Do you pre-bolus to any extent?
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If you are good at figuring out what your dose should be, and not relying on the pump to calculate it, adjust the carb ratio to be a bit more aggressive, and the correction factor to be a LOT more aggressive. This, and having a more aggressive basal, makes it easier for the pump to raise the basal enough to keep the big spikes from happening, and to bring them down in a mild manner.
I put in some intense time at first to really tweak the settings to make it work for me.
BTW, if you are not in sleep mode, the autobolus is only 60% of what it thinks the bolus should be. So even though it boluses for over 160 and rising, it is not enough.
It does a good job of assisting when you forget to bolus, don’t come close to guessing the carbs, or just life! that is still a good thing, but it does wait until you are already climbing higher. By the time it gives the partial bolus, you will be going fairly high, no matter what.
Doing the sleep mode will start giving a higher basal at a MUCH lower (120) BG count, and starts to gain the upper hand before it gets too far out of hand. Thing is, they limit how aggressive it can be, so adjusting the settings to be more than you would normally be at, is one of the only way that we can currently tweak the system to work for us.
As always, adjust these settings slowly.
I like to make an adjustment, then run it for two weeks and watch my overall patterns. I never adjust for one or two days. Two weeks is my shortest time frame that I adjust pump settings for.
Also, create mutliple profiles on the pump! You can copy what you have and make adjustments to that. Keep the current profile there and safe. Very easy to switch back to.
I had three profiles while testing. Now I am back to just two (one for Novolog, the other for Fiasp/LoomJev).
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It depends on when. Our son is a picky eater and has historically had slow digestion for some meals. So, we prebolus the entire meal for breakfast, prebolus for part of lunch (about half) and then bolus for the remainder an hour later, and will prebolus part or all of dinner depending on what it is (1.5 units upfront for pizza, nothing if it’s anything he doesn’t like…)
However, the spikes we’ve seen have been with a 20 minute prebolus, which we ordinarily would never do. I did notice that my endo had changed our settings so that his morning carb ratio only extended to 9am, which is awful for weekends as we might get brunch at 9:30. So I fixed that and also strengthened the morning carb ratio and reduced the ISF during the day by about 5% (250 to 240).
So far the day has been better – fewer lows, though hovering in the 150ish range too long – but I also had to give a few extra boluses after breakfast.
Seems like we’re getting closer to better settings.
@Hammer your advice to wait a few weeks to evaluate changes seems good in theory. Because this is a loaner that will be returned in a few weeks max, I’m going to be on more of an accelerated timetable. The fact that his daily patterns, such as his TDD, meals, etc. seem to be fairly typical gives me a bit more confidence.
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I was a little hesitant to set up 24/7 sleep mode because my son’s basal rates are low.
On Loop, using high temp basals to correct spikes led to high blood sugars, then lows.
This is common for kids, where basal is low but carb ratios often aren’t. Some of his carb ratios, for instance, are nearly as strong as an adult’s (1:16 for breakfast), but his basal rates are tiny (0.2 units/hr). So compensating for a mistimed meal bolus with basal became a misery.
I think for adults, who have higher basal rates, ramping up basal works better. That’s why we used the FreeAPS version of Loop, which gives lots of little microboluses to control highs – it worked better for our son.
But the fact that ControlIQ only allows these correction boluses to happen once an hour, and only at 60% of the maximum needed, makes me wonder if the benefits of getting the high temp basal started earlier (past 120) may outweigh the downsides of temp basal as a generally slow method of curbing a high.
I’ll try doing 24/7 sleep mode tomorrow to see how that goes.
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@TiaG Yeah, limited time frames makes this a bit harder. But with your experience and past data, you should be able to make a pretty good guess. I just like to ramp up to what I consider my ‘max safe’ levels. You can obviously make fairly safe guesses to increase as see how it does.
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Oh, and I know very little about how younger ones work for basals, so I am not one to give much for advise on that.
I can give advise on the pump and how it works though.
I do know that CIQ does a good job of managing the basals. Obviously this will be a much more difficult job with such small amounts, but this pump IS very good with small amounts in controlled a fashion.
Sleep mode actually sounds more like how you were using FreeAPS. In sleep mode it just gives small adjustments to the basal rate, and NEVER gives it’s own bolus (those are only done manually.)
I know that even without raising my basals, that being more aggressive with my correction factor and letting CIQ adjust basals does a darn good job.
