So we’re trying out a loaner Tslim with Control IQ from my son’s endocrinologist.
So far it seems great – average blood sugar and time in range seems about the same as with Loop but I’ve been paying a lot less attention to things like if he brought his OrangeLink or if his phone is near him. And he’s had fewer low treatments; Control IQ seem to catch him before he drops too low and his blood sugar rebounds on its own.
However, I’m still a little unclear on what I should be tweaking vs. leaving alone. The endocrinologist entered some numbers into the pump; which ones are productive to change?
For instance, he’s been spiking high after meals; will Tslim adjust his carb ratio? Or should I do that?
Does it adjust the sensitivity factor? Or should I be tweaking that?
How much do the programmed basal rates matter? So far it seems fine but I’m just not sure what role it plays?
Samson gets very insulin resistant right after bed and is still going high right after he goes to sleep, though of course he wakes up at 100. If I want to avoid that post-bedtime spike, would that be changed via a sensitivity factor adjustment or a basal adjustment? Like what factors will be taken into account when adjusting the settings and will it be confusing to have a 3 hour ISF change for the algorithm?
If I give an extended bolus, will the pump also be giving microboluses if blood sugar is still going high? Or should I cancel the extended bolus and give a correction?
Does sleep mode turn on on its own?
Thanks for any help you can offer; we have this pump for about two weeks basically, so not a ton, but so far it seems really cool. We may not choose it now because Samson now prefers being able to be bolused from a phone and not having tubing for things like soccer. But it makes me feel like something better is on the horizon for him soon.
There’s a very fine line between having your settings perfect while having great control with CIQ and having the system be frustrating as hell. The algorithm does not adjust ISF or carbs on it’s own. The entire algorithm goes off of the settings you enter into the pump. Don’t be surprised if you have to increase the basal rates much higher with CIQ than you had with basal-iq. It takes a lot of time and tweaking of all the settings, including ISF and carb ratio to finally get to where you’ll want to be.
You can only run an extended bolus for a maximum of 2 hours.
You should be running the pump in sleep mode 24/7. Native CIQ sucks, sleep mode all the time is how you should be using the pump.
You have full control over the profile settings and Control IQ will use the profile(s) that you have set. So you can adjust Basil rates and correction factors that best meet your needs. Control IQ uses those setting and then makes adjustments (Basil and Correction Bolus) to keep you within the target range. The only thing you don’t have control over is the insulin duration and the target BG.
I also run in sleep mode for 24 hours since I like the 110 target of sleep mode. You won’t get correction bolluses in sleep mode, but you will still get basil adjustment to keep you in within the 110 target.
Keep in mind Tandem is suspose to release the option to bolus from the t connect app later this year. So that will be pretty cool. If you haven’t, I would down load the app to get an idea what that will look like. Even with limited capabilities I use the app a lot.
Also they will be release tsport pump later this year which will be Tandems patch pump which will controlled fully by the t connect app and also will have Control IQ.
The 110 target is not just for sleep mode. The algorithm targets the BG at 110 no matter what. The only thing that changes in sleep mode are the thresholds. Native CIQ thresholds are 120-180, while sleep mode is 110-120 for tighter control.
Sleep mode is a setting, you set the time for the sleep mode and the system does switch on its own. With that being said, our sleep mode runs from 12:01 am to 11:59 pm, so it is really only in regular CIQ for a couple of minutes.
@TiaG IMO the TSlim is fantastic at avoiding hypos, but slow to react to hyperglycemia. I run a higher than normal basal rate late evening until 4 am or so because of IR. The other bummer (maybe just for me) is that CIQ will not allow you to do a dual wave (extended) bolus past the 2 hr mark. So if I eat something late in the evening and have slow digestion I am going to be higher in the am than I would like since I can only bolus for now and 2 hrs from now.
Other than that, CIQ has been a freaking awesome upgrade for me! It took a while to trust it, but now that I do I no longer micro-manage my bgs every 5 minutes. I check every few hours, or if I get an alarm on XDrip (I set my high bg threshold to 160 on XDrip so I have time to mitigate any highs before they get crazy, and my low to 90 because, well because I tend to crash hard and quickly.) Many here run in sleep mode 24/7 so they get a lower upper threshold value which is oriented to a lower A1c.
Since starting CIQ, my A1c has moved a basis point to either side of my starting A1c. Prior to CIQ, I was lucky if my A1c was within 4 basis points of my last. I have fewer highs and fewer lows overall, and those that I do have are nowhere near the extreme values I used to get. Life is good
No. One way to enable sleep mode (or the exercise mode) is to go into the “Activity” settings and “Start” or “Stop” it.
As mentioned earlier, you can also set two schedule settings when sleep mode will automatically turn on/off. Once you have set up a schedule then sleep will “turn on its own”, but you have to actually create a schedule for this to happen.
So instead of doing a dual wave extended bolus, just do a normal bolus and start a temp basal at the same time. And let the temp basal act as the extended bolus.
I think the only trick would be that you would need to calculate the amount, since it is probably in percentage.
Your body doesn’t care if you called it extended bolus or temp basal. It’s just concurrent insulin delivery but at different lengths of time. So that would be a fun trick to use a temp basal to do it.
So here’s something I can clearly see – Tslim does a good job of keeping Samson in range vernight and prior to eating, but after meals he goes super high and it seems like it would take hours for it to bring him down again.
For instance, he ate French toast at around 9, and actually came down (that brief spike then dip), and then about an hour after the meal started rising precipitously and was stuck super high for three hours. (In this case after about hour two I just got impatient and bolused 2 units, which brought him down, so I don’t know how long it would have taken to get him down but I suspect it’s 6 hours or more)
We are using the same carb ratios we had in Loop and also I’m not sure how long it takes for carbs to “Decay” in Control-IQ or if they just vanish, so that when he started rising again was it just based on the programmed ISF, rather than accounting for any carbs on board?
I guess I’m wondering if there’s any kind of automatic setting that could account for these spikes?
There’s no automatic setting. I’ve had to double my basal rates from basal-iq when I moved over to CIQ. Tandem cannot explain why and have not even tried to. I would start with increasing rates, lowering the ISF and carb ratios to make the pump more aggressive. It sounds dangerous at first but he’s covered by the low glucose suspend.
OK. I’m wondering if it will make sense to do this if we only have it for a few weeks, but I guess if I want to seethe best the system can do I shouldn’t just be sticking with the programmed settings.
As @ThomasB said, there is no automatic setting that will account for a.meal spike. CIQ makes 1 correction (add insulin) per hour which is generally not enough for a.mealtime.spike. That said, if you bolus for a meal, CIQ can make an Auto-correction to add additional insulin to the mealtime bolus if needed (once\hour).
CIQ will reduce\suspend basal insulin as often and for long as is needed to keep.the patient from going hypo.
I have been on CIQ for over a year now and have been battling the steep and long-lasting after-meal spikes. Increasing basal and making ISF more aggressive helps. But it is still a problem for me unless I avoid all carby foods. I also find that Insulin On Board (IOB) is useless because of CIQ constantly adding and subtracting from it. Frankly, I don’t know why the IOB information is even there since there is no action I can take using it.
Did you try increasing the carb ratios too?
Yesterday was a pretty crummy day in terms of high blood sugars, so I increased his basal rate in the evening hours, reduced his sensitivity during the day, and strengthened the carb ratios.
@TiaG, Yes, but very slightly. I am extremely cautious in making changes. I don’t think that carb ratio has much to do with it because I enter the carb count and sometimes I fudge on that.
