auto keeps people at a nice, flat line, but mornings are a beast. This is what I was trying to ask you guys about on Michel’s post yesterday about the difference between missed basal vs. correction bolus. You mentioned having reduced your basal to 65%, but then you never answered how you then avoid the rise. I am curious because I thought it was bad to have such a reduction, but maybe it’s not the reduction itself that’s the problem but the inability to manually adjust anything on the tail end. Which brings me to the next point… auto is the only cook in the kitchen. You can’t give yourself a correction, you can’t do an extended bolus or a temp basal of your choice. You have one alternative, and that is “temp target” that adjusts your target BG to a 150. You can also suspend.
Another thing you have to remember is that every single thing you do that affects your blood sugar is going to affect what auto is going to give you over the days to come. This is where it gets tricky… actually, where it got tricky is when you enter it, but it gets tricker here. If you exercise, if you have a really high carb meal, if your set is leaking insulin, if you disconnect… auto can only be aware of these things through the result its had on your blood sugar, but it will have no idea why. So if you exercise without suspending, auto might remember the next day your having a drastically reduced need for insulin at noon and start to hit the brakes the next day…
There’s so… much… more. People say to just let it learn you. I can feel my skin crawl when i hear that. I spent almost 3 months in before and was on my BEST EVER behavior, and we just couldn’t get it done. But as i said before, i wasn’t willing to change settings.
But i’ll tell you up front what my hesitation was… the theory is that you can increase the size of your micros by jacking up some of your settings. So people lower their active insulin time to the lowest it’ll go— 2 or 2.5 hours. They sometimes double their ICR. It was my belief that people were doing this to try to get back some of the insulin that they were missing in auto, but the reason i wasn’t comfortable with it is because auto never delivers the same thing. So if you buy yourself a bunch of extra insulin and NEED it, that’s great. If auto mode happens to offer your full amount, you plummet. And people do report some major plummeting. However, with your help, i’d Be willing to try a couple of these things.
But you don’t need to do it if you don’t think you want to. Honest. It’s going to be a ride.
I just wrote so much I don’t even feel like going back to proofread. If I need something to fall asleep to tonight, I’ll pull it back up. If you have anything to ask or say, I’d love to hear it, and if you are done hearing about it, I will respect that, too. And I MEAN IT. No hard feelings…