I was actually MORE aggressive with my basals before going on CIQ.
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This threead is interesting, as it is time to replace my MM 630g. One reason to consider the tslim is to reduce the amount of band width for maintaining bg. But it sounds as though on the CIQ you have to finagle settings to keep up TIR. I am currently at 92% TIR, and giving micro-boluses when needed to get spikes down.
I wonder if I would get frustrated and turn off the CIQ? In the past I did not choose the tslim because I had difficulty seeing the screen in bright sunlight, or even partial shade. In fact, what I noticed when I compared several different tslim pumps was that there was a variation in screen brightness (and no way to know beforehand.
So, would people who have this pump still find the CIQ worth it?
BTW, I am now on the 630g + Dex G6.
Thanks,
Mike
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My son has been using the Tslim system for approx 6 years now. The screen brightness has never been an issue for him. As to the CIQ being on/off, the beauty of the system is the upgrade-ability as long as you are in warranty. So if they design something that works better 2 years from now, you will get access to it. If you are already in TIR 92% of the time, I doubt you will see much improvement with CIQ, but for my son whose TIR is much lower, removing the need to micro-manage the small doses himself has been very helpful for his mental health.
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Tandem also has a mobile phone app which I use a lot and in a lot of ways perfer to the pump itself and more functionality(bolus from phone) is coming this summer (already FDA approved).
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I wish I had the eyesight of my younger years. I was dxd at age 12, and am now 69;, ie 57 yrs of T1D. I have had extensive laser treatment from PDR back in the 80’s. Consequently, glare affects my eyesight. Contrast and brightness of the screen is very important.
Jim26,
The phone app would be great for me. Besides seeing what is on the pump, are you able to program, set temp basels, and etc.?
Mike
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Sleep mode ALL the time? Why? I’m about to start using this pump, so please elaborate! Also I’m very active, so was planning to use gym mode…
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@Mikey417, the ability to program via phone is not current available, but should be approved and rolled out this summer/fall. Didn’t think of glare, of course that is not an issue for my 18y/o.
Sleep mode tries to keep you at 112 instead of below 160.
Sleep mode will NOT give a bolus though.
In sleep mode, it will start adjusting your basal a LOT earlier that in normal mode.
Honestly, there are a lot of things I can eat or drink, and never touch my pump. It just adjusts the basal some and I go on with MY life instead of constantly monitoring my BG.
Btw, I recently started using the exercise mode to keep my BG up while outside working around the farm. Sleep mode can be a little too aggressive the way I have it set (I have my setup VERY aggressive, so this is a personal issue.)
There are ways to tweak your settings to make the sleep mode more adaptable changes. I, and a few others, have posted on here how we have changed the settings to really take advantage of the Control IQ system.
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This is awesome. I hope this proves to be a game changer for me. I’ll be sure to check out those posts.
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My son has used continuous sleep mode successfully since he got the pump. Takes the thought out of diabetes for him.
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FWIW, all-day-long sleep mode was a recipe for continuous highs and lows for Samson and I think it really has to do with the ratio of your ISF to your basal rate. If your basal rate is low, then it will take time to ramp up to the extra insulin you need and you risk overshooting.
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I agree that on sleep mode alone, that it isn’t aggressive enough.
But, some slight tweaks to the profile can make big changes.
That being said, doing those kind of tweaks are something I would recommend more for someone that understands what they are doing.
I have a higher basal rate and higher correction and carb ratios. The combination of all those are what makes sleep mode work very well for me.
I would be very hesistant to use this approach with a child, or someone that doesn’t understand the repercussions that can happen because of these changes.
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Do you carb count precisely? Do you eat carb heavy? I could see using sleep mode with aggressive basal and ISF being ideal for low carb, but I don’t know enough to know that with any expertise.
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I used to count precisely, but not any more.
Carb heavy, well, sometimes! Other times I don’t eat enough to bother bolusing for.
When I got the Control IQ, I torture tested both the pump settings and myself. I ate all kinds of stuff!
Honestly, if I went back to being more conscious about what I eat, I could probably drop my A1c under 5. But with a MUCH higher quality of life, I am stable in the 5.6 to 5.7 range. (5.1 and 5.2 was where I was at before Control IQ, but I paid a lot more attention to what I was eating and bolusing, etc.)
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Yay!!! Am I reading this correctly? I cannot wait for their patch pump!
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